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

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

Validation of the Spanish version of the borderline symptom list, short form (BSL-23)

Background: The Borderline Symptom List-23 (BSL-23) is a reliable and valid self-report instrument for assessing Borderline Personality Disorder (BPD) severity. The psychometric properties of the original version have proven to be adequate. The aim of the present study was to validate the Spanish language version of the BSL-23. Methods: The BSL-23 was administered to 240 subjects with BPD diagnosis. Factor structure, reliability, test-retest stability, convergent validity, and sensitivity to change were analyzed. Results: The Spanish version of the BSL-23 replicates the one-factor structure of the original version. The scale has high reliability (Cronbach's alpha=.949), as well as good test-retest stability, which was checked in a subsample (n=74; r=.734; p<.01). The Spanish BSL-23 shows moderate to high correlations with depressive symptomatology, state and trait anxiety, hostility and impulsivity scores and BPD measures. The Spanish BSL-23 is able to discriminate among different levels of BPD severity and shows satisfactory sensitivity to change after treatment, which was verified by assessing change before and after 12 group sessions of Dialectical Behavioral Therapy in a subgroup of 31 subjects. Conclusions: Similar to the original BSL-23, the Spanish BSL-23 is a reliable and valid instrument for assessing BPD severity and sensitivity to change

Preventing crime in cooperation with the mental health care profession

Although major mental disorders do not have a central position in many criminological theories, there seems to be an evident relationship between these disorders and criminal behavior. In daily practice police officers and mental health care workers work jointly to prevent nuisance and crime and to keep the city livable. Examining the situations where the criminal justice system and mental health institutes are jointly involved to prevent crime, some pitfalls emerge that seem to threaten successful cooperation. There appear to be unrealistic expectations of the possibility to reduce the risk of reoffending by means of treatment and of the possibility to predict which offender poses a risk to society. Another complexity is the fact that both parties work from different backgrounds and pursue different goals. The way society and the criminal justice system deal with persons who are assumed to be a risk to the community because of a mental disorder demands a further investigation from a criminological perspective

Efficacy of an adjunctive brief psychodynamic psychotherapy to usual inpatient treatment of depression: rationale and design of a randomized controlled trial.

BACKGROUND: A few recent studies have found indications of the effectiveness of inpatient psychotherapy for depression, usually of an extended duration. However, there is a lack of controlled studies in this area and to date no study of adequate quality on brief psychodynamic psychotherapy for depression during short inpatient stay exists. The present article describes the protocol of a study that will examine the relative efficacy, the cost-effectiveness and the cost-utility of adding an Inpatient Brief Psychodynamic Psychotherapy to pharmacotherapy and treatment-as-usual for inpatients with unipolar depression. METHODS/DESIGN: The study is a one-month randomized controlled trial with a two parallel group design and a 12-month naturalistic follow-up. A sample of 130 consecutive adult inpatients with unipolar depression and Montgomery-Asberg Depression Rating Scale score over 18 will be recruited. The study is carried out in the university hospital section for mood disorders in Lausanne, Switzerland. Patients are assessed upon admission, and at 1-, 3- and 12- month follow-ups. Inpatient therapy is a manualized brief intervention, combining the virtues of inpatient setting and of time-limited dynamic therapies (focal orientation, fixed duration, resource-oriented interventions). Treatment-as-usual represents the best level of practice for a minimal treatment condition usually proposed to inpatients. Final analyses will follow an intention-to-treat strategy. Depressive symptomatology is the primary outcome and secondary outcome includes measures of psychiatric symptomatology, psychosocial role functioning, and psychodynamic-emotional functioning. The mediating role of the therapeutic alliance is also examined. Allocation to treatment groups uses a stratified block randomization method with permuted block. To guarantee allocation concealment, randomization is done by an independent researcher. DISCUSSION: Despite the large number of studies on treatment of depression, there is a clear lack of controlled research in inpatient psychotherapy during the acute phase of a major depressive episode. Research on brief therapy is important to take into account current short lengths of stay in psychiatry. The current study has the potential to scientifically inform appropriate inpatient treatment. This study is the first to address the issue of the economic evaluation of inpatient psychotherapy. TRIAL REGISTRATION: Australian New Zealand Clinical Trial Registry (ACTRN12612000909820)

Antidepressant Response in Major Depressive Disorder: A Meta-Regression Comparison of Randomized Controlled Trials and Observational Studies

To compare response to antidepressants between randomized controlled trials (RCTs) and observational trials.Published and unpublished studies (from 1989 to 2009) were searched for by 2 reviewers on Medline, the Cochrane library, Embase, clinicaltrials.gov, Current Controlled Trial, bibliographies and by mailing key organisations and researchers. RCTs and observational studies on fluoxetine or venlafaxine in first-line treatment for major depressive disorder reported in English, French or Spanish language were included in the main analysis. Studies including patients from a wider spectrum of depressive disorders (anxious depression, minor depressive episode, dysthymia) were added in a second analysis. The main outcome was the pre-/post-treatment difference on depression scales standardised to 100 (17-item or 21-item Hamilton Rating Scale for Depression or Montgomery and Åsberg Rating Scale) in each study arm. A meta-regression was conducted to adjust the comparison between observational studies and RCTs on treatment type, study characteristics and average patient characteristics. 12 observational studies and 109 RCTs involving 6757 and 11035 patients in 12 and 149 arms were included in the main analysis. Meta-regression showed that the standardised treatment response in RCTs is greater by a magnitude of 4.59 (2.61 to 6.56). Study characteristics were related to standardised treatment response, positively (study duration, number of follow-up assessments, outpatients versus inpatients, per protocol analysis versus intention to treat analysis) or negatively (blinded design, placebo design). At patient level, response increased with baseline severity and decreased with age. Results of the second analysis were consistent with this.Response to antidepressants is greater in RCTs than in observational studies. Observational studies should be considered as a necessary complement to RCTs