Dissemination of psychotherapy Modules for traumatized Refugees Experience gained from the Trauma Work in Crisis and Conflict Regions

Elbert T, Wilker S, Schauer M, Neuner F. Dissemination psychotherapeutischer Module für traumatisierte Geflüchtete. Erkenntnisse aus der Traumaarbeit in Krisen- und Kriegsregionen. NERVENARZT. 2017;88(1):26-33.With each additional accumulative exposure to severe and traumatic stressors, the likelihood of developing mental health problems and physical diseases increases. Displaced individuals have usually experienced a number of serious threats to health due to organized violence in their home country or attacks during the flight. Frequently, domestic violence adds additional strain to the stressors experienced. The resulting impairments in psychosocial functioning reduce the resources needed for social adjustment and integration. Social exclusion then in turn often further aggravates the existing mental health complications. For the treatment of trauma spectrum disorders, different evidence-based psychotherapies are available. In high-income countries, trained and licensed psychotherapists are typically in positions to apply such interventions; however, even an advanced system with a high capacity, such as the psychotherapeutic care offered in Germany, severely struggles to manage the demands associated with the rapid addition of hundreds of thousands of displaced people. Germany's mental healthcare system at present lacks the resources, both human and technological, to effectively manage the present demands. Systematic scientific studies in resource-poor regions of war and conflict have demonstrated that the dissemination of effective treatment to local personnel, even with limited training, results in substantial improvements in the mental health challenges within the community: Organized as a cascade model, members of the refugee community learn to identify weakened fellow citizens requiring in-depth diagnostic interviews. Educated, bilingual individuals acquainted with their country's healthcare system (e. g. nurses, teachers and social workers) receive training to conduct structured interviews and evidence-based interventions under the supervision of centrally organized licensed psychotherapists. More complex cases are referred to local psychotherapists, psychiatrists or specialized treatment centers. These humanitarian efforts are based on the convention for the protection of human rights and secure the safety, freedom and dignity of these persons

Treating children traumatized by war and Tsunami: A comparison between exposure therapy and meditation-relaxation in North-East Sri Lanka

<p>Abstract</p> <p>Background</p> <p>The North-Eastern part of Sri Lanka had already been affected by civil war when the 2004 Tsunami wave hit the region, leading to high rates of posttraumatic stress disorder (PTSD) in children. In the acute aftermath of the Tsunami we tested the efficacy of two pragmatic short-term interventions when applied by trained local counselors.</p> <p>Methods</p> <p>A randomized treatment comparison was implemented in a refugee camp in a severely affected community. 31 children who presented with a preliminary diagnosis of PTSD were randomly assigned either to six sessions Narrative Exposure Therapy for children (KIDNET) or six sessions of meditation-relaxation (MED-RELAX). Outcome measures included severity of PTSD symptoms, level of functioning and physical health.</p> <p>Results</p> <p>In both treatment conditions, PTSD symptoms and impairment in functioning were significantly reduced at one month post-test and remained stable over time. At 6 months follow-up, recovery rates were 81% for the children in the KIDNET group and 71% for those in the MED-RELAX group. There was no significant difference between the two therapy groups in any outcome measure.</p> <p>Conclusion</p> <p>As recovery rates in the treatment groups exceeded the expected rates of natural recovery, the study provides preliminary evidence for the effectiveness of NET as well as meditation-relaxation techniques when carried out by trained local counselors for the treatment of PTSD in children in the direct aftermath of mass disasters.</p> <p>Trial registration</p> <p>ClinicalTrials.gov Identifier:NCT00820391</p

Precision of genetic parameters and breeding values estimated in marker assisted BLUP genetic evaluation

In practical implementations of marker-assisted selection economic and logistic restrictions frequently lead to incomplete genotypic data for the animals of interest. This may result in bias and larger standard errors of the estimated parameters and, as a consequence, reduce the benefits of applying marker-assisted selection. Our study examines the impact of the following factors: phenotypic information, depth of pedigree, and missing genotypes in the application of marker-assisted selection. Stochastic simulations were conducted to generate a typical dairy cattle population. Genetic parameters and breeding values were estimated using a two-step approach. First, pre-corrected phenotypes (daughter yield deviations (DYD) for bulls, yield deviations (YD) for cows) were calculated in polygenic animal models for the entire population. These estimated phenotypes were then used in marker assisted BLUP (MA-BLUP) evaluations where only the genotyped animals and their close relatives were included

Modelling Mechanically Induced non-Newtonian Flows to Improve the Energy Efficiency of Anaerobic Digesters

In this paper, a finite volume based computational fluid dynamics (CFD) model has been developed for investigating the mixing of non-Newtonian flows and operating conditions of an anaerobic digester. A CFD model using the multiple reference frame has been implemented in order to model the mixing in an anaerobic digester. Two different agitator designs have been implemented: a design currently used in a full-scale anaerobic mixing device, SCABA, and an alternative helical ribbon design. Lab-scale experiments have been conducted with these two mixing device designs using a water-glycerol mixture to replicate a slurry with total solids concentration of 7.5%, which have been used to validate the CFD model. The CFD model has then been scaled up in order to replicate a full-scale anaerobic digester under real operating parameters that is mechanically stirred with the SCABA design. The influence of the non-Newtonian behaviour has been investigated and found to be important for the power demand calculation. Furthermore, the other helical mixing device has been implemented at full scale and a case study comparing the two agitators has been performed; assessing the mixing capabilities and power consumption of the two designs. It was found that, for a total solids concentrations of 7.5%, the helical design could produce similar mixing capabilities as the SCABA design at a lower power consumption. Finally, the potential power savings of the more energy efficient helical design has been estimated if implemented across the whole of the United Kingdom (UK)/Austria

Family violence, war, and natural disasters: A study of the effect of extreme stress on children's mental health in Sri Lanka

Catani C, Jacob N, Schauer E, Kohila M, Neuner F. Family violence, war, and natural disasters: a study of the effect of extreme stress on children's mental health in Sri Lanka. BMC Psychiatry. 2008;8(1): 33.BACKGROUND: The consequences of war violence and natural disasters on the mental health of children as well as on family dynamics remain poorly understood. Aim of the present investigation was to establish the prevalence and predictors of traumatic stress related to war, family violence and the recent Tsunami experience in children living in a region affected by a long-lasting violent conflict. In addition, the study looked at whether higher levels of war violence would be related to higher levels of violence within the family and whether this would result in higher rates of psychological problems in the affected children. METHODS: 296 Tamil school children in Sri Lanka's North-Eastern provinces were randomly selected for the survey. Diagnostic interviews were carried out by extensively trained local Master level counselors. PTSD symptoms were established by means of a validated Tamil version of the UCLA PTSD Index. Additionally, participants completed a detailed checklist of event types related to organized and family violence. RESULTS: 82.4% of the children had experienced at least one war-related event. 95.6% reported at least one aversive experience out of the family violence spectrum. The consequences are reflected in a 30.4% PTSD and a 19.6% Major Depression prevalence. Linear regression analyses showed that fathers' alcohol intake and previous exposure to war were significantly linked to the amount of maltreatment reported by the child. A clear dose-effect relationship between exposure to various stressful experiences and PTSD was found in the examined children. CONCLUSION: Data argue for a relationship between war violence and violent behavior inflicted on children in their families. Both of these factors, together with the experience of the recent Tsunami, resulted as significant predictors of PTSD in children, thus highlighting the detrimental effect that the experience of cumulative stress can have on children's mental health

Rabies screen reveals GPe control of cocaine-triggered plasticity.

Identification of neural circuit changes that contribute to behavioural plasticity has routinely been conducted on candidate circuits that were preselected on the basis of previous results. Here we present an unbiased method for identifying experience-triggered circuit-level changes in neuronal ensembles in mice. Using rabies virus monosynaptic tracing, we mapped cocaine-induced global changes in inputs onto neurons in the ventral tegmental area. Cocaine increased rabies-labelled inputs from the globus pallidus externus (GPe), a basal ganglia nucleus not previously known to participate in behavioural plasticity triggered by drugs of abuse. We demonstrated that cocaine increased GPe neuron activity, which accounted for the increase in GPe labelling. Inhibition of GPe activity revealed that it contributes to two forms of cocaine-triggered behavioural plasticity, at least in part by disinhibiting dopamine neurons in the ventral tegmental area. These results suggest that rabies-based unbiased screening of changes in input populations can identify previously unappreciated circuit elements that critically support behavioural adaptations

Validation of theory-based models for the control of plasma currents in W7-X divertor plasmas

A theory-based model for the control of plasma currents for steady-state operation in W7-X is proposed and intended for model-based plasma control. The conceptual outline implies the strength of physics-based models: it offer approaches applicable to future conditions of fusion devices or next-step machines. The application at extrapolated settings is related to the validity range of the theory model. Therefore, the predictive power of theory-based control models could be larger than for data-driven approaches and limitations can be predicted from the validity range for the prediction of bootstrap currents in W7-X. The model predicts the L/R response when density or heating power is changed. The model is based on neoclassical bootstrap current calculations and validated for different discharge conditions. While the model was found to be broadly applicable for conducted electron-cyclotron-heated discharges in W7-X, limits were found for cases when the polarization of the electron cyclotron heating was changed from X2 to O2-heating. The validity assessment attempts to quantify the potential of the derived model for model-based control in the operational space (density, heating power) of W7-X