Non-Pharmacological Approach to Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a commonly diagnosed gastrointestinal condition. It represents a significant healthcare burden and still remains a real challenge. Over the years, IBS has been described as a strict illness of the gastrointestinal tract (medical model) or as a more complex multi-symptomatic disorder of the brain-gut axis (biopsychosocial or psychosomatic model). The reason why IBS has been such a challenge and is so difficult to handle might be related to different approaches. These differences in the view of the syndrome have affected the assessment, treatment and handling of the IBS patient. Patients with IBS, where the symptoms from the gastrointestinal tract are one part of a multi-symptom palette sometimes hidden in the body or mind, need a more holistic outlook. The key to an effective treatment approach is a gastroenterological examination to exclude other diseases along with an assessment of the whole body and its awareness by a body-mind therapist. This chapter discusses the view of the patient together with patient evaluations and body-mind treatment from a practical point of view

IODP expedition 347: Baltic Sea basin paleoenvironment and biosphere

The Integrated Ocean Drilling Program (IODP) expedition 347 cored sediments from different settings of the Baltic Sea covering the last glacial–interglacial cycle. The main aim was to study the geological development of the Baltic Sea in relation to the extreme climate variability of the region with changing ice cover and major shifts in temperature, salinity, and biological communities. Using the Greatship Manisha as a European Consortium for Ocean Research Drilling (ECORD) mission-specific platform, we recovered 1.6 km of core from nine sites of which four were additionally cored for microbiology. The sites covered the gateway to the North Sea and Atlantic Ocean, several sub-basins in the southern Baltic Sea, a deep basin in the central Baltic Sea, and a river estuary in the north. The waxing and waning of the Scandinavian ice sheet has profoundly affected the Baltic Sea sediments. During the Weichselian, progressing glaciers reshaped the submarine landscape and displaced sedimentary deposits from earlier Quaternary time. As the glaciers retreated they left a complex pattern of till, sand, and lacustrine clay, which in the basins has since been covered by a thick deposit of Holocene, organic-rich clay. Due to the stratified water column of the brackish Baltic Sea and the recurrent and widespread anoxia, the deeper basins harbor laminated sediments that provide a unique opportunity for high-resolution chronological studies. The Baltic Sea is a eutrophic intra-continental sea that is strongly impacted by terrestrial runoff and nutrient fluxes. The Holocene deposits are recorded today to be up to 50 m deep and geochemically affected by diagenetic alterations driven by organic matter degradation. Many of the cored sequences were highly supersaturated with respect to methane, which caused strong degassing upon core recovery. The depth distributions of conservative sea water ions still reflected the transition at the end of the last glaciation from fresh-water clays to Holocene brackish mud. High-resolution sampling and analyses of interstitial water chemistry revealed the intensive mineralization and zonation of the predominant biogeochemical processes. Quantification of microbial cells in the sediments yielded some of the highest cell densities yet recorded by scientific drilling

Visions of a more precise soil biology

Includes bibliographical references (pages 389-390).Soils have often been viewed as a black box. Soil biology is difficult to study with the precision we would wish, due to the presence of considerable soil heterogeneity, a huge diversity of organisms, and a plethora of interacting processes taking place in a complex physical-chemical environment. We have isolated a tiny fraction of the known organisms, and the possible interactions of soil parent materials, landscape, land use, depth and time with the biota mean that we are to some extent still fumbling in the dark. There have been great advances, but we argue that the pace of advance could be faster. To progress, science needs new theory and concepts but also acceptable methodologies. Coherent and generally accepted theoretical knowledge exists in many areas, but there is a shortage of valid and exact methods to test new and sometimes even old hypotheses. New methods add knowledge, but they also can add to the confusion if they are not tied to the existing knowledge base. We speculate on how to improve soil biology through improving the way we perform and interpret research. Can we deal with soil variability? Can we measure the critical variables with adequate precision to test our hypotheses? Can we avoid reinventing the wheel? Can we find a balance between the freedom to test new and maybe even controversial ideas and the control and direction of research required by society?

Temperature sensitivity of decomposition in relation to soil organic matter pools: Critique and outlook

Knorr et al. (2005) concluded that soil organic carbon pools with longer turnover times are more sensitive to temperature. We show that this conclusion is equivocal, largely dependent on their specific selection of data and does not persist when the data set of Kätterer et al. (1998) is analysed in a more appropriate way. Further, we analyse how statistical properties of the model parameters may interfere with correlative analyses that relate the Q 10 of soil respiration with the basal rate, where the latter is taken as a proxy for soil organic matter quality. We demonstrate that negative parameter correlations between Qio-values and base respiration rates are statistically expected and not necessarily provide evidence for a higher temperature sensitivity of low quality soil organic matter. Consequently, we propose it is premature to conclude that stable soil carbon is more sensitive to temperature than labile carbon

Fidelity of delivery and contextual factors influencing children’s level of engagement: Process evaluation of the Online Remote Behavioural Intervention for Tics (ORBIT) Trial (Preprint)

BACKGROUND: The Online Remote Behavioural Intervention for Tics (ORBIT) study was a multicentre randomized controlled trial of a complex intervention that consisted of an online behavioural intervention for children and young people (CYP) with tic disorders. In this first part of a two-stage process evaluation, we conducted a mixed-methods study exploring reach, dose, and fidelity of the intervention and contextual factors influencing engagement with the intervention. OBJECTIVE: This study aims to explore the fidelity of delivery and the contextual factors underpinning the ORBIT intervention. METHODS: Baseline study data and intervention usage metrics from participants in the intervention arm were used as quantitative implementation data (n=112). The experiences of being in the intervention were explored by semi-structured interviews with children (n=20) and parent (n=20) participants, therapists (n=4), and referring clinicians (n=6). A principal components analysis was used to create a comprehensive, composite measure of CYP’s engagement with the intervention. Engagement factor scores reflected relative uptake as assessed by a range of usage indices including chapters accessed, number of pages visited and number of logins. RESULTS: The intervention was implemented with high fidelity, and participants deemed the intervention acceptable and satisfactory. Engagement and adherence were high with child participants completing an average of 7.5/10 chapters and 100/112 (89.3%) participants completed a minimum of 4 chapters: the pre-defined threshold for effective dose. Compared to the total population of children with tic disorders, the sample tended to have more educated parents and live in more economically advantaged areas but socioeconomic factors were not related to engagement factor scores. Factors associated with higher engagement factor scores included participants enrolled at the London site vs. the Nottingham site (P=.011), self-referred vs. clinic-referred (P=.041), higher parental engagement as evidenced by number of parental chapters completed (ρ=0.73, n=111, P<.001) and more therapist time for parent (ρ=0.46, n=111, P<.001). A multiple linear regression indicated that parents’ chapter completion (β=.69, t110=10.18, P<.001) and therapist time for parent (β=.19, t110=2.95, P=.004) were the only significant independent predictors of engagement factor scores. CONCLUSIONS: Overall, the intervention had high fidelity of delivery and was evaluated positively by participants, although reach may have been constrained by the nature of the randomized controlled trial. Parental engagement and therapist time for parent were strong predictors of intervention implementation which has important implications for the design and implementation of digital therapeutic interventions into Child and Adolescent Mental Health Services. Clinical Trial: International Standard Randomized Controlled Trial Number (ISRCTN) 70758207; https://doi.org/10.1186/ISRCTN70758207 and ClinicalTrials.gov NCT03483493; https://clinicaltrials.gov/ct2/show/NCT0348349

Temperature sensitivity of decomposition in relation to soil organic matter pools: critique and outlook

Knorr et al.&nbsp;(2005) concluded that soil organic carbon pools with longer turnover times are more sensitive to temperature. We show that this conclusion is equivocal, largely dependent on their specific selection of data and does not persist when the data set of K&#228;tterer et al.&nbsp;(1998) is analysed in a more appropriate way. Further, we analyse how statistical properties of the model parameters may interfere with correlative analyses that relate the Q₁₀ of soil respiration with the basal rate, where the latter is taken as a proxy for soil organic matter quality. We demonstrate that negative parameter correlations between Q₁₀-values and base respiration rates are statistically expected and not necessarily provide evidence for a higher temperature sensitivity of low quality soil organic matter. Consequently, we propose it is premature to conclude that stable soil carbon is more sensitive to temperature than labile carbon

Factors influencing the efficacy of an online behavioural intervention for children and young people with tics: Process evaluation of a randomised controlled trial

The Online Remote Behavioural Intervention for Tics (ORBIT) trial found that an internet-delivered, therapist-supported, and parent-assisted Exposure and Response Prevention (ERP) intervention reduced tic severity and improved clinical outcomes. This process evaluation aimed to explore mechanisms of impact and factors influencing efficacy. Participants were 112 children with a tic disorder and their parents randomised to the active intervention arm of the ORBIT trial. Child engagement was assessed by usage metrics and parent engagement by chapter completion. Experiences of the digital intervention were explored by semi-structured interviews. Outcomes (3-months post randomisation) were change in tic severity and overall clinical improvement. Tic severity reduced from baseline to 3-month follow-up and 36% were rated as much improved clinically. Greater tic severity at baseline predicted reduction in tic severity. Parental engagement was the only independent predictor of clinical improvement. There were no statistically significant mediators or moderators of the relationship between level of child engagement and outcome. From the qualitative findings, child participants appreciated working together with parents on the intervention and participants found the intervention engaging. ORBIT may be an effective and acceptable intervention for children and young people with tic disorders, with parental engagement being a key factor in successful outcomes

Protocol for the Process Evaluation of the Online Remote Behavioural Intervention for Tics (ORBIT) randomized controlled trial for children and young people

BackgroundProcess evaluations are an important component in the interpretation and understanding of outcomes in trials. The Online Remote Behavioural Intervention for Tics (ORBIT) study is a randomized controlled trial evaluating the effectiveness of an Internet-delivered behavioural intervention (called BIP TIC) compared to an Internet-delivered education programme aimed at children and young people with tics. A process evaluation will be undertaken alongside the main trial to determine precisely how the behavioural intervention works and ascertain whether, and if so, how, the intervention could be successfully implemented in standard clinical practice. This protocol paper describes the rationale, aims, and methodology of the ORBIT trial process evaluation.MethodsThe process evaluation will have a mixed-methods design following the UK Medical Research Council 2015 guidelines, comprising both quantitative and qualitative data collection. This will include analysing data usage of participants in the intervention arm; purposively sampled, semi-structured interviews of parents and children, therapists and supervisors, and referring clinicians of the ORBIT trial, as well as analysis of qualitative comments put into the online therapy platform by participants at the end of treatment. Qualitative data will be analysed thematically. Quantitative and qualitative data will be integrated in a triangulation approach, to provide an understanding of how the intervention works, and what resources are needed for effective implementation, uptake and use in routine clinical care.DiscussionThis process evaluation will explore the experiences of participants, therapists and supervisors and referring clinicians of a complex online intervention. By contextualising trial efficacy results, this will help understand how and if the intervention worked and what may be required to sustain the implementation of the treatment long term. The findings will also aid in our understanding of factors that can affect the success of complex interventions. This will enable future researchers developing online behavioural interventions for children and young people with mental health and neurological disorders to gain invaluable information from this process evaluation.Trial registrationInternational Standard Randomised Controlled Trials Number, ISRCTN70758207. Registered on 20 March 2018.ClinicalTrials.gov, NCT03483493. Registered on 30 March 2018

Anthropogenic and climatic impacts on a coastal environment in the Baltic Sea over the last 1000 years

Coastal environments have experienced large ecological changes as a result of human activities over the last 100-200 years. To understand the severity and potential consequences of such changes, paleoenvironmental records provide important contextual information. The Baltic Sea coastal zone is naturally a vulnerable system and subject to significant human-induced impacts. To put the recent environmental degradation in the Baltic coastal zone into a long-term perspective, and to assess the natural and anthropogenic drivers of environmental change, we present sedimentary records covering the last 1000 years obtained from a coastal inlet (Gasfjarden) and a nearby lake (Lake Storsjon) in Sweden. We investigate the links between a pollen-based land cover reconstruction from Lake Storsjon and paleoenvironmental variables from Gasfjarden itself, including diatom assemblages, organic carbon (C) and nitrogen (N) contents, stable C and N isotopic ratios, and biogenic silica contents. The Lake Storsjon record shows that regional land use was characterized by small-scale agricultural activity between 900 and 1400 CE, which slightly intensified between 1400 and 1800 CE. Substantial expansion of cropland was observed between 1800 and 1950 CE, before afforestation between 1950 and 2010 CE. From the Gasfjarden record, prior to 1800 CE, relatively minor changes in the diatom and geochemical proxies were found. The onset of cultural eutrophication in Gasfjarden can be traced to the 1800s and intensified land use is identified as the main driver. Anthropogenic activities in the 20th century have caused unprecedented ecosystem changes in the coastal inlet, as reflected in the diatom composition and geochemical proxies. (c) 2018 Elsevier Ltd. All rights reserved.Peer reviewe