Enhancing assertive community treatment with cognitive behavioral social skills training for schizophrenia: study protocol for a randomized controlled trial.

BackgroundSchizophrenia leads to profound disability in everyday functioning (e.g., difficulty finding and maintaining employment, housing, and personal relationships). Medications can effectively reduce positive symptoms (e.g., hallucinations and delusions), but they do not meaningfully improve daily life functioning. Psychosocial evidence-based practices (EBPs) improve functioning, but these EBPs are not available to most people with schizophrenia. The field must close the research and service delivery gap by adapting EBPs for schizophrenia to facilitate widespread implementation in community settings. Our hybrid effectiveness and implementation study represents an initiative to bridge this divide. In this study we will test whether an existing EBP (i.e., Cognitive Behavioral Social Skills Training (CBSST)) modified to work in practice settings (i.e., Assertive Community Treatment (ACT) teams) commonly available to persons with schizophrenia results in better consumer outcomes. We will also identify key factors relevant to developing future CBSST implementation strategies.Methods/designFor the effectiveness study component, persons with schizophrenia will be recruited from existing publicly funded ACT teams operating in community settings. Participants will be randomized to one of the 2 treatments (ACT alone or ACT + Adapted CBSST) and followed longitudinally for 18 months with assessments every 18 weeks after baseline (5 in total). The primary outcome domain is psychosocial functioning (e.g., everyday living skills and activities related to employment, education, and housing) as measured by self-report, testing, and observation. Additional outcome domains of interest include mediators of change in functioning, symptoms, and quality of services. Primary analyses will be conducted using linear mixed-effects models for continuous data. The implementation study component consists of a structured, mixed qualitative-quantitative methodology (i.e., Concept Mapping) to characterize and assess the implementation experience from multiple stakeholder perspectives in order to inform future implementation initiatives.DiscussionAdapting CBSST to fit into the ACT service delivery context found throughout the United States creates an opportunity to substantially increase the number of persons with schizophrenia who could have access to and benefit from EBPs. As part of the implementation learning process training materials and treatment workbooks have been revised to promote easier use of CBSST in the context of brief community-based ACT visits.Trial registrationClinicalTrials.gov NCT02254733 . Date of registration: 25 April 2014

Circulation and hydrological characteristics of the North Aegean Sea: a contribution from real-time buoy measurements

In the framework of the POSEIDON Project, a network of open sea oceanographic buoys equipped with meteorological and oceanographic sensors has been operational in the Aegean Sea since 1998. The analysis of upper-ocean physical data (currents at 3m, temperature and salinity at 3-40m depths) collected during the last 2 years from the stations of the North Aegean basin indicates a strong temporal variability of flow field and hydrological characteristics in both synoptic and seasonal time scales. The northern part of the basin is mainly influenced by the Black Sea Water outflow and the mesoscale variability of the corresponding thermohaline fronts, while the southern stations are influenced by the general circulation of the Aegean Sea with strong modulations caused by the seasonally varying atmospheric forcing

Temperature and salinity variability in the Greek Seas based on POSEIDON stations time series: preliminary results

Temperature and salinity time series provided by three POSEIDON monitoring stations (buoys) are examined in order to study the seasonal and interannual variability of the water mass characteristics. The sites at Athos (North Aegean Sea), E1M3A (Central Cretan Sea) and Pylos (Eastern Ionian Sea) were chosen, as these buoys provide measurements at various depths, while they represent 3 major basins respectively. The study of the T and S characteristics reveals important seasonal changes and highlights the particular characteristics of each basin. Dense water production in the Northern Aegean is found to be hindered by the presence of the surface Black Sea Water (BSW) mass. On the other hand, the intermediate water mass in the Cretan Sea is shown to be ventilated during the winter season. A significant temperature and salinity increase has been monitored over both the Central Cretan and Eastern Ionian Seas starting from the middle of 2008 and 2009 respectively. This could possibly be attributed to changes in the intermediate water masses of the Eastern Mediterranean, without ruling out the possibility of water mass exchanges between the two basins

A 2-year intercomparison of the WAM-Cycle4 and the WAVEWATCH-III wave models implemented within the Mediterranean Sea

In this work we present the implementation of a wave forecast/hindcast system for the Mediterranean Sea at a 1/10º horizontal resolution and we show a first assessment of its performance by inter-comparing model results to observational data time series at selected points for the period 2000-2001. The system which is part of the POSEIDON-II operational system includes the WAM – Cycle4 and the WAVEWATCH-III wave forecast models (implemented within the same region) one way coupled with the non-hydrostatic version of the ETA atmospheric model which provides at 3-hour intervals the necessary wind velocity fields to the wave models. The same system but based on the WAM-Cycle4 wave model, has been used in the past for the production of the Aegean Sea wind and wave Atlas. Overall, the inter-comparison shows that both wave models are rather skilful in predicting the integral wave parameters with significant wave height skill scores in the range 0.85-0.90 and mean period scores in the range 0.77-0.83. It is also evident that WAM model has a tendency to overestimate mean wave periods while the opposite is true for WAVEWATCH-III model. Differences between the two models simulated spectra exist along the main passage of cyclonic systems over the Mediterranean Sea while in the wind seas dominated areas of the basin (the Aegean Sea for example) the two models show almost the same behavior

Dynamic downscaling of the ERA-40 data using a mesoscale meteorological model

A sophisticated downscaling procedure that was applied to reproduce high resolution historical records of the atmospheric conditions across the Mediterranean region is presented in this paper. This was accomplished by the dynamical downscaling of the European Center for Medium-Range Forecasts ERA-40 reanalyses with the aid of the atmospheric model of the POSEIDON weather forecasting system. The full three dimensional atmospheric fields with 6 hours of temporal resolution and the surface meteorological parameters at hourly intervals were produced for a 10-year period (1995-2004). The meteorological variables are readily available at 10 km resolution and may constitute the atmospheric forcing to drive wave, ocean hydrodynamic and hydrological models, as well as the baseline data for environmental impact assessment studies. A brief overview of the procedure and a quantitative estimation of the benefit of the new dynamical downscaling dataset are presented

A multi-model assessment of the impact of currents, waves and wind in modelling surface drifters and oil spill

Validation of oil spill forecasting systems suffers from a lack of data due to the scarcity of oil slick in situ and satellite observations. Drifters (surface drifting buoys) are often considered as proxy for oil spill to overcome this problem. However, they can have different designs and consequently behave in a different way at sea, making it not straightforward to use them for oil spill model validation purposes and to account for surface currents, waves and wind when modelling them. Stemming from the need to validate the MEDESS4MS (Mediterranean Decision Support System for Marine Safety) multi-model oil spill prediction system, which allows access to several ocean, wave and meteorological operational model forecasts, an exercise at sea was carried out to collect a consistent dataset of oil slick satellite observations, in situ data and trajectories of different type of drifters. The exercise, called MEDESS4MS Serious Game 1 (SG1), took place in the Elba Island region (Western Mediterranean Sea) during May 2014. Satellite images covering the MEDESS4MS SG1 exercise area were acquired every day and, in the case an oil spill was observed from satellite, vessels of the Italian Coast Guard (ITCG) were sent in situ to confirm the presence of the pollution. During the exercise one oil slick was found in situ and drifters, with different water-following characteristics, were effectively deployed into the oil slick and then monitored in the following days. Although it was not possible to compare the oil slick and drifter trajectories due to a lack of satellite observations of the same oil slick in the following days, the oil slick observations in situ and drifters trajectories were used to evaluate the quality of MEDESS4MS multi-model currents, waves and winds by using the MEDSLIK-II oil spill model. The response of the drifters to surface ocean currents, different Stokes drift parameterizations and wind drag has been examined. We found that the surface ocean currents mainly drive the transport of completely submerged drifters. The accuracy of the simulations increases with higher resolution currents and with addition of the Stokes drift, which is better estimated when provided by wave models. The wind drag improves the modelling of drifter trajectories only in the case of partially emerged drifters, otherwise it leads to an incorrect reproduction of the drifters׳ direction, which is particularly evident in high speed wind conditions

An integrated open-coastal biogeochemistry, ecosystem and biodiversity observatory of the eastern Mediterranean – the Cretan Sea component of the POSEIDON system

There is a general scarcity of oceanic observations that concurrently examine air–sea interactions, coastal–open-ocean processes and physical–biogeochemical processes, in appropriate spatiotemporal scales and under continuous, long-term data acquisition schemes. In the Mediterranean Sea, the resulting knowledge gaps and observing challenges increase due to its oligotrophic character, especially in the eastern part of the basin. The oligotrophic open Cretan Sea's biogeochemistry is considered to be representative of a greater Mediterranean area up to 106&thinsp;km2, and understanding its features may be useful on even larger oceanic scales, since the Mediterranean Sea has been considered a miniature model of the global ocean. The spatiotemporal coverage of biogeochemical (BGC) observations in the Cretan Sea has progressively increased over the last decades, especially since the creation of the POSEIDON observing system, which has adopted a multiplatform, multivariable approach, supporting BGC data acquisition. The current POSEIDON system's status includes open and coastal sea fixed platforms, a Ferrybox (FB) system and Bio-Argo autonomous floats that remotely deliver fluorescence as a proxy of chlorophyll-a (Chl-a), O2, pH and pCO2 data, as well as BGC-related physical variables. Since 2010, the list has been further expanded to other BGC (nutrients, vertical particulate matter fluxes), ecosystem and biodiversity (from viruses up to zooplankton) variables, thanks to the addition of sediment traps, frequent research vessel (R/V) visits for seawater–plankton sampling and an acoustic Doppler current profiler (ADCP) delivering information on macrozooplankton–micronekton vertical migration (in the epipelagic to mesopelagic layer). Gliders and drifters are the new (currently under integration to the existing system) platforms, supporting BGC monitoring. Land-based facilities, such as data centres, technical support infrastructure, calibration laboratory and mesocosms, support and give added value to the observatory. The data gathered from these platforms are used to improve the quality of the BGC-ecosystem model predictions, which have recently incorporated atmospheric nutrient deposition processes and assimilation of satellite Chl-a data. Besides addressing open scientific questions at regional and international levels, examples of which are presented, the observatory provides user-oriented services to marine policy makers and the society, and is a technological test bed for new and/or cost-efficient BGC sensor technology and marine equipment. It is part of European and international observing programs, playing a key role in regional data handling and participating in harmonization and best practices procedures. Future expansion plans consider the evolving scientific and society priorities, balanced with sustainable management.</p

Challenges for Sustained Observing and Forecasting Systems in the Mediterranean Sea

The Mediterranean community represented in this paper is the result of more than 30 years of EU and nationally funded coordination, which has led to key contributions in science concepts and operational initiatives. Together with the establishment of operational services, the community has coordinated with universities, research centers, research infrastructures and private companies to implement advanced multi-platform and integrated observing and forecasting systems that facilitate the advancement of operational services, scientific achievements and mission-oriented innovation. Thus, the community can respond to societal challenges and stakeholders needs, developing a variety of fit-for-purpose services such as the Copernicus Marine Service. The combination of state-of-the-art observations and forecasting provides new opportunities for downstream services in response to the needs of the heavily populated Mediterranean coastal areas and to climate change. The challenge over the next decade is to sustain ocean observations within the research community, to monitor the variability at small scales, e.g., the mesoscale/submesoscale, to resolve the sub-basin/seasonal and inter-annual variability in the circulation, and thus establish the decadal variability, understand and correct the model-associated biases and to enhance model-data integration and ensemble forecasting for uncertainty estimation. Better knowledge and understanding of the level of Mediterranean variability will enable a subsequent evaluation of the impacts and mitigation of the effect of human activities and climate change on the biodiversity and the ecosystem, which will support environmental assessments and decisions. Further challenges include extending the science-based added-value products into societal relevant downstream services and engaging with communities to build initiatives that will contribute to the 2030 Agenda and more specifically to SDG14 and the UN's Decade of Ocean Science for sustainable development, by this contributing to bridge the science-policy gap. The Mediterranean observing and forecasting capacity was built on the basis of community best practices in monitoring and modeling, and can serve as a basis for the development of an integrated global ocean observing system

Can cognitive insight predict symptom remission in a first episode psychosis cohort?

BACKGROUND: The outcome of first episode psychosis (FEP) is highly variable and difficult to predict. Cognitive insight measured at illness onset has previously been found to predict psychopathology 12-months later. The aims of this study were to examine whether the prospective relationship between cognitive insight and symptom severity is evident at four-years following FEP and to examine some psychological correlates of cognitive insight. METHODS: FEP participants (n = 90) completed the Beck Cognitive Insight Scale (BCIS) at illness onset, and associations between BCIS scores with symptom severity outcomes (4-years after FEP) were assessed. The BCIS scales (self-reflectiveness and self-certainty) were examined as a composite score, and individually compared to other cognitive measures (IQ and jumping to conclusions (JTC) bias). RESULTS: Regression analyses revealed that the cognitive insight composite did not predict 4-year symptom remission in this study while the self-reflection subscale of the BCIS predicted severity of symptoms at 4-years. Self-certainty items of the BCIS were not associated with symptom severity. Significant correlations between the JTC bias, self-certainty and IQ were found, but self-reflection did not correlate with these other cognitive measures. CONCLUSIONS: Self-reflective capacity is a more relevant and independent cognitive construct than self-certainty for predicting prospective symptom severity in psychosis. Improving self-reflection may be a useful target for early intervention research