Effects of media stories featuring coping with suicidal crises on psychiatric patients: Randomized controlled trial.

BACKGROUND: Accumulating evidence suggests beneficial effects of media stories featuring individuals mastering their suicidal crises, but effects have not been assessed for psychiatric patients. METHODS: We randomized n = 172 adult psychiatric patients (n = 172, 97.1% inpatients) to read an educative article featuring a person mastering a suicidal crisis (n = 92) or an unrelated article (n = 80) in a single-blind randomized controlled trial. Questionnaire data were collected before (T1) and after exposure (T2) as well as 1 week later (study end-point, T3). The primary outcome was suicidal ideation as assessed with the Reasons for Living Inventory; secondary outcomes were help-seeking intentions, mood, hopelessness, and stigmatization. Differences between patients with affective versus other diagnoses were explored based on interaction tests. RESULTS: We found that patients with affective disorders (n = 99) experienced a small-sized reduction of suicidal ideation at 1-week follow up (mean difference to control group [MD] at T3 = -0.17 [95% CI -0.33, -0.03], d = -0.15), whereas patients with nonaffective diagnoses (n = 73) experienced a small-sized increase (T2: MD = 0.24 [95% CI 0.06, 0.42], d = 0.19). Intervention group participants further experienced a nonsustained increase of help-seeking intentions (T2: MD = 0.53 [95% CI 0.11, 0.95], d = 0.19) and a nonsustained deterioration of mood (T2: MD = -0.14 [95% CI -0.27, -0.02], d = -0.17). CONCLUSIONS: This study suggests that patients with affective disorders appear to benefit from media materials featuring mastery of suicidal crises. More research is needed to better understand which patient groups are at possible risk of unintended effects.

Recover recovery style from psychosis: a psychometric evaluation of the German version of the Recovery Style Questionnaire (RSQ).

AIMS: The way an individual handles the experience of psychosis, the so-called 'recovery style', has been shown to substantially affect long-term outcomes. The Recovery Style Questionnaire (RSQ) measures this psychological dimension. The aim of this study was to provide a validation of the German version of the RSQ and to raise awareness for recovery-oriented approaches. METHODS: The RSQ was translated into German according to the guidelines of the WHO and patients were administered this questionnaire and measures of internalised stigma, psychotic symptoms, illness concept, empowerment, self-esteem and quality of life. Descriptive statistics were demonstrated to characterise the sample. Reliability was assessed in different forms: internal consistency, test-retest reliability and split-half reliability. Items were evaluated with descriptive data and item-total correlations. Convergent and discriminant validity were shown, and a confirmatory factor analysis was performed. In order to ameliorate the model, a post hoc model modification was done. RESULTS: The sample consisted of 138 patients diagnosed with schizophrenia spectrum disorders (mean age: 35.7 years; 53.6% men; mean duration of illness: 20.6 years) with a mean RSQ overall percentage of 66.12 (s.d. ± 17.43%), mainly representing the categories 'mixed picture' and 'tends towards integration'. The reliability of the RSQ was acceptable with a Cronbach's α of 0.741 and a test-retest coefficient of 0.502. Item-total correlations were not acceptable for 27 of 39 items. Moderate evidence for convergent validity of the RSQ was found. Confirmatory factor analysis revealed that the 13-factor model with 39 items originally proposed was partially poorly replicated in the present sample (χ2 ratio to degrees of freedom (χ2/df) of 1.732, Comparative Fit Index (CFI) of 0.585, Normed Fit Index (NFI) of 0.414, Tucker-Lewis Index (TLI) of 0.508, root mean square error of approximation (RMSEA) of 0.095). The RSQ was modified based on item-total correlations and path coefficients of the single items. The confirmatory factor analysis of the resulting one-factor model with 11 items showed adequate fit to the data (χ2/df of 1.562, CFI of 0.936, NFI of 0.847, TLI of 0.910, RMSEA of 0.083) and demonstrated good model fit. CONCLUSIONS: Despite partially insufficient psychometric data of the original RSQ, the concept of recovery style is beneficial to psychiatric research and clinical practice. The underlying idea is valuable, and the questionnaire needs further development. Therefore, a short version of the RSQ is proposed.

Optimisation of a sol-gel synthesis route for the preparation of MgF2 particles for a large scale coating process.

A synthesis route for the preparation of optically transparent magnesium fluoride sols using magnesium acetate tetrahydrate as precursor is described. The obtained magnesium fluoride sols are stable for several months and can be applied for antireflective coatings on glass substrates. Reaction parameters in the course of sol synthesis are described in detail. Thus, properties of the precursor materials play a crucial role in the formation of the desired magnesium fluoride nanoparticles, this is drying the precursor has to be performed under defined mild conditions, re-solvation of the dried precursor has to be avoided and addition of water to the final sol-system has to be controlled strictly. Important properties of the magnesium fluoride sols like viscosity, particle size distribution, and structural information are presented as well.

Evaluation of an integrated care program for schizophrenia: concept and study design.

Concept and design of an independent scientific evaluation of different pathways of care for schizophrenia patients in Germany with respect to effectiveness and efficiency are presented. In this prospective, observational study, schizophrenia patients receiving an integrated care treatment, the intervention group (IG), are compared with patients under routine care conditions treated by the same physician (first control group, CG 1). A second control group (CG 2) of patients treated by office-based psychiatrists not participating in the integrated care program will be recruited and their data compared with the two other groups. The total amount of psychiatric hospital days after 12 months is defined as primary outcome parameter. Secondary outcome parameters comprise the frequency of psychiatric inpatient readmissions, severity of schizophrenia symptoms, remission rates and quality of life. Patients undergo assessments at baseline, month 6 and 12 using standardized and experimental questionnaires. Routine data of a regional German social health insurance fund complement information on included patients. Additionally, a cost-effectiveness and cost-utility analysis will be performed. Until now, 137 psychiatrists included 980 patients in the integrated care project in Lower Saxony, Germany, and 47 psychiatrists (IG and both CGs) are willing to participate in the independent evaluation. For the first time, a prospective observational controlled evaluation study of a countrywide integrated care project planning to recruit 500 schizophrenia patients has started using comprehensive assessments as well as routine data of a social health insurance fund.

[The health-care situation in outpatient psychiatry--results of a survey among members of the Germany Association of Psychotherapists (DPtV)]. / Zur Versorgungslage im Bereich der ambulanten Psychotherapie--Ergebnisse einer Erhebung unter den Mitgliedern der Deutschen Psychotherapeuten Vereinigung (DPtV).

BACKGROUND: Mental-health problems are of increasing importance in the German population. Nonetheless there is a lack of data concerning outpatient psychotherapeutic care, especially with a focus on psychotherapy sessions approved by social health insurances and performed by psychological psychotherapists and paediatric psychotherapists. METHODS: The study presents the results of a survey among all members of the German Association of Psychotherapists (DPtV) and is based on questionnaires filled in by 2,497 psychotherapists (return rate 33.3%). The assessment is based on the therapists' data without an external validation. Main topics of the survey were characteristics of the supply of psychotherapeutic care, therapeutic time contingents per patient and their utilisation and demographic and socio-economic features of patients. Evaluating the survey, the results were analysed overall and by groups of therapists varying in demographic features, professional qualifications and regional criteria, using bivariate as well as multivariate methods. RESULTS: The study provides evidence indicating an underprovision of outpatient psychotherapeutic care. Psychotherapists who use a waiting list reported average waiting times of more than 2.5 months. Additionally there are differences in psychotherapeutic care between various patient groups. In regions with lower population density we found less provision of psychotherapeutic care compared to regions with higher population density. Taking into account epidemiological data, the study indicates that the participation of men, persons of older age and patients with lower levels of education in psychotherapeutic care is below average. CONCLUSION: The results suggest a considerable degree of underprovision and inadequate provision of outpatient psychotherapeutic care. With regard to special population groups, further research is necessary to identify utilisation barriers towards psychotherapy.

Industry and regulatory performance in 2012: a year in review.

2012 was a robust year for new molecular entity (NME) approvals in the major geographic regions. What is behind this apparent improved performance? Has the pharmaceutical industry turned the tide in research and development productivity? In this analysis, we look not only at the number of approvals in 2012 but also at their clinical and market potential. We discuss how changes in the regulatory and reimbursement environment impact current industry performance and how this might evolve.

[Health-based risk adjustment. Effects and side effects]. / Morbiditätsorientierter Risikostrukturausgleich. Wirkungen und Nebenwirkungen.

Numerous health systems have introduced competition between health plans while banning risk-rated premiums. Risk adjustment for health plans is introduced to reduce incentives for risk selection and to create incentives for health plans to permanently invest in care for the chronically ill. According to the international health economics state of the art, risk adjustment in the German social health insurance system has used information on health status (measured by diagnoses and drug prescriptions) on top of demographic information since 2009. In non-competitive health care systems similar mechanisms are sometimes established, e.g. to achieve an equitable distribution of resources between regions. An evaluation of the first year of health-based risk adjustment demonstrates a superior performance in comparison to the old, demographic risk adjustment. The old risk adjustment formula (without ex post high-cost pooling) showed R(2) of 5.8%, CPM of 10.4% and MAPE of 2,226 €, in contrast to the new health status-based risk adjustment formula (without cash benefit for sick allowance) which reaches R(2) 20.2%, CPM 22.5% and MAPE 1,817 €. However, to make competition between health plans functional for improvement of quality and efficiency of health care, health plans must be granted additional instruments to act as prudent buyers of health care.

Synaptic vesicles studied by dynamic light scattering.

The size polydispersity distribution of synaptic vesicles (SVs) is characterized under quasi-physiological conditions by dynamic light scattering (DLS). Highly purified fractions of SVs obtained from rat brain still contain a small amount of larger contaminant structures, which can be quantified by DLS and further reduced by asymmetric-flow field-flow (AFFF) fractionation. The intensity autocorrelation functions g (2)(τ) recorded from these samples are analyzed by a constrained regularization method as well as by an alternative direct modeling approach. The results are in quantitative agreement with the polydispersity obtained from cryogenic electron microscopy of vitrified SVs. Next, different vesicle fusion assays based on samples composed of SVs and small unilamellar proteoliposomes with the fusion proteins syntaxin 1 and SNAP-25A are characterized by DLS. The size increase of the proteoliposomes due to SNARE-dependent fusion with SVs is quantified by DLS under quasi-physiological conditions.

Controlled assembly of silane-based polymers: chemically robust thin-films.

We describe the controlled assembly of silane-based copolymers on various interfaces that have surface silanol groups. This assembly occurs as a result of the formation of very robust siloxane bonds (Si-O-Si) due to a condensation reaction between the alkoxysilane groups of the polymers and surface hydroxyl groups of the substrates. Deposition of these copolymers is not self-limiting; therefore, they could not be assembled into discrete monolayers. However, UV-visible data collected as a function of deposition cycle reveals a linear relationship, confirming the deposition of a constant amount of polymer in each deposition cycle. A linear variation of layer thickness with deposition cycles is also observed. The assembled polymer layers are found to be very robust and resistant even when exposed to piranha solution for several hours.

Association between friction and wear in diarthrodial joints lacking lubricin.

OBJECTIVE: The glycoprotein lubricin (encoded by the gene Prg4) is secreted by surface chondrocytes and synovial cells, and has been shown to reduce friction in vitro. In contrast to man-made bearings, mammalian diarthrodial joints must endogenously produce friction-reducing agents. This study was undertaken to investigate whether friction is associated with wear. METHODS: The lubricating ability of synovial fluid (SF) samples from humans with genetic lubricin deficiency was tested in vitro. The coefficient of friction in the knee joints of normal and lubricin-null mice was measured ex vivo; these joints were also studied by light and electron microscopy. Atomic force microscopy was used to image and measure how lubricin reduces friction in vitro. RESULTS: SF lacking lubricin failed to reduce friction in the boundary mode. Joints of lubricin-null mice showed early wear and higher friction than joints from their wild-type counterparts. Lubricin self-organized and reduced the work of adhesion between apposing asperities. CONCLUSION: These data show that friction is coupled with wear at the cartilage surface in vivo. They imply that acquired lubricin degradation occurring in inflammatory joint diseases predisposes the cartilage to damage. Lastly, they suggest that lubricin, or similar biomolecules, will have applications in man-made devices in which reducing friction is essential.

Consciousness, information, and living systems.

The possibility of a proactive role for consciousness in the establishment of physical reality has been addressed via an extensive 26-year program investigating physical anomalies in human/machine interactions and non-sensory acquisition of information about remote geographical locations. Empirical databases comprising many hundreds of millions of random events confirm that information can be introduced into, or extracted from, otherwise random physical processes solely through the agencies of human intention and subjective resonance. Much of the evidence mitigates the likelihood that the anomalies are manifestations of neo-cortical cognitive activity. Rather, they may be expressions of a deeper information organizing capacity of biological origin that emerges from the uncertainty inherent in the complexity of all living systems.

Correlations of random binary sequences with pre-stated operator intention: a review of a 12-year program.

Strong correlations between output distribution means of a variety of random binary processes and pre-stated intentions of some 100 individual human operators have been established over a 12-year experimental program. More than 1000 experimental series, employing four different categories of random devices and several distinctive protocols, show comparable magnitudes of anomalous mean shifts from chance expectation, with similar distribution structures. Although the absolute effect sizes are quite small, of the order of 10(-4) bits deviation per bit processed, over the huge databases accumulated, the composite effect exceeds 7sigma (p approximately 3.5 x 10(-13)). These data display significant disparities between female and male operator performances, and consistent serial position effects in individual and collective results. Data generated by operators far removed from the machines and exerting their efforts at times other than those of machine operation show similar effect sizes and structural details to those of the local, on-time experiments. Most other secondary parameters tested are found to have little effect on the scale and character of the results, with one important exception: studies performed using fully deterministic pseudorandom sources, either hard-wired or algorithmic, yield null overall mean shifts, and display no other anomalous features.

Information and uncertainty in remote perception research.

This article has four purposes: 1) to present for the first time in archival form all results of some 25 years of remote perception research at this laboratory; 2) to describe all of the analytical scoring methods developed over the course of this program to quantify the amount of anomalous information acquired in the experiments; 3) to display a remarkable anti-correlation between the objective specificity of those methods and the anomalous yield of the experiments; and 4) to discuss the phenomenological and pragmatic implications of this complementarity. The formal database comprises 653 experimental trials performed over several phases of investigation. The scoring methods involve various arrays of descriptor queries that can be addressed to both the physical targets and the percipients' description thereof, the responses to which provide the basis for numerical evaluation and statistical assessment of the degree of anomalous information acquired. Twenty-four such recipes have been employed, with queries posed in binary, ternary, quaternary, and ten-level distributive formats. Thus treated, the database yields a composite z-score against chance of 5.418 (p = 3 x 10(-8), one-tailed). Numerous subsidiary analyses agree that these overall results are not significantly affected by any of the secondary protocol parameters tested, or by variations in descriptor effectiveness, possible participant response biases, target distance from the percipient, or time interval between perception effort and agent target visitation. However, over the course of the program there has been a striking diminution of the anomalous yield that appears to be associated with the participants' growing attention to, and dependence upon, the progressively more detailed descriptor formats and with the corresponding reduction in the content of the accompanying free-response transcripts. The possibility that increased emphasis on objective quantification of the phenomenon somehow may have inhibited its inherently subjective expression is explored in several contexts, ranging from contemporary signal processing technologies to ancient divination traditions. An intrinsic complementarity is suggested between the analytical and intuitive aspects of the remote perception process that, like its more familiar counterpart in quantum science, brings with it an inescapable uncertainty that limits the extent to which such anomalous effects can be simultaneously produced and evaluated.

FieldREG II: consciousness field effects: replications and explorations.

Based on formal analysis of 18 exploratory applications, 12 of which have been reported previously, a testable general hypothesis for FieldREG experiments has been postulated, namely that data taken in environments fostering relatively intense or profound subjective resonance will show larger deviations of the mean relative to chance expectation than those generated in more pragmatic assemblies. The 61 subsequent FieldREG applications reported here comprise 21 hypothesis-based formal replications, along with 40 further explorations designed to learn more about the circumstances that favor anomalous deviations. The results of the formal replications strongly confirm the general hypothesis, yielding a composite probability against chance for the resonant subset of 2.2 x 10(-6) compared to 0.91 for the mundane subset. The exploratory work suggests other venues in which anomalous effects of group consciousness can be expected, and also identifies a number of situations that do not appear to be conducive to such responses.

The complementarity of consciousness.

The concept of complementarity, originally proposed by Bohr in a microphysical context, and subsequently extended by himself, Heisenberg and Pauli to encompass subjective as well as objective dimensions of human experience, can be further expanded to apply to many common attitudes of human consciousness. At issue is the replacement of strict polar opposition of superficially antithetical consciousness capacities, such as analysis and synthesis, logic and intuition, or doing and being, by more generous conjugation that allows the pairs to operate in constructive triangulation and harmony. In this format, the physical principle of uncertainty also acquires metaphoric relevance in limiting the attainable sharpness of specification of any consciousness complements, and may serve to define their optimum balance in establishing reality. These principles thus lend themselves to representation of wave-like vs. particle-like operations of consciousness; to trade-offs between rigor and ambience in consciousness research; to generic masculine/feminine reinforcement; and to the interplay of science and spirit in any creative enterprise.

Information, consciousness, and health.

A 16-year empirical assessment of anomalous human/machine interactions provides strong evidence that consciousness can add information to otherwise random digital strings. A parallel program of remote perception studies establishes the inverse process: the anomalous acquisition of information about distant physical targets. Remarkably, neither of these extraordinary capabilities shows any dependence on either the distance or the time separating the participant from the target. The relevance of these consciousness abilities to human health follows from recognition that physiology entails myriad subtle information processes, all of which involve some degree of randomicity in their normal functions, and thus may be similarly influenced by conscious volition.

A modular model of mind/matter manifestations (M5).

While ongoing empirical research into anomalous mind/matter interactions continues to reaffirm the reality of such phenomena, it has heretofore failed to stimulate viable theoretical models, or even to suggest effective strategies for more productive experimentation. In contrast to prevalent presumption, re-examination of several large databases from this laboratory raises doubt that such effects are produced by direct attention of the conscious mind to the observable physical processes addressed. Rather, an alternative route is indicated wherein unconscious mind and intangible physical mechanisms are invoked to achieve anomalous acquisition of mental information about, or anomalous mental influence upon, otherwise inaccessible material processes. Implications for more effective experiments include subtler feedback schemes that facilitate submission of conscious intention to unconscious mental processing; physical target systems that provide a richness of intangible potentialities; operators who are amenable to such interactions; and an environmental ambience that supports the composite strategy. Theoretical requisites include better understanding of the information dialogue between conscious and unconscious aspects of mind; more pragmatic formulations of the relations between tangible and intangible physical processes; and most importantly, cogent representation of the merging of mental and material dimensions into indistinguishability at their deepest levels.

The PEAR proposition.

For more than a quarter century, the Princeton Engineering Anomalies Research (PEAR) laboratory has engaged in a broad range of experiments on consciousness-related physical anomalies and has proposed a corresponding selection of theoretical models that have combined to illuminate the fundamental nature of the provocative phenomena that emerge. Productive pursuit of this topic has inescapably involved a spectrum of political, cultural, personal, and interpersonal factors that are normally not encountered in more conventional scientific scholarship, but have both enriched and complicated the enterprise in many ways. Some of the insights gleaned from the work are objectively specifiable, such as the scale and structural character of the anomalous effects; their relative insensitivity to objective physical correlates, including distance and time; the oscillating sequential patterns of performance they display; the major discrepancies between male and female achievements; and their irregular replicability at all levels of experience. But many others relate to subjective issues, such as the responsiveness of the effects to conscious and unconscious intention and to individual and collective resonance; the relevance of ambience and attitude in their generation; and the importance of intrinsic uncertainty as a source of the anomalies. This blend of empirical features predicates radical excursions of the dedicated models, and hence of the more general scientific paradigms, to allow consciousness and its subjective information processing capacities a proactive role in the establishment of objective reality, with all of the complications of specificity, causality, and reproducibility that entails. The attendant complexities of conceptualization, formulation, and implementation notwithstanding, pragmatic applications of these phenomena in many sectors of public endeavor now can be foreseen.

Endophysical models based on empirical data.

Any proposed endophysical models need to acknowledge a number of subjective correlates that have been well established in such objectively quantifiable experimental contexts as anomalous human/machine interactions and remote perception information acquisition. Most notable of these factors are conscious and unconscious intention; gender disparities; serial position effects; intrinsic uncertainties; elusive replicability; and emotional resonance between the participants and the devices, process, and tasks. Perhaps even more pertinent are the insensitivities of the anomalous effects to spatial and temporal separations of the participants form the physical targets. Inclusion of subjective coordinates in the models, and exclusion of physical distance and time, raise formidable issues of specification, quantification, and dynamical formulation from both the physical and psychological perspectives. A few primitive examples of possible approaches are presented.