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Schizophrenia and other psychotic disorders are associated with high degrees of impairment and often respond inadequately to pharmacotherapy alone. In recent years, numerous clinical trials have been published showing the benefits of adjunctive cognitive behavior therapy for treating psychosis. However, research in this area has been hampered by the inherent problems conducting psychotherapy research in severely mentally ill populations. This paper provides a brief overview of the cognitive-behavioral treatment of psychosis and discusses the state of the evidence in this area, including its many unresolved issues. (Contains 1 figure.)

Introduction and Objective: ExactVuTM is a real-time micro-ultrasound system which provides, according to the Prostate Risk Identification Using Micro-Ultrasound protocol (PRI-MUS), a 300% higher resolution compared to conventional transrectal ultrasound. To evaluate the performance of ExactVuTM in the detection of Clinically significant Prostate Cancer (CsPCa). Materials and methods: Patients with Prostate Cancer diagnosed at fusion biopsy were imaged with ExactVuTM. CsPCa was defined as any Gleason Score ≥ 3+4. ExactVuTM examination was considered as positive when PRI-MUS score was ≥ 3. PRI-MUS scoring system was considered as correct when the fusion biopsy was positive for CsPCa. A transrectal fusion biopsy- proven CsPCa was considered as a gold standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the receiver operator characteristic (ROC) curve (AUC) were calculated. Results: 57 patients out of 68 (84%) had a csPCa. PRI-MUS score was correctly assessed in 68% of cases. Regarding the detection of CsPCa, ExactVuTM ’s sensitivity, specificity, PPV, and NPV was 68%, 73%, 93%, and 31%, respectively and the AUC was 0.7 (95% CI 0.5-0-8). For detecting CsPCa in the transition/ anterior zone the sensitivity, specificity, PPV, and NPV was 45%, 66%, 83% and 25% respectively ant the AUC was 0.5 (95% CI 0.2-0.9). Accounting only the CsPCa located in the peripheral zone, sensitivity, specificity, PPV, and NPV raised up to 74%, 75%, 94%, 33%, respectively with AUC 0.75 (95% CI 0.5-0-9). Conclusions: ExactVuTM provides high resolution of the prostatic peripheral zone and could represent a step forward in the detection of CsPCa as a triage tool. Further studies are needed to confirm these promising results.

Abstract Background The herniation of the ureter into the inguinal canal is a rare condition, but probably underreported. Acquired nephroptosis could cause herniation of the ureter and, therefore, when diagnosed, a full study of the urinary tract should be performed especially in patients with inguinal hernia. Case presentation We present the case of an 86-year-old white man with a herniated ureter likely caused by acquired nephroptosis presenting with acute urinary retention, documented with magnetic resonance imaging for the first time. Conclusions The Fast Imaging Employing Steady State Acquisition sequence on magnetic resonance imaging, for many reasons, could allow correct evaluation of the urinary tract, especially in cases of renal dysfunction that contraindicate the use of intravenous contrast agents.

The processes involved in moving from vulnerability to resilience imply shared commitments between community and social actors. This paper documents such a shared experience among groups of high school learners from three cities in Veracruz state, Mexico, which have been periodically affected by extreme weather conditions. Earlier research carried out with high school learners and teachers analysed the resilience that the community demonstrated while coping with, and recovering from, an environmental contingency. In this initial research stage, we obtained information from official sources, and from questionnaires and interviews on the physical and social elements that impact the learners’ vulnerability. In addition, we identified the participants’ interest in being involved in processes to build resilient communities. With all this information, it was then possible to make progress in the development of strategies towards building the relevant capacities in those high school learners interested in becoming change agents in their own communities. The research also contributed to the creation of intra-community contingency support networks in the three municipalities participating in the study. In addition, high school learners and teachers became interested in initiating environmental protection activities and in taking on the commitment to communicate their concerns to decision-makers in their own communities to try and influence public policy. Accordingly, these actions and shared commitments can be seen to foster community and social resilience.

Argues that sustainability is a process that links social equity, economic growth, and environmental protection; therefore, sustainable consumption is a mode of consumption congruent with this meaning of sustainability. (Author/CCM)

Sarcoidosis is a multisystemic disease histologically characterized by non-caseating epithelioid granulomas and multinucleated giant cells; the etiology is still uncertain, and likely related to a complex interplay between environmental and genetic factors. The genitourinary system is affected in fewer than 0.2% of all clinically diagnosed cases of sarcoidosis and in 5% of those identified in autopsy studies. In this report, we describe a case of a 42–year-old male with one hypoechoic lesion per testis on B-mode evaluation; contrast-enhanced ultrasound (CEUS) on both lesions was carried out. During the early phase, the masses showed a hypovascular appearance as compared to the surrounding testicular tissue, maintaining the hypo-enhancement in the late phase. Tissue biopsy for pathological evaluation confirmed testicular sarcoid involvement, showing non-caseating granulomas. Allowing visualization of testicular microvascularisation, CEUS may play an important role in excluding malignancy, avoiding unnecessary aggressive treatment for benign conditions, such as sarcoidosis. A review of the literature of reported cases since 2004 of sarcoidosis involving the testis is also included.

The diagnosis of extrapulmonary tuberculosis in patients with end-stage renal disease can be challenging as the signs and symptoms are often non-specific. In this study, we present a case of extrapulmonary tuberculosis in an Ethiopian woman with end-stage renal disease who had subcarinal and right hilar lymphadenopathy, moderate sized right pleural effusion, hypercalcemia, and elevated parathyroid hormone–related protein in the setting of an elevated 1,25-dihydroxyvitamin D. After being started on appropriate tuberculosis treatment, patient’s parathyroid hormone–related protein level decreased and calcium level normalized. Our literature review showed that the elevation of parathyroid hormone–related protein in extrapulmonary tuberculosis has not been well studied, and it is our aim to explore the role of parathyroid hormone–related protein in extrapulmonary tuberculosis.

Una posible alternativa para reducir la vulnerabilidad ante inundaciones es contribuir a desarrollar resiliencia comunitaria. Los docentes de nivel medio superior (bachillerato) pueden ser actores clave en las comunidades y por tanto promotores de acciones que propicien resiliencia. En este texto se describe la metodología utilizada y los resultados iniciales de un estudio dirigido a identificar la resiliencia individual y comunitaria en docentes de bachillerato en tres localidades de los municipios de Tlacotalpan, Cotaxtla y La Antigua en el estado de Veracruz, México. Las condiciones físicas y sociales en las localidades del estudio incrementan la fragilidad de su población y por tanto su vulnerabilidad a sufrir daños por inundaciones, posiblemente agravadas por el cambio climático. Tratándose de un fenómeno complejo y global, no existe lugar donde sus efectos no lleguen. Aunque los principales responsables del cambio climático son los países denominados desarrollados son los países en desarrollo los que sufren en mayor medida sus impactos. Entre sus consecuencias, el aumento de la temperatura global ha incidido en la intensidad de los ciclones tropicales resultando en inundaciones con severos costos en municipios vulnerables como los incluidos en esta investigación.

In light of the challenging developmental issues confronting the countries of Latin America, this response article analyzes the power and resistance of education for sustainable development from both theoretical and policy perspectives. Of particular concern are the neo-productivist strategies driving the latest stage of capitalist development. This needed discussion about education and development fluctuates between necessity and contingency. Derrida's concept of the "constitutive outside" accounts for how existing tensions within education for sustainable development inform the need for new identification models that are open, unsteady, incomplete, and relational. The constitutive outside also recovers the notion of "tragic optimism" (Santos, 2009) for clarifying the complexity of the struggle for emancipation and the confidence of the human capacity to create horizons of possibility. This confidence and capacity cannot be objectified from the impossible discourse (and palimpsest) of the texts/policies of education for sustainable development.

Nowadays, challenges in the contemporary world lead to the education to propose its current themes. Environmental education is not an exception. The magnitude and complexity of global environmental problems such as the climate change, the ocean acidification and the loss of the biodiversity have generated issues that had attracted pedagogical attention for decades. This article presents the early results of a study aimed at assessing the perception of risk and vulnerability of communities that frequently are affected by extreme hydrometeorological phenomena. These findings could be a starting point for the design of educational programs aimed at strengthening community resilience. We start from the assumption based on socio-cognitive factors that determine the dispositions in order to the populations can act under similar circumstances, we can find key elements that allow us to infer their reactions to difficult situations. This considering their previous experience and their singularities in the adaptation to climate change, in the social learning in extreme situations and in the identification of their strengths and weaknesses.

RESUMEN La formación de educadores ambientales fue planteada como un imperativo del campo desde los primeros años de su implantación en México. Si bien el desarrollo de programas de profesionalización en la forma de diplomados, especializaciones y maestrías ha sido continuo, también ha sido vulnerable a los cambios en las propias universidades de adscripción, así como a los de las políticas ambientales gubernamentales. El presente artículo da cuenta de esta historia. Se conceptualiza el problema, se resume el perfil actual que se observa y se apuntan algunas salidas que se han ido construyendo para fortalecer este campo. En este sentido, destaca especialmente el hecho de que diversas maestrías y doctorados en ciencias o en educación aceptan propuestas de investigación en educación ambiental. Con ello, la esfera de profesionalización se ha expandido más allá del circuito de los educadores ambientales, lo que ha favorecido el diálogo y los intercambios creativos y productivos con otras áreas de conocimiento y alrededor de diversas temáticas, entre ellas lo intercultural, la conservación, las ciencias, el cambio climático, la literatura y la poesía, entre otras, que en su conjunto ofrecen una perspectiva sobre los procesos de profesionalización de los educadores ambientales en México.

T-cell lymphomas are aggressive diseases associated with poor outcome. Here, the authors show that the THZ1, a CDK7 inhibitor, suppresses STAT transcriptional activity leading to apoptosis and sensitization to BCL2 inhibitors in T-cell lymphomas.

ABSTRACT Introduction and Objectives: We aim to present the use of 3D digital and physical renal model (1–5) to guide the percutaneous access during percutaneous nephrolithotripsy (PNL). Materials and Methods: We present the clinical case of a 30 years old man with left renal stone (25x15 mm). A virtual 3D reconstruction of the anatomical model including the stone, the renal parenchyma, the urinary collecting system (UCS) and the skeletal landmarks (lumbar spine and ribs) was elaborated. Finally, a physical 3D model was created with a 3D printer including the renal parenchyma, UCS and the stone. The surgeon evaluated the 3D virtual reconstruction and manipulated the printed model before surgery to improve the anatomical knowledge and to facilitate the percutaneous access. In prone position, combining ultrasound and fluoroscopy implemented by the preoperative anatomical planning based on the 3D virtual and printed model, an easy and safe access of the inferior calyx was achieved. Then, the patient underwent PNL using a 30 Fr Amplatz sheet with semi-rigid nephroscope and ultrasound energy to achieve a complete lithotripsy of the pelvic stone. Results: The procedure was safely completed with 1 single percutaneous puncture (time of puncture 2 minutes). Overall surgical time was 90 min. No intra and postoperative complications were reported. The CT scan performed before discharge confirmed a complete stone free state. Conclusion: The 3D-guided approach to PNL facilitates the preoperative planning of the puncture with better knowledge of the renal anatomy and may be helpful to reduce operative time and improve the learning curve.

El estado de Veracruz, México, ha sufrido en años recientes inundaciones frecuentes asociadas al cambio climático. El propósito de este estudio fue conocer la vulnerabilidad y resiliencia social en jóvenes de bachillerato de tres localidades: Cotaxtla, Tlacotalpan y José Cardel. Se aplicó un cuestionario a 411 estudiantes y se realizaron 16 entrevistas a actores clave. Los resultados de dicha consulta indicaron desconocimiento de acciones para gestionar su vulnerabilidad y de los impactos regionales agravados por el cambio climático, lo cual se utilizó como insumo para el diseño de talleres de educación ambiental sobre la vulnerabilidad y resiliencia social ante el cambio climático. En los talleres participaron un total de 436 estudiantes y 42 profesores de bachillerato, con participación de instancias gubernamentales. Por medio de este proceso se logró una mayor sensibilización de los estudiantes y profesores sobre los impactos regionales del cambio climático, y de acciones de mitigación y adaptación, se conformaron redes inter e intracomunitarias y se elaboraron mapas de riesgo. El trabajo realizado es el inicio de una serie de tareas de educación ambiental que se han de continuar trabajando, a fin de que las comunidades, a partir de sus aprendizajes sociales, dinamicen y fortalezcan su resiliencia social frente a los riesgos del cambio climático.

Severe mental illnesses, including schizophrenia and other psychotic-spectrum disorders, are a major cause of disability worldwide. Although efficacious pharmacological and psychosocial interventions have been developed for treating patients with schizophrenia, relapse rates are high and long-term recovery remains elusive for many individuals. Furthermore, little is still known about the underlying mechanisms of these illnesses. Thus, there is an urgent need to better understand the contextual factors that contribute to psychosis so that they can be better targeted in future interventions. Ecological Momentary Assessment (EMA) is a dynamic procedure that permits the measurement of variables in natural settings in real-time through the use of brief assessments delivered via mobile electronic devices (i.e., smartphones). One advantage of EMA is that it is less subject to retrospective memory biases and highly sensitive to fluctuating environmental factors. In the current article, we describe the research-to-date using EMA to better understand fluctuating symptoms and functioning in patients with schizophrenia and other psychotic disorders and potential applications to treatment. In addition, we describe a novel EMA protocol that we have been employing to study the outcomes of patients with schizophrenia following a hospital discharge. We also report the lessons we have learned thus far using EMA methods in this challenging clinical population.

Research suggests that cognitive and behavioral therapies produce significant benefits over medications alone in the treatment of severe, nonpsychotic major depression or primary psychotic disorders such as schizophrenia. However, previous research has not demonstrated the efficacy of psychotherapy for major depression with psychotic features. In this initial treatment development study, we conducted an open trial of a new behavioral intervention that combines elements of behavioral activation and acceptance and commitment therapy for depression and psychosis. Fourteen patients with major depressive disorder with psychotic features were provided with up to 6 months of Acceptance-Based Depression and Psychosis Therapy (ADAPT) in combination with pharmacotherapy. Patients reported a high degree of treatment credibility and acceptability. Results showed that patients achieved clinically significant and sustained improvements through posttreatment follow-up in depressive and psychotic symptoms, as well as psychosocial functioning. In addition, the processes targeted by the intervention (e.g., acceptance, mindfulness, values) improved significantly over the course of treatment, and changes in processes were correlated with changes in symptoms. Results suggest that ADAPT combined with pharmacotherapy is a promising treatment approach for psychotic depression that should be tested in a future randomized trial. (Contains 3 tables and 1 figure.)

Objective: The objective was to learn about the characteristics of psychotherapists who use energy meridian techniques (EMTs). Methods: We conducted an Internet-based survey of the practices and attitudes of licensed psychotherapists. Results: Of 149 survey respondents (21.4% social workers), 42.3% reported that they frequently use or are inclined to use EMTs. EMT therapists reported higher use of a number of techniques from different theoretical orientations, reliance on intuition in decision making, positive attitudes toward complementary and alternative treatments, erroneous health beliefs, and importance placed on the intuitive appeal of evidence-based treatments. EMT therapists also had lower scores on a test of critical thinking. Conclusions: Results suggest that a number of characteristics differentiate therapists who are inclined to use EMTs, which can aid in future educational efforts. (Contains 2 tables and 2 figures.)

A través de un instrumento demoscópico que consideró las tres dimensiones de la teoría de las representaciones sociales, se investigaron conocimientos y creencias sobre el cambio climático en población adulta de las cuencas de los ríos Jamapa y Pixquiac. La población de ambas cuencas admite la existencia del cambio climático e identifica problemas ambientales locales, varios de ellos relacionados con el fenómeno en sus causas o consecuencias. Están conscientes del origen antrópico del fenómeno y de que este agrava los problemas seculares de pobreza, migraciones, enfermedades, desnutrición y hambrunas. Es evidente la ausencia de acciones institucionales de mitigación y adaptación. La televisión es el medio por el que la mayoría se informa sobre el tema y las autoridades responsables tienen poca credibilidad entre la población. Pese a todo, no se observa una representación social del cambio climático.

El número conmemorativo de la revista CPU-e que aquí se presenta tiene como finalidad la de aportar un registro documental sobre la historia del Instituto de Investigaciones en Educación de la Universidad Veracruzana, con motivo del cuarenta aniversario de su fundación. El tema, pues, puede inscribirse dentro de la historia de las instituciones, aunque en esta ocasión no consiste en un estudio archivístico que implica siempre una revisión exhaustiva de fuentes bibliográficas; en este caso se trata principalmente de un rescate de la memoria oral, de la memoria viva, de la experiencia vivida, considerada como un recurso invaluable para definir la identidad. Partimos de que la autorreflexión y la reflexión colectiva nos permiten encontrar los significados de nuestras acciones en el marco de una totalidad de sentido. Los artículos que integran este número dan forma a narraciones sucintas sobre algunos hechos que explican la configuración actual del Instituto de Investigaciones en Educación, a partir de los principales acontecimientos que lo han constituido y sus repercusiones presentes y futuras. No nos ha interesado exponer solamente algunos datos de la evolución de su estructura, porque sabemos que no basta para que haya relato con que los acontecimientos se representen en un orden cronológico, sino que se requiere que se revelen como dotados de un orden de significación. De ahí que nos interesó exponer especialmente dichos procesos de significación, sus dinámicas de encuentro y desencuentro, sus capacidades de dar respuesta a las necesidades sociales de su momento; o sea, nos ha movido intentar explicar las fuerzas que lo generaron en el pasado, pero sobre todo las que lo transforman y lo proyectan hacia el futuro. La historia del Instituto de Investigaciones en Educación encuentra su razón de ser en el presente, no en el pasado. Por ello, los propósitos de los ensayos aquí reunidos no se dirigen a hacer un relato objetivante, sino a ofrecer interpretaciones del porqué de su situación actual; del porqué es como es a partir de la adhesión de nuevos sujetos a una propuesta institucional a la que cada uno ha contribuido a forjar; del cómo se constituyeron las líneas de investigación y los programas académicos que hoy ofrece y que lo han posicionado en el entorno nacional e internacional; del porqué de su nivel alcanzado. Y aunque el presente está ligado al pasado, está más ligado al futuro que se desea construir, porque es de ese proyecto del que obtiene el impulso para ascender, para transformarse, para mejorar. La idea del número es intentar construir un orden de significación de los hechos institucionales para poder hacer inteligible la identidad actual del Instituto, considerando sus tensiones y conflictos pero también las mediaciones que han dado cauce a su proceso de institucionalización, a partir de la trama de significados que se fueron construyendo alrededor del mismo. Un orden de significación en el que convergen la dimensión intersubjetiva, las trayectorias académicas y profesionales y su inscripción en el marco más amplio de una Universidad Veracruzana atravesada por múltiples sentidos, así como los territorios disciplinares de confluencia, entre otros, que construyen identidades en torno a líneas de investigación y cuerpos académicos que se vinculan de diversas formas entre sí, con otras entidades y otras instituciones, lo que va moldeando un orden simbólico y un ideario de una comunidad que se constituye con base en un proyecto académico. Edgar J. González Gaudiano 8 de octubre de 2014

El artículo hace un recuento de la trayectoria de esta institución, destacando las estrategias que han permitido al Instituto consolidarse en el campo de la investigación. Estas estrategias definen al mismo tiempo las características que le otorgan su personalidad actual. Se analiza ese devenir en tres etapas clave en la historia del Instituto desde su fundación hasta su momento presente y se proyectan los desafíos a enfrentar en el futuro próximo. Abstract This article summarizes the trajectory of this institution, pointing out the strategies that have allowed the institute to consolidate in the field of research. At the same time, these strategies define the characteristics that provide the institute’s current personality. It evolution is analyzed in three key stages of the institute’s history, from its founding to present time and the challenges to be faced in a near future are presented.

El año 2005 representa el inicio del Decenio de las Naciones Unidas de la Educación para el Desarrollo Sustentable (EDS) mismo que se pretende aplicar hasta el año 2014. La entrada en vigor del mismo, ha conducido a los educadores ambientales de todo el mundo, y en especial a la comunidad de América latina y el caribe a la reactivación de un debate que se había dejado postergado desde la década de los noventa. En México, fue durante el segundo Congreso Iberoamericano de Educación Ambiental en Jalisco, que se iniciaron las discusiones en torno al devenir y compromiso de la educación ambiental, aunque, huelga decirlo, fueron muchos y muy diversos los eventos y espacios internacionales y regionales donde ambos temas, la educación y el desarrollo sustentable fueron analizados.

La educación ambiental se encuentra atravesada por una diversidad de discursos de distinto tipo y peso relativo. Algunos de ellos promovidos por agencias y programas de Naciones Unidas y distintos organismos internacionales. Otros surgidos de la hibridación de los planteamientos originales del campo con las tradiciones educativas de corte libertario de la región. Estos últimos, desde luego, constituidos en los márgenes del campo educativo en su conjunto y, por ello, con una presencia más definida en programas no formales para adultos, vinculados a procesos de desarrollo comunitario y principalmente en áreas rurales e indígenas. Como puede inferirse la diversidad conceptual del campo de la educación ambiental es muy amplia y llena de antagonismos, lo que se expresa en un conjunto de distintas luchas en diferentes esferas tanto de lo educativo como de lo ambiental, y tanto en el terreno internacional como en el regional y nacional.

Tratándose de un desafío de global magnitud, el cambio climático amerita de una urgente atención por parte de todos los actores sociales. Aunque exista un pequeño grupo de escépticos que ponga en duda la alta responsabilidad de la actividad humana hacia este fenómeno, es evidente el impacto que el cambio climático ha tenido y tiene sobre los ecosistemas, así como sobre el incremento de los procesos de degradación ambiental. Por tal motivo, es inminente para la protección de los seres humanos y de todas las especies vivas del planeta, priorizar la adopción de medidas de mitigación y de adaptación hacia las causas y consecuencias del cambio climático. En este artículo se presentan los principales resultados de una investigación realizada con el objetivo de conocer la representación social que sobre el cambio climático tienen los jóvenes universitarios. Algunos aspectos teóricos y metodológicos sobre las representaciones sociales y el cambio climático son abordados en la primera parte del artículo. En el estudio participaron estudiantes de las cinco sedes de la Universidad Veracruzana, de nivel licenciatura y posgrado. Entre los hallazgos se detectó que la información científica transmitida por diversas fuentes, científicas y populares, no es suficientemente influyente entre los jóvenes para generar cambios de comportamiento, orientados a frenar el cambio climático. Se recomiendan nuevas estrategias de comunicación y de educación ambiental dirigidas a generar conductas ambientalmente sustentables.

There has been much discussion in the literature recently regarding the conceptual and technical differences between so-called second- (e.g., Beckian cognitive therapy) and third-wave (e.g., acceptance and commitment therapy) behavioral therapies. Previous research has not addressed the potential similarities and differences among the practitioners of these types of approaches. The current study examined possible differences in the characteristics of second-wave (n = 55) and third-wave cognitive-behavioral therapists (n = 33) using an Internet-based survey. There were differences found at the technical level between the two groups. As expected, third-wave therapists reported greater use of mindfulness/acceptance techniques. Also, third-wave therapists reported greater use of exposure techniques and second-wave therapists reported greater use of cognitive restructuring and relaxation techniques. In general, third-wave clinicians were more eclectic at the technical level and demonstrated significantly greater use of family systems techniques, existential/humanistic techniques, and the total number of techniques. No significant differences were found on the attitudinal measures administered, including reliance on an intuitive thinking style, acceptance of complementary and alternative therapies and related health beliefs, or most attitudes toward evidence-based practices. The authors did not identify many differences between second-wave and third-wave therapists other than in terms of the techniques they employ. The clinical and research implications for these findings are discussed. (Contains 2 tables.)

There is a paucity of research on the emergence of suicidal ideation in recently hospitalized patients undergoing treatment for depression. As part of a larger clinical trial, patients (N = 103) with major depression without suicidal ideation at hospital discharge were followed for up to 6 months while receiving study-related outpatient treatments. Fifty-five percent reported the emergence of suicidal ideation during the outpatient period, with the vast majority (79%) exhibiting this problem within the first 2 months post-discharge. Seventy percent of those reporting severe suicidality prior to hospitalization exhibited a reemergence of suicidal ideation post-discharge. However, 29% without significant suicidality at the index hospitalization later developed suicidal ideation during the outpatient treatment period. A faster time to the emergence of suicidal ideation was predicted by both higher prehospitalization levels of suicidal ideation as well as greater depression severity at hospital discharge. Overall, rates of emergent suicidal ideation found in the current sample of recently hospitalized patients were higher than those reported in previous outpatient samples.

Treatment adherence is a frequent problem in bipolar disorder, with research showing that more than 60% of bipolar patients are at least partially nonadherent to medications. Treatment nonadherence is consistently predictive of a number of negative outcomes in bipolar samples, and the discontinuation of mood stabilizers places these patients at high risk for relapse. Several types of adjunctive treatment (family, psychoeducational, cognitive-behavioral) have been investigated for improving symptoms and functioning in bipolar patients with some success. To date, less attention has been paid to developing treatments specifically to promote treatment adherence to and engagement with pharmacological as well as behavioral treatments in patients with bipolar disorder. First, we review the effects of adjunctive interventions specifically on treatment adherence outcomes in 14 published clinical trials. Based on this empirical knowledge base, we present a preliminary description of the treatment strategies that appear most promising for improving adherence. The article also provides research recommendations for developing more effective interventions for the purpose of improving bipolar treatment adherence. Finally, special treatment considerations, including the potential impact of comorbid substance abuse and bipolar depression, are discussed. (Contains 1 table and 1 note.)

This article develops an historical and contemporary Latin-American perspective on the issues raised by Stevenson's 1987 article, "Schooling and Environmental Education: Contradictions in Purpose and Practice". It shows that since its inception as a pedagogical field in the 1970s, environmental education has faced many challenges and resistances in the educational systems of Latin America. An analysis of the competing and contradictory discourses of environmental education in developed and developing countries suggests that among other things, system inadequacies and malfunctions, social inequalities, the agendas of modernity and globalisation, and the hybridisation of the field (e.g. with Education for Sustainable Development, adult education, emancipatory educational and political traditions) continue to fissure the discursive identity and configurations of the field in Latin America. The article explores how this affects curricular reform and teacher professional preparation and development, in the context of a depleted conventional school curriculum and its growing inability to respond to the complex challenges of the present. Such a situation can be contrasted with deliberations on the potential articulations of environmental education with the everyday life of the community, a source of opportunity and more positive note on which the article ends. (Contains 6 notes.)

Bipolar disorder is characterized by a chronic and fluctuating course of illness. Although nonadherence to pharmacotherapy is a frequent problem in the disorder, few studies have systematically explored psychosocial factors related to treatment discontinuation. Previous research with depressed patients receiving psychotherapy has suggested that expectancies for improvement are related to treatment outcomes and that the therapeutic alliance may partially mediate this relationship. The current study found evidence for a similar relationship between patients' initial expectancies for improvement, patient and doctor-rated alliance, and long-term outcomes in bipolar patients treated with pharmacotherapy for up to 28 months following an acute episode. The results highlight the need for the assessment of expectancies and alliance in bipolar treatment and suggest possible targets for psychosocial interventions.

Since its acceptance as a pedagogic field, environmental education has experienced divergence and antagonism in its theoretical and methodological approaches and standpoints. In this paper, the author talks about the conflicting relationship between environmental education and education for sustainable development as well as the many discourses found in environmental education. He argues that, in order to countermand the maximalism associated with ESD, the political priority of environmental education has to be reinforced by intensifying the development of skills, and stimulating interaction on key environmental issues between environmental educators and educators in related fields that complement this issue. He further asserts that environmental education cannot be blamed for the poor results of environmental, social and economic policies, thereby justifying the imposition of obscure neologisms in an attempt to postpone the inevitable confrontation between the risks and threats of the present, and those waiting around the next corner.

Cognitive Behavioral Group Therapy (CBGT) is the most widely researched intervention program for social anxiety disorder (SAD, also known as social phobia), with a number of studies demonstrating its effectiveness. Another common treatment, social skills training (SST), has also been shown to be efficacious for SAD. The present study compared the standard CBGT intervention with a protocol in which SST was integrated into CBGT. Participants met diagnostic criteria for the generalized subtype of SAD, and most also met criteria for avoidant personality disorder and other comorbid Axis I disorders. The results revealed improvement in a variety of outcome measures for both treatments, but significantly greater gains for the CBGT plus SST condition. In fact, the effect sizes obtained for this treatment were among the largest found to date in any study of SAD. Clinical implications are discussed, and directions for future research are suggested.

The inception of the United Nations Decade of Education for Sustainable Development (2005-14) has excited controversy over the validity of the concept of education for sustainable development (ESD), as well as reactivating a critical review of the environmental education field as a whole. This article analyzes the peculiarities of ESD, the conditions that gave rise to it, the characteristics of its proposed configuration and the implications for environmental education. (Contains 5 notes.)

We explore the relation between the local fractal dimension and the development of the built-up area of the Northern Margin of the Metropolitan Area of Lisbon (NMAL), for the period between 1960 and 2004. To this end we make use of a Generalized Local Spatial Entropy (GLSE) function based on which urban areas can be classified into five different types. Our analysis of NMAL shows how some of the growth dynamics encountered can be linked to the plethora of social, economic and political changes that have taken place in NMAL (and Portugal), during the last 40 years, allowing for the establishment of urban planning measures to either inhibit or promote sprawl in urban areas.

HIV disproportionately affects young Black men who have sex with men (YBMSM) in the Southern United States. Pre-exposure prophylaxis (PrEP) is an efficacious, biomedical approach to prevent HIV. While Mississippi (MS) has among the highest rates of new HIV infections, it also ranks among the top three states for unmet PrEP need. Thus, increasing engagement in PrEP care for YBMSM in MS is imperative. A potential method to improve psychological flexibility and promote PrEP uptake, explored by this study, is the incorporation of Acceptance and Commitment Therapy (ACT) into PrEP interventions. ACT is an evidence-based intervention used to treat a wide range of mental and physical illnesses. Twenty PrEP-eligible YBMSM and ten clinic staff working with YBMSM in MS were surveyed and interviewed between October 2021 and April 2022. The brief survey covered PrEP structural barriers, PrEP stigma, and psychological flexibility. Interview topics included internal experiences related to PrEP, existing health behaviors, PrEP related personal values, and relevant constructs from the Adaptome Model of Intervention Adaptation (service setting, target audience, mode of delivery, and cultural adaptations). Qualitative data were coded based on ACT and the Adaptome model, organized using NVivo, then thematically analyzed. Patients identified side effects, costs, and taking a daily prescription as top barriers to taking PrEP. Staff reported the top barrier to PrEP for clients was concern others would believe they were living with HIV. Levels of psychological flexibility and inflexibility varied widely among participants. The resulting thematic categories derived from the interviews included 1) thoughts, emotions, associations, memories, and sensations (TEAMS) related to PrEP and HIV, 2) general health behaviors (existing coping techniques, views on medication, HIV/PrEP approach and avoidance), 3) values related to PrEP use (relationship values, health values, intimacy values, longevity values), and 4) Adaptome Model adaptations. These results informed the development of a new intervention, ACTPrEP. Interview data organized by the Adaptome Model of Intervention Adaptation determined appropriate ACT-informed intervention components, content, intervention adaptations, and implementation strategies. Interventions informed by ACT that help YBMSM endure short-term discomfort related to PrEP by relating it to their values and long-term health goals are promising for increasing individuals' willingness to initiate and maintain PrEP care. • HIV disproportionately affects young Black men who have sex with men (YBMSM). Pre-exposure prophylaxis (PrEP) prevents HIV. • 20 PrEP-eligible YBMSM and 10 clinic staff in Mississippi were surveyed and interviewed between October 2021 and April 2022. • Thematic categories: thoughts, emotions, associations, memories, and sensations, health behaviors, values, and adaptations. • Interventions informed by ACT can help YBMSM endure short-term discomfort and increase willingness to initiate PrEP. [ABSTRACT FROM AUTHOR]