Allometric relationships of ecologically important Antarctic and Arctic zooplankton and fish species.

Allometric relationships between body properties of animals are useful for a wide variety of purposes, such as estimation of biomass, growth, population structure, bioenergetic modelling and carbon flux studies. This study summarizes allometric relationships of zooplankton and nekton species that play major roles in polar marine food webs. Measurements were performed on 639 individuals of 15 species sampled during three expeditions in the Southern Ocean (winter and summer) and 2374 individuals of 14 species sampled during three expeditions in the Arctic Ocean (spring and summer). The information provided by this study fills current knowledge gaps on relationships between length and wet/dry mass of understudied animals, such as various gelatinous zooplankton, and of animals from understudied seasons and maturity stages, for example, for the krill Thysanoessa macrura and larval Euphausia superba caught in winter. Comparisons show that there is intra-specific variation in length-mass relationships of several species depending on season, e.g. for the amphipod Themisto libellula. To investigate the potential use of generalized regression models, comparisons between sexes, maturity stages or age classes were performed and are discussed, such as for the several krill species and T. libellula. Regression model comparisons on age classes of the fish E. antarctica were inconclusive about their general use. Other allometric measurements performed on carapaces, eyes, heads, telsons, tails and otoliths provided models that proved to be useful for estimating length or mass in, e.g. diet studies. In some cases, the suitability of these models may depend on species or developmental stages. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00300-021-02984-4.

Of Time Gals and Mega Men: Empirical Findings on Gender Differences in Digital Game Genre Preferences and the Accuracy of Respective Gender Stereotypes.

We investigated the accuracy of gender stereotypes regarding digital game genre preferences. In Study 1, 484 female and male participants rated their preference for 17 game genres (gender differences). In Study 2, another sample of 226 participants rated the extent to which the same genres were presumably preferred by women or men (gender stereotypes). We then compared the results of both studies in order to determine the accuracy of the gender stereotypes. Study 1 revealed actual gender differences for most genres-mostly of moderate size. Study 2 revealed substantial gender stereotypes about genre preferences. When comparing the results from both studies, we found that gender stereotypes were accurate in direction for most genres. However, they were, to some degree, inaccurate in size: For most genres, gender stereotypes overestimated the actual gender difference with a moderate mean effect size.

[Language competence of four-year-old children with immigration background in Hesse: quo vadis?] / Sprachstand 4-jähriger Kinder mit Migrationshintergrund in Hessen: quo vadis?

A sustainable integration of persons with immigration background is more topical than ever before. The importance of language as one of the key aspects of integration is beyond discussion. In 2018, ca. 1 091 000 persons with the non-German citizenship were registered in the German state of Hesse. One third of all Hessian inhabitants and a half of those of preschool age had an immigration background. The tendency is increasing due to, first, ongoing immigration and, second, higher birth rates in non-German families. Consequently, the numbers of preschoolers with minimal German language skills and with language-related disorders such as hearing disorders are also rising. This study aimed to analyze the German language competence of Hessian four-year-old children with immigration background. The assessment was carried out by the validated, standardized test "Kindersprachscreening". For children who were classified as needing additional medical assistance in acquiring German, following variables were analyzed: participation in therapies, known diagnoses of impairments and illnesses, parents' and kindergarten teachers' awareness of the child's need for additional medical assistance in acquiring German.

[Digital public health: data protection and data security]. / Datenschutz und Datensicherheit in Digital Public Health.

Digital public health applications are becoming increasingly popular; for example, about 45% of smartphone users have health or fitness apps on their devices. Most of these applications transfer the user's personal data to the provider of the health app. Application providers must comply with the relevant data protection statutes.In this article we provide a survey of important data protection requirements and the necessary technical measures for data security that the provider of a health app must observe. This includes - amongst other things - mechanisms for consent, determination of and compliance with the legitimate purposes of the processing, and the granting of so-called "rights of the data subject" (e.g. right of access). Furthermore, the provider of the health application must follow best practice recommendations from the area of data security. Therefore, the provider must ensure that, for example, unauthorized access, manipulation, loss, and destruction of personal data are prevented by appropriate technical and organizational measures. State-of-the-art procedures such as encryption, rights management, securing integrity, pseudonymization, and logging are some examples of technical and organizational measures. When implementing these measures, it must be taken into account that the processing of health data generally entails high risk for the rights and freedoms of the data subjects and that unauthorized access to and/or manipulation of data, for example, can lead to the publication of a stigmatizing diagnosis or incorrect medication.

Airborne Observations of Summer Thinning of Multiyear Sea Ice Originating From the Lincoln Sea.

To better understand recent changes of Arctic sea ice thickness and extent, it is important to distinguish between the contributions of winter growth and summer melt to the sea ice mass balance. In this study we present a Lagrangian approach to quantify summer sea ice melt in which multiyear ice (MYI) floes that were surveyed by airborne electromagnetic thickness sounding within Nares Strait during summer were backtracked, using satellite imagery, to a region in close proximity (3-20 km) to spring ice thickness surveys carried out in the Lincoln Sea. Typical modal total MYI thicknesses, including ~0.4-m snow, ranged between 3.9 and 4.7 m in the Lincoln Sea during April. Ice-only modal thicknesses were between 2.2 and 3.0 m in Nares Strait during August. Total thinning including snow and ice was 1.3 ± 0.1 m including 0.4 ± 0.09 m of snow melt and 0.9 ± 0.2 m of ice melt. This translates to a seasonal net heat input of 305 ± 69 MJ/m2 (262 ± 60 MJ/m2 for ice only) and seasonal net heat flux of 57 ± 13 W/m2 (45 ± 10 W/m2 for ice only), which is unlikely to be explained by solar radiation fluxes alone. Furthermore, our approach provides an improvement on traditional ice mass balance buoy estimates because it integrates melt over larger spatial scales, where melt can be highly variable due to differential melt experienced between melt ponds, bare ice, hummocks, and ridges.

Dependency of Antarctic zooplankton species on ice algae-produced carbon suggests a sea ice-driven pelagic ecosystem during winter.

How the abundant pelagic life of the Southern Ocean survives winter darkness, when the sea is covered by pack ice and phytoplankton production is nearly zero, is poorly understood. Ice-associated ("sympagic") microalgae could serve as a high-quality carbon source during winter, but their significance in the food web is so far unquantified. To better understand the importance of ice algae-produced carbon for the overwintering of Antarctic organisms, we investigated fatty acid (FA) and stable isotope compositions of 10 zooplankton species, and their potential sympagic and pelagic carbon sources. FA-specific carbon stable isotope compositions were used in stable isotope mixing models to quantify the contribution of ice algae-produced carbon (αIce ) to the body carbon of each species. Mean αIce estimates ranged from 4% to 67%, with large variations between species and depending on the FA used for the modelling. Integrating the αIce estimates from all models, the sympagic amphipod Eusirus laticarpus was the most dependent on ice algal carbon (αIce : 54%-67%), and the salp Salpa thompsoni showed the least dependency on ice algal carbon (αIce : 8%-40%). Differences in αIce estimates between FAs associated with short-term vs. long-term lipid pools suggested an increasing importance of ice algal carbon for many species as the winter season progressed. In the abundant winter-active copepod Calanus propinquus, mean αIce reached more than 50% in late winter. The trophic carbon flux from ice algae into this copepod was between 3 and 5 mg C m-2  day-1 . This indicates that copepods and other ice-dependent zooplankton species transfer significant amounts of carbon from ice algae into the pelagic system, where it fuels the food web, the biological carbon pump and elemental cycling. Understanding the role of ice algae-produced carbon in these processes will be the key to predictions of the impact of future sea ice decline on Antarctic ecosystem functioning.

Early detection and integrated care for adolescents and young adults with severe psychotic disorders: rationales and design of the Integrated Care in Early Psychosis Study (ACCESS III).

AIM: The Integrated Care in Early Psychosis (ACCESS III) Study examined the efficacy and cost-effectiveness of a combined intervention consisting of strategies to improve early detection and quality of care (integrated care including therapeutic assertive community treatment) in adolescents and young adults in the early phase of a severe psychotic disorder from 2011 to 2014. METHODS: This is a prospective, single-centre, 1-year cohort study comparing an intervention condition (early detection plus integrated care, n = 120) to the historical control condition (standard care, SC, n = 105) for adolescents and young adults aged 12-29 years suffering from a severe, early-phase psychotic disorder (i.e. within 2 years of treatment). RESULTS: Primary outcome is the rate of combined symptomatic (i.e. Positive and Negative Syndrome Scale (PANSS) criteria) and functional (i.e. Global Assessment of Functioning scale (GAF) ≥ 60 points criterion) remission over at least 6 months at study endpoint. Secondary outcome comprises the comparison of the reduction in the duration of untreated psychosis within the 4-year study duration between integrated care and SC, course of psychopathology, functioning, quality of life, satisfaction with care, cost and quality-adjusted life years (QALYs) in comparison to a historical control group. CONCLUSION: To the authors' knowledge, this is the first study assessing the efficacy and cost-effectiveness of a combined intervention consisting of early detection strategies and strategies to improve quality of care in both adolescents and young adults with early-phase psychosis. The results will be published in 2016.

Pan-Arctic sea ice-algal chl a biomass and suitable habitat are largely underestimated for multiyear ice.

There is mounting evidence that multiyear ice (MYI) is a unique component of the Arctic Ocean and may play a more important ecological role than previously assumed. This study improves our understanding of the potential of MYI as a suitable habitat for sea ice algae on a pan-Arctic scale. We sampled sea ice cores from MYI and first-year sea ice (FYI) within the Lincoln Sea during four consecutive spring seasons. This included four MYI hummocks with a mean chl a biomass of 2.0 mg/m2 , a value significantly higher than FYI and MYI refrozen ponds. Our results support the hypothesis that MYI hummocks can host substantial ice-algal biomass and represent a reliable ice-algal habitat due to the (quasi-) permanent low-snow surface of these features. We identified an ice-algal habitat threshold value for calculated light transmittance of 0.014%. Ice classes and coverage of suitable ice-algal habitat were determined from snow and ice surveys. These ice classes and associated coverage of suitable habitat were applied to pan-Arctic CryoSat-2 snow and ice thickness data products. This habitat classification accounted for the variability of the snow and ice properties and showed an areal coverage of suitable ice-algal habitat within the MYI-covered region of 0.54 million km2 (8.5% of total ice area). This is 27 times greater than the areal coverage of 0.02 million km2 (0.3% of total ice area) determined using the conventional block-model classification, which assigns single-parameter values to each grid cell and does not account for subgrid cell variability. This emphasizes the importance of accounting for variable snow and ice conditions in all sea ice studies. Furthermore, our results indicate the loss of MYI will also mean the loss of reliable ice-algal habitat during spring when food is sparse and many organisms depend on ice-algae.

Tears or Fears? Comparing Gender Stereotypes about Movie Preferences to Actual Preferences.

This study investigated the accuracy of gender-specific stereotypes about movie-genre preferences for 17 genres. In Study 1, female and male participants rated the extent to which 17 movie genres are preferred by women or men. In Study 2, another sample of female and male participants rated their own preference for each genre. There were three notable results. First, Study 1 revealed the existence of gender stereotypes for the majority of genres (i.e., for 15 of 17 genres). Second, Study 2 revealed the existence of actual gender differences in preferences for the majority of genres (i.e., for 11 of 17 genres). Third, in order to assess the accuracy of gender stereotypes on movie preferences, we compared the results of both studies and found that the majority of gender stereotypes were accurate in direction, but inaccurate in size. In particular, the stereotypes overestimated actual gender differences for the majority of movie genres (i.e., 10 of 17). Practical and theoretical implications of these findings are discussed.

Bacterial communities from Arctic seasonal sea ice are more compositionally variable than those from multi-year sea ice.

Arctic sea ice can be classified into two types: seasonal ice (first-year ice, FYI) and multi-year ice (MYI). Despite striking differences in the physical and chemical characteristics of FYI and MYI, and the key role sea ice bacteria play in biogeochemical cycles of the Arctic Ocean, there are a limited number of studies comparing the bacterial communities from these two ice types. Here, we compare the membership and composition of bacterial communities from FYI and MYI sampled north of Ellesmere Island, Canada. Our results show that communities from both ice types were dominated by similar class-level phylogenetic groups. However, at the operational taxonomic unit (OTU) level, communities from MYI and FYI differed in both membership and composition. Communities from MYI sites had consistent structure, with similar membership (presence/absence) and composition (OTU abundance) independent of location and year of sample. By contrast, communities from FYI were more variable. Although FYI bacterial communities from different locations and different years shared similar membership, they varied significantly in composition. Should these findings apply to sea ice across the Arctic, we predict increased compositional variability in sea ice bacterial communities resulting from the ongoing transition from predominantly MYI to FYI, which may impact nutrient dynamics in the Arctic Ocean.

Genetic, ecological and geographic covariables explaining host range and specificity of a microsporidian parasite.

Parasites often have a smaller geographic distribution than their hosts. Common garden infection trials can untangle the role that historical contingencies, ecological conditions and the genetic constitution of local host populations play in limiting parasite geographic range; however, infection trials usually overestimate the range of hosts in which a parasite could naturally persist. This study overcomes that problem by using multigeneration, long-term persistence experiments. We study the microsporidian parasite Hamiltosporidium tvaerminnensis in monoclonal populations of Daphnia magna from 43 widely spread sites. The parasite persisted well in hosts collected from its natural geographic range, but demonstrated long-term persistence in only a few host genotypes outside this range. Genetic distance between hosts from the parasite's origin site and newly tested host populations correlated negatively with parasite persistence. Furthermore, the parasite persisted only in host populations from habitats with a high likelihood of drying up in summer, although we excluded environmental variation in our experiments. Together, our results suggest that host genetic factors play the dominant role in explaining the limited geographic range of parasites and that these genetic differences covary with geographic distance and the habitat type the host is adapted to.

[Early Detection and Integrated Care in Adolescents and Young Adults with Severe Psychotic Illnesses]. / Früherkennung und integrierte Versorgung von Jugendlichen und jungen Erwachsenen mit schweren psychotischen Erkrankungen.

This is a prospective 1-year follow-up study comparing a combined intervention consisting of multidimensional early detection strategies with age- and interdisciplinary integrated care (intervention group, n = 120) with standard care (historical control group, n = 105) in adolescents and young adults within the early phase of psychosis. Data at study entry indicate a high complexity and severity of illness. Primary outcome is the 6-month rate of combined symptomatic and functional remission at study endpoint.

Comparing springtime ice-algal chlorophyll a and physical properties of multi-year and first-year sea ice from the Lincoln Sea.

With near-complete replacement of Arctic multi-year ice (MYI) by first-year ice (FYI) predicted to occur within this century, it remains uncertain how the loss of MYI will impact the abundance and distribution of sea ice associated algae. In this study we compare the chlorophyll a (chl a) concentrations and physical properties of MYI and FYI from the Lincoln Sea during 3 spring seasons (2010-2012). Cores were analysed for texture, salinity, and chl a. We identified annual growth layers for 7 of 11 MYI cores and found no significant differences in chl a concentration between the bottom first-year-ice portions of MYI, upper old-ice portions of MYI, and FYI cores. Overall, the maximum chl a concentrations were observed at the bottom of young FYI. However, there were no significant differences in chl a concentrations between MYI and FYI. This suggests little or no change in algal biomass with a shift from MYI to FYI and that the spatial extent and regional variability of refrozen leads and younger FYI will likely be key factors governing future changes in Arctic sea ice algal biomass. Bottom-integrated chl a concentrations showed negative logistic relationships with snow depth and bulk (snow plus ice) integrated extinction coefficients; indicating a strong influence of snow cover in controlling bottom ice algal biomass. The maximum bottom MYI chl a concentration was observed in a hummock, representing the thickest ice with lowest snow depth of this study. Hence, in this and other studies MYI chl a biomass may be under-estimated due to an under-representation of thick MYI (e.g., hummocks), which typically have a relatively thin snowpack allowing for increased light transmission. Therefore, we suggest the on-going loss of MYI in the Arctic Ocean may have a larger impact on ice-associated production than generally assumed.

Pediatric health-related quality of life: a structural equation modeling approach.

OBJECTIVES: One of the most referenced theoretical frameworks to measure Health Related Quality of Life (HRQoL) is the Wilson and Cleary framework. With some adaptions this framework has been validated in the adult population, but has not been tested in pediatric populations. Our goal was to empirically investigate it in children. METHODS: The contributory factors to Health Related Quality of Life that we included were symptom status (presence of chronic disease or hospitalizations), functional status (developmental status), developmental aspects of the individual (social-emotional) behavior, and characteristics of the social environment (socioeconomic status and area of education). Structural equation modeling was used to assess the measurement structure of the model in 214 German children (3-5 years old) participating in a follow-up study that investigates pediatric health outcomes. RESULTS: Model fit was χ2 = 5.5; df = 6; p = 0.48; SRMR  = 0.01. The variance explained of Health Related Quality of Life was 15%. Health Related Quality of Life was affected by the area education (i.e. where kindergartens were located) and development status. Developmental status was affected by the area of education, socioeconomic status and individual behavior. Symptoms did not affect the model. CONCLUSIONS: The goodness of fit and the overall variance explained were good. However, the results between children' and adults' tests differed and denote a conceptual gap between adult and children measures. Indeed, there is a lot of variety in pediatric Health Related Quality of Life measures, which represents a lack of a common definition of pediatric Health Related Quality of Life. We recommend that researchers invest time in the development of pediatric Health Related Quality of Life theory and theory based evaluations.

Diet quality determines interspecific parasite interactions in host populations.

The widespread occurrence of multiple infections and the often vast range of nutritional resources for their hosts allow that interspecific parasite interactions in natural host populations might be determined by host diet quality. Nevertheless, the role of diet quality with respect to multispecies parasite interactions on host population level is not clear. We here tested the effect of host population diet quality on the parasite community in an experimental study using Daphnia populations. We studied the effect of diet quality on Daphnia population demography and the interactions in multispecies parasite infections of this freshwater crustacean host. The results of our experiment show that the fitness of a low-virulent microsporidian parasite decreased in low, but not in high-host-diet quality conditions. Interestingly, infections with the microsporidium protected Daphnia populations against a more virulent bacterial parasite. The observed interspecific parasite interactions are discussed with respect to the role of diet quality-dependent changes in host fecundity. This study reflects that exploitation competition in multispecies parasite infections is environmentally dependent, more in particular it shows that diet quality affects interspecific parasite competition within a single host and that this can be mediated by host population-level effects.

Effectiveness of integrated care including therapeutic assertive community treatment in severe schizophrenia spectrum and bipolar I disorders: the 24-month follow-up ACCESS II study.

OBJECTIVE: The ACCESS treatment model offers assertive community treatment embedded in an integrated care program to patients with psychoses. Compared to standard care and within a controlled study, it proved to be more effective in terms of service disengagement and illness outcomes in patients with schizophrenia spectrum disorders over 12 months. ACCESS was implemented into clinical routine and its effectiveness assessed over 24 months in severe schizophrenia spectrum disorders and bipolar I disorder with psychotic features (DSM-IV) in a cohort study. METHOD: All 115 patients treated in ACCESS (from May 2007 to October 2009) were included in the ACCESS II study. The primary outcome was rate of service disengagement. Secondary outcomes were change of psychopathology, severity of illness, psychosocial functioning, quality of life, satisfaction with care, medication nonadherence, length of hospital stay, and rates of involuntary hospitalization. RESULTS: Only 4 patients (3.4%) disengaged with the service. Another 11 (9.6%) left because they moved outside the catchment area. Patients received a mean of 1.6 outpatient contacts per week. Involuntary admissions decreased from 34.8% in the 2 previous years to 7.8% during ACCESS (P < .001). Mixed models repeated-measures analyses revealed significant improvements among all patients in psychopathology (effect size d = 0.64, P < .001), illness severity (d = 0.84, P = .03), functioning level (d = 0.65, P < .001), quality of life (d = 0.50, P < .001), and client satisfaction (d = 0.11, P < .001). At 24 months, 78.3% were fully adherent to medication, compared to 25.2% at baseline (P = .002). CONCLUSIONS: ACCESS was successfully implemented in clinical routine and maintained excellent rates of service engagement and other outcomes in patients with schizophrenia spectrum disorders or bipolar I disorder with psychotic features over 24 months. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01888627.

Distinct bacterial assemblages reside at different depths in Arctic multiyear sea ice.

Bacterial communities in Arctic sea ice play an important role in the regulation of nutrient and energy dynamics in the Arctic Ocean. Sea ice has vertical gradients in temperature, brine salinity and volume, and light and UV levels. Multiyear ice (MYI) has at least two distinct ice layers: old fresh ice with limited permeability, and new saline ice, and may also include a surface melt pond layer. Here, we determine whether bacterial communities (1) differ with ice depth due to strong physical and chemical gradients, (2) are relatively homogenous within a layer, but differ between layers, or (3) do not vary with ice depth. Cores of MYI off northern Ellesmere Island, NU, Canada, were subsectioned in 30-cm intervals, and the bacterial assemblage structure was characterized using 16S rRNA gene pyrotag sequencing. Assemblages clustered into three distinct groups: top (0-30 cm); middle (30-150 cm); and bottom (150-236 cm). These layers correspond to the occurrence of refrozen melt pond ice, at least 2-year-old ice, and newly grown first-year ice at the bottom of the ice sheet, respectively. Thus, MYI houses multiple distinct bacterial assemblages, and in situ conditions appear to play a less important role in structuring microbial assemblages than the age or conditions of the ice at the time of formation.

The effectiveness of stuttering treatments in Germany.

PURPOSE: Persons who stutter (PWS) should be referred to the most effective treatments available, locally or regionally. A prospective comparison of the effects of the most common stuttering treatments in Germany is not available. Therefore, a retrospective evaluation by clients of stuttering treatments was carried out. METHOD: The five most common German stuttering treatments (231 single treatment cases) were rated as to their perceived effectiveness, using a structured questionnaire, by 88 PWS recruited through various sources. The participants had received between 1 and 7 treatments for stuttering. RESULTS: Two stuttering treatments (stuttering modification, fluency shaping) showed favorable and three treatments (breathing therapy, hypnosis, unspecified logopedic treatment) showed unsatisfactory effectiveness ratings. The effectiveness ratings of stuttering modification and fluency shaping did not differ significantly. The three other treatments were equally ineffective. The differences between the effective and ineffective treatments were of large effect sizes. The typical therapy biography begins in childhood with an unspecified logopedic treatment administered extensively in single and individual sessions. Available comparisons showed intensive or interval treatments to be superior to extensive treatments, and group treatments to be superior to single client treatments. CONCLUSION: The stuttering treatment most often prescribed in Germany, namely a weekly session of individual treatment by a speech-language pathologist, usually with an assorted package of mostly unknown components, is of limited effectiveness. Better effectiveness can be expected from fluency shaping or stuttering modification approaches, preferably with an intensive time schedule and with group sessions. EDUCATIONAL OBJECTIVES: Readers will be able to: (a) discuss the five most prevalent stuttering treatments in Germany; (b) summarize the effectiveness of these treatments; and (c) describe structural treatment components that seem to be preferable across different kinds of treatments.

[The Hamburg-model of integrated care for patients with psychosis: Part 1. Rationale, treatment concept and results of the pre-study]. / Integrierte Versorgung von Patienten mit psychotischen Erkrankungen nach dem Hamburger Modell: Teil 1. Rationalen, Behandlungsmodell und Ergebnisse der Vorstudie.

OBJECTIVE: The "Hamburg model" designates an integrated care model for severely ill patients with psychotic disorders financed by the health insurance system in accordance with § 140 SGB V. METHODS: It comprises comprehensive and long-term treatment within a regional network of the psychosis center of the University Medical Center Hamburg-Eppendorf (UKE) and private psychiatrists. The treatment model consists of therapeutic assertive community treatment (ACT) provided by a highly specialized treatment team and need-adapted in- and outpatient care. RESULTS AND CONCLUSIONS: The present article summarizes the disease- and treatment-specific rationales for the model development as well as the model structure and treatment contents. The article further summarizes the effectiveness and efficiency results of a study comparing the Hamburg model and treatment as usual (without ACT) within a 12-month follow-up study (ACCESS trial).

[The Hamburg-model of integrated care for patients with psychosis: Part 2. Results of the clinical course over 2- and 4-years of treatment]. / Integrierte Versorgung von Patienten mit psychotischen Erkrankungen nach dem Hamburger Modell: Teil 2. Ergebnisse des 2- und 4-Jahres-Langzeitverlaufs.

OBJECTIVE: Since the beginning of the integrated care model for severely ill patients with psychotic disorders ("Hamburg model") in 2007 different clinical parameters have been consecutively assessed within a naturalistic, observational, prospective study. METHODS: Clinical outcome of the 2-year and 4-year follow-ups of n = 158 patients. RESULTS: A significant and ongoing improvement of psychopathology, severity of illness, functional outcome, quality of life and satisfaction with care in this sample of severely ill and merely chronic patients with psychosis was shown. Moreover, medication adherence improved and quality and quantity of outpatient treatment increased. CONCLUSION: The ongoing psychosocial stabilisation of the patients most likely result from a combination of various factors: continuity of care, multimodal and individualized care, therapeutic specialisation and the multidisciplinary ACT team. RESULTS provide clinical and scientific evidence for future implementations of the integrated care model "Hamburg Model" for the treatment of psychosis.