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The main aim of the current study was to present the abilities of widely used crop models to simulate four different field crops (winter wheat, spring barley, silage maize and winter oilseed rape). The 13 models were tested under Central European conditions represented by three locations in the Czech Republic, selected using temperature and precipitation gradients for the target crops in this region. Based on observed crop phenology and yield from 1991 to 2010, performances of individual models and their ensemble were analyzed. Modelling of anthesis and maturity was generally best simulated by the ensemble median (EnsMED) compared to the ensemble mean and individual models. The yield was better simulated by the best models than estimated by an ensemble. Higher accuracy was achieved for spring crops, with the best results for silage maize, while the lowest accuracy was for winter oilseed rape according to the index of agreement (IA). Based on EnsMED, the root mean square errors (RMSEs) for yield was 1365 kg/ha for winter wheat, 1105 kg/ha for spring barley, 1861 kg/ha for silage maize and 969 kg/ha for winter oilseed rape. The AQUACROP and EPIC models performed best in terms of spread around the line of best fit (RMSE, IA). In some cases, the individual models failed. For crop rotation simulations, only models with reasonable accuracy (i.e. without failures) across all included crops within the target environment should be selected. Application crop models ensemble is one way to increase the accuracy of predictions, but lower variability of ensemble outputs was confirmed.
Healthcare workers (HCWs) not fulfilling the coronavirus disease 2019 (COVID-19) case definition underwent severe acute respiratory coronavirus virus 2 (SARS-CoV-2) screening. Risk of exposure, adherence to personal protective equipment (PPE), and symptoms were assessed. In total, 2,000 HCWs were screened: 5.5% were positive for SARS-CoV-2 by polymerase chain reaction (PCR). There were no differences in PPE use between SARS-CoV-2–positive and –negative HCWs (adherence, >90%). Nursing and kitchen staff were independently associated with positive SARS-CoV-2 results.
DNA methylation of the elongation of very long chain fatty acids protein 2 (ELOVL2) was suggested as a biomarker of biological aging, while childhood maltreatment (CM) has been associated with accelerated biological aging. We investigated the association of age and CM experiences with ELOVL2 methylation in peripheral blood mononuclear cells (PBMC). Furthermore, we investigated ELOVL2 methylation in the umbilical cord blood mononuclear cells (UBMC) of newborns of mothers with and without CM. PBMC and UBMC were isolated from 113 mother–newborn dyads and genomic DNA was extracted. Mothers with and without CM experiences were recruited directly postpartum. Mass array spectrometry and pyrosequencing were used for methylation analyses of ELOVL2 intron 1, and exon 1 and 5′ end, respectively. ELOVL2 5′ end and intron 1 methylation increased with higher age but were not associated with CM experiences. On the contrary, overall ELOVL2 exon 1 methylation increased with higher CM, but these changes were minimal and did not increase with age. Maternal CM experiences and neonatal methylation of ELOVL2 intron 1 or exon 1 were not significantly correlated. Our study suggests region-specific effects of chronological age and experienced CM on ELOVL2 methylation and shows that the epigenetic biomarker for age within the ELOVL2 gene does not show accelerated biological aging years after CM exposure.
Compare the efficacy of two interventions addressing emotional and existential well-being in early life-limiting illness.
Primary trial analysis (n = 135) included patients with advanced cancer, congestive heart failure, or end-stage renal disease; Arm 1 received the Outlook intervention, addressing issues of life completion and preparation, and Arm 2 received relaxation meditation (RM). Primary outcomes at five weeks (primary endpoint) and seven weeks (secondary): completion and preparation (QUAL-E); secondary outcomes: anxiety (POMS) quality of life (FACT-G) and spiritual well-being (FACIT-Sp) subscales of faith, meaning, and peace.
Average age was 62; 56% were post-high school-educated, 54% were married, 52% white, 44% female, and 70% had a cancer diagnosis. At baseline, participants demonstrated low levels of anxiety (<5 on POMS subscale) and depression (<10 on CESD) relative to population norms. Results of the primary analysis revealed no significant differences in mean Preparation by treatment arm at five weeks (14.4 Outlook vs. 14.8 RM; between-group difference −0.4 [95% CI, −1.6, 0.8], p = 0.49) or seven weeks (15.2 vs.15.4; between-group difference −0.2 [95% CI, −1.5, 1.0], p = 0.73). There were also no significant differences in mean Life Completion by treatment arm between five weeks (26.6 Outlook vs. 26.3 RM; between-group difference 0.2 [95% CI, −1.2, 1.7], p = 0.76) or seven weeks (26.5 vs. 27.5; between-group difference −1.0 [95% CI, −2.7, 0.7], p = 0.23). Compared to RM, Outlook participants did not have significant differences over time in the secondary outcomes of overall quality of life, anxiety, depression, FACT-G subscales, and FACIT-Sp subscales.
In early-stage life-limiting illness, Outlook did not demonstrate a significant difference in primary or secondary outcomes relative to RM. Results underscore the importance of pre-screening for distress. Qualitatively, Outlook participants were able to express suppressed emotions, place illness context, reflect on adaptations, and strengthen identity. Screening for distress and identifying specified measures of distress, beyond anxiety and depression, is essential in our ability to adequately assess the multi-dimensional mechanisms that decrease existential suffering.
For endozoochorous species, the quality component of seed dispersal effectiveness depends in part on the treatment seeds receive in the animal's gut. Covering a variety of taxa, diet, digestion system and body size of Prosopis flexuosa seed dispersers, we analysed differences among species in (1) mean retention time of ingested seeds, (2) recovery of viable seeds, (3) seed germination in comparison with seeds collected from trees and (4) germination of seeds after two different periods of retention in the gut. Feeding experiments were conducted with captive individuals of Dolichotis patagonum, Lycalopex gymnocercus, Rhea americana, Chelonoidis chilensis and Lama guanicoe. On the first day, we provided them with fruits containing controlled amounts of seed, and on the subsequent days, we collected faeces in order to recover seeds. We performed germination and viability tests on seeds coming from faeces and collected from trees. The results showed differences among species in the mean retention time of seeds. Chelonoidis chilensis had the longest mean retention time, but its effect on seed recovery and germination was similar to that of the other species, except for L. guanicoe, which showed the lowest seed recovery. When scarification and promotion of seed germination were considered, herbivorous mammals and tortoises (L. guanicoe, D. patagonum and C. chilensis) were the ones increasing germinability, whereas R. americana and L. gymnocercus did not significantly increase final seed germination percentage, which was similar to that for seeds collected from trees. P. flexuosa seeds receive a variety of treatments from endozoochorous dispersers, which might result in an overall fitness benefit for a plant living in unpredictable environments.
Pelagic seabird populations have declined strongly worldwide. In the North Atlantic there was a huge reduction in seabird populations following the European colonization of the Azores, Madeira and Canary archipelagos but information on seabird status and distribution for the subtropical region of Cabo Verde is scarce, unavailable or dispersed in grey literature. We compiled and compared the historical and current distribution of all seabird species breeding in the Cabo Verde archipelago, updated their relative abundance, investigated their inland habitat preferences, and reviewed their threats. Currently, the breeding seabird community in Cabo Verde is composed of Bulwer’s Petrel Bulweria bulwerii, White-faced Storm-petrel Pelagodroma marina aedesorum, Cape Verde Shearwater Calonectris edwardsii, Cape Verde Storm-petrel Hydrobates jabejabe, Cape Verde Petrel Pterodroma feae, Boyd's Shearwater Puffinus lherminieri boydi, Brown Booby Sula leucogaster, and Red-billed Tropicbird Phaethon aethereus. One breeding species is currently extinct, the Magnificent Frigatebird Fregata magnificens. The relative abundance of Cape Verde Shearwater, Boyd’s Shearwater, Cape Verde Petrel, and Cape Verde Storm-petrel was determined from counts of their nocturnal calls in Santo Antão, São Vicente, Santa Luzia, Branco, Raso and São Nicolau. Cape Verde Petrel occurred only on mountainous islands (Santo Antão, São Nicolau, Santiago, and Fogo) from mid-to high elevations. Larger species such as the Cape Verde Shearwater and Boyd’s Shearwater exhibited a wider distribution in the archipelago, occurring close to the coastline but at lower densities on populated islands. Small procellariforms such as the Cape Verde Storm-petrel occurred at high densities only on rat-free islets and in steep areas of main islands where introduced cats and rats are unlikely to occur. The main threats to seabird populations in Cabo Verde range from predation by introduced predators, habitat alteration or destruction, and some residual human persecution.
The dispersal of Crocodylus from Africa to Europe during the Miocene is not well understood. A small collection of cranial fragments and postcranial elements from the latest Miocene (6.2 Ma) site of Venta del Moro (Valencia, Spain) have previously been referred to Crocodylus cf. C. checchiai Maccagno, 1947 without accompanying descriptions. Here we describe and figure for the first time the crocodylian remains from Venta del Moro, which represent at least two individuals. Our comparisons indicate that this material clearly does not belong to Diplocynodon or Tomistoma—the only two other crocodylians described so far for the European late Miocene. The material is only tentatively referred to cf. Crocodylus sp. because the apomorphies of this genus are not preserved and a referral to C. checchiai cannot be supported on a morphological basis. However, it is likely that this late Miocene species, originally described from Libya (As Sahabi) and later identified also in Kenya, could have dispersed across the Mediterranean Basin multiple times and colonized the southern areas of Mediterranean Europe, as evidenced by several Crocodylus or Crocodylus-like remains described during the past years.
Estuarine habitats are major nurseries for the European flounder Platichthys flesus, with different year classes sharing food and space resources. Hence, an understanding of feeding strategies that optimize resource use and maintain carrying capacity is fundamental for sustainable and successful ecosystem management. The main feeding areas of juvenile European flounder (including 0-group and 1-group age classes) in the Lima estuary (northern Portugal) nursery ground were investigated by integrating stomach content analyses with stable isotopic values (δ13C and δ15N) and fish condition indices (Fulton K and RNA:DNA ratio). The 0-group flounder that were associated with the upstream section of the estuary presented the lowest δ13C value (−25.58 ± 1.86‰), while 1-group flounder exhibited a higher δ13C value (−22.59 ± 2.51‰), indicating use of the more saline areas of the estuary (lower and middle sections). The two age groups did not differ in terms of δ15N (0-group: 13.93 ± 0.29‰; 1-group: 13.50 ± 0.96‰), indicating similar trophic levels. The low salinity upper estuary was the main feeding area of 0-group flounder (74%), while 1-group flounder fed along the estuary both upstream (52%) and downstream (48%). Juvenile flounder showed high individual condition based on the Fulton K index (0-group: 1.05 ± 0.08; 1-group: 1.07 ± 0.05) and RNA:DNA (0-group: 1.70 ± 0.70; 1-group: 1.41 ± 0.47). These indices deal with fish health, and hence indicate nursery habitat quality. It is concluded that in this temperate nursery habitat, different feeding strategies sustained the condition of the European flounder juveniles, compared with other flounder populations.
We consider Stavskaya’s process, which is a two-state probabilistic cellular automaton defined on a one-dimensional lattice. The state of any vertex depends only on itself and on the state of its right-adjacent neighbour. This process was one of the first multicomponent systems with local interaction for which the existence of a kind of phase transition has been rigorously proved. However, the exact localisation of its critical value remains as an open problem. We provide a new lower bound for the critical value.
The Cenozoic genus Terebratula seems to be an exception to the post-Permian trend in brachiopod retreat to offshore habitats, because it was species rich and numerically abundant in warm-temperate shallow-water environments in the Mediterranean and the Paratethys realms. This was so despite the general dominance of bivalves and the pervasive bioturbation and predation pressure during the Neogene. Terebratula, however, went extinct in the Calabrian (Pleistocene). The optimal environmental conditions for Terebratula during its prime are poorly known. The Águilas Basin (SE Spain) is an ideal study area to investigate the habitat of Terebratula, because shell beds of this brachiopod occur there cyclically in early Pliocene deposits. We evaluate the paleoecological boundary conditions controlling the distribution of Terebratula by estimating its environmental tolerances using benthic and planktic foraminiferal and nannoplanktic assemblages and oxygen isotopes of the secondary layer brachiopod calcite. Our results suggest that Terebratula in the Águilas Basin favored oligotrophic to mesotrophic, well-oxygenated environments at water depths of 60–90 m. Planktic foraminiferal assemblages and oxygen isotopes point to sea-surface temperatures between ~16°C and 22°C, and bottom-water temperatures between 17°C and 24°C. The analyzed proxies indicate that Terebratula tolerated local variations in water depth, bottom temperature, oxygenation, productivity, and organic enrichment. Terebratula was probably excluded by grazing pressure from well-lit environments and preferentially occupied sediment-starved, current-swept upper offshore habitats where coralline red algae were absent. Narrow temperature ranges of Terebratula species might have been a disadvantage during the high-amplitude seawater temperature fluctuations that started about 1 Ma, when the genus went extinct.
Implementation of genome-scale sequencing in clinical care has significant challenges: the technology is highly dimensional with many kinds of potential results, results interpretation and delivery require expertise and coordination across multiple medical specialties, clinical utility may be uncertain, and there may be broader familial or societal implications beyond the individual participant. Transdisciplinary consortia and collaborative team science are well poised to address these challenges. However, understanding the complex web of organizational, institutional, physical, environmental, technologic, and other political and societal factors that influence the effectiveness of consortia is understudied. We describe our experience working in the Clinical Sequencing Evidence-Generating Research (CSER) consortium, a multi-institutional translational genomics consortium.
A key aspect of the CSER consortium was the juxtaposition of site-specific measures with the need to identify consensus measures related to clinical utility and to create a core set of harmonized measures. During this harmonization process, we sought to minimize participant burden, accommodate project-specific choices, and use validated measures that allow data sharing.
Identifying platforms to ensure swift communication between teams and management of materials and data were essential to our harmonization efforts. Funding agencies can help consortia by clarifying key study design elements across projects during the proposal preparation phase and by providing a framework for data sharing data across participating projects.
In summary, time and resources must be devoted to developing and implementing collaborative practices as preparatory work at the beginning of project timelines to improve the effectiveness of research consortia.
Nowadays several authors defend the existence of an obsessive-compulsive (OC) spectrum in which eating disorders (ED), especially anorexia nervosa, would be include. We investigated the presence of OC symptoms in bulimic and anorexic patients and its relationships with personality traits.
The Maudsley Obsessive Compulsive Questionnaire (MOCQ) and the revised version of the Temperament and Character Inventory (TCI-R) were administered to patients and healthy controls.
Patients show higher scores than controls in the global punctuation of de MOCQ, and in the checking and doubt subscales. Cases also score higher in harm avoidance (dimension associated with personality disorders of cluster C) and in its subscale anticipatory worry. No differences were found between patients subgroups.
Restricting Anorexia Nervosa (RAN, n = 21)
Binging-Purging Anorexia Nervosa (BPAN, n = 29)
Bulimia Nervosa (BN, n = 34)
Control (C, n = 52)
RAN, BPAN, BN > C
Checking subscale (MOCQ)
BPAN, BN > C
RAN, BPAN, BN > C
Harm avoidance (TCI-R)
BPAN, BN > C
Anticipatory worry vs optimism (TCI-R)
RAN, BPAN, BN > C
Patients present more OC behaviours in comparison with healthy population but measures of obsessivity do not differ between the types of ED. Traits of personality characteristically associated to cluster C and to anxiety disorders seem to be also common features. These results do not support a separated classification of RAN into the OC spectrum.
To determine the clinical profile of patients diagnosed of delusional disorder (DD) admitted to a psychiatric ward.
Retrospective chart review of inpatients with diagnoses of delusional disorder (DD) according ICD-10 criteria admitted to a psychiatric ward (Hospital de Conxo, Santiago de Compostela) between January 1998 and December 2008. Sociodemographic and clinical variables were collected, with special attention to comorbidity and presumed risk factors.
The sample consisted in 56 inpatients (30 women, mean age 54 ± 11). 64.3% were single including never married (33.9%), divorced, separated and widowed and 33.9% lived alone. The most frequent type of DD was persecutory (67%) followed by mixed type (16%). 16.1% presented hallucinations (most frequent auditory). In comparison with the other types, patients with persecutory delusions usually lived alone (p < 0.05). Most frequent comorbidities were substance abuse and affective disorders. Familiar background of psychoses was recorded in 21.4% and history of emigration in 12.5%. 5.4% suffered deafness. During the period studied 53.6% were admitted two or more times. After the most recent admission 32.1% were on depot antipsychotic.
In concordance with other previous reports, DD seemed to be more prevalent in women in middle or late adulthood and persecutory were the most frequent delusions. In our sample, most patients were not married and high prevalence of family antecedents of psychoses was found. It could be related with its hospital origin; then it could be hypothesized living alone and having familiar background of psychoses to be risk factors of hospitalization.
In our work we propose to use the adult developmental eye movement test (A-DEM) of Gene Sampedro et al, for the study of saccadic movements in schizophrenia.
To study the importance of saccades and attention in a sample of institutionalized patients with schizophrenia in a Unit of Psychosocial Rehabilitation.
Sample formed by 30 people.15 patients and 15 controls. 15 patients were corresponding to all the schizophrenic patients admitted in January, 2009 in a Unit of Psycosocial Rehabilitation of Conxo's Psychiatric Hospital. The 15 of the group control were selected of random form between sanitary personnel without psychiatric pathology, homogenizing the variables chronological age and sex with regard to the group of investigation.
The A-DEM vertical half to 44.37 seconds in the control group versus 59.54 seconds in the sample of patients. Regarding the results of the horizontal A-DEM obtained an average score of 47.07 seconds compared to control group obtained 60.68 seconds in the group of patients. The schizophrenic patients are characterized for having an attention diminished in 87 %, opposite to 47 % of the group control that they have a normal attention and 40 % increased. These differences of saccadic movements and of the attention are statistically significant.
Schizophrenic patients have few saccades both horizontally and vertically slower than normal people.
Schizophrenic patients show a marked deficit of attention to the normal population.
The aim of this study is to assess the personality traits in a sample of Spanish anorexic and bulimic outpatients.
The revised version of the Temperament and Character Inventory was administered to 76 women attended in an Eating Disorders Unit and to 46 healthy controls. Both groups were matched by gender, age and instruction.
Diagnoses in the sample were distributed as follows: bulimia nervosa (BN) 33, binging-purging type anorexia nervosa (BPAN) 23 and restricting anorexia nervosa (RAN) 18. RAN patients were significantly younger (21.6 vs. 26.3 p < 0.01). Differences in the harm avoidance, persistence and selfdirectedness subscales of the TCI were found (see table).
BPAN, BN > C
RAN > C
C > RAN, BPAN, BN
In concordance with previous reports, compared with healthy controls, patients show lower scores in self-directedness. Persistence seems to be associated with restricting behaviours, whereas harm avoidance with binging and purging. RAN trends to have low scores in novelty seeking items and BN shows lower reward dependence, but this differences are not statistically significant, perhaps because of sample size.
Attention Deficit/Hyperactivity Disorder (ADHD) is one of the most prevalent psychiatric disorders in children (5.29%) worldwide, and highly comorbid with other psychiatric disorders.
To evaluate ADHD symptoms prevalence/frequency in young ambulatory patients diagnosed with other psychiatric disorders.
Non-interventional, multicentre, and cross-sectional, retrospective study. Patients aged 15-24 having a primary diagnosis of: Substance Use (SUD), Borderline personality (BPD), Anxiety (AD), Affective, Antisocial Personality (APD), or Conduct Disorders(CD) or Bulimia, giving inform consent were included (not previously treated/diagnosed with ADHD). ADHD symptoms prevalence was captured following DSM-IV criteria and moderate ADHD symptoms was considered as scoring >24 in the ADHD RS (DuPaul).
795 patients meeting in- and exclusion criteria were analyzed in the study. Mean age was 21.12 (SD: 2.64), and the majority were men (57.5%).A probable ADHD diagnosis (6 or more DSMIV symptoms and ADHD RS moderate symptoms) was apparent in: 40.3% of SUD patients, 23.7% of AD, 21.7% of Affective Disorders, 30.3% of Bulimia, 48.3% of BPD, 41.7% of CD and 57.1% of APD. Moreover, patients with SUD (ODD: 1.54) and BPD (ODD: 2.2) had significantly more risk vs. rest of population studied of having moderate ADHD symptoms. Also, patients having a probable ADHD diagnosis were significantly rated more severe in the GCI-Severity scale than the rest of population studied.
This cross-sectional study showed that ADHD symptoms are highly prevalent in young ambulatory patients diagnosed primarily with other psychiatric disorders, what seems to worse patient outcome if not diagnosed/managed on time. ADHD comorbidity risk varied significantly depending on the primary diagnosis.
To compare the efficacy and safety of the intramuscular formulations of ziprasidone and haloperidol in treating agitation in schizophrenic patients attended in an emergency room.
Consecutive patients were alternatively assigned to receive 20 mg of IM ziprasidone or 10 mg of IM haloperidol. Efficacy measures were improvement in Behavioral Activity Rating Scale (BARS), in the sum of five items of the Positive and Negative Syndrome Scale that focused on agitation (PANSS-A) and scores on the Clinical Global Impression improvement scale (CGI-I), obtained 45 minutes and 2 hours after the IM medication. Tolerability assessments included changes in ECG, monitoring of vital signs and register of adverse events.
Finally 18 patients (13 men, mean age 40.8 ±10.2) were included in the analysis of data. At arrival in the emergency room, there were no differences between ziprasidone (Z) and haloperidol (H) groups in age, mean QTc length, mean BARS and mean PANSS-A scores. Analyzing the global sample there was an improvement in agitation scores. No significant differences were found between the groups in change of BARS and PANSS-A scores, in CGI-I scores or in the variation of the length of QTc interval at two hours. No serious adverse events were reported.
In spite of the small sample size, both treatments ziprasidone IM and haloperidol IM seems to be similarly effective for the management of psychotic agitation in the emergency room. Both were well tolerated. Lengthening of QTc interval due to ziprasidone IM had not been found in our sample.
To explore the relationship between symptomatic and functional outcomes in adults (age 18-65 years) with ADHD during open label treatment with PR OROS MPH.
Post hoc analyses of a 7-week open-label extension (OLE) (N=370) of a 5 week, placebo controlled double-blind study (DB) which explored safety, efficacy, functional and quality of life outcomes in subjects with a diagnosis of ADHD (DSM-IV). Medication was flexibly dosed (18-90 mg/day) and adjusted individually to best effect during OLE. Regression analyses were performed on the change from DB baseline at OL endpoint in functionality and quality of life as measured by the Sheehan Disability Scale (SDS) and Quality of Life (Q-LES-Q). Baseline score, country, randomization group, sex, change from baseline in CAARS Hyperactivity / Impulsivity, CAARS Inattention and CGI-S at DB endpoint were included as covariates in the analyses.
337 / 370 patients completed the 7-week open label treatment. Improvement on CAARS Hyperactivity / Impulsivity at DB endpoint was significantly related with improvement in SDS “work”, “social life”, “family life” (at least p< 0.005) and “total score” as well as quality of life (p< 0.05) at the end of open label treatment. Change in CGI-S and CAARS Inattention at DB endpoint vs. DB baseline were not related with improvements in any of the functional or quality of life scales at OL endpoint (p>0.05).
These results indicate that improvement in daily functioning and QOL under active treatment may be particularly related to improvement in hyperactivity symptoms.
There is no direct relationship between migration and mental health, certain risk (e.g. acculturative stress) and protective factors of psychosocial well-being are inversely related with psychopathology. Acculturation strategies have been found to be related to psychopathology however this relationship has been minimaly examined with psychosocial well-being. The objectives of this study are to examine the relationship between acculturative stress, acculturation, and psychosocial well-being.
The sample consists of 150 immigrant inpatients hospitalized in tertiary care between 18 and 65 years of age. Acculturative stress, acculturation, social adaptation, anxiety and depression, as well as sociodemogrpahic and attitudinal items were evaluated.
With general health situation controlled, the study found a negative relationship between acculturative stress and psychosocial well-being, as well as between the marginalization acculturation strategy and psychosocial well-being. A relationship was found between acculturation strategies and acculturative stress. There is no positive relationship between the integration acculturation strategy and psychosocial well-being, although the majority of the study participants preferred integration, followed by assimilation. The latter is associated with lower levels of acculturative stress and higher psychosocial well-being. Separation, on the other hand, is associated with lower levels of anxiety and depression, and with a higher quality of life.
None of the acculturation strategies demonstrates a clear advantage in relation to psychosocial well-being, however, marginalization appears to be the least adaptive. It may be useful to revise the notion of what constitutes the most adaptive acculturation strategy for an individual, taking into account his or her psychosocial well-being.
Recent reports indicate that the quality of care provided to immigrant and ethnic minority patients is not at the same level as that provided to majority group patients. Although the European Board of Medical Specialists recognizes awareness of cultural issues as a core component of the psychiatry specialization, few medical schools provide training in cultural issues. Cultural competence represents a comprehensive response to the mental health care needs of immigrant and ethnic minority patients. Cultural competence training involves the development of knowledge, skills, and attitudes that can improve the effectiveness of psychiatric treatment. Cognitive cultural competence involves awareness of the various ways in which culture, immigration status, and race impact psychosocial development, psychopathology, and therapeutic transactions. Technical cultural competence involves the application of cognitive cultural competence, and requires proficiency in intercultural communication, the capacity to develop a therapeutic relationship with a culturally different patient, and the ability to adapt diagnosis and treatment in response to cultural difference. Perhaps the greatest challenge in cultural competence training involves the development of attitudinal competence inasmuch as it requires exploration of cultural and racial preconceptions. Although research is in its infancy, there are increasing indications that cultural competence can improve key aspects of the psychiatric treatment of immigrant and minority group patients.