This single-case design study examined the effectiveness of adapting evidence-based treatments (EBTs) for children in a community clinic through a university-community partnership. Community clinic therapists treated eight youths (five males), ages 10 to 14, of whom four were Caucasian, two were Latino, one was African-American, and one was Caucasian/African-American. Youths presented with a primary diagnosis of a DSM-IV (American Psychiatric Association, 1994) internalizing disorder (plus multiple comorbidities). An adapted treatment combining multiple elements based on two primary treatment manuals: Coping Cat (Kendall et al., 1990) and PASCET (Weisz et al., 1999) was used. Youths with comorbid externalizing symptoms were also treated with elements from a parent-training manual (Barkley, 1997). Results of visual and clinical significance analysis demonstrated mixed support for the adapted treatment in a community clinic setting. The findings support further efforts to test the effectiveness of adapted EBTs in a community clinic setting and population.

Anxiety disorders share the feature of excessive fear, anxiety and related behavioural disturbances. Fear is defined as the emotional response to a real or a perceived imminent threat and anxiety is the anticipation of a future threat. The anxiety disorders covered in this thesis are panic disorder with or without agoraphobia, social phobia, post-traumatic stress disorder, generalized anxiety disorder and anxiety disorder not otherwise specified. Cognitive behavioural treatment protocols are typically designed to target one specific disorder and falls under the definition of disorder-specific cognitive behavioural therapy. It is however unclear if this is the most optimal approach in regards to the high comorbidity between anxiety disorders and depressive disorders. Internet-based cognitive behavioural therapy has in the past generally been disorder-specific and from above mentioned predicament two alternative treatment approaches emerged, the tailored and the transdiagnostic approach that aims to simultaneously treat both principal and comorbid disorders. Previous trials on internet-based cognitive behavioural therapy have targeted adults in general and relatively few target adolescents, young adults and older adults. The aims of this thesis were to further develop and test the effects of tailored internet-based cognitive behavioural therapy on the basis of age, for adolescents, young adults and older adults. Specifically by developing and testing the effects of individually tailored internet-based cognitive behavioural therapy for adolescents with anxiety and comorbid depressive symptoms and by adapting and testing the effects of individually tailored internet-based cognitive behavioural therapy for young adults and older adults with anxiety and comorbid depressive symptoms. These aims were tested in two pilot effectiveness studies (Paper I and III) and two efficacy randomised controlled trials (Paper II and IV). The results from these four trials showed significant results across all outcome measures with overall moderate to large effect sizes. The tentative conclusion based on these results is that tailoring internet-based cognitive behavioural therapy can be a feasible approach in the treatment of anxiety symptoms and comorbid depressive symptoms for adolescents, young adults and older adults. Despite the positive findings of the studies in this thesis, there is a need for more research examining the acceptability and effectiveness of internet-based cognitive behavioural therapy for adolescents, young adults and older adults with anxiety and depression before implementation on a larger scale.

Treatment for perpetrators of Intimate partner violence (IPV) is most often provided by community based IPV perpetrator programmes. These programmes have become an integral part of the response to IPV despite the fact that they are plagued by high rates of attrition and researchers suggest their effectiveness may be limited. It has been suggested that the retention rates and effectiveness of the programmes may be improved by tailoring treatment to specific subgroups of IPV perpetrators. This study was an evaluation of a community based IPV perpetrator programme. Participants were twenty two male IPV perpetrators who were court and not court ordered to treatment for violence towards a female intimate partner. Only seven participants completed the programme. Their self reported incidents of violence, alcohol consumption, change readiness and levels of working alliance were measured up to four times during the 18 week programme. Results indicated that participants who completed the programme or the majority of it significantly reduced their violence towards intimate partners and their levels of alcohol consumption. Higher levels of violence were associated with alcohol abuse and non court ordered status. As expected, court ordered participants reported lower levels of readiness to change and working alliance, and higher levels of alcohol abuse. However they were more likely to complete the programme compared with non court ordered participants. Implications of these findings are discussed.

Hepatitis C virus (HCV) infection globally affects 130-150 million people. It causes both acute and chronic infections. Due to the severe side effects and low success rates of interferon based treatments, which formed the standard treatment for HCV, the treatment paradigm shifted to direct acting antivirals (DAAs). DAAs have revolutionized the treatment of hepatitis C virus infection. Clinical trials with combinations of DAAs have recorded >90% response with shorter treatment durations and fewer side effects than earlier treatments involving IFN. Outside the controlled setting of a clinical trial, however, response rates with DAA combinations are much lower (<70%). DAAs can fail if HCV accumulates mutations that confer drug resistance. Interestingly, the pre-existence of mutant frequency in the virus appears not to influence treatment outcome. A better predictor for DAA treatment outcome is yet to be unravelled. Surprisingly, individuals who respond poorly to IFN appear to be more likely to fail DAA treatment. IFN is a generic antiviral that improves immune responses and is expected not to have any bearing on DAA treatment outcomes. Why individuals with poor IFN sensitivity fail DAA treatment remains a mystery. In a recent study of the IFN signalling network, HCV has been shown to compromise IFN activity. It induces bistability in the network leading to distinct phenotypic responses of cells to IFN exposure. In particular, individuals who respond poorly to IFN tend to have a higher percentage of cells that are refractory to IFN; these cells allow viral persistence despite IFN exposure. We hypothesized here that in such individuals, greater ongoing replication would allow increased development of resistance and thus lead to the failure of DAAs. We constructed a model of viral dynamics that accounts for the distinct phenotypic responses of cells to IFN, viral replication and mutation, and the development of resistance to DAAs. Our model predicted that although the relative prevalence of pre- existing mutants is unaffected by IFN sensitivity, in agreement with observations, the growth of drug resistant mutants is accelerated in individuals with poor IFN sensitivity. Based on a distribution of IFN sensitivity across individuals, our model accurately described clinical observations of the response rates to different current treatment protocols. With this model, we predict that the common strategy of increasing the genetic barrier by adding more drugs to the combination was not necessary to avert the development of drug resistance. Instead, an optimised increase in DAA dosage alone or DAA+PR or PR dosage depending on the patient’s IFN sensitivity could help achieve success.

Depression är en funktionsnedsättande problematik som påverkar en stor del av den vuxna populationen varje år. Trots ett omfattande behov av hjälp så råder det brist på tillgång till effektiv behandling. Kognitiv Beteendeterapi (KBT) är en evidensbaserad metod som har stöd vid behandling av depression och förmedlad via internet skulle metoden kunna tillgängliggöras för fler. Dock är det i dagsläget oklart vilka format och vilket innehåll som kan användas när behandlingen förmedlas via internet, samt vilken betydelse den terapeutiska alliansen har för en behandling som till största del sker på distans. Syftet med denna avhandling var att undersöka effekterna för olika format av internetbehandling (epostterapi, guidad självhjälp och blended treatment) vid depression, samt alliansens roll i dessa format. Studiernas resultat visar på att epostterapi och internetförmedlade självhjälpsprogram med behandlarstöd var effektiva metoder för att behandla depression. Alliansskattningar var höga, vilket visar att en positiv terapeutisk allians kan uppnås i internetbehandling. Patientskattningar av allians kunde inte predicera utfallet i någon av behandlingarna, men behandlarskattad allians predicerade förbättring på depressionsskattningar i blended treatment. Den här avhandlingen innehåller den första randomiserade kontrollerade studien på KBT-baserad epostterapi vid depression, samt det första internet-förmedlade självhjälpsprogrammet baserat på beteendeaktivering och ACT. / Depression is a debilitating disorder that affects a large part of the adult population every year. Yet there is still a lack of access to effective care for people in need. Cognitive Behaviour therapy (CBT) is an evidence-based method for treating depression that together with the increased availability of Internet services provides an opportunity to increase access to effective treatment. Internet-based interventions can be effective in the treatment of depression, but there is a lack of knowledge concerning which formats of delivery that can be used and if therapeutic alliance is of equal importance when providing treatment over the Internet. The overall aim of this thesis was to examine the effects of different treatment formats (email therapy, guided self-help, and blended treatment) in internet-based CBT for depression and to further examine the role of alliance in these treatment modalities. Findings from this thesis show that email therapy and internetbased treatment programs were effective methods for treating depression. Alliance ratings were high, showing that a positive therapeutic alliance can be achieved in internet-based treatments. Patient-rated alliance could not predict outcome in any of the different treatment formats. However, therapist-rated alliance predicted change in depression during blended treatment. This thesis includes the first randomized controlled study on CBTbased email therapy, and the first internet-based behavioral activation program with ACT-components, for adult depression.

This study examined the effectiveness of child centered play therapy (CCPT) with academically at-risk 1st graders. In this quasi-experimental design, twenty-one 1st grade students were assigned to the experimental group and 20 students were assigned to the no treatment control group. The children in the experimental group received two 30 minute play therapy sessions per week for the duration of eight weeks. Three hypotheses were analyzed. A two-factor repeated measures analysis of variances (SPANOVA) were performed on each dependent variable to determine if the experimental group performed differently from the control group across time according to the pretest and posttest results of the Young Child's Achievement Test (YCAT), the Pictorial Scale of Perceived Competence and Social Acceptance for Young Children (PSPCSAYC), and the Student-Teacher Relationship Scale (STRS). Additionally, partial η2 was calculated to determine practical significance. One hypothesis was retained at the .05 level of significance. Findings indicated that academically at-risk 1st graders who participated in CCPT scored statistically significant higher on academic achievement. Specifically, children assigned to the experimental group demonstrated a statistically significant increase in Early Achievement Composite (p = .03) when compared to children assigned to the no treatment control group. No statistical significant results were found on Self-Concept and Student-Teacher Relationship Stress.

Theoretical section focuses on the concept of mindfulness, its historical background, variety of theoretical approaches and definitions of mindfulness. On this basis I provide own definition of mindfulness. Then, I present an overview of the features and characteristics of mindfulness, its applications in clinical environment, mindfulness-based approaches, effective therapeutic factors, and also its use with specific mental disorders. I also address neural correlates of mindfulness, developmental aspects of mindfulness and overview of measurement methods. Empirical section consists of standardization of Five Facets Mindfulness Questionnaire for the Czech population and verification of its factor model. Further I monitored the relation of mindfulness to chosen demographic variables. Results showed modestly significant correlation with age and education, and independence of sex and overall mindfulness score. In four subscales of the questionnaire, however, sexes differed. The hypothesis that mindfulness is related to profession was also confirmed. Highest mindfulness scores were reached by helping professions, especially psychotherapists, lowest scores were reached by technical professions. Next, results confirmed the hypothesis about relation between mindfulness and life satisfaction (cognitive...

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No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Tese - Claudia Santos Goncalves Barreto Bezerra.pdf: 2059173 bytes, checksum: 45f41522691fac0d28d22bbc3d3ec16b (MD5) Previous issue date: 2014-04-28 / Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG / The attention deficit/hyperactivity disorder is a neurodevelopmental disorder provided in the International C lassification of Diseases (ICD) characterizing a continuing pattern of attention deficit and/or hyperactivity/impulsivity with more intense and higher rates than what presented by individuals at the same development level. This dissertation was organized u sing the models of scientific articles analyzing the results from school performance by students of the Colégio de Aplicação (a school maintained by a university) of the Federal University of Goiás, 7 to 14 age group with and without ADHD diagnosis. Initia lly, the prospective observational study to assess comparative effectiveness involved 355 students and investigated the results from school performance by 60 of them before and during Methylphenidate - based treatment (MPH) and psychotherapy compared with th e control group. The students had their school performance and treatment adherence monitored for the first eight months. The literature review on the theme is presented in the first article submitted to the journal “Revista Ciência & Saúde Coletiva” (Journ al of Science and Collective Health), entitled “ Methylphenidate - based treatment and school performance by students with attention deficit/hyperactivity disorder : integrative literature review”. The review included scientific articles published from 2006 to 2013. Six hundred and sixteen out of the 629 articles found did not meet the criteria for inclusion and 13 were part of the sample. Most of the studies emphasized that the group of children with ADHD undergoing methylphenidate - based treatment improved the ir performance compared with the group of children with ADHD with no records for the treatment and stimulant - based therapies are more beneficial in the long term. The second article, entitled “Re/Assessment on the diagnosis of attention deficit/hyperactivi ty disorder in students ” presents the results from the clinical reassessment of 29 children previously diagnosed with ADHD or suspected ADHD. The reassessment confirmed the diagnosis of 74% of the children previously diagnosed and 70% of suspected ADHD. Th e third article, entitled “The use of methylphenidate for students with attention deficit/hyperactivity disorder and poor school performance” presents the major results of this study and proves that the use of methylphenidate - based treatment for students A DHD was associated with improved school records for basic mandatory disciplines . The medication had positive influence on school performance however even undergoing drug - based treatment the students were not able to achieve the levels of performance by stu dents without ADHD with typical school performance. / xii RESUMO O Transtorno de Déficit de Atenção/Hiperatividade é um transtorno do neurodesenvolvimento previsto no Código Internacional de Doenças e caracterizado por um quadro persistente de déficit de atenção e/ou de hiperatividade/impulsividade mais acentuado e grave do que o observado em outros indivíduos com o mesmo nível de desenvolvimento. A presente tese foi construída no modelo de artigos científicos que an alisou os resultados do desempenho acadêmico de escolares do Colégio de Aplicação da Universidade Federal de Goiás, de 7 a 14 anos com e sem diagnóstico de TDA/H. O estudo de caráter prospectivo, observacional e comparativo teve a participação inicial de 3 55 estudantes e investigou os resultados de desempenho escolar de 60 deles, antes e durante o tratamento com metilfenidato (MPH) e psicoterapia em comparação com um grupo controle. Os estudantes foram acompanhados em seu desempenho escolar e em adesão supe rvisionada ao tratamento durante o período de oito meses. A revisão de literatura do tema investigado é apresentada no primeiro artigo, submetido à “Revista Ciência & Saúde Coletiva”, intitulado “Tratamento com Metilfenidato e o desempenho de escolares com Transtorno de Déficit de Atenção/Hiperatividade: revisão integrativa da literatura”. A revisão incluiu artigos científicos publicados no período 2006 a 2013. Dos 629 artigos encontrados, 616 não atenderam aos critérios de inclusão e 13 fizeram parte da am ostra. A maioria dos estudos evidenciou que o grupo de crianças com TDA/H, em tratamento com MPH, mostrou melhor desempenho escolar em relação ao grupo com TDA/H sem histórico de tratamento. E que os tratamentos com estimulantes trazem mais benefícios quan do adotados em longo prazo. O segundo artigo intitulado “Re/Avaliação diagnóstica de Transtorno de Déficit de Atenção/Hiperatividade em escolares” apresenta os resultados da reavaliação clínica de 29 crianças, anteriormente, diagnosticadas com TDA/H ou cas os suspeitos. A re/avaliação confirmou o diagnóstico de 74% das crianças portadoras de diagnóstico e 70% dos casos suspeitos. Já o terceiro artigo intitulado: “A utilização do Metilfenidato por escolares com Transtorno de Déficit de Atenção/Hiperatividade e baixo desempenho escolar” apresenta os resultados principais desse estudo e constatou que o tratamento com Metilfenidato pelos escolares com TDA/H foi associado ao aumento das médias nos resultados da avaliação escolar das disciplinas elementares. A medi cação influenciou positivamente no desempenho dos estudantes, entretanto, mesmo em tratamento medicamentoso esses estudantes não atingiram o nível de desempenho dos escolares sem TDA/H com desempenho escolar típico.

Rapid urbanization has led to the generation of enormous wastewater after independence. The domestic wastewater generated in municipalities is rich in nutrients such as carbon, nitrogen and phosphorus along with other ions. The generated wastewater due to lack of adequate appropriate infrastructure including low treatment efficiencies are either untreated or partially treated and are let into water bodies. Present sewage treatment plants (STP’s) in the city are either under capacity or malfunctioning and hence are unable to meet the growing demand of burgeoning urban population. Water bodies have the ability to uptake nutrients (remediation by algae, bacteria, macrophytes) provided the wastewater inflow does not exceed the threshold. However, the sustained flow of wastewater beyond the water body’s treatment ability has led to the serious problem of nutrient enrichment in surface water bodies which is evident from algal bloom and profuse growth of invasive exotic macrophytes. This necessitates cost effective environmentally sound treatment options. The current research focuses on the characterisation of domestic wastewater fed ponds/lakes, understanding of nutrient regimes in wastewaters, pond dynamics, nutrient transformation and resource recovery. This has aided in devising an algae based treatment system for Bangalore city. The interplay between various biotic and abiotic factors governs water quality in a water body. Regular monitoring helps in characterisation of the water body and also helps in identifying the sources of external input (if any) to the system. Wastewater generated in urban localities in India, due to lack of adequate appropriate infrastructure including low treatment efficiencies are untreated or partially treated and are let into water bodies. Understanding the nature of the wastewater flow regimes and the turnover of biota with prevalent nutrient conditions is required to design treatment systems. Treatment involves breakdown of complex organism forms into simpler forms and transformations of organic nutrients into inorganic forms that are finally absorbed and assimilated by microbes as algae and bacteria. In wastewater fed urban pond systems, an array of microphytes as well as macrophytes grow and help in nutrient cycling in the system and still manage to remove nutrients to satisfactory levels. However, sustained inflow of wastewater with high nutrients results in the deterioration of the system as nutrient input exceed the supportive and assimilative capability resulting in proliferation of macrophytes, algal blooms, froth formations rendering the system anoxic that results in the loss of functional abilities of the urban pond systems. This biota in the system plays a major role in nutrient removal and recycles. Understanding the nutrient cycling aspects of urban wastewater fed systems is essential to find out the key players in treatment and for devising a sustainable treatment option with resource recovery. The review of wastewater generation, treatment systems highlight shortfall of the treatment systems and need for sustainable treatment for removal and recovery of nutrients such as C, N and P. Characterisation of Varthur water body (spatial extent 220 ha) located in the south of Bangalore city has been done through monthly monitoring for 18 months with the analyses of physico-chemical and biological. The analysis showed BOD removal of 70% (filterable) when the lake functioned as an anaerobic–aerobic lagoon for 6 months at an estimated residence time of 5 days. During this period, the biota of the lake, especially primary producers such as algae, treat the water through remediation of nutrients to nearly standard water quality levels. However, the growth and spread of invasive exotic macrophytes such as water hyacinth rendered the lake anaerobic which reduces its ability (due to absence of low algae) to treat the water. This highlights the role of algae especially Chlorophycean members as Chlorococcum sp., Chlorella sp. and Monoraphidium sp. in treating urban domestic wastewater and the scope for introducing algal ponds/lagoons to treat wastewater treatment and it may be used in a larger number of small towns to enable local reuse of water. The entire pond systems comprises of various components that are deeply affected by the biotic and abiotic factors in the system. Hence, studies on major biotic components were conducted especially on algae and macrophytes and the impact of abiotic factors as wind, light, and precipitation with seasonality’s. The diurnal and spatio-temporal variations in the dissolved oxygen as well other treatment parameters were used for zonation through multivariate analysis. Physico-chemical parameters confirm the nutrient enrichment (high Amm.-N) in the water body due to the sustained inflow of wastewater. High levels of nutrients together with BOD have resulted in the lower DO levels affecting the biological life. Study on biota revealed macrophytes altering the photosynthetic regime in the algae in water bodies thus, creating anoxia and nutrient re-suspension. The multivariate analysis showed three distinct zones (clusters) on the basis of physico-chemical variables and nutrient concentrations in the lake. The sedimentary C and N analysis showed a steady increase in the C: N ratio as a function of residence time. Importance of the various sub-systems in the water body in terms of nutrient uptake and accumulation showed algal systems to be efficient. C budgeting accounted to ~ 7 t/d i.e. ~2574 t/y, indicated that the lake is an accumulator of C. An estimated relatively high gas emission across the water/air interface (17 t/d) to carbon burial into sediments (2.3 t/d) further indicates very high emissions compared to sedimentation showing the dominance of internal C cycles. The overall mass balance, gas exchange and carbon burial balance showed Varthur water body as a major emitter of C due to high primary production, substantive allochthonous carbon inputs and intensive anthropogenic activities in the water body. Gaseous carbon emission accounted for 28 % of the total Influx C. The spatial profile of N in sediment ranged from 2280-3539 mg/kg of sediment dry mass. Very low value of N:P ratio in sediments suggested possible N limitation. The determination of ammonification and nitrification showed lower nitrification rates than the ammonification rates. The potentially mineralisable nitrogen content in Varthur pond sediments varied greatly from 21.65% to 75.54% and was strongly correlated (r2=0.85) to sedimentary TN. N budgeting showed NH4-N as the predominant Nr form for microbial uptake and is the major mechanism for nitrogen removal, followed by the sedimentation process. Bacterial biomass, algal biomass and macrophyte biomass accounted for 14, 4 and 1% N removal, respectively. Ammonium concentration and nitrification accounted for 27% and 2%, respectively. While bacterial uptake remained fairly constant throughout the year, micro-algae was the major player during monsoon and winter and macrophytes dominated Nr capture during summer among autotrophs. From the estimates, it has been observed that nearly 55% Nr was recovered, recycled as cell mass and transferred to a crop system when such N-captured water is used for irrigating fodder crops. About 45% of N input into the system was lost and methods to reduce this loss need to be evolved in the future. The spatial profile of P in sediment ranged from 2111.35-3982.03 mg/kg of sediment dry mass. Inorganic-P (IP) ranging from 1270.27-3505.73 mg/kg was found to be the major fraction (61.16-91.56%) of sedimentary P. High p values in both water columns and sediments showed potential P excess conditions. P concentrations in micro and macro-algae collected during the due course of the study (on dry biomass basis) were 0.347% and 0.939% P respectively. The P fractionation revealed metal oxide bound P (NaOH-P) and constituted major fraction of IP indicating, high concentrations of Fe and Al in sediments. High concentrations of sedimentary N and P indicated possible higher trophic status (bio-productivity/unit volume) signifying its towering nutrient status evidenced from the rank order of P fractions: NaOH-P > HCl-P > NH4Cl-P, which is specific for highly enriched water bodies. P budgeting showed that bulk of the P is trapped in sediment layer with a potential of ~50 % recovery from the sediments indicating, ~70% P retention within the system. The biotic components such as bacteria, algae and macrophytes accumulates a substantial amount of P, immobilising ~139, ~482 and ~131 tonness/yr of P. The sequential P extraction shows that ~70 % of sediment bound P is readily reducible during anoxic conditions which can potentially become bio-available to trigger algal growth. Assessment of treatment efficiency of facultative algal ponds, showed moderate treatment levels with 60 % total COD removal, 50% of filterable COD removal; 82% of total BOD removal and 70% of filterable BOD removal. The N removal efficiency was lower. However, a rapid decrease in the suspended solids after a faster euglenoids growth indicated particulate C removal by algal ingestion. Euglenoides dominated the facultative pond and Chlorophycean members were more abundant in the maturation ponds owing to variable surface BOD loadings. Significant correlations between algal biomass and nutrients indicate the importance of the type and nature of algal communities that can be used as an efficient tool for predicting the dynamics of various phases in wastewater treatment systems. Detailed morphological analysis of dominant algal species i.e. euglenoides was also performed. Euglenophycean members (>14 species) sampled from various locations in the facultative pond based system showed various striae patterns and distinct nano channels on the cell surface that might have possible role in cell secretions. Comparative assessment of treatment systems reveal that algal pond systems performed well under higher organic load with a COD removal efficiency of 70%, TN removal efficiency of 73% and TP removal efficiency of 22%. However, the facultative pond based systems were effective in suspended solid (SS) removal up to 93% and BOD removal up to 82%. The conventional wastewater treatment systems were efficient in terms of SS removal up to 88%, COD removal up to 74% and BOD removal up to 63%, but were highly ineffective in nutrient removal. The evaluation of treatment processes in mechanically aerated systems, facultative ponds and large shallow lake based systems in terms of capital and annual O&M costs, COD removal cost and land requirements reveals that the mechanical systems require 5 times more capital and O&M costs than ponds. The treatment systems were also ranked in terms of the total annual cost (e.g., capital, manpower, chemical, repair, electricity, land). It showed that algal pond systems followed by facultative pond based system are economically better choice than mechanical technologies. Finally, it was found that the large pond based systems could be economically the best option for the developing countries considering all factors, including economic viability and treatment efficiency. The treatment efficiency analysis showed that algal pond systems were the most effective options for treating urban wastewater. Culturing native wastewater species in growth media and wastewaters, assessment of efficient cell disruption and solvent systems, lipid profiles of wastewater algal species were studied. Wastewater grown algal species as Euglena sp., Spirogyra sp., Phormidium sp., Lepocinclis ovum, and Chlorococcum sp. are comparatively rich in lipids. These algae grow mixotrophically and can store substantial amount of wastewater carbon as TAG’s in varied environments. Among the different cell disruption methods used for the study, sonication was the most effective. The combination of maceration and methanol: chloroform: water (2:1:0.8, v/v) (Bligh and Dyer’s, solvent) gave highest lipid extraction yield among other combinations. Further more these wastewater algae as Lepocinclis ovum and Chlorococcum sp. were found to grow better in wastewaters. Increased lipid content was recorded during the cell cultures with accumulation of quality FAME with high saturates predominated by C16-C18 fatty acids. These wastewater algal lipids are suitable for bio-energy generation with potential biomass productivity (6.52 t/ha/yr) of wastewater-grown species as Euglena. The studies on Euglena sp. showed mixotrophic mode that offers an efficient removal of TOC, N and P from domestic wastewater without any pre-treatment. Lipid profiles of the extracted algal oil were similar to the vegetative feedstock oils, indicating a good quality fuel for energy generation. Mixed algal consortia’s bioremediation potential (removal of nutrients) with the scope for biofuel production highlights self flocculating abilities of algal consortia aided in the effective treatment of wastewater with substantial algal harvest. Studies on cultivating wastewater algal consortia in novel cascading algal parcel flow reactor (CAPFR) operating in continuous mode showed 70-80 % nutrient and ~90 % C removal with in a residence time of ~4 days with highest cell densities (0.91 g/l) and productivities (0.26 g/l/d) in the last stages. The lipid contents varied from 26-28 % with highest lipid productivities ~58 mg/l/d in the 2nd phase of the bioreactor. Most of the lipids were associated with the pigments as chlorophyll and carotenoids. Furthermore, the algal rector removed bacteria up to 4 log orders. Essential cations and phosphates were responsible for self clumping of algal biomass in the final stages with a high internal P content within the cell. The algal biomass also showed substantial exothermic peaks and high heat values (~18 MJ/kg). Studies on continuous cultivation of Dictyosphaerium sp. showed that this species could adapt to wastewater conditions and also showed good nutrient removal at lower HRT (2.5 days). The high biomass productivities with high lipid content (~36%) at low HRT in the continuous mode offer potential options for economic and feasible nutrient removal with biofuel production. Investigations on city wastewaters showed low nutrient ratio indicating C limitations and possible scope for algal wastewater treatment. Integration of algal ponds in the present treatment network requires an additional land ranging from ~0.37 to 2.75 ha to treat an MLD of wastewater depending on the nutrient content and influent waters fed to algal systems. The treatment plants require an additional ~1.6 ha of land to treat 1 MLD of wastewater considering an average N and P values of 18 and 5 mg/l. The continuous algal bio-processes implemented at decentralised levels would help in the economical ways for nutrient removal and recycling of the nutrient free waters after treatment. This meets multiple objectives of low cost treatment of wastewater, nutrient recovery and fuel production. Algal nutrient capture and consequent biofuel production would ensure sustainability through i) water purification ii) nutrients capture and iii) biofuel to meet the growing energy demand, and would be an optimal treatment option for urban wastewater. The thesis consists of 10 chapters and basically deals with the development of a sustainable and economically viable bioprocess for wastewater treatment and biomass production. Chapter 1 provides a brief introduction to wastewater; domestic wastewater composition, generation and treatment in developing nations and in the country and review of the various techniques for treatment of domestic wastewaters, advantages of algal processes in nutrient removal (C, N and P) and production of valued by-product such as lipid generation, for its use as biofuel. Chapter 2 is based on primary field investigations in a wastewater fed urban water body/pond systems involving monthly sampling and analysis of various physico-chemical and biological parameters. Assessment of treatment capabilities of the continuous systems through detailed characterisation of treatment parameters is explained in the second chapter. Chapter 3 discusses the role of the major biotic (algae and macrophytes) and abiotic factors in nutrient transformations, the diurnal variations in parameters especially dissolved oxygen, multivariate spatio-temporal analysis of functional abilities for zoning, the activities in the sludge/sediment and transitions in the CN ratio as a function of residence time. Chapter 4 involves studies in C, N and P quantification and budgeting in such pond systems and partitioning of the nutrients and their distribution in various biotic and abiotic subsystems. This chapter also highlights the major nutrient losses from the system and un-utilised nutrient stocks, paving way for beneficial use of nutrients from such man made lagoon wastewater systems. Chapter 5 discusses the mechanisms and efficacies of algal pond based treatment systems through a detailed study and highlight its advantages over the mechanical ASP based systems. This has been done through a comparative assessment of treatment efficiency, economics and environmental externalities. This study also provides necessary insights and potential of wastewater algal species such as Euglena for its abilities in nutrient removal and biomass generation. This provides insights to algal treatment options for optimal resource recovery and utilisation from wastewaters. Chapter 6 focuses on testing the growth, biomass and lipid production of various wastewater algae isolated from treatment ponds. The chapter identifies suitable cell disruption and extraction routes for efficient lipid extraction and assesses the potential of these wastewater grown algae for regional and national biofuel production. Chapter 7 discusses the effectiveness of wastewater grown Euglena sp. and algal consortia in nutrient removal and as a source of lipids for biofuel generation. Chapter 8 involves the design and operation of a continuous algal (uni-algal/algal consortia) bioreactor devised taking insights from earlier field based studies and their potential as efficient urban wastewater treatment systems. Chapter 9 discusses the present nutrient levels in the city wastewaters and also an analysis of the temporal and spatial variation of nutrients in city sewers and elaborates the scope for integration of the algal modules i.e. continuous algal bioreactors (designed in the previous chapter) into existing STP’s. Chapter 10 elaborates significant contributions and outcome of the research.

Background: Depression is one of the most frequent and costly mental disorders. While there is increasing evidence for the efficacy of online self-help to improve depression or prevent relapse, there is little evidence in blended care settings, especially combined with inpatient face-to-face psychotherapy. Therefore, we evaluated whether an evidencebased online self-help program improves the efficacy of inpatient psychotherapy. Methods: A total of 229 depressed patients were randomly allocated either to an online selfhelp program (intervention group [IG]; Deprexis) or an active control group (CG; weekly online information on depression) in addition to inpatient psychodynamic psychotherapy. Both groups had access to their respective experimental intervention for 12 weeks, regardless of inpatient treatment duration. Reduction of depressive symptoms, as measured with the Beck Depression Inventory-II, was the primary outcome at the end of the intervention (T2). Results: Depressive symptoms were statistically significantly lower in the IG compared to the active CG at T2 with a moderate betweengroup effect size of d = 0.44. The same applied to anxiety ( d = 0.33), quality of life ( d = 0.34), and self-esteem ( d = 0.38) at discharge from inpatient treatment (T1). No statistically significant differences were found regarding dysfunctional attitudes ( d = 0.14) and work ability ( d = 0.08) at T1. Conclusions: This is the first evidence for blended treatment combining online self-help with inpatient psychotherapy. The study opens new and promising avenues for increasing the efficacy of inpatient psychotherapy. Future studies should determine how integration of online self-help into the therapeutic process can be developed further.