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In this book, Vasilis Politis argues that Plato's Forms are essences, not merely things that have an essence. Politis shows that understanding Plato's theory of Forms as a theory of essence presents a serious challenge to contemporary philosophers who regard essentialism as little more than an optional item on the philosophical menu. This approach, he suggests, also constitutes a sharp critique of those who view Aristotelian essentialism as the only sensible position: Plato's essentialism, Politis demonstrates, is a well-argued, rigorous, and coherent theory, and a viable competitor to that of Aristotle. This book will appeal to students and scholars with an interest in the intersection between philosophy and the history of philosophy.
Background: Inappropriate ordering of urine cultures and the resulting unnecessary use of antibiotics can lead to complications of antimicrobial therapy including resistance, adverse effects (eg, disruption of microbiome and C. difficile infection), and increased healthcare costs, as well as the erroneous determination of CAUTI in patients with Foley catheters. A retrospective analysis of patients with CAUTI revealed frequent ordering of urine cultures for conditions and symptoms not supported by current IDSA guidelines. As a result, we created an action plan to reverse the trend of inappropriate urine culture ordering. Methods: Our urine culture reduction campaign was developed with input from the infectious disease service, antibiotic stewardship team (AST), infection prevention, pharmacy, and the microbiology service. The following educational efforts were included: (1) distribution of outpatient pocket cards with communication to providers about appropriate ordering of urine cultures; (2) creation of an evidence-based order set for urinalysis and urine cultures distributed electronically as emails and screensavers on computer stations and in person via didactic sessions with physicians and nursing staff; (3) a practice pointer for staff nurses that included recommended changes to urine culture ordering and encouraged open dialogue with physicians regarding the appropriateness of urine cultures; (4) didactic and personal communications to counter long-standing myths, such as “Urine cultures always for change in mental status”; (5) a peer-review process to evaluate and justify deviations from the testing algorithm.
Results: The first and second months after the introduction of the campaign, the microbiology laboratory reported 23% and 37% reductions in urine cultures ordered, respectively. During the same period, a 48% reduction in CAUTIs was reported for the entire health system. Conclusions: Reducing the number of inappropriate urine cultures is achievable with intense communication utilizing a multifaceted approach. With continued educational activities, we expect to sustain and even improve our successful reduction of inappropriate urine culture orders, ultimately improving patient outcomes.
Healthcare services are increasingly confronted with challenges related to old age mental disorders. The survey aimed to provide an overview of existing psychogeriatric services in Albania, Bulgaria, Greece, and North Macedonia.
After identification of psychogeriatric units across the four countries, their head physicians were asked to provide data on their clinical, teaching, and research activity, as well as staff composition. Moreover, the attitudes of head physicians to current needs and future service development were explored.
A total of 15 psychogeriatric units were identified (3 in Bulgaria, 8 in Greece, and 4 in North Macedonia). Results show wide variation regarding the location, team size and composition, service availability, numbers of patients attending, and inpatient treatment length. Most head physicians underscored the urgent need for breakthroughs in the graduate and postgraduate education in psychogeriatrics of medical and nonmedical professionals, as well as in the interconnection of their units with community primary healthcare services and long-term care facilities for seniors via telemedicine. They would welcome the development of national standards for psychogeriatric units, potentially embodying clear pointers for action. A number of head physicians advocated the development of nationwide old age mental health registries.
Regional disparities in resources and services for seniors’ mental health services were unveiled. These data may enrich the dialogue on optimizing psychogeriatric services through planning future cross-border collaborations mainly based on telemedicine services, especially in the era of the novel coronavirus pandemic, and training/education in psychogeriatrics of mental health professionals.
The objectives of this work were (a) to determine the presence of streptococci in samples from small ruminant dairy farms (bulk-tank milk and, where possible, teatcup swabs), (b) to investigate the potential adverse effects of streptococci on milk quality and (c) to investigate the importance of some husbandry factors for the isolation of streptococci. Bulk-tank milk samples and teatcups swab samples were examined bacteriologically for the presence of streptococci. Somatic cell counting and milk composition measurements were also performed. The husbandry factors present in each farm were assessed for potential associations with the isolation of streptococci. Streptococci were isolated from milk samples from 31.4% of sheep and 17.4% of goat farms and from 4.8% of sheep and 5.9% of goat teatcups. Streptococci were isolated more frequently from the upper part than the lower part of teatcups: 5.0% vs. 1.9%. Most isolates (57.9%) were identified as Streptococcus uberis. Most isolates (68.4%) were slime-producing; slime-production was more frequent among isolates from teatcups (83.3%) than from bulk-tank milk (55.0%). Somatic cell counts and milk composition did not differ between farms in which streptococci were or were not isolated. Machine-milking was associated with the isolation of streptococci from bulk-tank milk samples. The initial stage of the milking period (first two months) was found to be associated with the isolation of streptococci from milking machine teatcups in sheep farms only.
Antimicrobial stewardship of anti-infectives prescribed upon hospital discharge was implemented to improve the rate of appropriate prescribing at discharge. Appropriate prescribing significantly improved from 47.5% to 85.2% (P < .001), antimicrobial days of therapy decreased, and 30-day readmission rates decreased. Discharge antimicrobial stewardship was effective in improving anti-infective prescribing practices.
An increased incidence of adverse cardiovascular events has been reported in psychiatric patients, but the exact mechanisms underlying this association are still uncertain. Elevated plasma level of lipoprotein(a) [Lp(a)] is an independent risk factor for atherothrombotic disease in the general population. To study the implications of Lp(a) in psychiatric patients, we measured the plasma levels of Lp(a) in 74 patients with psychiatric disorders (39 schizophrenia, 10 major depression, 13 bipolar disorder and 12 personality disorder) and 74 healthy controls. The Lp(a) levels of the patient groups with schizophrenia, major depression and bipolar disorder were significantly higher than that of the control group. The median Lp(a) value of these diagnostic groups was comparable with those reported in patients with prior atherothrombotic events. On the other hand, no differences were found among personality disorder and controls. Our findings suggest that the elevation of plasma Lp(a) may contribute to increased cardiovascular risk in several patients with psychiatric disorders.
We assessed the recovery-orientation of the Pavia Rehabilitation Services using an Italian Version of the DREEM (Developing Recovery Enhancing Environment Measure). A preliminary Italian Version of the DREEM was translated by the first author (MB) and a back-translation was carried out by a trained translator (MT). A third member of the research team (JS) resolved disagreements between the two versions by discussion and consensus with MB and MT. The final version was administered to the patients of the rehabilitation services of Pavia. 15 patients out of a possible 21 (71.4%) participated in the first interview. Demographic information including gender (53% male, 47% female), age range (26-35 years: 27%, 36-45 years: 33%, 46-55 years: 27%, 56-65 years: 6%, 66 years and over: 7%), ethnicity (Italian: 100%) was collected. 20% had been using mental health services for between 5 and 10 years, and 80% for more than 10 years. The section “elements of recovery and recovery enhancing services” scored 1.2 for “importance ratings for recovery elements” and 2.4 for “staff performance”, with a performance gap of 1.2. Mean scores for “organizational climate” and “recovery markers” were 2.3 in both sections. The mean score of 1.2 on the importance ratings shows that patients have a good understanding of recovery elements. The other scores reveal a fairly good recovery orientation of the service, but with a wide margin for improvements as indicated by the performance gap. The Italian version of the DREEM is useful; the results can promote reflections, discussion and learning within the staff.
Forty-five cases of psychotic patients with admission urinalysis positive for cannabis were compared with psychotic controls without evidence of cannabis use. Cases and controls were matched for age, sex and year of admission, and were compared for socio-demographic data, circumstances of admission, diagnosis, and symptoms at admission. Three differences were found: cases were more likely to be Afro-Caribbean than white (P = 0.01), to manifest incoherence of speech (P= 0.02) and agitation (P= 0.01). In other respects the case and control groups were indistinguishable, and no pattern of symptoms characterised the “cannabis psychosis“group. These findings do not support the view that “cannabis psychosis” has a distinct psycho-phenomenological pattern Epidemiological studies are required to further clarify the association for psychotic patients between Afro-Caribbean ethnic groups and the likelihood of having a positive urine test for cannabis.
There is some evidence that repetitive transcranial magnetic stimulation (rTMS) may be effective in treating depression. Using an intensive methodology of rTMS in two drug-resistant patients, we observed a good antidepressant effect, but also, induction of manic symptoms.
Protected areas are cornerstones of conservation efforts worldwide. However, protected areas do not act in isolation because they are connected with surrounding, unprotected lands. Few studies have evaluated the effects of protected areas on wildlife populations inhabiting private lands in the surrounding landscapes. The lowland tapir Tapirus terrestris is the largest terrestrial mammal of the Neotropics and is categorized as Vulnerable on the IUCN Red List. It is necessary to understand the influence of landscape characteristics on the tapir's habitat use to enable effective conservation management for this species. Our objectives were to (1) determine the potential distribution of the lowland tapir's habitat in the Southern Yungas of Argentina, and (2) evaluate the role of protected areas and other covariates on tapir habitat use in adjacent private lands. We used records of lowland tapirs to model the species' potential distribution and determined habitat use with occupancy modelling. Based on the covariates found to be significant in our models, we constructed predictive maps of probability of habitat use and assessed the area of potential habitat remaining for the species. Probability of habitat use was higher in the vicinity of two national parks and small households than further away from them. We found that in 85% of the lowland tapir's potential distribution the probability of habitat use is high (> 0.5). These areas are near the three national parks in the study area. The probability of detecting lowland tapirs increased with distance to roads. We conclude that national parks play a key role in the persistence of lowland tapir populations on adjacent private lands.
There is evidence that women with breast cancer can develop anxiety and depression, ultimately affecting patients’ compliance and quality of life.
Previous studies investigated psychological distress in women with breast cancer at different stages of the disease. However, few data are available about Italian women in the early steps of their clinical history.
To investigate psychological distress, anxiety and depressive symptoms in a sample of women with a recent diagnosis of breast cancer.
This cross-sectional study involved twenty-five women consecutively attending the oncology outpatient clinic for their first oncology evaluation after surgery. Anxious and depressive symptomatology was assessed through the Hospital Anxiety and Depression Scale (HADS) and Distress Thermometer (DT). Socio-demographic and clinical characteristics were also collected. Correlations were analyzed using Spearman's correlation coefficient.
The mean values (±SD) of the HADS Anxiety and Depression Subscales were 7.6 (±4.7) and 5.7 (±4.4) respectively. Five patients (24%) scored ≥10 at the HADS Anxiety subscale and 16% scored ≥10 at the HADS Depression subscale, suggesting the presence of clinically relevant symptomatology. DT mean score (±SD) was 5.36 (±3.5), with 48% of patients scoring ≥7, indicative of significant psychological distress. Multivariate analysis showed an inverse correlation between psychological distress severity and time after cancer diagnosis.
These preliminary findings show a prevalence of anxious and depressive symptoms in one out four women with breast cancer. Further prosecution of the study will help to identify women at risk for psychiatric comorbidities, suggesting the development of targeted interventions.
Depression and apathy are common behavioral symptom of Alzheimer's disease (AD) and antidepressants, despite their role in improving depression have a minimum impact in improving apathy. Agomelatine has been shown to be effective in alleviating depression and reversing treatment emergent apathy.
The purpose of the current pilot study is to determine the efficacy of agomelatine in depressed patients with AD and comorbid apathy.
In this prospective 4 month study, twenty depressed elderly AD patients (age 65-85) who had been treated with SSRI and/or SNRI and shown a partial response to the antidepressant prescribed, in terms of apathy, were switched to agomelatine. Subjects were monitored for depression (Hamilton Rating Scale for Depression, HDRS), cognitive functions (Mini–Mental State Examination, MMSE) and apathy (Neuropsychiatric Inventory –apathy item, NPI-a).
Within groups, differences of HDRS, CSDD, MMSE and NPI-a scores at baseline, 2nd and 4th month of agomelatine treatment were estimated with repeated measure analysis of variance.
Following agomelatine, a numeric but not statistically significant improvement was observed in depression scores (8.2±3.5 vs 7.8±3.1, p=0.234, 7.8±3.1 vs5.8±2.3, p=0.421). A marked improvement in MMSE score was observed at both 2nd (22.2±4.9 vs 20.9± 5.4, p=0.05) and 3rd assessment(22.2±4.9 vs 23.9±4.9, p<0.05). Apathy score was also improved over the consecutive assessments (25.3±5.9 vs 18.6±3.9, p<0.05 and 18.6±3.9 15.5±4.3, p<0.05).
The present study demonstrated a good therapeutic response to agomelatine in elderly AD patients with depression and apathy symptoms in terms of alleviating apathy.
Several psychotropic medications (i.e. antipsychotics, antidepressant) have been recently associated with QTc prolongation. Despite literature data report only mild prolongation of QTc following the use of antidepressants or typical antipsychotics, post-marketing studies have clearly evidenced an increased risk of QTc prolongation and potentially lethal arrhythmias (i.e. torsade de pointes) in psychiatric patients.
We aimed to evaluate the prevalence of prolonged QTc and to identify potential predictors influencing QTc in a psychiatric inpatient population.
Medical records of 200 patients admitted to our psychiatric ward between 2007 and 2012 were retrospectively reviewed.
Prevalence of prolonged QTc at admission was very low (0.1%). No significant differences in QTc interval were observed between patients taking or not antipsychotics (P = 0.66), mood stabilizers (P = 0.36), or antidepressants (P = 0.07). A statistically significant difference was observed between patients on depot formulation and patients who were taking oral antipsychotic (P = 0.02). However, the pharmaceutical class of the medications appeared not significant.
We observed a very low rate of QTc prolongation in psychiatric inpatients at admission. Surprisingly we did not find a significant effect of specific medications; however, in our sample intramuscular formulation was associated with lower QTc interval.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Psychiatric population is characterized by a higher prevalence of cardiovascular events compared to general population. This difference might be due, in part, to the metabolic adverse effects of psychotropic agents, and, in part, to common risk factors such as smoking, sedentary lifestyle and unhealthy diet. Another potential risk factor is represented by the presence of metabolic syndrome (MetS).
We aimed to evaluate the prevalence of MetS and to identify the baseline predictors for the longitudinal development of MetS in a sample of Italian psychiatric inpatients.
Medical records of 343 patients admitted to our psychiatric ward between 2007 and 2012 were retrospectively reviewed.
Prevalence of MetS was 21.5%. MetS appeared directly associated with age and number of medication assumed. ROC curves showed HDL as the best predictor of metabolic syndrome in our sample.
Our results confirm previous data on the association between metabolic syndrome and exposure to complex polytherapy. Additionally, our findings support the notion of psychiatric patients as an at-risk group for metabolic abnormalities, which should be carefully monitored.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The Rufous-throated Dipper Cinclus schulzi is endemic to the Southern Yungas of north-western Argentina and southern Bolivia. The species is categorised as ‘Vulnerable’ on the IUCN Red List on the basis of small population size and restricted range. The purpose of our study was to determine the distribution of potentially suitable habitat for the Rufous-throated Dipper, estimate its population size, and assess potential distribution within strict protected areas, in north-western Argentina. We surveyed 44 rivers in the Southern Yungas of Argentina from 2010 to 2013 to determine dipper density (i.e. the number of individuals detected per km surveyed). The dipper’s potential distribution was assessed using a maximum entropy modeling approach based on 31 occurrence points and eight bioclimatic and two topographic variables as predictors. The species is dependent on mountain forest rivers, so the potential distribution was restricted to rivers. We estimated dipper population size by multiplying density by the potential distribution along rivers. Finally, we calculated the extent of suitable habitat contained within the boundaries of Argentina´s National Parks. Dipper density was 0.94 ± 1.55 individuals/km. We estimate that within north-west Argentina there are ~2,815 km of river that are potential habitat, with an area of occupancy of 141 km2 and a population size of 2,657 ± 4,355 dippers. However, of this river extent, less than 5% is within National Parks. Our results highlight the need to create new and to enlarge existing National Parks that protect the potentially suitable habitat of the species. Although more information is needed for Bolivia, the country-level area of occupancy and population size of the dipper found in Argentina provides strong evidence that the IUCN Red List classification of this species as ‘Vulnerable’ is warranted.
This research paper addresses the hypothesis that the fortification of goat milk base with whey protein concentrate (WPC) could affect both the textural and the biofunctional properties of set-style yoghurt. The effect of fortification of goat milk base with two different WPCs on thermophilic bacteria counts, proteolysis, physical and biofunctional properties of set-style yoghurts was studied at specific sampling points throughout a 4-week storage period. Fortification and storage did not influence thermophilic counts. Physical properties were affected significantly (P < 0.05) by the composition of the protein and the mineral fraction of the WPC but not by the storage. ACE-inhibitory activity was moderate in accordance to low lactobacilli counts and lack of proteolysis. DPPH-radical scavenging activity, Fe2+-chelating activity and superoxide scavenging activity were high. At 28 d an anti-inflammatory effect was observed, which was not affected by WPC addition.
The majority of the work today regarding the effects of extended milking intervals has focused on dairy cattle and only to a limited extent on dairy goats and sheep. The aim of this study was to investigate the effect of different non-milking intervals on milk yield and composition, mammary physiology and welfare indices in dairy ewes. Thirty-six multiparous ewes in late lactation were allocated to one of four groups of nine and subjected to 24, 48 or 72 h of non-milking or normal milking interval (12 h) (group A, B, C and D, respectively). Data showed that there were no significant differences in milk yield among the experimental groups during the third day after re-milking. Furthermore, no significant differences in milk lactose, protein and fat concentration among the experimental groups were observed after 7, 14 and 21 d of re-milking, respectively. Non-milking for 72 h resulted in a temporary increase of sodium concentration, Na + /K + ratio and enzymatic activities of plasmin (PL), plasminogen (PG) and plasminogen activator (PA) in milk. However, these parameters had similar values among the experimental groups on day 5 after re-milking. The concentration of lactose in blood was also significantly increased as a result of the 72 h non-milking interval and returned to its initial levels the second day after re-milking. These data, taken together, suggest that early involution events that occurred as an effect of non-milking were fully reversible within a short period of time. Finally, no significant signs of welfare impairment were observed in ewes due to extended milking intervals. In conclusion, non-milking up to 72 h had no negative effects on milk yield and composition, mammary physiology and welfare parameters in dairy ewes.