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Shared decision-making denotes a structured process that encourages full participation by patient and provider in making complex medical decisions. There has been extensive and growing interest in its application to long-term illnesses but surprisingly not in severe psychiatric disorders, such as schizophrenia. However, the great majority of schizophrenics are capable of understanding treatment choices and making rational decisions. Although the main justification for shared decision-making is ethical, several randomized controlled trials support its effectiveness in improving the quality of decisions, but robust evidence in objective health outcomes is needed.
Aims and objectives
Of the study: to demonstrate the effectiveness, measured as treatment adherence and readmissions at 3, 6 and 12 months, of shared decision making in the choice of antipsychotic treatment at discharge.
Of the oral presentation: to present the study design; to make an interim report of the data obtained at the moment of the congress.
Randomized controlled trial, prospective, two parallel groups, not masked, comparing two interventions (shared decision making and treatment as usual). Study population: Inpatients diagnosed of schizophrenia and schizoaffective disorders (ICD-10/DSM-IV-R: F20 y F25) at Adult Acute Hospitalization Unit at Jerez General Hospital.
Currently in the recruiting phase with 55 patients included in the study. An interim analysis of at least half of the target sample size.
We will show the study design and decision tools employed. Conclusions in relation to the effectiveness (adherence and readmissions) and subjective perception.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Effectiveness of shared decision making in treatment planning at discharge of inpatient with schizophrenia: interim analysis.
Shared decision-making denotes a structured process that encourages full participation by patient and provider in making complex medical decisions. Hamann et al. conducted a few years ago a randomized controlled trial with schizophrenic inpatients and found increased knowledge and perceived involvement in decisions about antipsychotic treatment at discharge by the experimental group, but not clear beneficial effects on long term outcomes. The present communication introduces the DECIDE study.
Aims and objectives
Of the study: to demonstrate the effectiveness, measured as treatment adherence and readmissions at 3, 6 and 12 months, of shared decision making in the choice of antipsychotic treatment at discharge in a simple of schizophrenics hospitalized after an acute episode of their disorder. Of the oral presentation: to present preliminary conclusions with more of the half of the sample.
Randomized controlled trial, prospective, two parallel groups, not masked, comparing two interventions (shared decision making and treatment as usual). Study population: inpatients diagnosed of schizophrenia and schizoaffective disorders (ICD-10/DSM-IV-R: F20 y F25) at Adult Acute Hospitalization Unit at Jerez General Hospital.
At discharge, increased scale score COMRADE, both subscales (Satisfacción in communication and trust in the decision) statistically significant. At 3 months follow-up, intensification of these differences in effect size and statistical significance and shows trends in health outcomes. We will present results for 6 and 12 months.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The aim of the present poster is to describe an initial complex case of schizoaffective disorder with other clinical adverse conditions (metabolic disorders) in a young adult male, which gradually went into a positive treatment way from polipharmacy to monoteraphy. His psychiatric history started when he was 25-year-old, he was diagnosed of heroine dependence, hypercholesterolemia and hypertrigliceridemia. In 2000 he had a suicide attempt in a context of depressive mood and delusions. He needed a psychiatric hospitalization for the first time in his life and he received anti-psychotics for the first time too. Drug abuse was detected in that hospitalization (cannabis and alcohol). In 2001 was diagnosed of paranoid schizophrenia. In 2007 the diagnosis was modified to schizoaffective disorder and also was detected high blood pressure, Diabetes Mellitus II and overweight. From 2007 to the present he passed from a scheme treatment composed by four or more psychotropic drugs to monotherapy (only one psychotropic drug, an anti-psychotic), he stayed clinically stable and all his metabolic parameters remained equal or improved.
In recent decades, concern about rabbit welfare and sustainability has increased. The housing system is a very important factor for animal welfare. However, information about how different available housing types for female rabbits affect their health status is scarce, but this is an important factor for their welfare. Hence, the objective of this study was to evaluate the health status of female rabbits in five common housing systems: three different single-housing systems with distinct available surfaces and heights; a single-housing system with a platform; a collective system. Female rabbits in the collective and platform cages had greater cortisol concentrations in hair than those in the single-housing system with no platform. Haptoglobin concentrations and kit mortality rates during lactation were greater for the collective-cage female rabbits. The collective group had more culled females and more lesions than in the other groups. The main reasons for culling in all the groups were reproduction problems and presence of abscesses, and the collective group of females was the most affected. In conclusion, it appears that keeping females together in collective systems negatively affects their health status and welfare, while single-housing systems imply lower kit mortality rates during lactation and cortisol concentrations, and fewer lesions in female rabbits.
Although executive and other cognitive deficits have been found in patients with borderline personality disorder (BPD), whether these have brain functional correlates has been little studied. This study aimed to examine patterns of task-related activation and de-activation during the performance of a working memory task in patients with the disorder.
Sixty-seven DSM-IV BPD patients and 67 healthy controls underwent fMRI during the performance of the n-back task. Linear models were used to obtain maps of within-group activations and areas of differential activation between the groups.
On corrected whole-brain analysis, there were no activation differences between the BPD patients and the healthy controls during the main 2-back v. baseline contrast, but reduced activation was seen in the precentral cortex bilaterally and the left inferior parietal cortex in the 2-back v. 1-back contrast. The patients showed failure of de-activation affecting the medial frontal cortex and the precuneus, plus in other areas. The changes did not appear to be attributable to previous history of depression, which was present in nearly half the sample.
In this study, there was some, though limited, evidence for lateral frontal hypoactivation in BPD during the performance of an executive task. BPD also appears to be associated with failure of de-activation in key regions of the default mode network.
This article undertakes the first systematic examination of Frank’s (1979, 1981, 1987, 1990, 2007b, 2008) claim that Old Norse influence is discernible in the language of Beowulf. It tests this hypothesis first by scrutinizing each of the alleged Nordicisms in Beowulf, then by discussing various theoretical considerations bearing on its plausibility. We demonstrate that the syntactic, morphological, lexical, and semantic peculiarities that Frank would explain as manifestations of Old Norse influence are more economically and holistically explained as consequences of archaic composition. We then demonstrate that advances in the study of Anglo-Scandinavian language contact provide strong reasons to doubt that Old Norse could have influenced Beowulf in the manner that Frank has proposed. We conclude that Beowulf is entirely devoid of Old Norse influence and that it was probably composed ca. 700, long before the onset of the Viking Age.
The single intradermal comparative cervical tuberculin (SICCT) test and post-mortem examination are the main diagnostic tools for bovine tuberculosis (bTB) in cattle in the British Isles. Latent class modelling is often used to estimate the bTB test characteristics due to the absence of a gold standard. However, the reported sensitivity of especially the SICCT test has shown a lot of variation. We applied both the Hui–Walter latent class model under the Bayesian framework and the Bayesian model specified at the animal level, including various risk factors as predictors, to estimate the SICCT test and post-mortem test characteristics. Data were collected from all cattle slaughtered in abattoirs in Northern Ireland in 2015. Both models showed comparable posterior median estimation for the sensitivity of the SICCT test (88.61% and 90.56%, respectively) using standard interpretation and for post-mortem examination (53.65% and 53.79%, respectively). Both models showed almost identical posterior median estimates for the specificity (99.99% vs. 99.80% for SICCT test at standard interpretation and 99.66% vs. 99.86% for post-mortem examination). The animal-level model showed slightly narrower posterior 95% credible intervals. Notably, this study was carried out in slaughtered cattle which may not be representative for the general cattle population.
To evaluate how rearing programmes could affect resources allocation and reproductive performance of primiparous rabbit females, a total of 118 rabbit females were used to evaluate the effects of five rearing feeding programmes on their performance from 1st to 2nd parturition: CAL, fed ad libitum C diet (11.0 MJ digestible energy (DE), 114 g digestible protein (DP) and 358 g NDF/kg dry matter (DM) until 1st parturition; CR, fed ad libitum with C diet until 12 weeks of age and then C diet restricted (140 g/day) until 1st parturition; F, fed ad libitum with F diet (8.7 MJ DE, 88 g DP and 476 NDF/kg DM) until 1st parturition; FC, fed with F diet ad libitum until 16 weeks of age, and C diet ad libitum until 1st parturition; FCF, fed with F diet ad libitum until 16 weeks of age, then C diet ad libitum until 20 weeks and then F diet ad libitum until 1st parturition. From 1st parturition, C diet was ad libitum offered to all the experimental groups until 2nd parturition. CAL females presented lower feed intake than females of F, FC and FCF groups in the 1st week of lactation (on av. −16.6%; P<0.05). During 1st lactation, the perirenal fat thickness change in CAL females was not different from 0 (+0.02 mm), while in the other four groups it increased (on av. +0.44 mm; P<0.05). Plasma of females fed with F diet during rearing (F, FC and FCF) had lower non-esterified fatty acids content than those exclusively fed with C diet (–0.088 and –0.072 mmol/l compared to CAL and CR, respectively; P<0.05). FCF litters had higher weight than F litters at day 21 of lactation (+247 g; P<0.05), but FCF litter had significantly lower weight than FC litters at weaning (+170 g; P<0.05). CR females had the shortest average interval between the 1st and 2nd parturition (49 days) and FCF females the longest (+ 9 days compared to CR; P<0.05). At 2nd parturition, liveborn litters of F females were larger and heavier than litters of FCF females (+2.22 kits and +138 g; P<0.05), probably due to the lower mortality at birth of F litters (–16.5 percentage points; P<0.05). In conclusion, rearing females on fibrous diets seems to increase the ability of primiparous rabbit females to obtain resources, especially at the onset of lactation.
To compare the epidemiology, clinical characteristics, and mortality of patients with bloodstream infections (BSI) caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (ESBL-EC) versus ESBL-producing Klebsiella pneumoniae (ESBL-KP) and to examine the differences in clinical characteristics and outcome between BSIs caused by isolates with CTX-M versus other ESBL genotypes
As part of the INCREMENT project, 33 tertiary hospitals in 12 countries retrospectively collected data on adult patients diagnosed with ESBL-EC BSI or ESBL-KP BSI between 2004 and 2013. Risk factors for ESBL-EC versus ESBL-KP BSI and for 30-day mortality were examined by bivariate analysis followed by multivariable logistic regression.
The study included 909 patients: 687 with ESBL-EC BSI and 222 with ESBL-KP BSI. ESBL genotype by polymerase chain reaction amplification of 286 isolates was available. ESBL-KP BSI was associated with intensive care unit admission, cardiovascular and neurological comorbidities, length of stay to bacteremia >14 days from admission, and a nonurinary source. Overall, 30-day mortality was significantly higher in patients with ESBL-KP BSI than ESBL-EC BSI (33.7% vs 17.4%; odds ratio, 1.64; P=.016). CTX-M was the most prevalent ESBL subtype identified (218 of 286 polymerase chain reaction-tested isolates, 76%). No differences in clinical characteristics or in mortality between CTX-M and non–CTX-M ESBLs were detected.
Clinical characteristics and risk of mortality differ significantly between ESBL-EC and ESBL-KP BSI. Therefore, all ESBL-producing Enterobacteriaceae should not be considered a homogeneous group. No differences in outcomes between genotypes were detected.
Factors influencing early development such as birth weight, nest competition, and the diet received during rearing have been proposed as elements conditioning the future reproductive performance of European rabbit (Oryctolagus cuniculus) females. To evaluate their effects, we followed the life of 1513 females from birth to time of death, culling or censoring (animals alive at a fixed date). Between 0 and 63 days of age 353 females died. From the remaining 1160 females, 864 were chosen based on their birth weight to be transferred from the selection to the production farm. At this farm, 431 females received the control diet (184 g of CP, 381 g of NDF and 11.8 MJ of DE per kg DM), while the other 433 received the fibrous diet (134 g of CP, 436 g of NDF and 10.0 MJ of DE per kg DM). Throughout the rearing period, we checked for the individual live weight and body condition (perirenal fat thickness) at first artificial insemination. Reproductive lifespan was defined as the number of days between the first parturition and the time of death, culling or censoring. Birth weight affected the survival of newborn females during lactation and the presence of a milk spot at birth (related to nest competition) increased the survivability of newborns weighing <45 g (P<0.001). Rearing diet altered the growth curve of females and their body condition at first insemination. The diet also altered the relative risk of death during the rearing period, which was lower among females fed on the fibrous diet (−12.5%; P<0.001). Therefore, a higher number of females fed with this diet reached their reproductive life, directly affecting the productivity measured per housed female. Fatter females at first insemination had smaller litter sizes and a higher risk of being culled than lean ones (P<0.05). In general, the fibrous diet reduced the risk of leaving the herd at early rearing, and both birth weight and perirenal fat thickness affected female’s reproductive lifespan. An excess of fat (positive change in one unit of perirenal fat) at their first insemination represented an increased the risk of death or elimination of 13%.
Genetic selection and nutrition management have played a central role in the development of commercial rabbitry industry over the last few decades, being able to affect productive and immunological traits of the animals. However, the implication of different energy sources in animals from diverse genetic lines achieving such evolutionary success remains still unknown. Therefore, in this work, 203 female rabbits housed and bred in the same conditions were used from their first artificial insemination until their fifth weaning. The animals belonged to three different genetic types diverging greatly on breeding goals (H line, hyper-prolific (n=66); LP line, robust (n=67) and R line, selected for growth rate (n=67), and were assigned to two experimental diets, promoting major differences in energy source (cereal starch or animal fat)). The aims of this work were to: (1) characterize and describe blood leucocyte populations of three lines of rabbit does in different physiological stages during their reproductive period: first artificial insemination, first weaning, second parturition and fifth weaning; and (2) study the possible influence of two different experimental diets on the leucocyte populations in peripheral blood. Flow cytometry analyses were performed on blood samples taken from females at each different sampling stade. Lymphocyte populations at both weanings were characterized by significantly lower counts of total, CD5+ and CD8+ lymphocytes (–19.8, –21.7 and –44.6%; P<0.05), and higher counts of monocytes and granulocytes (+49.2 and +26.2%; P<0.05) than in the other stages. Females had higher blood counts of lymphocytes B, CD8+ and CD25+ and lower counts of CD4+ at first than at fifth weaning (+55.6, +85.8, +57.5, –14.5%; P<0.05). G/L ratio was higher at both weanings (P<0.05), and CD4+/CD8+ ratio increased progressively from the 1AI to the 5 W (P<0.001). Regarding the effect of genetic type in blood leucocyte counts, LP animals presented the highest counts for total, B, CD5+ and CD8+ lymphocytes (+16.7, +31.8, +24.5 and +38.7; P<0.05), but R rabbits showed the highest counts for monocytes and granulocytes (+25.3 and +27.6; P<0.05). The type of diet given during the reproductive life did not affect the leucocyte population counts. These results indicate that there are detectable variations in the leucocyte profile depending on the reproductive stage of the animal (parturition, weaning or none of them). Moreover, foundation for reproductive longevity criteria allows animals to be more capable of adapting to the challenges of the reproductive cycle from an immunological viewpoint.
The specialization process associated with genetic selection could be associated with functional disorders, affecting the reproductive success of females (fitness). We hypothesized that by modulating energy acquisition and allocation of females we could balance productivity and reproductive success. To test this hypothesis, we used 203 rabbit females belonging to three genetic types: H (n=66) maternal line specialized in prolificacy, LP (n=67) generalist maternal line, R (n=70) paternal line specialized in growth rate. We fed each genetic type with two diets specifically designed to promote milk yield (AF) or body reserves recovery (CS). We controlled females between their first and fifth reproductive cycles, recording traits related with productivity and fitness of females. H females fed CS had on average 11.2±0.43 kits with an individual weight of 54±1.2 g at birth and 525±11 g at weaning. Their conception rate when multiparous was 44% and their survival rate at the end of the experiment 30%. When they were fed AF, the individual weight of kits was 3.8 g heavier (P<0.05) at birth and 38 g heavier at weaning (P<0.05), the conception rate when multiparous increased 23 percentage points (P<0.05) and the survival rate at the end of the experiment 25 percentage points (P<0.05). LP females fed CS had on average 10.8±0.43 kits with an individual weight of 52±1.2 g at birth and 578±11 g at weaning. Their conception rate when multiparous was 79% and their survival rate at the end of the experiment 75%. When they were fed AF, it only increased individual weight of kits at weaning (+39 g; P<0.05). R females fed CS had on average 8.4±0.43 kits with an individual weight of 60±1.2 g at birth and 568±11 g at weaning. Their conception rate when multiparous was 60% and their survival rate at the end of the experiment 37%. When they were fed AF, they presented 1.4 kits less at birth (P<0.05) but heavier at birth (+4.9 g; P<0.05) and at weaning (+37 g; P<0.05). Therefore, we observed that genetic types prioritized different fitness components and that diets could affected them. In this sense, seems that more specialized genetic types, were more sensitive to diets than the more generalist type.
To achieve functional but also productive females, we hypothesised that it is possible to modulate acquisition and allocation of animals from different genetic types by varying the main energy source of the diet. To test this hypothesis, we used 203 rabbit females belonging to three genetic types: H (n=66), a maternal line characterised by hyper-prolificacy; LP (n=67), a maternal line characterised by functional hyper-longevity; R (n=79), a paternal line characterised by growth rate. Females were fed with two isoenergetic and isoprotein diets differing in energy source: animal fat (AF) enhancing milk yield; cereal starch (CS) promoting body reserves recovery. Feed intake, weight, perirenal fat thickness (PFT), milk yield and blood traits were controlled during five consecutive reproductive cycles (RCs). Females fed with CS presented higher PFT (+0.2 mm, P<0.05) and those fed AF had higher milk yield (+11.7%, P<0.05). However, the effect of energy source varied with the genetic type and time. For example, R females presented a decrease in PFT at late lactation (−4.3%; P<0.05) significantly higher than that observed for H and LP lines (on av. −0.1%; P>0.05), particularly for those fed with AF. Moreover, LP females fed with AF progressively increased PFT across the RC, whereas those fed with CS increased PFT during early lactation (+7.3%; P<0.05), but partially mobilised it during late lactation (−2.8%; P<0.05). Independently of the diet offered, LP females reached weaning with similar PFT. H females fed with either of the two diets followed a similar trajectory throughout the RC. For milk yield, the effect of energy source was almost constant during the whole experiment, except for the first RC of females from the maternal lines (H and LP). These females yielded +34.1% (P<0.05) when fed with CS during this period. Results from this work indicate that the resource acquisition capacity and allocation pattern of rabbit females is different for each genetic type. Moreover, it seems that by varying the main energy source of the diet it is possible to modulate acquisition and allocation of resources of the different genetic types. However, the response of each one depends on its priorities over time.
Exploring the spatial distribution of the star formation rate (SFR) in nearby galaxies is essential to understand their evolution through cosmic time. With this aim in mind, we use a representative sample that contains a variety of morphological types, the CALIFA Integral Field Spectroscopy (IFS) sample. Previous to this work, we have verified that our extinction-corrected Hα measurements successfully reproduce the values derived from other SFR tracers such as Hαobs + IR or UVobs + IR (Catalán-Torrecilla et al. 2015).
Now, we go one step further applying 2-dimensional photometric decompositions (Méndez-Abreu et al. (2008), Méndez-Abreu et al. (2014)) over these datacubes. This method allows us to obtain the amount of SFR in the central part (bulge or nuclear source), the bar and the disk, separately. First, we determine the light coming from each component as the ratio between the luminosity in every component (bulge, bar or disk) and the total luminosity of the galaxy. Then, for each galaxy we multiply the IFS datacubes by these previous factors to recover the luminosity in each component. Finally, we derive the spectrum associated to each galaxy component integrating the spatial information in the weighted datacube using an elliptical aperture covering the whole galaxy.
2D photometric decomposition applied over 3D datacubes will give us a more detailed understanding of the role that disks play in more massive galaxies. Knowing if the disks in more massive SF galaxies have on average a lower or higher level of star formation activity and how these results are affected by the presence of nuclear bars are still open questions that we can now solve. We describe the behavior of these components in the SFR vs. stellar mass diagram. In particular, we highlight the role of the disks and their contribution to both the integrated SFR for the whole galaxy and the SFR in the disk at different stellar masses in the SFR vs. stellar mass diagram together with their relative position to the star forming Main Sequence.
ST131 Escherichia coli is an emergent clonal group that has achieved successful worldwide spread through a combination of virulence and antimicrobial resistance. Our aim was to develop a mathematical model, based on current knowledge of the epidemiology of ESBL-producing and non-ESBL-producing ST131 E. coli, to provide a framework enabling a better understanding of its spread within the community, in hospitals and long-term care facilities, and the potential impact of specific interventions on the rates of infection. A model belonging to the SEIS (Susceptible–Exposed–Infected–Susceptible) class of compartmental models, with specific modifications, was developed. Quantification of the model is based on the law of mass preservation, which helps determine the relationships between flows of individuals and different compartments. Quantification is deterministic or probabilistic depending on subpopulation size. The assumptions for the model are based on several developed epidemiological studies. Based on the assumptions of the model, an intervention capable of sustaining a 25% reduction in person-to-person transmission shows a significant reduction in the rate of infections caused by ST131; the impact is higher for non-ESBL-producing ST131 isolates than for ESBL producers. On the other hand, an isolated intervention reducing exposure to antimicrobial agents has much more limited impact on the rate of ST131 infection. Our results suggest that interventions achieving a continuous reduction in the transmission of ST131 in households, nursing homes and hospitals offer the best chance of reducing the burden of the infections caused by these isolates.
Traditional laboratory studies on dust-ice systems have proved how the nature of the dust surface significantly affects ice structure and reactivity. Although the surface composition effects have been widely studied recently, no attention has been paid to the dust sizes. We show how dust the grains size and topography, as well as their composition, affects their interaction with light and the morphology of water ice mantles on top of them.
Amorphous solid water (ASW) is of great importance in astrochemistry as it has been detected in star forming regions, comets, and cold solar-system objects. A key property of ASW is its porous nature (with the extent of porosity reflecting the formation and growth conditions) and the subsequent pore collapse when the ice is heated. If interstellar ices are porous there are huge implications to both the process of planet formation and the budgets of molecular gas in the solid and gas phases. It is therefore vital to understand ASW porosity over astronomically relevant conditions in order to effectively model its potential effects on these processes.
Our aim is to study the Star Formation Rate (SFR) by galaxy components such as bulges, bars and disks in a representative sample of nearby galaxies. A 2-dimensional (2D) photometric decomposition approach (GASP2D) is used to obtain these components. The availability of IFS data for the CALIFA galaxies makes possible to go one step further as we can apply the previous decompositions over 3D datacubes to disentangle the spatial distribution of the SFR over different components free from the limitations associated to narrow-band imaging.
Chamarito lamb was recognized as a quality brand in Spain in April 2010 and this meat is highly appreciated in the local market, but little is known about how a short fattening period may affect final product quality. Twenty lambs, ten from the Ternasco category and ten from the suckling lamb category, were slaughtered and their carcass characteristics compared. All animals were weighed at birth, weaning and before slaughter, and average daily gain was calculated. Cold carcasses were weighed and bruising score, carcass conformation and carcass fatness were noted. The left back of each carcass was separated for dissection. The meat pH, cooking and thawing losses, texture, colour and fatty acid composition were measured on M. longissimus samples. Production traits and meat quality variables were analysed fitting a one-way model with the fixed effect of mean lamb age at harvest. The conformation and degree of fatness of Ternasco-type lambs was not significantly different from suckling lambs but the pH values 24.00 hours post-mortem in muscle (pHult) of the former was slightly higher. The fatty acid profile of suckling lambs was more suitable for a healthy human diet.