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Clinical trials (CT) are the main scientific support of the recommendations of pharmacological treatment of patients with schizophrenia. However, CT tend to strengthen the internal validity at the expense of external validity and the ability to generalize the results to the clinical population. For this reason, in recent years have developed large practical clinical trials that expand the inclusion criteria to incorporate as many real patients as possible. The first and most significant of these trials was the CATIE study (Lieberman et al, 2005).
To analyze eligibility for participation in CATIE of patients admitted during 2009 in a psychiatric inpatient unit with a diagnosis of schizophrenia.
A total of 145 patients (27.6% females, mean age 39.6+/−12.8 years), consecutively admitted to an inpatient psychiatric ward with a clinical diagnosis of schizophrenia were assessed to test if they would fulfill criteria for participation in CATIE.
60 (41.4%) patients did not fulfill CATIE inclusion criteria. Mental retardation (n = 22, p < 0.001), absence of informed consent (n = 15, p < 0.001) and refusal to take oral medication (n = 12, p < 0.001) were the main factors responsible for not meeting inclusion criteria.
Meeting the criteria was not significantly related to gender or specific diagnosis.
41.4% of patients admitted to a psychiatric inpatient unit with a diagnosis of schizophrenia did not meet criteria for participation in the CATIE study.
Involuntary admission of mentally ill patients tends to be related to clinical severity and worst therapeutic response.
To evaluate whether there is a relationship between involuntary admission and prescription of two or more antipsychotics (that is, polytherapy) among patients with schizophrenia and other psychosis.
A total of 241 patients (40.2% females, mean age 39.7+/−13.0 years) consecutively admitted during 2009 to a psychiatric inpatient ward with diagnosis of schizophrenia and other psychoses were assessed.
Out of the total sample, 150 (62.2%) patients were on polytherapy, and of the 241 patients 134 (55.6%) were involuntarily admitted. Involuntary admission was unrelated to age (p = 0.335), specific diagnosis (p = 0.452), or length of psychosis (p = 0.234). On the contrary, it was related to gender (61.8% of males vs. 46.4% of females were involuntary, p = 0.018) and to polytherapy/monotherapy prescription (62.0% of patients on polytherapy vs. 45.1% of patients on monotherapy were involuntarily admitted; and 53.3% of voluntary patients vs. 69.4% of involuntary were on polytherapy p = 0.010). After controlling for age, gender, specific diagnosis and length of psychosis the association between involuntary admission and being in polytherapy remained significant (p = 0.047).
Patients involuntarily admitted are more prone to be on antipsychotic polytherapy.
Cortisol-binding globulin (CBG) is an alpha-1-glycoprotein with high affinity for cortiso that could be a potential biological marker of chronic stress, according to several previous studies. In order to examine CBG concentrations in bipolar disorder, we determined serum CBG levels by radioimmunoassay with monoclonal antibodies in a sample of 39 RDC bipolar I patients in remission and 21 healthy age-, sex- and weight-matched control subjects. Only lithium treatment was permitted. Plasma cortisol and serum lithium levels were also determined. Bipolar males showed statistically significant lower serum CBG levels than controls, whereas women showed very similar values. No correlation was found between CBG levels and cortisol or lithium concentrations. It is concluded that CBG levels are affected by chronic affective illness, even during remission periods, at least in bipolar males.
Pharmacological treatment of patients with schizophrenia and other psychoses get scientific backing of its main clinical trials. Methodological guarantees these test tend to strengthen the internal validity of the results at the expense of external validity and the ability to generalize the results to the clinical population. For this reason, and to minimize the shortcomings of external validity while maintaining internal validity, has been promoted in recent years to carry out large clinical trials based on clinical practice. This type of test expands the criteria for inclusion, limiting the exclusion criteria to incorporate as many patients as possible. The first and most significant of these trials was the CATIE trial (Lieberman et al, 2005).
Discuss eligibility patients admitted during the year 2009 in a psychiatric inpatient unit with a diagnosis of schizophrenia for participation in CATIE.
A total of 145 patients (27.6% females, mean age 39.6+/−12.8 years), consecutively admitted to an inpatient psychiatric ward with a clinical diagnosis of schizophrenia or other psychoses were assessed to test if they would fulfill criteria for participation in CATIE.
60 (41.4%) patients did not fulfill CATIE inclusion criteria. Mental retardation (n = 22, p < 0.001), absence of consent (n = 15, p < 0.001) and refusal to take oral medication (n = 12, p < 0.001) were the main factors responsible for not meeting criteria. Meeting the criteria was not significantly related to gender or specific diagnosis.
The 41.38% of patients did not meet criteria for participation in the CATIE study.
Previous studies have reported progressive brain changes and cognitive deficits in early-onset psychosis (EOP). Little is known on the relationship between longitudinal changes in brain structure and neurocognition.
Naturalistic 5-year prospective study comparing frontal gray matter (GM) volume and executive functions in adolescents with a first episode of EOP and a sample of healthy controls at baseline, 2-year and 5-year follow-up.
Thirty-six patients (age at baseline 15.8 ±.7, 66.6% male) and 34 controls (15.4±1.4, 55.9% male) comprised the study sample. Both patients and controls presented with frontal GM loss during the first five years of follow-up. During the first two years, patients presented with significantly greater GM loss than controls in the left (F=9.642, p=0.003) and right frontal lobe (F=7.585, p=0.008), with no significant differences between year 2 and 5. Patients with EOP performed significantly worse in executive tasks than controls in all visits. During the first two years of follow-up, controls, but not patients, presented with a significant improvement in executive functioning (F=7.523, p=0.009), with similar evolution of cognitive functioning between years 2 and 5 in both groups (F=0.908, p=0.346). Changes in frontal GM volume and executive functioning were not significantly correlated within the entire follow-up period.
Over the first two years of illness, patients with EOP show greater frontal GM loss and less improvement in executive functions than expected. This could be a critical period for the development of deficits in EOP, in which more intensive interventions would be warranted.
Recently, several authors have argued in favor of extending the less common clinical phenotype of schizophrenia to a vulnerability phenotype of schizophrenia in the general population. It has been proposed that high levels in any of four different symptom dimensions (affective, psychosis, negative and cognitive) would lead to clinical assessment, identification of correlated symptoms in other dimensions and finally, the diagnosis of schizophrenia. Being so, we would expect to find such a dimensional pattern in the previous diagnoses of schizophrenic patients.
We examined previous contacts of a large cohort of patients diagnosed, according to the International Classification of Diseases (ICD-10), with schizophrenia (n = 26,163) in public mental health centers of Madrid (Spain) from 1980 to 2008. Of those patients, 56.7% received another diagnosis prior to schizophrenia. Non-schizophrenia diagnoses within the category of ‘schizophrenia, schizotypal and delusional disorders’ were common (F2; 40.0%). The other most frequent prior diagnoses were ‘neurotic, stress-related and somatoform disorders’ (F4; 47.3%), ‘mood disorders’ (F3; 41.4%), and ‘disorders of adult personality and behavior’ (F6; 20.8%). We then examined the probability of progression to schizophrenia, considering also time proximity. The strongest associations were between several F2 spectrum diagnoses with schizophrenia. However, some affective disorders (F3x) were also linked with schizophrenia but anxiety (F4) or personality disorders (F6) were not.
Our findings support two of the previously described dimensions (psychotic, affective) in the development of schizophrenia. Several limitations of the dimensional model will be discussed in view of these findings.
For more than 60 years, Colombia experienced an armed conflict involving government forces, guerrillas, and other illegal armed groups. Violence, including torture and massacres, has caused displacement of entire rural communities to urban areas. Lack of information on the problems displaced communities face and on their perceptions on potential solutions to these problems may prevent programs from delivering appropriate services to these communities. This study explores the problems of Afro-Colombian survivors from two major cities in Colombia; the activities they do to take care of themselves, their families, and their community; and possible solutions to these problems.
This was a qualitative, interview-based study conducted in Quibdó and Buenaventura (Colombia). Free-list interviews and focus groups explored the problems of survivors and the activities they do to take care of themselves, their families, and their community. Key-informant interviews explored details of the identified mental health problems and possible solutions.
In Buenaventura, 24 free-list interviews, one focus group, and 17 key-informant interviews were completed. In Quibdó, 29 free-list interviews, one focus group, and 15 key-informant interviews were completed. Mental health problems identified included: (1) problems related to exposure to torture/violent events; (2) problems with adaptation to the new social context; and (3) problems related to current poverty, lack of employment, and ongoing violence. These problems were similar to trauma symptoms and features of depression and anxiety, as described in other populations. Solutions included psychological help, talking to friends/family, relying on God’s help, and getting trained in different task or jobs.
Afro-Colombian survivors of torture and violence described mental health problems similar to those of other trauma-affected populations. These results suggest that existing interventions that address trauma-related symptoms and current ongoing stressors may be appropriate for improving the mental health of survivors in this population.
Santaella-TenorioJ, Bonilla-EscobarFJ, Nieto-GilL, Fandiño-LosadaA, Gutiérrez-MartínezMI, BassJ, BoltonP. Mental Health and Psychosocial Problems and Needs of Violence Survivors in the Colombian Pacific Coast: A Qualitative Study in Buenaventura and Quibdó. Prehosp Disaster Med. 2018;33(6):567–574.
In ewe lambs, acceleration of growth and accumulation of both muscle and fat leads to earlier sexual maturity and better reproductive performance. The next stage in the development of this theme is to test whether these aspects of growth in young ewes affect milk production in their first lactation and the growth of their first progeny. We studied 75 young Merino ewes that had known phenotypic values for depth of eye muscle (EMD) and fat (FAT), and known Australian Sheep Breeding Values for post-weaning weight (PWT) and depths of eye muscle (PEMD) and fat (PFAT). They lambed for the first time at 1 year of age. Their lambs were weighed weekly from birth to weaning at 10 weeks to determine live weight gain and weaning weight. Progeny birth weight was positively associated with live weight gain and weaning weight (P<0.001). The PWT of the mothers was positively associated with birth weight (P<0.01), live weight gain and weaning weight of the progeny (P<0.05); however, these progeny traits were not influenced by EMD, FAT, PEMD, PFAT of the mothers (P>0.05). The PWT of the sire was positively associated with live weight gain (P<0.05) and weaning weight of the progeny (P<0.01). At around day 20 postpartum, we measured milk production and milk composition (fat, protein, lactose, total solids). Milk production was influenced positively by birth type (single or twin; P<0.05) and negatively by birth weight (P<0.05), but not by mother phenotype or genotype, sire genotype of the mother or the sex of the progeny (P>0.05). The concentrations of fat, protein, lactose and total solids in the milk were not affected by the phenotype or genotype of the mothers or of the sires of the mothers, or by the sex of the progeny (P>0.05). We conclude that selection of young Merino ewes for better growth, and more rapid accumulation of muscle and fat, will lead to progeny that are heavier at birth, grow faster and are heavier at weaning. Moreover, milk production and composition do not seem to be affected by the genetic merit of the mother for post-weaning live weight or PEMD or PFAT. Therefore, Merino ewes can lamb at 1 year of age without affecting the production objectives of the Merino sheep industry.
We propose a multi-layer approach to simulate hyperpycnal and hypopycnal plumes in flows with free surface. The model allows to compute the vertical profile of the horizontal and the vertical components of the velocity of the fluid flow. The model can describe as well the vertical profile of the sediment concentration and the velocity components of each one of the sediment species that form the turbidity current. To do so, it takes into account the settling velocity of the particles and their interaction with the fluid. This allows to better describe the phenomena than a single layer approach. It is in better agreement with the physics of the problem and gives promising results. The numerical simulation is carried out by rewriting the multilayer approach in a compact formulation, which corresponds to a system with nonconservative products, and using path-conservative numerical scheme. Numerical results are presented in order to show the potential of the model.
We consider a fractional equation involving the left and right Riemann–Liouville fractional integrals and with Sturm–Liouville boundary-value conditions. We establish the variational structure of the problem and, by using critical-point theory, the existence of an unbounded sequence of solutions is obtained.
In this work we present a multilayer shallow model to approximate the Navier–Stokes equations with the
-rheology through an asymptotic analysis. The main advantages of this approximation are (i) the low cost associated with the numerical treatment of the free surface of the modelled flows, (ii) the exact conservation of mass and (iii) the ability to compute two-dimensional profiles of the velocities in the directions along and normal to the slope. The derivation of the model follows Fernández-Nieto et al. (J. Comput. Phys., vol. 60, 2014, pp. 408–437) and introduces a dimensional analysis based on the shallow flow hypothesis. The proposed first-order multilayer model fully satisfies a dissipative energy equation. A comparison with steady uniform Bagnold flow – with and without the sidewall friction effect – and laboratory experiments with a non-constant normal profile of the downslope velocity demonstrates the accuracy of the numerical model. Finally, by comparing the numerical results with experimental data on granular collapses, we show that the proposed multilayer model with the
-rheology qualitatively reproduces the effect of the erodible bed on granular flow dynamics and deposits, such as the increase of runout distance with increasing thickness of the erodible bed. We show that the use of a constant friction coefficient in the multilayer model leads to the opposite behaviour. This multilayer model captures the strong change in shape of the velocity profile (from S-shaped to Bagnold-like) observed during the different phases of the highly transient flow, including the presence of static and flowing zones within the granular column.
A total of 16 pure-bred Iberian (IB) sows, all of them suckling six piglets, were used, eight of them in each of the two consecutive trials (1 and 2). Daily milk yield and composition were determined weekly over a 34-day lactation period. Within each litter, one piglet at birth and four piglets on day 35 of life were slaughtered. Milk intake per piglet tended to be greater in trial 2 (832 v. 893 g/day; P=0.066), but piglets grew at 168±3.3 g/day, irrespective of the trial. In the IB sow milk, the linoleic (LA) : linolenic (LNA) acid ratio averaged 14.6 and 15.2 in trial 1 and trial 2, respectively. A fivefold increase in piglet body fat content was observed over lactation (P<0.001). Most of this fat (81.4%) was present in the carcass. After 34 days of lactation, whole-body relative content of palmitic, palmitoleic, stearic and oleic acids were very close to those in the milk consumed, suggesting direct deposition. Daily deposition of LA derivatives and of LNA and its derivatives was found to be extremely low (<0.02 g, on average). Moreover, some of the arachidonic acid (ARA) in tissues of the IB piglet at birth disappeared throughout the lactating period. An overall fractional deposition for total fatty acids (FA) was 0.409. Fractional oxidation (disappearance) rates were 0.939 and 0.926 for n-6 and n-3 polyunsaturated FA. The overall rate of disappearance for the major non-essential FA (myristic, palmitic, palmitoleic, stearic and oleic acids), estimated as 1−the overall fractional deposition rate, was 0.546. It is concluded that the high degree of FA unsaturation, high oxidation rate of LA and LNA, and poor synthesis of ARA from LA and of docosahexaenoic acid from LNA found in the suckling piglet might increase the energy cost of whole-body fat accretion, a contributor to the observed low efficiency of use of milk energy for growth.
Nine wheat genotypes, bred for the high-input agronomical conditions of Henan Province (China), were tested under the high-yielding Mediterranean conditions of Spain. Two cultivars widely grown in the zone were included as controls. Crop growth and leaf chlorophyll (Chl) content, leaf stomatal conductance (gs) and canopy temperature (CT) were measured during the crop cycle and stable carbon (C), oxygen (O) and nitrogen (N) isotope compositions (δ13C, δ18O and δ15N) were analysed on different plant parts. The lower yield of the Chinese genotypes compared with the controls was due to fewer grains/unit area, associated with lower tillering and a plant height clearly below the optimal range. Moreover, Chinese wheat exhibited a lower spike fertility index than the controls, and this was associated with a less compact spike structure. The physiological characteristics that were related to better performance under high-yielding Mediterranean conditions consisted of a higher green aerial biomass, particularly during the reproductive stage, together with more favourable water conditions (higher gs and lower CT and δ13C), the capacity to take up water during grain fill (higher δ18O) and a more efficient uptake (lower δ15N) and utilization (lower leaf N and Chl content) of N fertilizer. It is concluded that Chinese genotypes exhibited a low acclimation capacity to the moderate stress typical of the high-yielding Mediterranean conditions.
Piglet body composition at weaning could be a determinant for pig’s viability and may be influenced by factors such as the nutritional management followed during suckling. An experiment was conducted to study whether intermittent suckling (IS) affects body composition at weaning and nutrient and energy retention during a 34-day lactation period in Iberian piglets. Litters were subjected to conventional suckling (CS) or IS (n=10 litters of six piglets per treatment) in two trials. All piglets had ad libitum access to creep feed from day 15 onwards. In IS, piglets were progressively separated from the sow for 6, 8 and 10 h daily during the last week of lactation, whereas in CS piglets had continuous access to their dams. Creep feed intake in litters and BW development of individual piglets were measured throughout the 34-day lactation. Within each litter, both at birth and at weaning (day 35), one piglet was used to assess nutrient retention and body composition by the comparative slaughter approach. During days 29 to 35 of the experiment, daily creep feed intake was greater in IS piglets (IS 124, CS 67 g/piglet, P=0.040), and average daily gain differed significantly between groups (IS 190, CS 150 g/day, P=0.010). BW at weaning was higher in the IS than in the CS piglets (IS 8.19, CS 7.48 kg, P=0.011). Empty-body fat and energy content at weaning were higher in the IS compared with CS litters, as well as fat content in the carcass (P=0.04). The IS treatment did not affect empty-body protein deposition, but significantly increased daily retention of fat, energy, ash and calcium, compared with CS litters (P<0.05). Thus, IS in Iberian piglets seems to enhance feed intake, growth rate and retention of some body components, which may contribute to a higher body fat content at weaning and facilitate the weaning process.
The formation of uranyl peroxide phases was identified as a corrosion product of spent fuel by Hanson et al . The subsequent analysis of this phase showed that metastudtite retained 241Am, 237Np and 239Pu . In this study, the retention of radionuclide Pu4+ and An3+, released from the spent fuel matrix into studtite structure, has been evaluated by the precipitation of studtite from uranyl dissolution with variable concentrations of REE (Th, Nd, Sm and Eu). Three different precipitation conditions parameters were studied: media of synthesis, time of synthesis and REE concentration. Synthesized phases were characterized by XRD and the cell parameter was calculated. The REE incorporation was determined by ICP-MS analysis. The results showed that studtite could incorporate 63% of Th in solution during its precipitation. Changes in the “a” cell parameter were identified. The results suggest that studtite coprecipitated with REE could play a role as a limiting for the REE mobility.
In this paper, a bilayer model is derived to simulate the evolution of a thin film flow over water. This model is derived from the incompressible Navier–Stokes equations together with suitable boundary conditions including friction and capillary effects. The derivation is based on the different properties of the fluids; thus, we perform a multiscale analysis in space and time, and a different asymptotic analysis to derive a system coupling two different models: the Reynolds lubrication equation for the upper layer and the shallow water model for the lower one. We prove that the model verifies a dissipative entropy inequality up to a second-order term. Moreover, we propose a correction of the model – by taking into account the second-order extension for the pressure – that admits an exact dissipative entropy inequality. Two numerical tests are presented. In the first test, we compare the numerical results with the viscous bilayer shallow water model proposed in Narbona-Reina et al. (Comput. Model. Eng. Sci., 2009, Vol. 43, pp. 27–71). In the second test, the objective is to show some of the characteristic situations that can be studied with the proposed model. We simulate a problem of pollutant dispersion near the coast. For this test, the influence of the friction coefficient on the coastal area affected by the pollutant is studied.
The reproductive efficiency of the entire sheep flock could be improved if ewe lambs go through puberty early and produce their first lamb at 1 year of age. The onset of puberty is linked to the attainment of critical body mass, and therefore we tested whether it would be influenced by genetic selection for growth rate or for rate of accumulation of muscle or fat. We studied 136 Merino ewe lambs with phenotypic values for depth of eye muscle (EMD) and fat (FAT) and Australian Sheep Breeding Values at post-weaning age (200 days) for live weight (PWT), eye muscle depth (PEMD) and fat depth (PFAT). First oestrus was detected with testosterone-treated wethers and then entire rams as the ewes progressed from 6 to 10 months of age. Blood concentrations of leptin and IGF-I were measured to test whether they were related to production traits and reproductive performance (puberty, fertility and reproductive rate). In total, 97% of the lambs reached first oestrus at average weight 39.4 ± 0.4 kg (mean ± s.e.m.) and age 219 days (range 163 to 301). Age at first oestrus decreased with increases in values for PWT (P < 0.001), and concentrations of IGF-I (P < 0.05) and leptin (P < 0.01). The proportion of ewe lambs that achieved puberty was positively related with increases in values for EMD (P < 0.01), FAT (P < 0.05) or PWT (P < 0.01), and 75% of the ewe lambs were pregnant at average weight 44.7 ± 0.5 kg and age 263 days (range 219 to 307). Ewe lambs that were heavier at the start of mating were more fertile (P < 0.001) and had a higher reproductive rate (P < 0.001). Fertility and reproductive rate were positively correlated with increases in values for EMD (P < 0.01), FAT (P < 0.05), PWT (P < 0.01) and leptin concentration (P < 0.01). Fertility, but not reproductive rate, increased as values for PFAT increased (P < 0.05). Leptin concentration increased with increases in values for EMD (P < 0.001), FAT (P < 0.001), PWT (P < 0.001), PEMD (P < 0.05) and PFAT (P < 0.05). Many of these relationships became non-significant when PWT or live weight was added to the statistical model. We conclude that selection for genetic potential for growth can accelerate the onset of puberty and increase fertility and reproductive rate of Merino ewe lambs. The metabolic hormones, IGF-I and leptin, might act as a physiological link between the growing tissues and the reproductive axis.
Botulism is a severe neuroparalytic disorder that can be potentially life-threatening. In Barcelona, Spain, no outbreaks had been reported in the past 25 years. However, in September 2011, two outbreaks occurred involving two different families. A rare case of Clostridium baratii which produced a neurotoxin F outbreak was detected in five family members who had shared lunch, and several days before that another family was affected by C. botulinum toxin A which was probably present in homemade pâté.
The lipid content and fatty acid (FA) profile in pig tissues are strongly influenced by genotype and nutrient supply, with implications in meat quality. The de novo lipid synthesis and pattern of FA unsaturation could be an important cause of variation in the overall efficiency of energy utilization among breeds. To test the effects of pig genotype and CP supply on the evolution of back-fat tissue FA profile throughout the growing and finishing stages, 32 Iberian (IB) and Landrace × Large White (LR × LW) barrows were offered one of two diets differing in CP content (13% or 17% as fed). A pair-fed procedure (0.8 × ad libitum intake of IB pigs) was used. Subcutaneous fat samples were taken at the dorso-lumbar region at ∼38, 50, 65, 90 and 115 kg BW. Higher proportions of total monounsaturated FA (MUFA; P < 0.01) and lower proportions of total saturated FA (SFA; P < 0.01 to 0.05) were found in the outer back-fat layer of pigs both at 50 and 115 kg BW. Pig genotype affected the FA composition of both subcutaneous back-fat layers. The proportions of C18:0 and SFA in fat tissue were higher in IB than in LR × LW pigs from 38 to 65 kg BW, especially in the outer layer. In addition, MUFA contents were higher in IB pigs at 115 kg BW in both layers (+5% on average; P < 0.01). Increased proportions of C18:2 n-6 and polyunsaturated FA (PUFA) were found in LR × LW pigs, irrespective of the stage of growth and back-fat layer (P⩽0.02). At 50 kg BW, pigs receiving the high-protein diet presented the highest C18:2 n-6, C18:3 n-3, C20:5 n-3 and PUFA contents. A significant genotype × CP content interaction was observed for C18:3 n-3 because of the increased concentration of this FA in LR × LW pigs when offered the 17% CP diet (P < 0.05). Higher C16:0 and SFA contents (+5%; P = 0.03) were found in pigs offered the 13% CP diet and slaughtered at 115 kg BW. There was a genotype × CP interaction for MUFA concentration because of the higher MUFA content observed in IB pigs offered the highest protein content diet (P = 0.03). Our results suggest that genetic variation in de novo lipid synthesis and pattern of FA unsaturation might contribute to explain differences in back-fat FA profile of IB and LR × LW pigs under identical nutritional management. They could be also relevant to explain the low efficiency of nutrient and energy utilization in the IB pig.