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Unlike well-known global patterns of plant species richness along altitudinal gradients, in the mountainous areas of the Brazilian Caatinga, species richness and diversity reach their maxima near mountain tops. The causes of this unusual pattern are not well understood, and in particular the role of edaphic factors on plant community assembly along these gradients has not been investigated. Our goal was to assess the role of edaphic factors (fertility and soil texture) on plant community composition and structure on two mountains of the Brazilian semi-arid region. In 71 plots (Bodocongó site, twenty-one 200-m2 plots, 401–680 m asl; Arara site, fifty 100-m2 plots, 487–660 m asl) we recorded 3114 individuals representing 61 plant species; in addition, at each plot we collected composite soil samples from 0–20 cm depth. Significant altitude-related changes were observed both for community structure and composition, and edaphic variables. A canonical correspondence analysis allowed the distinction of two groups of plots according to species abundances, indicating a preferential habitat distribution of species depending both on altitude and soil variables. Although soil fertility was lowest at the highest altitudes, these areas had high richness and diversity. Conversely, the more fertile foothills were characterized by the dominance of generalist pioneer species. Despite the relatively short altitudinal range that characterizes the studied mountains, this study elucidates the role of edaphic factors on the floristic composition and species richness patterns on the mountains of the Brazilian semi-arid region.
This paper proposes an approach for the high-level programming of co-designed robots that reduces programming complexity. Particularly, the work presented focuses on the programming framework of an intelligent system, based on the IEEE Standard Ontologies for Robotics and Automation, which allows users the automatic design of robots and the automatic implementation of controllers in the Robot Operating System (ROS). In our approach, the co-designed robot functionalities are automatically translated into visual programming blocks allowing non-expert users an easy robot programming by means of a visual programming language. Several robot configurations and three case studies are provided as a proof of concept. The validation, in terms of usability, of the framework has been carried out with inexperienced users showing promising results.
Estuarine habitats are major nurseries for the European flounder Platichthys flesus, with different year classes sharing food and space resources. Hence, an understanding of feeding strategies that optimize resource use and maintain carrying capacity is fundamental for sustainable and successful ecosystem management. The main feeding areas of juvenile European flounder (including 0-group and 1-group age classes) in the Lima estuary (northern Portugal) nursery ground were investigated by integrating stomach content analyses with stable isotopic values (δ13C and δ15N) and fish condition indices (Fulton K and RNA:DNA ratio). The 0-group flounder that were associated with the upstream section of the estuary presented the lowest δ13C value (−25.58 ± 1.86‰), while 1-group flounder exhibited a higher δ13C value (−22.59 ± 2.51‰), indicating use of the more saline areas of the estuary (lower and middle sections). The two age groups did not differ in terms of δ15N (0-group: 13.93 ± 0.29‰; 1-group: 13.50 ± 0.96‰), indicating similar trophic levels. The low salinity upper estuary was the main feeding area of 0-group flounder (74%), while 1-group flounder fed along the estuary both upstream (52%) and downstream (48%). Juvenile flounder showed high individual condition based on the Fulton K index (0-group: 1.05 ± 0.08; 1-group: 1.07 ± 0.05) and RNA:DNA (0-group: 1.70 ± 0.70; 1-group: 1.41 ± 0.47). These indices deal with fish health, and hence indicate nursery habitat quality. It is concluded that in this temperate nursery habitat, different feeding strategies sustained the condition of the European flounder juveniles, compared with other flounder populations.
We consider Stavskaya’s process, which is a two-state probabilistic cellular automaton defined on a one-dimensional lattice. The state of any vertex depends only on itself and on the state of its right-adjacent neighbour. This process was one of the first multicomponent systems with local interaction for which the existence of a kind of phase transition has been rigorously proved. However, the exact localisation of its critical value remains as an open problem. We provide a new lower bound for the critical value.
Implementation of genome-scale sequencing in clinical care has significant challenges: the technology is highly dimensional with many kinds of potential results, results interpretation and delivery require expertise and coordination across multiple medical specialties, clinical utility may be uncertain, and there may be broader familial or societal implications beyond the individual participant. Transdisciplinary consortia and collaborative team science are well poised to address these challenges. However, understanding the complex web of organizational, institutional, physical, environmental, technologic, and other political and societal factors that influence the effectiveness of consortia is understudied. We describe our experience working in the Clinical Sequencing Evidence-Generating Research (CSER) consortium, a multi-institutional translational genomics consortium.
A key aspect of the CSER consortium was the juxtaposition of site-specific measures with the need to identify consensus measures related to clinical utility and to create a core set of harmonized measures. During this harmonization process, we sought to minimize participant burden, accommodate project-specific choices, and use validated measures that allow data sharing.
Identifying platforms to ensure swift communication between teams and management of materials and data were essential to our harmonization efforts. Funding agencies can help consortia by clarifying key study design elements across projects during the proposal preparation phase and by providing a framework for data sharing data across participating projects.
In summary, time and resources must be devoted to developing and implementing collaborative practices as preparatory work at the beginning of project timelines to improve the effectiveness of research consortia.
The co-infection between visceral leishmaniasis (VL) and human immunodeficiency virus (HIV) has increased in several countries in the world. The current serological tests are not suitable since they present low sensitivity to detect the most of VL/HIV cases, and a more precise diagnosis should be performed. In this context, in the present study, an immunoproteomics approach was performed using Leishmania infantum antigenic extracts and VL, HIV and VL/HIV patients sera, besides healthy subjects samples; aiming to identify antigenic markers for these clinical conditions. Results showed that 43 spots were recognized by antibodies in VL and VL/HIV sera, and 26 proteins were identified by mass spectrometry. Between them, β-tubulin was expressed, purified and tested in ELISA experiments as a proof of concept for validation of our immunoproteomics findings and results showed high sensitivity and specificity values to detect VL and VL/HIV patients. In conclusion, the identified proteins in the present work could be considered as candidates for future studies aiming to improvement of the diagnosis of VL and VL/HIV co-infection.
Nowadays several authors defend the existence of an obsessive-compulsive (OC) spectrum in which eating disorders (ED), especially anorexia nervosa, would be include. We investigated the presence of OC symptoms in bulimic and anorexic patients and its relationships with personality traits.
The Maudsley Obsessive Compulsive Questionnaire (MOCQ) and the revised version of the Temperament and Character Inventory (TCI-R) were administered to patients and healthy controls.
Patients show higher scores than controls in the global punctuation of de MOCQ, and in the checking and doubt subscales. Cases also score higher in harm avoidance (dimension associated with personality disorders of cluster C) and in its subscale anticipatory worry. No differences were found between patients subgroups.
Restricting Anorexia Nervosa (RAN, n = 21)
Binging-Purging Anorexia Nervosa (BPAN, n = 29)
Bulimia Nervosa (BN, n = 34)
Control (C, n = 52)
RAN, BPAN, BN > C
Checking subscale (MOCQ)
BPAN, BN > C
RAN, BPAN, BN > C
Harm avoidance (TCI-R)
BPAN, BN > C
Anticipatory worry vs optimism (TCI-R)
RAN, BPAN, BN > C
Patients present more OC behaviours in comparison with healthy population but measures of obsessivity do not differ between the types of ED. Traits of personality characteristically associated to cluster C and to anxiety disorders seem to be also common features. These results do not support a separated classification of RAN into the OC spectrum.
To determine the clinical profile of patients diagnosed of delusional disorder (DD) admitted to a psychiatric ward.
Retrospective chart review of inpatients with diagnoses of delusional disorder (DD) according ICD-10 criteria admitted to a psychiatric ward (Hospital de Conxo, Santiago de Compostela) between January 1998 and December 2008. Sociodemographic and clinical variables were collected, with special attention to comorbidity and presumed risk factors.
The sample consisted in 56 inpatients (30 women, mean age 54 ± 11). 64.3% were single including never married (33.9%), divorced, separated and widowed and 33.9% lived alone. The most frequent type of DD was persecutory (67%) followed by mixed type (16%). 16.1% presented hallucinations (most frequent auditory). In comparison with the other types, patients with persecutory delusions usually lived alone (p < 0.05). Most frequent comorbidities were substance abuse and affective disorders. Familiar background of psychoses was recorded in 21.4% and history of emigration in 12.5%. 5.4% suffered deafness. During the period studied 53.6% were admitted two or more times. After the most recent admission 32.1% were on depot antipsychotic.
In concordance with other previous reports, DD seemed to be more prevalent in women in middle or late adulthood and persecutory were the most frequent delusions. In our sample, most patients were not married and high prevalence of family antecedents of psychoses was found. It could be related with its hospital origin; then it could be hypothesized living alone and having familiar background of psychoses to be risk factors of hospitalization.
The aim of this study is to assess the personality traits in a sample of Spanish anorexic and bulimic outpatients.
The revised version of the Temperament and Character Inventory was administered to 76 women attended in an Eating Disorders Unit and to 46 healthy controls. Both groups were matched by gender, age and instruction.
Diagnoses in the sample were distributed as follows: bulimia nervosa (BN) 33, binging-purging type anorexia nervosa (BPAN) 23 and restricting anorexia nervosa (RAN) 18. RAN patients were significantly younger (21.6 vs. 26.3 p < 0.01). Differences in the harm avoidance, persistence and selfdirectedness subscales of the TCI were found (see table).
BPAN, BN > C
RAN > C
C > RAN, BPAN, BN
In concordance with previous reports, compared with healthy controls, patients show lower scores in self-directedness. Persistence seems to be associated with restricting behaviours, whereas harm avoidance with binging and purging. RAN trends to have low scores in novelty seeking items and BN shows lower reward dependence, but this differences are not statistically significant, perhaps because of sample size.
To compare the efficacy and safety of the intramuscular formulations of ziprasidone and haloperidol in treating agitation in schizophrenic patients attended in an emergency room.
Consecutive patients were alternatively assigned to receive 20 mg of IM ziprasidone or 10 mg of IM haloperidol. Efficacy measures were improvement in Behavioral Activity Rating Scale (BARS), in the sum of five items of the Positive and Negative Syndrome Scale that focused on agitation (PANSS-A) and scores on the Clinical Global Impression improvement scale (CGI-I), obtained 45 minutes and 2 hours after the IM medication. Tolerability assessments included changes in ECG, monitoring of vital signs and register of adverse events.
Finally 18 patients (13 men, mean age 40.8 ±10.2) were included in the analysis of data. At arrival in the emergency room, there were no differences between ziprasidone (Z) and haloperidol (H) groups in age, mean QTc length, mean BARS and mean PANSS-A scores. Analyzing the global sample there was an improvement in agitation scores. No significant differences were found between the groups in change of BARS and PANSS-A scores, in CGI-I scores or in the variation of the length of QTc interval at two hours. No serious adverse events were reported.
In spite of the small sample size, both treatments ziprasidone IM and haloperidol IM seems to be similarly effective for the management of psychotic agitation in the emergency room. Both were well tolerated. Lengthening of QTc interval due to ziprasidone IM had not been found in our sample.
To explore the relationship between symptomatic and functional outcomes in adults (age 18-65 years) with ADHD during open label treatment with PR OROS MPH.
Post hoc analyses of a 7-week open-label extension (OLE) (N=370) of a 5 week, placebo controlled double-blind study (DB) which explored safety, efficacy, functional and quality of life outcomes in subjects with a diagnosis of ADHD (DSM-IV). Medication was flexibly dosed (18-90 mg/day) and adjusted individually to best effect during OLE. Regression analyses were performed on the change from DB baseline at OL endpoint in functionality and quality of life as measured by the Sheehan Disability Scale (SDS) and Quality of Life (Q-LES-Q). Baseline score, country, randomization group, sex, change from baseline in CAARS Hyperactivity / Impulsivity, CAARS Inattention and CGI-S at DB endpoint were included as covariates in the analyses.
337 / 370 patients completed the 7-week open label treatment. Improvement on CAARS Hyperactivity / Impulsivity at DB endpoint was significantly related with improvement in SDS “work”, “social life”, “family life” (at least p< 0.005) and “total score” as well as quality of life (p< 0.05) at the end of open label treatment. Change in CGI-S and CAARS Inattention at DB endpoint vs. DB baseline were not related with improvements in any of the functional or quality of life scales at OL endpoint (p>0.05).
These results indicate that improvement in daily functioning and QOL under active treatment may be particularly related to improvement in hyperactivity symptoms.
Adult attention deficit hyperactivity disorder (ADHD) has a prevalence up to 4% of the general adult population, however in Spain adult ADHD is underdiagnosed. Screening instruments can help clinicians to detect adult ADHD. The World Health Organization Adult ADHD Self-Report Scale-Version 1.1 (ASRS v1.1) is a 6-question scale designed to screen for adult ADHD.
A validation of Spanish version of the ASRS v1.1 was performed.
A case control study was carry out (adult ADHD vs non ADHD) in the Adult ADHD Program of the Hospital Universitari Vall d'Hebron (Barcelona). ADHD evaluation was performed using Conners Adult ADHD Diagnostic Interview for DSM-IV (CAADID-Part II) and the diagnosis was compared with the ASRS v1.1 responses. Logistic regression study was made to evaluate the sensitivity, specificity, positive and negative predictive values (PPV and NPV). Kappa coefficient of classification accuracy and area under curve (AUC) were calculated.
Sample consisted of 90 adult ADHD and 90 controls. Average age was 31.6 (SD=10.09) and 57.8% of subjects were men (there were no significant differences between the two groups). Logistic regression analysis showed that the score model proposed by the authors of scale is significant (c2 =129.36, p=.0005): Sensitivity (82.2%), specificity (95.6%), PPV (94.8%), NPV (84.3%), Kappa coefficient 0.78 and AUC 0.89.
The Spanish version of the ASRS v1.1 6-question shows adequate psychometric characteristics and it is a valid scale to screen ADHD for adults in a clinical setting.
Immigration to Spain is a recent but rapidly growing fenomena. The prevalence of psychiatric disorders in the immigrants relative to natives is an inconclusive theme, given that several studies have found contradictory results.
This study presents sociodemographic characteristics and the prevalence of mood disorders (detected with MINI) of 842 adults (411 Latinos and 431 Natives), attending primary care in the greater Barcelona metropolitan area.
Most of the sample was female (n=591; 70.2%), the mean age was 34.7 (±9.8) years, range 18-65. Significant (p< 0,001) differences were found between the two groups in: scholarization, housing, work status, income and percived social network.
The prevalence of actual major depresssive disorder (MDD) was 12.7% in the total sample, with a higer prevalence in the Latinos (n=68; 16.5%) than Natives (n=39; 9.0%); p=0.001 X2=10.57.There was no difference in total prevalences of other mood disorders between the two groups. Analysis -through logistic regression- of only those patients with complete data, (n=613; 307 Latinos and 306 Natives) showed that the probability of MDD was higer in Latinos than in Native patients (OR= 2.4; 95% CI= 1.5-4.0). After adjusting for gender and all the significantly different variables, the higer risk of MDD in Latinos disappeared (OR= 1.3; 95% CI= 0.7-2.4).
From these data we can conlude that the relation between immigrant status and depression is not direct but rather mediated by disadvantaged social conditions. In further similar studies social variables should be considered.
Attention Deficit Hyperactivity Disorder (ADHD)presents high levels of life-long comorbidity. Several studies demonstrate an elevated coocurrence between ADHD and Substance Use Disorder (SUD) as well as personality disorders.
The objective of this poster is to demonstrate differential characteristics between ADHD with SUD patients versus ADHD without SUD, in relation to Axis II comorbidity, ADHD symptoms severity and childhood behavioural disorders (conduct disorder and oppositional defiant disorder).
Another objective is to identify differences in the prevalence of SUD relative to gender and ADHD subtype (Inattentive, Hyperactive/Impulsive and Combined).
This will be done using a comparative-descriptive study that was carried out with a sample of 125 adults diagnosed with ADHD using the CAADID in the Adult ADHD Integral Programme (PIDAA) of Vall d'Hebron Universitari Hospital; 53 subjects presented associated SUD (DSM-IV). All the subjects were evaluated with ADHD Rating Scale, SCID-I, SCID-II and K-SADS.
Relative to ADHD group, subjects ADHD with SUD subjects showed higher comorbidity with Axis–II Disorders, especially with antisocial, schizoid and paranoid personality disorders, as well as major prevalence of conductual disorder and oppositional defiant disorder in childhood. There were no significant differences respect to ADHD symptoms severity nor ADHD subtype between both groups. A major proportion of men were observed in ADHD with SUD group compared to ADHD patients.
Prospective, randomized, two-arm, parallel assignment. 150 individuals diagnosed with major depression disorder (MDD) according to DSM-IV-TR criteria, taking combined therapy in doses considered appropriate for at least 9 months, without showing clinical remission, defined as having an HAMD17 total score ≤ 7, attending the out-patient psychiatry clinic, were initially screened through an interview with a psychiatrist. Those meeting study criteria were randomized to one of two groups: control and aerobic exercise. The study protocol was approved by the Institutional Review Board. All participants provided written informed consent. Study protocol Exercise group: individuals were assigned moderate intensity exercise, in addition to their usual pharmacological therapy. Control group: individuals who were not assigned any exercise and remained taking their usual pharmacological therapy. Both groups maintained the pharmacological therapy unchanged during the 12 week study period. All participants were evaluated at baseline (time 0: before starting the physical activity program), and at 4, 8 and 12 weeks for depressive symptoms, functional assessment and Quality of Life.
Results show that participants in the exercise group improved their quality of life parameters, suggesting that exercise could be an effective therapeutic adjuvant for non-remitted MDD patients.
Impulsive behaviours (impulse control deficit) and compulsive behaviours (over control) have been considered at the core of different disorders, but patients often present with mixed features of impulsive and compulsive behaviours (i.e. patients with OCD and borderline personality disorder). Therefore, a clinical spectrum from impulsivity to compulsivity could exist, in which obsessive compulsive disorder (OCD) and impulsive personality disorders (borderline personality disorder, antisocial personality disorder…) would be the endpoints.
Regarding treatment, SSRI have demonstrated high efficacy in the treatment of both impulsive and obsessive-compulsive symptoms. On the other hand, topiramate has been described as an effective agent in treating impulsive behavior.
The aim of this study is to test the hypothesis that coadjuvant treatment with SSRI and topiramate would improve the outcome of patients with comorbid OCD and impulsive behaviour disorders.
We will describe two clinical cases admitted to our Psychiatric Hospitalization Unit. Case 1 is a 39 years old female diagnosed with OCD, borderline personality disorder and alcohol dependence and case 2 is a 38 years old male with OCD, mixed personality disorder and cocaine abuse.
Treatment with topiramate (range dosage: 250-400 mg/daily) as well as SSRI (paroxetine 40 mg/daily- case 1; sertraline 200 mg/daily-case 2) improved affective instability and impulsive symptoms in both patients. Topiramate was well tolerated without important side effects.
Topiramate could be an interesting alternative in the coadjuvant treatment of OCD with impulsive features.
Acute coronary syndromes (ACS) are a major cause of morbidity and mortality in western industrialized countries and account for disability and loss of productivity. Type D personality and depression are established psychosocial factors with a negative impact on prognosis following acute events.
We evaluated 65 patients admitted to a coronary unit with ACS regarding type D personality (DS-14), depression (BDI-II, HADS), anxiety (HADS), clinical depression (clinical interview following DSM-IV-TR criteria) and quality of life (SF-36). SPSS 12.0 was used for statistical analysis and significance considered for p< 0.05.
We found that 38.5% of patients had type D personality and divided the sample into two groups. No significant differences were found regarding social and demographic factors but differences were found regarding diagnosis on admission: type D patients had more AMI with ST elevation (p< 0.05). Type D patients had significantly higher scores in depression and anxiety scales of the HADS (p< 0.01) and worse quality of life in most SF-36 subscales (p< 0.01). There was a negative and significant correlation between the HADS and all the SF-36 subscales, strongest in the mental health subscale (p< 0.01).
Type D patients have higher indices of anxiety and depression and worse quality of life when compared with other patients, and constitute a high risk group of worse prognosis. Our results also suggest differences between groups regarding the type of acute event but these results require further confirmation.
Musical hallucinations are a rare phenomenon in clinical practice. The purpose of this study was to analyze the clinical spectrum of musical hallucinations.
We analysed demographic and clinical features of cases published in English, Italian, French or Spanish between 1991 and 2006 registered in MEDLINE, including three of our own cases. The cases were separated into four groups according to their main diagnoses (hearing impairment; psychiatric disorder; neurological disorder; toxic or metabolic disorder).
115 patients with musical hallucinations were included, of which 63.5% were female. The mean age was 57,25 years. Main diagnoses were: psychiatric disorder (46.1%; schizophrenia 30.4%), neurological disorder (21,7%), hearing impairment (17,4%), toxic or metabolic disorder (12.2%) and 2.6% other diagnoses.
61.7% patients presented simple diagnoses while 36.5% presented two or more diagnoses. 2.1% of patients didn't receive any diagnoses. 35.7% of patients and 60.9% of non psychiatric patients presented hearing impairment.
Both instrumental and vocal were the more frequent musical hallucinations and most of the patients had insight about the abnormality of their perceptions. Another kind of hallucinations was present in 40.9% of patients, auditory hallucinations being the most common. Also, 38,3% of the global sample had abnormalities in brain structural image (MRI, CT).
Musical hallucinations are a heterogeneous phenomenon in clinical practice. published cases describe them as more common in women and in psychiatric and neurological patients. Hearing impairment seem to be an important risk factor in the development of musical hallucinations.
The co-occurence of depression and congestive heart failure (CHF) represents a great challenge and opportunity for those interested in exploring the complex interactions between the brain and the heart. The cumulative effect of these medical conditions has an evident effect on quality of life.
The objective of this study was to evaluate the quality of life and symptoms of depression among a group of 103 adult patients with CHF recruited from an outpatient cardiology practice and determine the factors related to a poor outcome. The challenge was to identify the group of patients who are at risk of suffering from depression and poor quality of life as early as possible and try to provide them appropriate psychiatric treatment.
The results of this study lead us to suggest that an older female patient with a more severe illness (NYHA ≥ II) and renal impairment is at great risk of presenting simultaneously depressive sintomatology and poorer perception of quality of life, thus beeing a strong candidate to a very negative evolution of her cardiac condition.
These findings allow us to define a group of patients that would surely benefit from a closer psychiatric and cardiac management.
The high prevalence of depression, the complexity of managing it and the recent evidence demonstrating that depression is associated with increased morbidity and mortality suggests that is important the development of collaborative and integrative approaches combining the medical expertise and interest of psychiatrists, cardiologists and internists and the involvement of psychologists and social workers.