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We propose a stochastic model for claims reserving that captures dependence along development years within a single triangle. This dependence is based on a gamma process with a moving average form of order
$p \ge 0$
which is achieved through the use of poisson latent variables. We carry out Bayesian inference on model parameters and borrow strength across several triangles, coming from different lines of businesses or companies, through the use of hierarchical priors. We carry out a simulation study as well as a real data analysis. Results show that reserve estimates, for the real data set studied, are more accurate with our gamma dependence model as compared to the benchmark over-dispersed poisson that assumes independence.
Patients with Bipolar Affective Disorder have high rates of somatic comorbidity and it's necessary to know the characteristics of these patients to develop preventive and therapeutic strategies.
To describe twelve patients diagnosed with BAD admitted to a Brief Hospitalization Unit.
Evaluation by a questionnaire which recorded sociodemographic data (sex, age, marital status, education, occupation, employment status); medical management indicators (average stay, number of previous admissions and if re-entering during the study); previous treatments (antipsychotics, antidepressants and benzodiazepines); somatic background (presence of cardiovascular risk factors that contrasted with taking blood pressure, BMI calculation, ECG and complete analytical) and consumption of toxic substances.
58.33% are women with a mean age of 41.91 years and 58.33% in single cases. 58.33% has secondary education, although the 41.66% isn’t working.
The average stay of admission is 20.83 days. 50% had between 1 and 4 more admissions and 33.33% re-enters.
25% doesn’t take medications. Of the rest, 77.77% taking neuroleptics, being the most common option with 57.14% treatment with quetiapine. The 88.88% takes mood-stabilizing and the 44.44% benzodiazepines.
No patient has altered the glucose profile. The 8.33% has high blood pressure control and 25% altered lipid profile. The average BMI is 28.64
The 66.66% smoke. The 33.33% consumed alcohol and cannabis on 16.66%.
Patients with BAD have high proportions of cardiovascular risk factors and important consumption of toxic substances. Reflected the impact of the disease in the sociolabour field and the need for many hospital admissions because of the chronic course and poor therapeutic adherence.
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.
The sociodemographic and clinical characteristics of 62 patients, who were consecutively admitted to medical or surgical departments in a general hospital in Barcelona, as a result of attempting suicide by jumping from buildings were investigated. All patients met DSM III criteria for at least one psychiatric diagnosis. The most frequent diagnosis was schizophrenia (40%), followed by depression (24%). The attempts made by depressed patients tended to be more lethal. Most of the schizophrenics presented active psychotic symptoms at the time of attempting suicide.
The aim of this study was to analyze the effectiveness of gabapentin administration to bipolar patients who had an incomplete response to other mood stabilizers.
Subjects and methods
Twenty-two RDC bipolar 1 and II patients were assessed by means of the SADS and entered if they gave their consent to participate. All them had suffered from frequent relapses, subsyndromal features (mostly depressive) and incomplete response to other drugs. They all received open-label increasing doses of gabapentin until clinical response. The patients were assessed through the CGI-BP and a specific questionnaire at baseline and at 12 weeks of follow-up.
Six out of the 22 patients dropped out for various reasons (four because of relapse, one because of side effects and one more because of poor compliance). Eight of the 16 patients that completed the 12-week follow-up showed at least two stages of improvement in the CGI. Using the last observation-carried forward analysis, the improvement was statistically significant for the depression subscale, and apparently related to social functioning, irritability and anxiety. Only one patient dropped out because of intolerance (mild rash). The mean dose of gabapentin was 1,310 mg/day.
Gabapentin may be a useful drug for the add-on treatment of bipolar patients with poor response to other mood stabilizers. Gabapentin may improve depressive residual symptoms such as irritability, social withdrawal or anxiety. These results should be confirmed in randomized clinical trials.
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.
Asenapine is the most recent compound that has been FDA- and EMA-approved for treatment of mania. Its efficacy and safety have been assessed in placebo-controlled trials, but little is known about its performance in routine clinical conditions. In this study, we compared features of patients treated with adjunctive asenapine or other adjunctive antipsychotics and the costs of the treatment.
A combined prospective and retrospective data collection and analysis was conducted from January 2011 to December 2013 following a clinical interview and assessment of manic and depressive symptoms (YMRS, HDRS-17), clinical state (CGI-BP-M), psychosocial functioning (FAST), sexual dysfunction (PRSexDQ) and health resource costs associated with treatment with adjunctive asenapine versus other adjunctive antipsychotics.
Hundred and fifty-two patients from different university hospitals were included. Fifty-three patients received adjunctive asenapine and 99 received other adjunctive antipsychotics concomitantly to mood stabilizers. Considering inpatients, those treated with adjunctive asenapine presented a significantly less severe manic episode (P = 0.001), less psychotic symptoms (P = 0.030) and more comorbid personality disorder (P = 0.002). Regarding outpatients, those treated with adjunctive asenapine showed significantly less severe manic episode (P = 0.046), more previous mixed episodes (P = 0.013) and more sexual dysfunction at baseline (P = 0.036). No significant differences were found in mean total costs per day.
Clinicians tended to use adjunctive asenapine in patients with less severe manic symptoms but more complex clinical profile, including more mixed episodes in the past, concomitant personality disorder, and sexual problems. Treatment with adjunctive asenapine was not associated with higher costs when compared to other options.
Asenapine is the most recent compound that hasbeen FDA- and EMA-approved for treatment of mania. Its efficacy and safety havebeen assessed in placebo-controlled trials, but little is known about itsperformance in routine clinical conditions. The MANACOR study assessed costsassociated with treatment of mania in several hospital settings acrossCatalonia, Spain. As part of the protocol, we compared cost-effectiveness ofasenapine versus other treatment options.
A combined prospective and retrospective datacollection and analysis was conducted from January 2011 to December 2013following a clinical interview and assessment of manic and depressive symptoms(YMRS, HDRS-17), clinical state (CGI-BP-M), psychosocial functioning (FAST),sexual dysfunction (PRSexDQ) and health resource costs associated withtreatment with asenapine versus other antipsychotics.
152 patients from different university hospitalswere included. 53 patients received asenapine and 99 received otherantipsychotics. Considering inpatients (N=117), those treated with asenapinepresented a significantly less severe manic episode (p=0.001), less psychoticsymptoms (p=0.030) and, more comorbid personality disorder (p=0.002). Regardingoutpatients, those treated with asenapine showed significantly less severemanic episode (p=0.046), more previous mixed episodes (p= 0.013) and, moresexual dysfunction at baseline (p=0.036). No significant differences were foundin mean total costs per day.
Non-randomized study design.
Clinicians tended to use asenapine in patientswith less severe manic symptoms but more complex clinical profile, includingmore mixed episodes in the past, concomitant personality disorder, and sexualproblems. Treatment with asenapine was not associated with higher costs when comparedto other options.
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.
Smoking is an addictive and chronic disease. Twenty-four percent of the Spanish population in 2012 smoked daily.
Aims and objectives
To evaluate a smoking cessation program in a Primary Care Center.
Observational, prospective study. We describe an individualized smoking cessation in Plaza del Ejército Health Center (Valladolid). Inclusion criteria: active smoker, ≥ 18 years old and belonging to the Health Center. Exclusion: severe mental illness. Included patients from November 2013 until January2014. Ended in July 2014. Four Medical residents participated, we present the results of one of them. During the first consultation motivational interviewing was conducted, physical examination and treatment was prescribed (cognitive behavioral therapy or drug treatment: varenicline). In subsequent consultations interview and follow-up. Variables: age, gender, pack-years, nicotine dependence (Fagerstrom) and Prochaska and DiClemente phase, weight, treatment used, dropout rate and final withdrawal of snuff.
Eleven patients, mean age 48.18 (13.61), 7 (63.6) women. Comorbidity: 6 (54.5) anxious-depressive pathology, 1 (9.1) dysthymia, 2 (18.2) endocrine pathology and 1 (9.1) respiratory disease. Four (36.4) showed high dependency and 2 (18.2) extreme. Media packages 20.50/year (19,20). Seven (63.6) were in action phase of Prochaska and DiClemente and 2 (18.2) in preparation. Visits range: 1-11. The average was 4.55 (3.64). Three (27.27) patients attended only the first visit. Four (36.4) achieved complete abstinence, 3 (27.27) met maintenance phase. One (9.1) reduced consumption in half. Patients gained average 0.5 kg (2.47).
The results are similar to those reported in other series. Modest dropout rate. No pharmacological treatment was used due to high coexistence of comorbidities, the only patient who used varenicline suffered insomnia. Average age and media packages were superior to other series.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
There are very few comparative controlled trials of risperidone versus olanzapine in manic patients. No previous naturalistic study has compared the efficacy of these two antipsychotics in the natural environment of manic inpatients.
The aim of this retrospective and naturalistic study was to evaluate the efficacy of acute treatment with risperidone vs. olanzapine in Bipolar I manic inpatients.
(1) Patients: the study includes all the inpatients diagnosed with bipolar I manic episode (DSM-IV) who were admitted during the years 2009 to 2014. Patients treated with risperidone and olanzapine concomitantly (n = 6) and patients not treated with risperidone or olanzapine (n = 129) were excluded.
The patients finally included (n = 183) were separated in two groups:
– treated with risperidone (n = 89);
– treated with olanzapine (n = 94).
(2) The Student-T test was used to compare, between the groups, the mean of scores in YMRS and CGI-S scales and the mean of length of stay.
Baseline characteristics were similar between the groups. The majority of patients were also treated with mood stabilizers (46% with lithium and 45% with valproate).
The mean decrease in CGI-S scores from baseline to the day of discharge was significantly (P < 0.003) higher in the risperidone group (−2.81 vs. −2.36). The length of stay was significantly (P < 0.004) lower in the olanzapine group (mean of 23.03 days vs. mean of 30.3).
(1) The CGI-S scores in manic patients treated with risperidone decreased more than in patients treated with olanzapine during admission. (2) The length of stay was significantly lower in patients treated with olanzapine.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Using a nonlinear evolution equation we examine the dependence of the dispersion of directional surface gravity waves on the Benjamin–Feir index (BFI) and crest length. A parameter for describing the deviation between the dispersion of simulated waves and the theoretical linear dispersion relation is proposed. We find that for short crests the magnitude of the deviation parameter is low while for long crests the magnitude is high and depends on the BFI. In the present paper we also consider laboratory data of directional waves from the Marine Research Institute of the Netherlands (MARIN). The MARIN data confirm the simulations for three cases of BFI and crest length.
Euclid is the ESA M2 mission and a milestone in the understanding of the geometry of the Universe. In total Euclid will produce up to 26 PB per year of observations. The Science Archive Systems (SAS) belongs to the Euclid Archive System (EAS) that sits in the core of the Euclid Science Ground Segment (SGS). The SAS is being built at the ESAC Science Data Centre (ESDC), which is responsible for the development and operations of the scientific archives for the Astronomy, Planetary and Heliophysics missions of ESA. The SAS is focused on the needs of the scientific community and is intended to provide access to the most valuable scientific metadata from the Euclid mission. In this paper we describe the architectural design of the system, implementation progress and the main challenges from the data management point of view in the building of the SAS.
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.
Chapter Preview. In this chapter we approach many of the topics of the previous chapters, but from a Bayesian viewpoint. Initially we cover the foundations of Bayesian inference. We then describe the Bayesian linear and generalized regression models. We concentrate on the regression models with zero-one and count response and illustrate the models with real datasets. We also cover hierarchical prior specifications in the context of mixed models. We finish with a description of a semi-parametric linear regression model with a nonparametric specification of the error term. We also illustrate its advantage with respect to the fully parametric setting using a real dataset.
The use of Bayesian concepts and techniques in actuarial science dates back to Whitney (1918) who laid the foundations for what is now called empirical Bayes credibility. He noted that the solution of the problem “depends upon the use of inverse probabilities.” This is the term used by T. Bayes in his original paper (e.g., Bellhouse 2004). However, Ove Lundberg was apparently the first one to realize the importance of Bayesian procedures (Lundberg 1940). In addition, Bailey (1950) put forth a clear and strong argument in favor of using Bayesian methods in actuarial science. To date, the Bayesian methodology has been used in various areas within actuarial science; see, for example, Klugman (1992), Makov (2001), Makov, Smith, and Liu (1996), and Scollnik (2001).
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.