Stochastic modeling of Dalbulus maidis, vector of maize diseases

We developed a simple linear stochastic model for Dalbulus maidis dependent exclusively on temperature, whose parameters were determined from published field and laboratory studies performed at different temperatures. This model takes into account the principal stages and events of the life cycle of this pest, which is vector of maize diseases. We implemented the effect of distributed delays or Linear Chain Trick (LCT) considering a fixed number of sub-stages for egg and nymph stages of Dalbulus maidis in order to accurately represent what is observed in nature. A sensitivity analysis allows us to observe that the speed of the dynamics is sensitive to changes in the development rates, but not to the longevity of each stage or the fecundity, which almost exclusively affect insect abundance. We used our model to study its predictive and explanatory capacity considering a published experiment as a case study. Although the simulation results show a behavior qualitatively equivalent to that observed in the experimental results it is not possible to explain accurately the magnitude, nor the times in which the maximum abundances of second-generation nymphs and adults are reached. Therefore, we evaluated three possible scenarios for the insect that allow us to glimpse some of the advantages of having a computational model in order to find out what processes, taken into account in the model, may explain the differences observed between published experimental results and model results. The three proposed scenarios, based on variations in the parameterized rates of the model, can satisfactorily explain the experimental observations. We observed that in order to better simulate the experimental results it is not necessary to modify fecundity or mortality rates. However, it is necessary to accelerate the average development rates of our model by 20 to 40 %, compatible with extreme values of the rates close to the upper edges of the confidence bands of our parameterization rate curves, according to insects with faster development rates already reported in literature.

Small area variations in non-affective first-episode psychosis: the role of socioeconomic and environmental factors

BACKGROUND

There is strong evidence supporting the association between environmental factors and increased risk of non-affective psychotic disorders. However, the use of sound statistical methods to account for spatial variations associated with environmental risk factors, such as urbanicity, migration, or deprivation, is scarce in the literature.

METHODS

We studied the geographical distribution of non-affective first-episode psychosis (NA-FEP) in a northern region of Spain (Navarra) during a 54-month period considering area-level socioeconomic indicators as putative explanatory variables. We used several Bayesian hierarchical Poisson models to smooth the standardized incidence ratios (SIR). We included neighborhood-level variables in the spatial models as covariates.

RESULTS

We identified 430 NA-FEP cases over a 54-month period for a population at risk of 365,213 inhabitants per year. NA-FEP incidence risks showed spatial patterning and a significant ecological association with the migrant population, unemployment, and consumption of anxiolytics and antidepressants. The high-risk areas corresponded mostly to peripheral urban regions; very few basic health sectors of rural areas emerged as high-risk areas in the spatial models with covariates.

DISCUSSION

Increased rates of unemployment, the migrant population, and consumption of anxiolytics and antidepressants showed significant associations linked to the spatial-geographic incidence of NA-FEP. These results may allow targeting geographical areas to provide preventive interventions that potentially address modifiable environmental risk factors for NA-FEP. Further investigation is needed to understand the mechanisms underlying the associations between environmental risk factors and the incidence of NA-FEP.

Culturally Responsive Language Assessment Through a Verbal Operant Experimental Analysis

Speakers from culturally and linguistically diverse backgrounds are disproportionately identified with communication deficits, a defining feature of autism spectrum disorder. The present case study demonstrates the use of a verbal operant experimental analysis as a measure of functional language. This analysis allows a bilingual participant to switch freely between responses in Spanish and English. Prior to receiving services, a pretreatment functional analysis of verbal behavior is used to identify the speaker's present level of functional language and develop an individualized treatment plan for shaping a more complex verbal repertoire. The benefits of culturally responsive early intensive behavioral intervention are demonstrated by a posttest evaluation 5 months later. Functional analyses of language are shown to be a verbal-community-centered approach to observing and measuring the verbal behavior of speakers from diverse backgrounds.

Parieto-Occipital Injury on Diffusion MRI Correlates with Poor Neurologic Outcome following Cardiac Arrest

BACKGROUND AND PURPOSE

MR imaging of the brain provides unbiased neuroanatomic evaluation of brain injury and is useful for neurologic prognostication following cardiac arrest. Regional analysis of diffusion imaging may provide additional prognostic value and help reveal the neuroanatomic underpinnings of coma recovery. The purpose of this study was to evaluate global, regional, and voxelwise differences in diffusion-weighted MR imaging signal in patients in a coma after cardiac arrest.

MATERIALS AND METHODS

We retrospectively analyzed diffusion MR imaging data from 81 subjects who were comatose for >48 hours following cardiac arrest. Poor outcome was defined as the inability to follow simple commands at any point during hospitalization. ADC differences between groups were evaluated across the whole brain, locally by using voxelwise analysis and regionally by using ROI-based principal component analysis.

RESULTS

Subjects with poor outcome had more severe brain injury as measured by lower average whole-brain ADC (740 [SD, 102] × 10-6 mm2/s versus 833 [SD, 23] × 10-6 mm2/s, P < .001) and larger average volumes of tissue with ADC below 650 × 10-6 mms/s (464 [SD, 469] mL versus 62 [SD, 51] mL, P < .001). Voxelwise analysis showed lower ADC in the bilateral parieto-occipital areas and perirolandic cortices for the poor outcome group. ROI-based principal component analysis showed an association between lower ADC in parieto-occipital regions and poor outcome.

CONCLUSIONS

Brain injury affecting the parieto-occipital region measured with quantitative ADC analysis was associated with poor outcomes after cardiac arrest. These results suggest that injury to specific brain regions may influence coma recovery.

Rapid and sustainable self-questionnaire for large-scale psychological screening in pandemic conditions for healthcare workers

Background

The pandemic caused by a coronavirus (COVID-19) has shocked healthcare systems worldwide. However, the psychological stressors remain unclear. The objective of this study was to assess the impact of a major pandemic on healthcare workers. We hypothesized that exposure to the virus would be the primary cause of psychological stress perceived by healthcare workers.

Methods

A national cross-sectional study conducted via an online questionnaire was distributed between April 9 and April 19, 2020 with a non-probabilistic sample technique. A structural equation model (SEM) was built with the variable "exposure to the virus" and the Psychological Stress and Adaptation at work Score (PSAS). "Exposure to the virus" was defined as the combined factors of 'personal-sphere', "work-related stress" and "hospital characteristics." A generalized linear model (GLM) was also tested.

Results

A total of 2,197 participants filled in the questionnaire and were analyzed. The exploratory factor analysis showed statistically significant variables related to the personal-sphere, work-related stress and the hospital's characteristics, although the confirmatory factor analysis showed only the work-related stress factors to be significant. The GLM showed that personal-sphere-related variables (P < .001), stress at work (P < 0.001) and age (P < 0.001) were statistically significant.

Conclusion

Physical exposure to the virus is an essential factor that contributes to the psychological impact perceived during the pandemic by healthcare professionals. A combination of personal-sphere variables, work-related stress and hospital characteristics is a significant factor correlating with the degree of stress measured by PSAS, a new and fast instrument to assess stress in healthcare workers.

Dynamic adsorption of diclofenac onto a magnetic nanocomposite in a continuous stirred-tank reactor

In this study, a waste-based magnetic activated carbon (MAC) was used for the first time in a continuous-flow stirred tank reactor (CSTR). The aim was to evaluate the dynamic removal of diclofenac (DCF) from water and wastewater. Firstly, the breakthrough curves corresponding to DCF adsorption from distilled water at different feed flow rates and doses of MAC were determined. After selecting the most favourable conditions, namely 0.18 h L^-1 flow rate and 400 mg L^-1 of MAC, the effect of different aqueous matrices was studied, with the breakthrough curves evidencing a performance decline in wastewater in comparison with distilled water. Finally, the exhausted MAC was magnetically recovered, regenerated by microwave-assisted heating and applied in two subsequent adsorption cycles. The regeneration studies pointed to a decrease of the specific surface area and an improvement of the magnetic retrievability of MAC. After the first regeneration step, just mild effects were observed in the dynamic adsorptive performance of MAC. However, after a second regeneration step, the performance declined ca. 50%. Overall, the results highlight the feasibility of producing waste-based magnetic composites that simultaneously combine high adsorption efficiency under dynamic operation in a CSTR, with easy retrievability and successful one-stage regeneration for further reutilization.

OP0223 DISTINGUISHING OSTEOARTHRITIS AND RHEUMATOID ARTHRITIS SYNOVIUM WITH MACHINE LEARNING USING AUTOMATED CELL DENSITY AND PATHOLOGIST SCORES

Background

Joint damage in the knee can be severe in both rheumatoid arthritis (RA) and osteoarthritis (OA) such that total knee replacement (TKR) is often the only management option. Pathological assessment of the extent or type of synovial tissue inflammation from joint explants or biopsies can be useful. However, an ongoing challenge in using semi-quantitative assessments of synovitis is the disagreement between human pathologist scores of the same sample. We previously developed and validated a computer vision algorithm to automatically count each cell nucleus in an H&E-stained synovial whole slide image and yield a value of cell density, defined as mean nuclei count per mm2 of tissue1.

Objectives

We sought to develop methods to distinguish OA from RA based on machine learning analysis of histologic features on H&E-stained synovial tissue samples.

Methods

We measured 14 pathologist-scored histology features (137 RA and 152 OA patients) and computer vision quantified cell density (60 RA and 147 OA patients) in H&E stained synovial tissue samples from total knee replacement arthroplasty explants. A random forest model was trained using disease state (OA vs RA) as classifier and histology features and/or cell density as inputs, and feature importance scores for the model were calculated.

Results

Synovium from patients with RA exhibited increased lymphocytic inflammation, lining hyperplasia, neutrophils, detritus, plasma cells, Russell bodies, binucleate plasma cells, sub-lining giant cells, synovial lining giant cells, and fibrin (all p<0.001), while synovium from patients with OA had increased mast cells and fibrosis (both p<0.001). Fourteen pathologist-scored features allowed for discrimination between RA and OA samples, producing a macro-averaged area under the receiver operating curve (AUC) of 0.85. This discriminatory ability was comparable to that of the computer vision score of cell density alone (AUC = 0.88). Combining the pathologist scores with the cell density metric improved the discriminatory power of the model (AUC = 0.91). The three most important features in this combined model were mast cells followed by cell density and fibrosis (Figure 1). AUC values for each individual feature are provided in Table 1. The optimal cell density threshold to distinguish RA from OA synovium was 3,400 cells per mm2, which yielded a sensitivity of 0.82 and specificity of 0.82.

Table 1.

Area under receiver operating characteristic curves (AUC) of the synovial features in distinguishing RA and OA patients

FeatureAUCAutomated Cell Density0.88Fibrosis0.84Mast cells0.80Lining hyperplasia0.78Lymphocytic inflammation0.69Fibrin0.68Plasma cells0.66Detritus0.64Binucleate plasma cells0.60Neutrophils0.60Synovial giant cells0.58Sub-lining giant cells0.57Russell bodies0.56Germinal centers0.51Mucoid change0.50Figure 1.

Importance of synovial features in distinguishing RA and OA synovium

Feature importance scores for supervised machine learning model including all 14 pathology scores and the computer vision-generated cell density.

Conclusion

H&E-stained images of RA and OA TKR explant synovium are distinct. We identified cell density, mast cells and fibrosis as the three most important features for making this distinction, with RA being characterized by increased cell density, low mast cells, and low fibrosis. Cell density greater than 3400 per mm2 of tissue yields a sensitivity of 0.82 and a specificity of 0.82 for distinguishing RA from OA. In the future, this can have clinical and research applications as this technique removes the requirement for subjective selection of a certain field of interest, is reproducible, and is scalable as it does not require technical expertise of a pathologist.

References

[1]Guan S, Mehta B…Orange DE. Rheumatoid Arthritis Synovial Inflammation Quantification Using Computer Vision. ACR Open Rheumatology. 2022 Jan 10;acr2.11381.

Acknowledgements

This work was supported by the C. Ronald MacKenzie Young Scientist Endowment Award, the Leon Lowenstein Foundation, and the Kellen Scholar Award supported by the Anna Marie and Stephen Kellen Foundation Total Knee Improvement Program.

Disclosure of Interests

Bella Mehta Paid instructor for: Novartis, Susan Goodman Consultant of: UCB, Grant/research support from: Novartis, Edward DiCarlo: None declared, Deanna Jannat-Khah Shareholder of: AstraZeneca, Cytodyn, and Walgreens, J. Alex Gibbons: None declared, Miguel Otero Consultant of: Regeneron Pharmaceuticals, Grant/research support from: Tissue Genesis, Laura Donlin Speakers bureau: Stryker, Consultant of: Stryker, Grant/research support from: Karius, Inc, Tania Pannellini: None declared, William Robinson: None declared, Peter Sculco Consultant of: Intellijoint Surgical, DePuy Synthes, Lima Corporate, Zimmer Biomet, and EOS Imaging, Grant/research support from: Intellijoint Surgical and Zimmer Biomet, Mark Figgie Shareholder of: HS2, Mekanika, and Wishbone, Consultant of: Lima and Wishbone, Jose Rodriguez Consultant of: ConforMIS, Medacta, Exactech, Inc, and Smith & Nephew, Grant/research support from: DePuy, Exactech, Inc, and Smith & Nephew, Jessica Kirschmann: None declared, James Thompson: None declared, David Slater: None declared, Damon Frezza: None declared, Zhenxing Xu: None declared, Fei Wang: None declared, Dana Orange: None declared

Informed consent in dentistry and medicine in Spain: Practical considerations and legality

BACKGROUND

The healthcare practice of dentistry, as well as medicine, is framed within a legal environment. Patients have the right to know all the information related to any action performed on them and dental or medical doctors are obliged to obtain their patient's prior written informed consent (IC) before undertaking any healthcare procedures.

MATERIAL AND METHODS

Here we reviewed the legality and jurisprudence in Spain regarding IC. We also used INFLESZ text readability analysis software to analyse a sample of official Spanish informed consent documents (ICDs) from different surgical and interventional procedures related to dentistry and oral cavity interventions.

RESULTS

It is a mistake to confound IC with ICDs. This error prevents physicians from considering the former as a care process in which the patient's authorisation signature is the last link in a chain formed, almost in its entirety, by the informative process and deliberation alongside the patient. Multiple factors can influence communication between practitioners and their patients. Importantly, treatment adherence is greater when patients feel involved and autonomous in shared decision-making and when the circumstances of their lives are adequately considered. We concluded that although the ICDs we analysed conformed to the requirements set out in international law, they were somewhat difficult to read according to the reading habits of the general Spanish population.

CONCLUSIONS

Knowledge about the legality of IC helps professionals to understand the problems that may arise from their non-compliance. This is because the omission or defective fulfilment of IC obligations is the origin of legal responsibility for medical practitioners. In this sense, to date, there have been more convictions for defective ICs than for malpractice. The information provided in ICs should include the risks, benefits, and treatment alternatives and must be tailored to the needs and capabilities of the patient to enable autonomous decision-making.

Correction to: Cochran's Q Test of Stimulus Overselectivity within the Verbal Repertoire of Children with Autism

[This corrects the article DOI: 10.1007/s40614-021-00315-w.].

Cochran's Q Test of Stimulus Overselectivity within the Verbal Repertoire of Children with Autism

Stimulus overselectivity remains an ill-defined concept within behavior analysis, because it can be difficult to distinguish truly restrictive stimulus control from random variation. Quantitative models of bias are useful, though perhaps limited in application. Over the last 50 years, research on stimulus overselectivity has developed a pattern of assessment and intervention repeatedly marred by methodological flaws. Here we argue that a molecular view of overselectivity, under which restricted stimulus control has heretofore been examined, is fundamentally insufficient for analyzing this phenomenon. Instead, we propose the use of the term "overselectivity" to define temporally extended patterns of restrictive stimulus control that have resulted in disproportionate populations of responding that cannot be attributed to chance alone, and highlight examples of overselectivity within the verbal behavior of children with autism spectrum disorder. Viewed as such, stimulus overselectivity lends itself to direct observation and measurement through the statistical analysis of single-subject data. In particular, we demonstrate the use of the Cochran Q test as a means of precisely quantifying stimulus overselectivity. We provide a tutorial on calculation, a model for interpretation, and a discussion of the implications for the use of Cochran's Q by clinicians and researchers.

COVID-19 psychological impact in 3109 healthcare workers in Spain: The PSIMCOV group

BACKGROUND

The current coronavirus disease (COVID-19) has a great impact worldwide. Healthcare workers play an essential role and are one of the most exposed groups. Information about the psychosocial impact on healthcare workers is limited.

METHODS

3109 healthcare workers completed a national, internet-based, cross-sectional 45-item survey between 9 and 19 April 2020. The objective is to assess the psychological impact of the COVID-19 pandemic in Spanish healthcare workers. A Psychological Stress and Adaptation at work Score (PSAS) was defined combining four modified versions of validated psychological assessment tests (A) Healthcare Stressful Test, (B) Coping Strategies Inventory, (C) Font-Roja Questionnaire and (D) Trait Meta-Mood Scale.

RESULTS

The highest psychosocial impact was perceived in Respiratory Medicine, the mean (S.D.) PSAS was 48.3 (13.6) and Geriatrics 47.6 (16.4). Higher distress levels were found in the geographical areas with the highest incidence of COVID-19 (>245.5 cases per 100 000 people), PSAS 46.8 (15.2); p < 0.001. The least stress respondents were asymptomatic workers PSAS, 41.3 (15.4); p < 0.001, as well as those above 60 years old, PSAS, 37.6 (16); p < 0.001. Workers who needed psychological therapy and did not receive it, were more stressed PSAS 52.5 (13.6) than those who did not need it PSAS 39.7 (13.9); p < 0.001.

CONCLUSIONS

The psychological impact in healthcare workers in Spain during COVID-19 emergency has been studied. The stress perceived is parallel to the number of cases per 100 000 people. Psychotherapy could have a major role to mitigate the experimented stress level.

Impact of COVID-19 Pandemic on Anesthesia and Critical Care Residents in Spain

Background

The pandemic caused by coronavirus disease 2019 (COVID-19) has substantially changed the activity in Spanish healthcare centers. Residents who face pandemics are vulnerable physicians with different knowledge and experience.

Objectives

This study aimed to determine the impact of COVID-19 pandemic on the Anesthesia and Critical Care residents and to establish its formative and personal consequences.

Methods

A 35-question digital survey was developed, and was distributed among Anesthesia and Critical Care residents in Spain. The quantitative variable "Objective Formative Impact Score" (PIOF) was defined, being proportional to the impact on formative routines.

Results

Several parameters were associated to a higher formative impact, such as the exposition to patients with COVID-19 (P = 0,020), an increase in the autonomy (P = 0,001), fear to contagion due to lack of protective equipment (P = 0,003), working in higher incidence areas (P < 0,001), being assigned to COVID-19 critical care units (P < 0,001), or to other departments different from Anesthesia and Critical Care. Residents experienced feelings of loneliness from the social distancing or ethical conflicts when working in suboptimal conditions.

Conclusions

COVID-19 pandemic has had a major impact on Anesthesia and Critical Care residents both personally and formatively. The designed parameter PIOF brings an objective value about residents' formation.

Just How Effective is Direct Instruction?

Despite overwhelming evidence in support of Direct Instruction, this research-validated curriculum has not been widely embraced by teachers or school administrators. The Direct Instruction model, developed and refined by Engelmann and colleagues over the past 50 years, has been the focus of numerous research studies, systematic reviews, and meta-analyses. Although its efficacy cannot be doubted, the significance of Direct Instruction's impact may be misunderstood. We attempt to clarify the importance of Direct Instruction with help from the binomial effect-size display. Binomial effect-size displays allow for intuitive and informative data-based decision making by clearly conveying the real-world importance of treatment outcomes through a juxtaposition of the relative proportions of success. The limitations of analyzing effect sizes in absolute terms are discussed. Using the binomial effect-size display as a framework, we present a series of dichotomies in an attempt to answer the question: Just how effective is Direct Instruction?

Trends in Incidence and Transmission Patterns of COVID-19 in Valencia, Spain

IMPORTANCE

Limited information on the transmission and dynamics of SARS-CoV-2 at the city scale is available.

OBJECTIVE

To describe the local spread of SARS-CoV-2 in Valencia, Spain.

DESIGN, SETTING, AND PARTICIPANTS

This single-center epidemiological cohort study of patients with SARS-CoV-2 was performed at University General Hospital in Valencia (population in the hospital catchment area, 364 000), a tertiary hospital. The study included all consecutive patients with COVID-19 isolated at home from the start of the COVID-19 pandemic on February 19 until August 31, 2020.

EXPOSURES

Cases of SARS-CoV-2 infection confirmed by the presence of IgM antibodies or a positive polymerase chain reaction test result on a nasopharyngeal swab were included. Cases in which patients with negative laboratory results met diagnostic and clinical criteria were also included.

MAIN OUTCOMES AND MEASURES

The primary outcome was the characterization of dissemination patterns and connections among the 20 neighborhoods of Valencia during the outbreak. To recreate the transmission network, the inbound and outbound connections were studied for each region, and the relative risk of infection was estimated.

RESULTS

In total, 2646 patients were included in the analysis. The mean (SD) age was 45.3 (22.5) years; 1203 (46%) were male and 1442 (54%) were female (data were missing for 1); and the overall mortality was 3.7%. The incidence of SARS-CoV-2 cases was higher in neighborhoods with higher household income (β2 [for mean income per household] = 0.197; 95% CI, 0.057-0.351) and greater population density (β1 [inhabitants per km2] = 0.228; 95% CI, 0.085-0.387). Correlations with meteorological variables were not statistically significant. Neighborhood 3, where the hospital and testing facility were located, had the most outbound connections (14). A large residential complex close to the city (neighborhood 20) had the fewest connections (0 outbound and 2 inbound). Five geographically unconnected neighborhoods were of strategic importance in disrupting the transmission network.

CONCLUSIONS AND RELEVANCE

This study of local dissemination of SARS-COV-2 revealed nonevident transmission patterns between geographically unconnected areas. The results suggest that tailor-made containment measures could reduce transmission and that hospitals, including testing facilities, play a crucial role in disease transmission. Consequently, the local dynamics of SARS-CoV-2 spread might inform the strategic lockdown of specific neighborhoods to stop the contagion and avoid a citywide lockdown.

Diagnostic change 2 years after a first episode of psychosis

Introduction

Psychiatric diagnoses are derived from expert opinion (1). Since no objective tests or markers are on the horizon, clinical psychiatry is anchored to “the patient’s altered experience, expression and existence, associated with suffering in self and/or others”(2). Many studies have examined diagnostic stability over time. In the last years investigators have been reporting prospective and retrospective consistencies of diagnoses between two time points, specially in first episodes of psychosis (3).

Objectives

To examine the prospective and retrospective stability of diagnostic categories 2 years after the first episode of psychosis

Methods

Data were examined from the First Episode Psychosis Program of Navarra (PEPsNA), a prospective observational study of a cohort of patients with first-episode psychosis in Navarra (Spain). Diagnosis was assigned using DSM-IV-TR at baseline and 24 months later. Diagnoses were divided into 5 categories: Affective psychosis, Schizophrenia spectrum psychosis, Schizoaffective disorder, acute psychosis and other diagnoses. Diagnostic change was examined using prospective and retrospective consistency

Results

A total of 78 first-episode psychosis cases with baseline and 24 months follow-up were identified. Table 1 shows the diagnosis movement matrix, and Figure 1 its graphical representation. Of cases, 71.8% (56/78) had the same baseline and 24 months follow-up diagnosis. Prospective and retrospective consistencies are shown in Table 2

Conclusions

The prospective and retrospective consistencies of Schizophrenia spectrum psychosis and acute psychosis were higher than others. Affective psychosis and Schizoaffective disorder show very variable consistencies

Impact of a first psychosis program in functional variables after two years of follow-up

Introduction

Early Intervention Services for Early-Phase Psychosis have shown efficacy and effectiveness (Correl C, JAMA). In Pamplona, Spain, there is an Early Intervention Program that has been providing multiprofesional assistance for First Psychotic Patients for the last two years.

Objectives

The aim of this study is to analize the longitudinal effects of the different interventions in several functional variables: GAF, Occupational State, CGI-CogS, QLS, Sofas and WHODAS II applied to 240 patients during two years of follow-up.

Methods

We apply an standard evaluation protocol to every patient at different times: premorbid, initial time and at months 6, 12, 18 and 24. We analyse the data with the SPSS statistical program to see the results in these variables.

Results

The GAF scale shows a decline during the first 6 months, but tends to reach and maintain the premorbid levels after a year of treatment. Regarding baseline, patients with normalized jobs or studies are 60.7%. This percentage persists during the next months of follow-up but decline at the 24^th month Both the Whodas and Sofas scale show improvement tends. The QLS results show a progresional improvement in every subcale during the whole time of follow-up.

Conclusions

The Early Intervention Services in Psychosis improve, not only psychopatological dimension but also functional areas, what is important for the whole recovery of First Psychotic Patients.

Impact of a first psychosis program in clinical variables after two years of follow-up

Introduction

Early Intervention Services for Early-Phase Psychosis have shown efficacy and effectiveness (Correl C, JAMA). In Pamplona, Spain, there is an Early Intervention Program that has been providing multiprofesional assistance for First Psychotic Patients for the last two years.

Objectives

The aim of this study is to analize the longitudinal effects of the different interventions in several clinical variables applied to 240 patients during two years of follow-up : CASH dimensions, substance abuse, antipsychotic type and dosage, remission rates, re-hospitalization rates and DSM 5 diagnoses.

Methods

We apply an standard evaluation protocol to every patient at different times: premorbid, initial time and at months 6, 12, 18 and 24. We analyse the data with the SPSS statistical program to see the results in these variables.

Results

The positive and disorganized dimensions show an evident decline during the treatment. The doses of antipsychotic drugs are low and tend to decline. 87% of patients are in monotherapy. The most frequent DSM 5 basal diagnosis is Brief Psychotic Episode, but during de follow-up the Diagnosis of Schizophrenia increase from 14,6% at baseline up to 46,2% at month 24. The remission rates are about 65% after 24 months.

Conclusions

Early Intervention Services improve psychopathological dimensions, prevents from re-hospitalization, allows the use of lower doses of Antipsychotic Drugs and improve the rates of remission. However, the diagnosis of Schizophrenia is high, so there is no evidence that these programs prevents from chronicity, but provide a better quality of life.

DEJELO YA Media Campaign Connects Spanish-Speaking Communities to Effective Support for Quitting Tobacco

Issue. New Mexico uses evidence-based approaches to help tobacco users quit, including a statewide free telephone quitline. The state Tobacco Use Prevention and Control program's goals include identifying and eliminating disparities. Priority Population. About 500,000 of the state's residents are Hispanic or Latino people who speak Spanish at home. Among them, about 16% of adults smoke cigarettes, meaning approximately 60,000 potentially need quitting support. Method. Data indicated gaps in utilization of Spanish-language quitline services. An equity-focused quality improvement approach was used to address this gap in collaboration with Nuestra Salud ("Our Health"), a community-based organization supporting Spanish-speaking people throughout New Mexico. Formative research in Spanish-speaking communities was conducted during 2013. Based on these findings, a culturally grounded DEJELO YA ("Quit Now") media campaign was developed and launched in 2015. Nuestra Salud led complementary community-based outreach. Service intake data and a 7-month evaluation survey from 2014-2016 were assessed descriptively to evaluate changes. Results. Quitline call frequencies increased by 31% among Spanish-speaking Hispanic/Latinos from 2014 to 2015, in comparison to 3% among non- Hispanics. Successful quitting improved for Spanish speakers from 32.9% in 2014 to 46.4% in 2016, while remaining stable among all English speakers (31.3% in 2015). Satisfaction with services was similar and unchanged for Spanish and English services (80.0% and 78.1%, respectively, in 2015). Implications for Practice. Implementation of an organically developed Spanish-language campaign was associated with improved quitline service utilization. Collaboration with a community-based organization in a quality improvement process was key. Sustained progress requires resources and attention to service capacity.

Prognostic factors in patients with vulvar cancer: the VULCAN study

OBJECTIVE

This study aimed to analyze the prognostic factors for overall and progression-free survival in patients with vulvar cancer.

METHODS

This international, multicenter, retrospective study included 2453 patients diagnosed with vulvar cancer at 100 different institutions. Inclusion criteria were institutional review board approval from each collaborating center, pathologic diagnosis of invasive carcinoma of the vulva, and primary treatment performed at the participating center. Patients with intraepithelial neoplasia or primary treatment at non-participating centers were excluded. Global survival analysis and squamous cell histology subanalysis was performed.

RESULTS

After excluding patients due to incomplete data entry, 1727 patients treated for vulvar cancer between January 2001 and December 2005 were registered for analysis (1535 squamous, 42 melanomas, 38 Paget's disease and 112 other histologic types). Melanomas had the worse prognosis (p=0.02). In squamous vulvar tumors, independent factors for increase in local recurrence of vulvar cancer were: no prior radiotherapy (p<0.001) or chemotherapy (p=0.006), and for distant recurrence were the number of positive inguinal nodes (p=0.025), and not having undergone lymphadenectomy (p=0.03) or radiotherapy (p<0.001), with a HR of 1.1 (95% CI 1.2 to 1.21), 2.9 (95% CI 1.4 to 6.1), and 3.1 (95% CI 1.7 to 5.7), respectively. Number of positive nodes (p=0.008), FIGO stage (p<0.001), adjuvant chemotherapy (p=0.001), tumor resection margins (p=0.045), and stromal invasion >5 mm (p=0.001) were correlated with poor overall survival, and large case volume (≥9 vs <9 cases per year) correlated with more favorable overall survival (p=0.05).

CONCLUSIONS

Advanced patient age, number of positive inguinal lymph nodes, and lack of adjuvant treatment are significantly associated with a higher risk of relapse in patients with squamous cell vulvar cancer. Case volume per treating institution, FIGO stage, and stromal invasion appear to impact overall survival significantly. Future prospective trials are warranted to establish these prognostic factors for vulvar cancer.

Compost Tea Reduces the Susceptibility of Pinus radiata to Fusarium circinatum in Nursery Production

Nutrition is one of the factors that most limits forestry plant growth; thus, current production in nurseries is based on conventional fertilization focused on enhancing vigor. However, an excessive intake of mineral nitrogen can cause morphological imbalances and the formation of more succulent tissues which, consequently, increase susceptibility to plant pathogens. Fusarium circinatum is the causal agent of pitch canker in plants of the Pinus genus, with Pinus radiata being the species most susceptible to this disease. This study compares the response of P. radiata seedlings to infection by F. circinatum as influenced by two fertilizers-conventional and aerated compost tea (ACT)-applied during the nursery phase. The potential of ACT against F. circinatum was first tested in vitro, where it was found to inhibit the pathogen's mycelial growth and conidial germination. In the greenhouse, infected plants fertilized with ACT exhibited less severe internal and external symptoms of pitch canker and lower levels of pathogen colonization of both stems and needles than with conventional fertilizer. An analysis of the hormone content and defense-related gene expression shows greater salicylic acid production and phenylalanine ammonium-lyase and chalcone synthase expression in ACT-fertilized pine. All of the parameters assessed are consistent in showing that biofertilization with ACT reduces the susceptibility of pine seedlings to the disease compared with conventional fertilization.

Low-level cyclic tibial compression attenuates early osteoarthritis progression after joint injury in mice

OBJECTIVE

Mechanical loading and joint health have a unique relationship in osteoarthritis (OA) onset and progression. Although high load levels adversely affect cartilage health, exercise that involves low to moderate load levels can alleviate OA symptoms. We sought to isolate the beneficial effects of mechanical loading using controlled in vivo cyclic tibial compression. We hypothesized that low-level cyclic compression would attenuate post-traumatic OA symptoms induced by destabilization of the medial meniscus (DMM).

METHODS

10-week-old C57Bl/6J male mice underwent DMM surgery (n = 51). After a 5-day post-operative recovery period, we applied daily cyclic tibial compression to the operated limbs at low (1.0N or 2.0N) or moderate (4.5N) magnitudes for 2 or 6 weeks. At the completion of loading, we compared cartilage and peri-articular bone features of mice that underwent DMM and loading to mice that only underwent DMM.

RESULTS

Compared to DMM alone, low-level cyclic compression for 6 weeks attenuated DMM-induced cartilage degradation (OARSI score, P = 0.008, 95% confidence interval (CI): 0.093 to 0.949). Low-level loading attenuated DMM-induced osteophyte formation after 2 weeks (osteophyte size, P = 0.033, 95% CI: 3.27-114.45 μm), and moderate loading attenuated subchondral bone sclerosis after 6 weeks (tissue mineral density (TMD), P = 0.011, 95% CI: 6.32-70.60 mg HA/ccm) compared to limbs that only underwent DMM. Finally, loading had subtle beneficial effects on cartilage cellularity and aggrecanase activity after DMM.

CONCLUSION

Low-level cyclic compression is beneficial to joint health after an injury. Therefore, the progression of early OA may be attenuated by applying well controlled, low-level loading shortly following joint trauma.

Stochastic population model of Zea mays L

We propose a minimalist stochastic population model of maize, focused on the description of the maize vegetative stages (seedlings with different number of leaves) involved in the propagation of vector-borne diseases. This model was parameterized from laboratory and field experiments and from observational field studies for multiple hybrids and different weather and soil conditions, taking into account only temperature as input variable. We propose three different submodels to estimate the distribution of the Final Leaf Number N_FLN in the plants and to estimate the tassel initiation probability. The first submodel (submodel A), with a fixed N_FLN, is adaptable to any particular hybrid, the second and third submodels allow to simulate plants with an empirical N_FLN distribution according to bibliographic averages (submodel B) or according to a Poisson Process (submodel C). The three submodels are able to describe the temporal development of populations and events. A good agreement is observed between the development times predicted by the model and the values obtained from laboratory experiments at constant temperature, field experiments carried out in Brazil and Australia and observational studies performed in Argentina. This model may be improved and coupled to leaf growth models and leaf area estimation models to be able to estimate not only the temporal development of populations and events but also the temporal development of the leaf area by plant, which is believed to be related to the carrying capacity of maize specialists insects, vectors of maize diseases.