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In a community mental health setting, we studied real-world relapse rates in patients with a history of psychosis, before and after switching from oral antipsychotics to a long-acting injectable antipsychotic (LAIA). We also aimed to evaluate the relevance of metabolic/demographic factors in relapse rate.
Methods:
Twenty-five individuals with a past history of psychosis and variable medication concordance who were switched from oral antipsychotics to LAIAs were included in the study. Oral agents were converted to olanzapine equivalents whilst LAIA generics were converted to flupenthixol depot equivalents. The depot equivalent oral dose of olanzapine was calculated, assuming an oral bioavailability of 40%. Relapse-rates occurring over the time periods on oral therapy were compared with rates occurring following initiation of LAIAs. Relapse was defined as any psychiatric hospital admission.
A multivariable Poisson regression model including drug formulation/age/sex/smoking status/BMI were fitted with follow-up time as an offset to estimate adjusted incidence rate ratios and associations with relapse outcomes.
Results:
The mean±SD age of the 25 individuals was 50.6±13.9 years whilst 12 (60%) were male. Mean BMI of males/females was 28.1±9.3 kg/m2/ 32±6.4 kg/m2(higher in women) respectively. 65% of patients received either flupenthixol or zuclopenthixol depot with next most common depot being Risperidal Consta. The median (IQR) of daily oral olanzapine equivalent was 10mg (6.9 – 20.0mg)/day and after switching to depot was 16.0mg (5.4 – 40.7mg)/day. The 4-week depot equivalent dose for services users switched to depot was flupenthixol 480mg (200 – 1220mg) / 4-weeks.
Following adjustment for age/sex/smoking status/BMI, relapse rates were significantly lower during LAIA treatment compared with oral treatment (incidence rate ratio [IRR] 0.13, 95% CI 0.08–0.22, p<0.001). Thus depot antipsychotics were associated with an 87% reduction in relapse rates compared to oral therapy. Male sex/younger age/lower BMI were independently associated with higher relapse rates (Exp (beta) 1.9/0.98/0.94 respectively (p<0.05)).
Conclusion:
In this real-world community mental health setting, this study highlights that depot antipsychotics provide a dramatic and sustained reduction of 87% in relapse rate for individuals with a history of psychosis. These findings support early prescription of LAIAs in prevention of psychosis relapse. Further evaluation is warranted to elucidate the potential of LAIAs as a treatment option after first presentation of psychosis.
Et al:
Ruth Parkman-Eason, Salford Royal Hospital, UK
Sophie Manttan, Salford Royal Hospital, UK
Yasitha llangasekera, University of Peradeniya, Sri Lanka
The holophrastic nature of children's one-word utterances has long been recognized by linguists. The child will use gesture, intonation, and a single word to convey a variety of messages. Syntactic models of grammar, however, are not equipped to capture adequately this early stage of language development. Fillmore's case grammar comes closer, but is still based on the syntactic category of verb in the deep structure. It is suggested that Fillmore's model can be adapted to account for this early stage if verb is replaced by a semantic category. This category is semantic transitivity, which designates a proposition as communicating either an act or a state. With this adaptation made, it is also suggested how gestures and intonation can be formally included in the semantic model for representing one-word utterances. An analysis is then presented of the one-word utterances recorded by Leopold. The results show that children's early one-word utterances convey states, while later ones refer to actions.
Poeppel and Wexler (1993) present the Full Competence Hypothesis, which claims that German children very early (circa age 2) acquire finiteness, verb agreement, and verb movement. They also propose the Grammatical Infinitive Hypothesis, which states that children have the option of using either a finite or nonfinite form and randomly select verbs for one or the other. The data on which these claims are based consist of 282 sentences from a German child at 2;1. We present a more conservative alternative, the Lexical/Semantic Hypothesis, which proposes that early learning is more lexically oriented, and that early word combinations can be explained by more semantically oriented accounts. To replace the Grammatical Infinitive Hypothesis, we put forth the Modal Hypothesis, which states that the distinction between finite and nonfinite forms can be accounted for by the modality of the sentence. Nonfinite forms occur in modal contexts, and finite ones occur in nonmodal ones. Data to support this alternative are presented from the analysis of 1084 sentences from four German children, including the subject studied in Poeppel and Wexler.
Background: Bacteremia is associated with significant morbidity and mortality. At least 14 days of antibiotic treatment has traditionally been the standard of care. However, shortening the duration of antibiotic therapy is a key strategy for improving antimicrobial stewardship. This meta-analysis of randomized controlled trials (RCTs), including the recently published BALANCE trial, seeks to identify the duration of antibiotics needed to optimize this mortality benefit by comparing seven versus 14 days of antibiotic duration. Hypothesis: The mortality risk ratio (RR) in the 7-day group is similar to 14-day group. Methods: Multiple electronic databases and trial registries were searched on December 29, 2024, for RCTs reporting mortality outcomes in patients with bacteremia treated for seven versus 14 days of antibiotics. We estimated the effect of these two-treatment durations using random-effects meta-analyses with the generic inverse variance method. Subgroup analyses were conducted to assess the impact of the source of bacteremia on mortality. Results: Four eligible RCTs consisting of 4,794 patients with bacteremia, were included. Median age was 71 years (interquartile range (IQR): 69-73), and 47% (IQR: 45%-49%) were male. Of the patients with bacteremia, 87% had gram-negative bacteria and 13% gram-positive bacteria. Patients with Staphylococcus aureus bacteremia, severe immune compromise, prosthetic heart valves, syndromes with well-defined requirement for prolonged treatment such as infective endocarditis or osteomyelitis, single positive blood culture with common contaminant, Candida or other fungi were excluded. Overall mortality rate was 8%. The RR for 90-day and 30-day mortality between 7 versus 14 days was 0.92 (95% CI: 0.79 – 1.06) and 0.92 (95% CI: 0.96-1.12), respectively. Median antibiotic-free days were higher in the 7-day group than 14- day group (19 days vs 14 days, p=0.03). The rates of Clostridioides difficile infection were similar in two groups (1.6% vs 1.5%, p=0.97). Subgroup analysis indicated no effect modification by the source of bacteremia. The risk of bias was assessed as low. Conclusions: This systematic review and meta-analysis of RCTs found no difference in mortality between 7- and 14-day treatment durations in low-risk patients with non-Staphylococcus aureus bacteremia. Reducing antibiotic treatment for uncomplicated gram-negative and gram-positive bacteremia to 7 days is a critical antibiotic stewardship intervention.
Information on pangolin life history and ecology is becoming increasingly available in African countries through community-based surveys and camera-trapping. However, there is a paucity of information on the largely arboreal black-bellied pangolin Phataginus tetradactyla, which is categorized as Vulnerable on the IUCN Red List. By targeting fallen trees or logs with camera traps we recorded the black-bellied pangolin opportunistically in Deng Deng National Park (East Region, Cameroon), a locality within the presumed distribution of the species within Cameroon. We obtained a low trapping rate of 0.063 events per 100 trap-days and the capture probability was one event recorded over 1,571 trap-days (0.0006 captures per day). Deploying camera traps that focus on fallen trees or logs could be explored as a method for detecting black-bellied pangolins.
Pangolins have long been hunted for food and for their scales, but information on local hunting strategies in African range countries and the patterns of pangolin trafficking around sourcing areas is limited. Such knowledge is vital to inform monitoring approaches and conservation interventions. We administered questionnaires to 367 people from 20 villages around two national parks in Cameroon to gain insights into local hunting practices, and trading and trafficking patterns. We found that tracking was the preferred method of hunting pangolins. Trapping was also used, and setting traps on fallen logs and near burrows improved the likelihood of catching pangolins. The white-bellied pangolin Phataginus tricuspis was the most traded species, and the giant pangolin Smutsia gigantea was the most sought after. We found no evidence of trade in the black-bellied pangolin Phataginus tetradactyla. Most respondents stated that pangolin prices had increased over the last 5 years, and scarcity of pangolins was the primary reason given for this increase. We identified a pangolin scale trafficking network operating from rural communities to neighbouring cities. Although most respondents recognized that hunting pangolins is illegal, c. 30% indicated that they were engaged in pangolin hunting.
The Jurassic to Cretaceous strata exposed in the Rollrock Section, Sverdrup Basin, Arctic Canada, represent one of the northernmost continuous outcrops spanning this poorly understood transition. The Oxfordian–Valanginian mudstones of the Rollrock Section were deposited in a shallow marine environment and, as such, provide the ideal lithology to investigate the response of high latitude dinoflagellate cyst populations to the frequent environmental perturbations of this time. Using a multivariate statistical approach, distinct palaeoecologically significant groups are identified and directly linked to time and palaeoenvironments, allowing for the reconstruction of underlying long term palaeoenvironmental trends. These palaeoenvironmental trends are identified to be driven by sequence stratigraphic cycles. For the first time, fourth order sequences are recorded from this pivotal period in the Sverdrup Basin and reveal an additional level of short term climatic events that complicate the identification of long term trends. The relationship existing between marine phytoplankton and climate is utilised to decipher the interplay of long-term and short-term climate fluctuations, distinguishing them from evolutionary trends. Two groups of dinoflagellate cysts, identified by process morphology, are recorded to act as environmental proxies. High percentages of proximochorate dinoflagellate cysts, such as Trichodinium erinaceoides, indicate more proximal, high energy, nutrient rich conditions and are dominant in fourth order transgressive systems tracts. High percentages of chorate dinoflagellate cysts, such as Oligosphaeridium complex, signify distal, low energy, nutrient depleted conditions and are dominant in fourth order highstand systems tracts.
Conceptions of negative liberty invariably refer to the removal of objective hindrances to physical action. Conceptions of positive liberty, by contrast, refer to the provision of goods that facilitate forms of empowerment and capacitation. This chapter argues that some of the goods necessary for empowerment and capacitation are subjective, or psychological, most (if not all) of which depends, in one form or another, on what philosophers since Hegel has dubbed "recognition." This chapter has three parts. Drawing from a sample of recognition theorists (Taylor, Honneth, Habermas, and Pippin), Part One defends the salience of recognition for empowerment, capacitation, and agency. Part two then describes forms of psycho-social pathology (damaged agency) that misrecognition of the absence of recognition typically causes. Part three concludes by defending the psychological and ontological validity of recognition as a coherent dimension of social freedom against some frequently raised objections.
This chapter examines how European thinkers working from within and without the Frankfurt School of critical theory have understood the public sphere as a distinctive political category. First-generation members of the school rejected institutional democracy and mass politics as ideologies that mask domination. The succeeding generation, whose most important representative is Jürgen Habermas, rejected that diagnosis. Habermas’s more optimistic assessment of the emancipatory potential of the public sphere as a medium of rational learning sought a middle ground between critics and defenders of liberal democracy. This ambivalence provoked strong counter-reactions from systems theorists, such as Niklas Luhmann, and from adherents of theories of agonal democracy descended from Carl Schmitt, on the right, and Hannah Arendt, on the Left. As we shall see, these reactions are amplified by those who seek to extend the public sphere beyond the boundaries of the nation state.