A multi-element psychosocial intervention for early psychosis (GET UP PIANO TRIAL) conducted in a catchment area of 10 million inhabitants: study protocol for a pragmatic cluster randomized controlled trial

Multi-element interventions for first-episode psychosis (FEP) are promising, but have mostly been conducted in non-epidemiologically representative samples, thereby raising the risk of underestimating the complexities involved in treating FEP in 'real-world' services

Whole body extract of Mediterranean fruit fly males elicits high attraction in virgin females

The search for effective female attractants emanating from the host or body of fruit flies has been an area of intensive research for over three decades. In the present study, bodies of male Mediterranean fruit flies, Ceratitis capitata (Wiedemann) (Diptera: Tephritidae), were extracted with diethyl ether or methanol and subjected to gas chromatography-mass spectrometry. Analysis revealed substantial qualitative and quantitative differences between males from a laboratory culture and wild males captured alive in an orchard. Most notably, the hydrocarbon sesquiterpene (+/-)-alpha-copaene, which is known to be involved in the sexual behaviour of the species, was found in substantial amounts in wild males, but was not detected in laboratory males. In laboratory tests, 15 laboratory or wild male equivalents of diethyl ether extracts or combined diethyl ether and methanol extracts, or, to a lesser extent, methanol extracts alone, were found to attract virgin females. In a citrus orchard, traps baited with combined diethyl ether and methanol extracts of wild males attracted significantly more virgin females than traps baited with various doses of pyranone or blends of other compounds identified in the extracts or reported in the literature, such as ethyl acetate, ethyl-(E)-3-octenoate, and 1-pyrroline. Traps baited with blends of compounds, however, displayed substantial attractiveness compared to control (non-baited) traps. These results are important for better understanding the mating system of C. capitata as well as for further improving existing monitoring and control systems

A multi-element psychosocial intervention for early psychosis (GET UP PIANO TRIAL) conducted in a catchment area of 10 million inhabitants: study protocol for a pragmatic cluster randomized controlled trial

BACKGROUND: Multi-element interventions for first-episode psychosis (FEP) are promising, but have mostly been conducted in non-epidemiologically representative samples, thereby raising the risk of underestimating the complexities involved in treating FEP in 'real-world' services. METHODS/DESIGN: The Psychosis early Intervention and Assessment of Needs and Outcome (PIANO) trial is part of a larger research program (Genetics, Endophenotypes and Treatment: Understanding early Psychosis - GET UP) which aims to compare, at 9 months, the effectiveness of a multi-component psychosocial intervention versus treatment as usual (TAU) in a large epidemiologically based cohort of patients with FEP and their family members recruited from all public community mental health centers (CMHCs) located in two entire regions of Italy (Veneto and Emilia Romagna), and in the cities of Florence, Milan and Bolzano. The GET UP PIANO trial has a pragmatic cluster randomized controlled design. The randomized units (clusters) are the CMHCs, and the units of observation are the centers' patients and their family members. Patients in the experimental group will receive TAU plus: 1) cognitive behavioral therapy sessions, 2) psycho-educational sessions for family members, and 3) case management. Patient enrollment will take place over a 1-year period. Several psychopathological, psychological, functioning, and service use variables will be assessed at baseline and follow-up. The primary outcomes are: 1) change from baseline to follow-up in positive and negative symptoms' severity and subjective appraisal; 2) relapse occurrences between baseline and follow-up, that is, episodes resulting in admission and/or any case-note records of re-emergence of positive psychotic symptoms. The expected number of recruited patients is about 400, and that of relatives about 300. Owing to the implementation of the intervention at the CMHC level, the blinding of patients, clinicians, and raters is not possible, but every effort will be made to preserve the independency of the raters. We expect that this study will generate evidence on the best treatments for FEP, and will identify barriers that may hinder its feasibility in 'real-world' clinical settings, patient/family conditions that may render this intervention ineffective or inappropriate, and clinical, psychological, environmental, and service organization predictors of treatment effectiveness, compliance, and service satisfaction