Unmet needs for treatment in 102 individuals with brief and limited intermittent psychotic symptoms (BLIPS): implications for current clinical recommendations

Abstract Aims To investigate clinical outcomes and unmet needs in individuals at Clinical High Risk for Psychosis presenting with Brief and Limited Intermittent Psychotic Symptoms (BLIPS). Methods Prospective naturalistic long-term (up to 9 years) cohort study in individuals meeting BLIPS criteria at the Outreach And Support In South-London (OASIS) up to April 2016. Baseline sociodemographic and clinical characteristics, specific BLIPS features, preventive treatments received and clinical outcomes (psychotic and non-psychotic) were measured. Analyses included Kaplan Meier survival estimates and Cox regression methods. Results One hundred and two BLIPS individuals were followed up to 9 years. Across BLIPS cases, 35% had an abrupt onset; 32% were associated with acute stress, 45% with lifetime trauma and 20% with concurrent illicit substance use. The vast majority (80%) of BLIPS individuals, despite being systematically offered cognitive behavioural therapy for psychosis, did not fully engage with it and did not receive the minimum effective dose. Only 3% of BLIPS individuals received the appropriate dose of cognitive behavioural therapy. At 4-year follow-up, 52% of the BLIPS individuals developed a psychotic disorder, 34% were admitted to hospital and 16% received a compulsory admission. At 3-year follow-up, 52% of them received an antipsychotic treatment; at 4-year follow-up, 26% of them received an antidepressant treatment. The presence of seriously disorganising and dangerous features was a strong poor prognostic factor. Conclusions BLIPS individuals display severe clinical outcomes beyond their very high risk of developing psychosis and show poor compliance with preventive cognitive behavioural therapy. BLIPS individuals have severe needs for treatment that are not met by current preventive strategies

Enough Is Enough? Searching for the Optimal Sample Size to Monitor European Habitats: A Case Study from Coastal Sand Dunes

A robust survey method that samples the main characteristics of plant assemblages is needed to assess the conservation status of European habitat in the Natura 2000 network. A measure of variability, called pseudo-multivariate dissimilarity-based standard error (MultSE), was recently proposed for assessing sample-size adequacy in ecological communities. Here, we used it on coastal sand dune systems in three Special Areas of Conservation (SACs) in Tuscany. Our aim was to assess the minimum number of replicates necessary to adequately characterize sand dune environments in terms of differences between habitats and SACs, after a preliminary baseline assessment of plant diversity. Analysis of \u3b1 and \u3b2 diversity indicated that especially between habitats the three SACs protect different plant communities. The study of the MultSE profiles showed that the minimum number of replicates was related to habitat features and varied between 10 and 25 plots. Two-way PERMANOVA and SIMPER analysis on the full and reduced datasets confirmed that SACs and habitats host different plant communities, and that the contribution of the target species remained unchanged even with a reduced sample size. The proposed methodological approach can be used to develop cost-effective monitoring programs and it can be useful for plant ecologists and biodiversity managers for assessing ecosystem health and changes

Contributi per una flora vascolare di Toscana. XII (739-812)

Vengono presentate nuove località e/o conferme relative a 74 taxa specifici e sottospecifici di piante vascolari della flora vascolare to- scana, appartenenti a 69 generi e 28 famiglie: Bunium, Trinia (Apia- ceae), Nerium (Apocynaceae), Lemna (Araceae), Artemisia, Bidens, Centaurea, Crupina, Gazania, Hieracium, Rhagadiolus, Symphyotri- chum, Tagetes, Tripleurospermum (Asteraceae), Impatiens (Balsami- naceae), Anredera (Basellaceae), Cynoglottis, Phacelia (Boraginaceae), Cardamine, Diplotaxis, Hornungia (Brassicaceae), Campanula, Lobe- lia (Campanulaceae), Cerastium, Dianthus, Polycarpon, Spergularia, Stellaria (Caryophyllaceae), Commelina (Commelinaceae), Fallopia (Convolvulaceae), Sempervivum (Crassulaceae), Dryopteris (Dryopte- ridaceae), Euphorbia (Euphorbiaceae), Lathyrus, Medicago, Ononis, Trigonella (Fabaceae), Geranium (Geraniaceae), Lycopus, Stachys (Lamiaceae), Malva (Malvaceae), Anacamptis, Cephalanthera, Epi- pactis, Orchis (Orchidaceae), Linaria (Plantaginaceae), Ceratochloa, Eragrostis, Festuca, Gastridium, Hyparrhenia, Molineriella, Phalaris, Phyllostachys, Setaria, Sporobolus, Stipellula (Poaceae), Anogramma (Pteridaceae), Anemonoides, Ranunculus (Ranunculaceae), Reseda (Resedaceae), Alchemilla, Kerria, Pyracantha, Rosa, Rubus (Rosa- ceae), Galium, Valantia (Rubiaceae), Thesium (Santalaceae). Infine, viene discusso lo status di conservazione delle entità e gli eventuali vincoli di protezione dei biotopi segnalati

Contributi per una flora vascolare di toscana. IX (507-605)

Contributions for a vascular flora of Tuscany. IX (507-605). New localities and/or confirmations concerning 98 specific and subspecific plant taxa of Tuscan vascular flora, belonging to 81 genera and 42 families are presented: Alisma, Baldellia (Alismataceae), Chenopodium (Amaranthaceae), Sternbergia (Amaryllidaceae), Bupleurum (Apiaceae), Vinca (Apocynaceae), Muscari, Polygonatum (Asparagaceae), Carlina, Centaurea, Chondrilla, Filago, Pallenis, Tagetes, Tr a - gopogon, Tyrimnus (Asteraceae), Impatiens (Balsaminaceae), Campsis (Bignoniaceae), Cardamine, Iberis, Isatis, Lepidium, Rorippa (Brassicaceae), Humulus (Cannabaceae), Centranthus (Caprifoliaceae), Atocion, Paronychia, Sabulina, Scleranthus (Caryophyllaceae), Euonymus (Celastraceae), Fumana (Cistaceae), Phedimus, Sedum (Crassulaceae), Juniperus (Cupressacesae), Carex, Cyperus, Schoenus (Cyperaceae), Erica (Ericaceae), Euphorbia (Euphorbiaceae), Astragalus, Cytisus, Gleditsia, Lotus, Trifolium, Vicia (Fabaceae), Geranium (Geraniaceae), Philadelphus (Hydrangeaceae), Phacelia (Hydrophyllaceae), Hermodactylus, Iris, Romulea (Iridaceae), Salvia, Ziziphora (Lamiaceae), Gagea, Lilium (Liliaceae), Lindernia (Linderniaceae), Mirabilis (Nyctaginaceae), Nymphaea (Nymphaeaceae), Ligustrum (Oleaceae), Oenothera (Onagraceae), Oxalis (Oxalidaceae), Plantago, Veronica (Plantaginaceae), Armeria (Plumbaginaceae), Eleusine, Festuca, Phleum, Setaria, Stipa, Tragu s (Poaceae), Stuckenia (Potamogetonaceae), Anemonoides, Ranunculus (Ranunculaceae), Reseda (Resedaceae), Aphanes, Cotoneaster, Eriobotrya, Malus, Rosa (Rosaceae), Galium (Rubiaceae), Nicotiana, (Solanaceae). In the end, the conservation status of the units and possible protection of the cited biotopes are discussed

Contributi per una flora vascolare di Toscana. XI (664-738)

Vengono presentate nuove località e/o conferme relative 75 taxa specifici e sottospecifici di piante vascolari della flora vascolare toscana, appartenenti a 67 generi e 41 famiglie: Delosperma (Aizoaceae), Dysphania (Amaranthaceae), Leucojum, Nothoscordum (Amaryllidaceae), Bupleurum, Coriandrum (Apiaceae), Araujia (Apocynaceae), Lemna (Araceae), Hydrocotyle (Araliaceae), Aristolochia (Aristolochiaceae), Bellevalia (Asparagaceae), Asphodelus (Asphodelaceae), Artemisia, Crepis, Eclipta, Erigeron, Hieracium, Senecio, Symphyotrichum, Tolpis (Asteraceae), Symphytum (Boraginaceae), Alyssum, Cardamine, Eruca, Isatis (Brassicaceae), Valerianella (Caprifoliaceae), Petrorhagia, Scleranthus (Caryophyllaceae), Commelina (Commelinaceae), Dichondra (Convolvulaceae), Sedum (Crassulaceae), Diospyros (Ebenaceae), Moneses (Ericaceae), Euphorbia (Euphorbiaceae), Medicago, Trifolium (Fabaceae), Myriophyllum (Haloragaceae), Juncus (Juncaceae), Salvia, Teucrium (Lamiaceae), Broussonetia (Moraceae), Spiranthes (Orchidaceae), Phelipanche (Orobanchaceae), Papaver (Papaveraceae), Passiflora (Passifloraceae), Cedrus, Pseudotsuga (Pinaceae), Bromopsis, Calamagrostis, Cenchrus, Drymochloa, Melica, Oloptum, Phleum, Sporobolus, Tragus (Poaceae), Stuckenia (Potamogetonaceae), Lysimachia (Primulaceae), Anemone, Aquilegia (Ranunculaceae), Eriobotrya (Rosaceae), Crucianella (Rubiaceae), Verbascum (Scrophulariaceae), Typha (Typhaceae), Urtica (Urticaceae), Viola (Violaceae). Infine, viene discusso lo status di conservazione delle entità e gli eventuali vincoli di protezione dei biotopi segnalati.New localities and/or confirmations concerning 75 specific and subspecific plant taxa of Tuscan vascular flora, belonging to 67 genera and 41 families are presented: Delosperma (Aizoaceae), Dysphania (Amaranthaceae), Leucojum, Nothoscordum (Amaryllidaceae), Bupleurum, Coriandrum (Apiaceae), Araujia (Apocynaceae), Lemna (Araceae), Hydrocotyle (Araliaceae), Aristolochia (Aristolochiaceae), Bellevalia (Asparagaceae), Asphodelus (Asphodelaceae), Artemisia, Crepis, Eclipta, Erigeron, Hieracium, Senecio, Symphyotrichum, Tolpis (Asteraceae), Symphytum (Boraginaceae), Alyssum, Cardamine, Eruca, Isatis (Brassicaceae), Valerianella (Caprifoliaceae), Petrorhagia, Scleranthus (Caryophyllaceae), Commelina (Commelinaceae), Dichondra (Convolvulaceae), Sedum (Crassulaceae), Diospyros (Ebenaceae), Moneses (Ericaceae), Euphorbia (Euphorbiaceae), Medicago, Trifolium (Fabaceae), Myriophyllum (Haloragaceae), Juncus (Juncaceae), Salvia, Teucrium (Lamiaceae), Broussonetia (Moraceae), Spiranthes (Orchidaceae), Phelipanche (Orobanchaceae), Papaver (Papaveraceae), Passiflora (Passifloraceae), Cedrus, Pseudotsuga (Pinaceae), Bromopsis, Calamagrostis, Cenchrus, Drymochloa, Melica, Oloptum, Phleum, Sporobolus, Tragus (Poaceae), Stuckenia (Potamogetonaceae), Lysimachia (Primulaceae), Anemone, Aquilegia (Ranunculaceae), Eriobotrya (Rosaceae), Crucianella (Rubiaceae), Verbascum (Scrophulariaceae), Typha (Typhaceae), Urtica (Urticaceae), and Viola (Violaceae). In the end, the conservation status of the units and eventual protection of the cited biotopes are discussed

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Integration of a psychiatric service in a long-term charitable facility for people with intellectual disabilities: a 5-year medication survey

Since the implementation of a psychiatric service in a long-term facility for people with intellectual disability, the usage of psychotropic and anti-convulsant drugs has been surveyed over the 5-year period 1994-1999. At that time, although the overall prevalence rate of residents on medication was not declining significantly, a decrease in number, dosage and polypharmacy of those receiving neuroleptic drugs occurred than 1994. A reduction also resulted among the in-patients prescribed anxiolytic preparations, despite a relative increase in their mean daily intake. Anti-convulsant drugs climbed slightly during the same interval with a parallel increase in the mean daily dosage. A retrospective comparison of current findings to prevalence, dosage and type of psychoactive medications dispensed 10 years previously in 1989 revealed no trend towards drug rationalisation. Until interdisciplinary training programmes as well as effective community services combining disability and mental health needs are forthcoming, a therapeutic approach involving early psychiatric inputs may contribute to ensure a more rational prescribing practice for long-stay adults with intellectual disability who are referred for neuropsychiatric consultation