Long-acting injectable versus daily oral antipsychotic treatment trials in schizophrenia: pragmatic versus explanatory study designs

Trial design characteristics related to the explanatory:pragmatic spectrum may contribute toward the inconsistent results reported in studies comparing long-acting injectable (LAI) versus daily oral antipsychotic (AP) treatments in schizophrenia. A novel approach examined the hypothesis that a more pragmatic design is important to show the advantages of LAI versus oral APs. A literature search identified comparative studies assessing the clinical efficacy/effectiveness of LAI versus oral APs in more than 100 schizophrenia patients, with 6-month or more duration/follow-up, and published between January 1993 and December 2013 (n=11). Each study\u27s design was rated using the six-domain ASPECT-R (A Study Pragmatic:Explanatory Characterization Tool-Rating). Nonparametric Wilcoxon rank-sum tests compared ratings of studies supporting (n=7) and not supporting (n=4) a LAI advantage. ASPECT-R total and domain scores were significantly higher (more pragmatic) in studies finding a LAI versus oral AP treatment advantage than those that did not. The rank order of this significance among domains was as follows: participant compliance assessment\u27 (P=0.005), medical practice setting/practitioner expertise\u27 (P=0.006), intervention flexibility\u27 (P=0.007), follow-up intensity/duration\u27 (P=0.009), primary trial outcomes\u27 (P=0.012), and participant eligibility\u27 (P=0.015). Findings support that more pragmatic, less explanatory design features are important to show advantages for LAI treatment. Explanatory studies may introduce features that obscure advantages related to adherence

Performance of AAOmega: the AAT multi-purpose fibre-fed spectrograph

AAOmega is the new spectrograph for the 2dF fibre-positioning system on the Anglo-Australian Telescope. It is a bench-mounted, double-beamed design, using volume phase holographic (VPH) gratings and articulating cameras. It is fed by 392 fibres from either of the two 2dF field plates, or by the 512 fibre SPIRAL integral field unit (IFU) at Cassegrain focus. Wavelength coverage is 370 to 950nm and spectral resolution 1,000-8,000 in multi-Object mode, or 1,500-10,000 in IFU mode. Multi-object mode was commissioned in January 2006 and the IFU system will be commissioned in June 2006. The spectrograph is located off the telescope in a thermally isolated room and the 2dF fibres have been replaced by new 38m broadband fibres. Despite the increased fibre length, we have achieved a large increase in throughput by use of VPH gratings, more efficient coatings and new detectors - amounting to a factor of at least 2 in the red. The number of spectral resolution elements and the maximum resolution are both more than doubled, and the stability is an order of magnitude better. The spectrograph comprises: an f/3.15 Schmidt collimator, incorporating a dichroic beam-splitter; interchangeable VPH gratings; and articulating red and blue f/1.3 Schmidt cameras. Pupil size is 190mm, determined by the competing demands of cost, obstruction losses, and maximum resolution. A full suite of VPH gratings has been provided to cover resolutions 1,000 to 7,500, and up to 10,000 at particular wavelengths.Comment: 13 pages, 4 figures; presented at SPIE, Astronomical Telescopes and Instrumentation, 24 - 31 May 2006, Orlando, Florida US

Nonpoint pollution of surface waters with phosphorus and nitrogen

Agriculture and urban activities are major sources of phosphorus and nitrogen to aquatic ecosystems. Atmospheric deposition further contributes as a source of N. These nonpoint inputs of nutrients are difficult to measure and regulate because they derive from activities dispersed over wide areas of land and are variable in time due to effects of weather. In aquatic ecosystems, these nutrients cause diverse problems such as toxic algal blooms, loss of oxygen, fish kills, loss of biodiversity (including species important for commerce and recreation), loss of aquatic plant beds and coral reefs, and other problems. Nutrient enrichment seriously degrades aquatic ecosystems and impairs the use of water for drinking, industry, agriculture, recreation, and other purposes. Based on our review of the scientific literature, we are certain that (1) eutrophication is a widespread problem in rivers, lakes, estuaries, and coastal oceans, caused by overenrichment with P and N; (2) nonpoint pollution, a major source of P and N to surface waters of the United States, results primarily from agriculture and urban activity, including industry; (3) inputs of P and N to agriculture in the form of fertilizers exceed outputs in produce in the United States and many other nations; (4) nutrient flows to aquatic ecosystems are directly related to animal stocking densities, and under high livestock densities, manure production exceeds the needs of crops to which the manure is applied; (5) excess fertilization and manure production cause a P surplus to accumulate in soil, some of which is transported to aquatic ecosystems; and (6) excess fertilization and manure production on agricultural lands create surplus N, which is mobile in many soils and often leaches to downstream aquatic ecosystems, and which can also volatilize to the atmosphere, redepositing elsewhere and eventually reaching aquatic ecosystems. If current practices continue, nonpoint pollution of surface waters is virtually certain to increase in the future. Such an outcome is not inevitable, however, because a number of technologies, land use practices, and conservation measures are capable of decreasing the flow of nonpoint P and N into surface waters. From our review of the available scientific information, we are confident that: (1) nonpoint pollution of surface waters with P and N could be reduced by reducing surplus nutrient flows in agricultural systems and processes, reducing agricultural and urban runoff by diverse methods, and reducing N emissions from fossil fuel burning; and (2) eutrophication can be reversed by decreasing input rates of P and N to aquatic ecosystems, but rates of recovery are highly variable among water bodies. Often, the eutrophic state is persistent, and recovery is slow

Detection of local-scale population declines through optimized tidal marsh bird monitoring design

Evaluating the efficacy of monitoring designs is crucial for the successful monitoring and conservation of populations. For tidal marsh bird species of conservation concern, detecting population declines at local spatial scales within actionable time frames is a top priority. We examined and compared the effectiveness of alternative monitoring strategies for detecting local-scale population declines using count data from 1176 spatially-independent salt marsh sampling points throughout the northeastern United States (Maine to Virginia). We used abundance estimates that accounted for imperfect detection as initial conditions to simulate annual population declines of 5%, 10%, 30%, and 50% over a 5-year sampling period. Under an optimal monitoring design with biennial sampling, we were able to successfully detect annual population declines of ≥30% for each species and for all species combined. However, this required a minimum of 15–20 points per site being sampled. Power to detect declines, although low for detecting smaller annual declines (i.e., \u3c10%), improved substantially when points were visited twice per season, yet a third visit provided a reduced benefit. When testing factors that could potentially influence power to detect declines, we found that the power within sites was positively related to species abundance. Power was similar between biennial sampling (3 of 5 years) and annual sampling (5 of 5 years), suggesting a more cost-effective approach would be to sample every other year. We found that within most sites, detecting annual declines of 10% or less over a relatively short 5-year duration would be difficult. Hence, we recommend that salt marsh bird monitoring programs in the northeastern United States conduct two visits to each site per sampling year, include 15 or more sampling points per site (without confounding spatial independence), and conduct monitoring efforts every other year. This approach will maximize the efficacy of site-level monitoring of tidal marsh birds, which can aid in assessments of coastal wetland conservation and related habitat management efforts

Psychological and nutritional correlates of objectively assessed physical activity in patients with anorexia nervosa

Background: Physical activity (PA) plays a role in the course of anorexia nervosa (AN). Objective: To assess the association between PA, nutritional status and psychological parameters in patients with AN. Method: Using a wearable activity monitor, PA was assessed in 60 female AN inpatients, by step count and time spent in 4 metabolic equivalent (MET)-intensity levels: sedentary behaviour, light, moderate and vigorous PA. In addition, BMI, psychological (patient-reported outcome questionnaires) and nutritional parameters (body fat, energy and macronutrient intake) were assessed. Results: The study population spent little time in vigorous PA. BMI on admission and discharge was higher when more time was spent in sedentary behaviour, and lower with more time spent in light PA. Relationships between PA and patient-reported outcomes were weak and limited to an association between vigorous PA and compulsiveness. Low fat mass was associated with more time spent in light PA, while subjects with higher step counts showed less intake of energy, carbohydrates and fat. Conclusion: The relationship between inadequate food intake and increased PA in patients with AN requires further investigation

Combined application of nitrogen and phosphorus to enhance nitrogen use efficiency and close the wheat yield gap on varying soils in semi‐arid conditions

A primary driver of the wheat yield gap in Australia and globally is the supply of nitrogen (N) and options to increase N use efficiency (NUE) are fundamental to closure of the yield gap. Co‐application of N with phosphorus (P) is suggested as an avenue to increase fertiliser NUE, and inputs of N and P fertiliser are key variable costs in low rainfall cereal crops. Within field variability in the response to nutrients due to soil and season offers a further opportunity to refine inputs for increased efficiency. The response of wheat to N fertiliser input (0, 10, 20, 40 and 80 kg N ha‐1) under four levels of P fertiliser (0, 5, 10 and 20 kg P ha−1) was measured on three key low rainfall cropping soils (dune, mid‐slope and swale) across a dune‐swale system in a low rainfall semi‐arid environment in South Australia, for three successive cropping seasons. Wheat on sandy soils produced significant and linear yield and protein responses across all three seasons, while wheat on a clay loam only produced a yield response in a high rainfall season. Responses to P fertiliser were measured on the sandy soils but more variable in nature and a consistent effect of increased P nutrition leading to increased NUE was not measured

Digital Trajectories to Care in First-Episode Psychosis.

OBJECTIVE::The emphasis on reducing the duration of untreated psychosis (DUP) has highlighted complex barriers to accessing appropriate services. Internet and social media use by individuals with first-episode psychosis (FEP) was examined to explore how these platforms might be used to facilitate treatment initiation. METHODS::Participants ages 15-35 were interviewed with the Pathways to Care for Psychosis Questionnaire, an 81-item instrument designed to explore online activity during symptom emergence. RESULTS::Of 112 participants, 90% used the Internet and social media daily. The Internet was listed as the most used resource (62%) for information while symptoms were emerging. A minority (19%) shared concerns via social media, and 76% responded favorably to the possibility of receiving online mental health support. CONCLUSIONS::The Internet and social media were part of daily life for participants with FEP. Activity continued throughout the DUP, offering the prospect of earlier intervention. Participants expressed positive attitudes toward Internet-based outreach and engagement efforts