A MULTI‐GENE ESTIMATE OF HIGHER‐LEVEL PHYLOGENETIC RELATIONSHIPS AMONG NIGHTJARS (AVES: CAPRIMULGIDAE)

ABSTRACT ∙ The higher‐level phylogenetic relationships of the nightjars and nighthawks (Caprimulgidae) have been challenging for traditional systematics due to their cryptic plumage and conservative morphology. We explored these relationships by combining two previously published molecular datasets with new data to generate a complete matrix (7,104 bp) of evolutionarily disparate sequence elements from four genes for 36 taxa. We analyzed each of the genes separately for base composition heterogeneity and heterozygosity. We analyzed the concatenated matrix in a likelihood framework using seven different partitioning schemes. As the number of subsets in a given partitioning scheme increased, tree length and likelihood score also increased; however, the branching topology was little affected by increasingly complex partitioning schemes. Our best maximum likelihood tree has increased bootstrap support at 13 of 30 ingroup nodes compared with previous analyses, a result likely due to doubling the length of the sequence data. Coalescent‐based species tree inference produced a tree congruent with all strongly supported nodes in the maximum likelihood tree. This topology agrees with previous molecular studies in identifying three small, early branching Old World genera (Eurostopodus, Lyncornis, and Gactornis) and four more speciose terminal clades, representing the New World nighthawks (genus Chordeiles) and three nightjar radiations centered in South America, Central America and the Old World, respectively. Increased node support across the tree reinforces a historical scenario with origins in the region surrounding the Indian Ocean, followed by diversification in the New World and subsequent recolonization and radiation in the Old World. Future work on this group should incorporate additional members of the genera Lyncornis and Eurostopodus, to determine which is the basal lineage of Caprimulgidae.RESUMEN ∙ Relaciones filogenéticas de más alto nivel de los atajacaminos (Aves: Caprimulgidae) en base a un análisis multigénico Las relaciones filogenéticas de más alto nivel de los atajacaminos y añaperos (Caprimulgidae) son un reto para la sistemática tradicional, debido a que el grupo posee morfología poco variable y plumajes crípticos. Exploramos relaciones filogenéticas en el grupo combinando dos conjuntos de datos moleculares ya publicados con nuevos datos. La matriz completa (7,104 bp) se generó con cuatro genes y 36 taxones, incluyendo marcadores con distintos modelos de evolución. Se examinó cada uno de los genes por separado para determinar heterocigosidad y heterogeneidad de la composición de bases. Se analizó la matriz concatenada en un marco de máxima verosimilitud utilizando siete particiones diferentes. La longitud de los árboles filogenéticos y su verosimilitud aumentaron a la par del número de subconjuntos en una partición particular; sin embargo, la topología del árbol varió poco entre particiones. En comparación con topologías publicadas, nuestro árbol de máxima verosimilitud tuvo mejor soporte para 13 de los 30 nodos internos, resultado que podría deberse al uso del doble de los datos de secuencias. El método de árboles de especies basado en coalescencia produjo una topología congruente con la obtenida por máxima verosimilitud. Esta topología concuerda con previos estudios moleculares, identificando tres pequeños géneros del Viejo Mundo como basales en la filogenia (Eurostopodus, Lyncornis y Gactornis), y cuatro clados terminales con más especies. Estos clados terminales representan los atajacaminos del Nuevo Mundo del género Chordeiles, y otras tres radiaciones de América del Sur, Central y del Viejo Mundo. Nuestros resultados sugieren un escenario histórico con orígenes del grupo en la región circundante al Océano Indico, seguido por la diversificación en las Américas y la posterior recolonización y radiación en el Viejo Mundo. Futuros estudios en este grupo deben incorporar miembros adicionales de los géneros Lyncornis y Eurostopodus, lo que permitirá estudiar cuál es el linaje basal de Caprimulgidae

Integrated motivational interviewing and cognitive behavioural therapy for people with psychosis and comorbid substance misuse: randomised controlled trial

Objectives To evaluate the effectiveness of integrated motivational interviewing and cognitive behaviour therapy in addition to standard care for patients with psychosis and a co-morbid substance use problem. Design Two-centre, open, rater-blind randomised controlled trial Setting UK Secondary Care Participants 327 patients with clinical diagnoses of schizophrenia, schizophreniform or schizoaffective disorder and DSM-IV diagnoses of drug and/or alcohol dependence or abuse Interventions Participants were randomly allocated to integrated motivational interviewing and cognitive behaviour therapy or standard care. Therapy has two phases. Phase one – “motivation building” – concerns engaging the patient, then exploring and resolving ambivalence for change in substance use. Phase two –“Action” – supports and facilitates change using cognitive behavioural approaches. Up to 26 therapy sessions were delivered over one year. Main outcomes The primary outcome was death from any cause or admission to hospital in the 12 months after therapy. Secondary outcomes were frequency and amount of substance use (Timeline Followback), readiness to change, perceived negative consequences of use, psychotic symptom ratings, number and duration of relapses, global assessment of functioning and deliberate self harm, at 12 and 24 months, with additional Timeline Followback assessments at 6 and 18 months. Analysis was by intention-to-treat with robust treatment effect estimates. Results 327 participants were randomised. 326 (99.7%) were assessed on the primary outcome, 246 (75.2%) on main secondary outcomes at 24 months. Regarding the primary outcome, there was no beneficial treatment effect on hospital admissions/ death during follow-up, with 20.2% (33/163) of controls and 23.3% (38/163) of the therapy group deceased or admitted (adjusted odds-ratio 1.16; P= 0.579; 95% confidence interval 0.68 to 1.99). For secondary outcomes there was no treatment effect on frequency of substance use or perceived negative consequences, but a statistically significant effect of therapy on amount used per substance-using day (adjusted odds-ratios: (a) for main substance 1.50; P=0.016; 1.08 to 2.09, (b) all substances 1.48; P=0.017; 1.07 to 2.05). There was a statistically significant treatment effect on readiness to change use at 12 months (adjusted odds-ratio 2.05; P=0.004; 1.26 to 3.31), not maintained at 24 months. There were no treatment effects on assessed clinical outcomes. Conclusions Integrated motivational interviewing and cognitive behaviour therapy for people with psychosis and substance misuse does not improve outcome in terms of hospitalisation, symptom outcomes or functioning. It does result in a reduction in amount of substance use which is maintained over the year’s follow up. Trial registration Current Controlled Trials: ISRCTN1440448

Understanding Outcomes in a Randomized Controlled Trial of a Ward-based Intervention on Psychiatric Inpatient Wards: A Qualitative Analysis of Staff and Patient Experiences.

OBJECTIVE: Team formulation is advocated to improve quality of care in mental health care and evidence from a recent U.K.-based trial supports its use in inpatient settings. This study aimed to identify the effects of formulation on practice from the perspectives of staff and patient participating in the trial, including barriers and enhancers to implementing the intervention. METHOD: We carried out semistructured interviews with 57 staff and 20 patients. Data were analyzed using thematic analysis. RESULTS: Main outcomes were: improved staff understanding of patients, better team collaboration and increased staff awareness of their own feelings. Key contextual factors were as follows: overcoming both staff and patient anxiety, unwelcome expert versus collaborative stance, competing demands, and management support. CONCLUSION: Team formulation should be implemented to improve quality of care in inpatient settings and larger definitive trials should be carried out to assess the effect of this intervention on patient outcomes

Estudio comparativo de los nuevos anticoagulantes orales

El tratamiento anticoagulante con Antagonistas de la Vitamina K (AVK) es muy complejo. Los nuevos anticoagulantes orales han supuesto una alternativa a los fármacos inhibidores de la vitamina K, presentando un mayor margen terapéutico así como una menor variabilidad intrae interindividual. Por otra parte, pueden administrarse a dosis fijas sin necesidad de una monitorización tan estrecha como requieren los AVK. Los nuevos anticoagulantes orales se clasifican en dos grupos atendiendo a su mecanismo de acción: inhibidores directos del factor X activado (FXa) (rivaroxabán, apixabán y edoxabán) y un inhibidor directo de la trombina (dabigatrán). Se han finalizado con resultados positivos diversos ensayos de fase III en profilaxis del tromboembolismo venoso en cirugía ortopédica, tratamiento del tromboembolismo venoso, o prevención del ictus en pacientes con fibrilación auricular. Para establecer una dosificación adecuada de estos fármacos, dado que las pruebas de laboratorio disponibles no son precisas ni permiten conocer el grado de anticoagulación, es necesario considerar otros factores como las interacciones farmacológicas y el estado de la función renal de cada paciente. En el futuro, las preferencias del paciente y las características farmacológicas serán relevantes para optimizar el tratamiento. Por todo ello, estos nuevos fármacos representan un nuevo paradigma en el tratamiento anticoagulante, aportando grandes ventajas, pero no exentos de inconvenientes

Genes Suggest Ancestral Colour Polymorphisms Are Shared across Morphologically Cryptic Species in Arctic Bumblebees

email Suzanne orcd idCopyright: © 2015 Williams et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Collaborative community based care for people and their families living with schizophrenia in India: protocol for a randomised controlled trial

BACKGROUND: There is a large treatment gap with few community services for people with schizophrenia in low income countries largely due to the shortage of specialist mental healthcare human resources. Community based rehabilitation (CBR), involving lay health workers, has been shown to be feasible, acceptable and more effective than routine care for people with schizophrenia in observational studies. The aim of this study is to evaluate whether a lay health worker led, Collaborative Community Based Care (CCBC) intervention, combined with usual Facility Based Care (FBC), is superior to FBC alone in improving outcomes for people with schizophrenia and their caregivers in India. METHODS/DESIGN: This trial is a multi-site, parallel group randomised controlled trial design in India.The trial will be conducted concurrently at three sites in India where persons with schizophrenia will be screened for eligibility and recruited after providing informed consent. Trial participants will be randomly allocated in a 2:1 ratio to the CCBC+FBC and FBC arms respectively using an allocation sequence pre-prepared through the use of permuted blocks, stratified within site. The structured CCBC intervention will be delivered by trained lay community health workers (CHWs) working together with the treating Psychiatrist. We aim to recruit 282 persons with schizophrenia. The primary outcomes are reduction in severity of symptoms of schizophrenia and disability at 12 months. The study will be conducted according to good ethical practice, data analysis and reporting guidelines. DISCUSSION: If the additional CCBC intervention delivered by front line CHWs is demonstrated to be effective and cost-effective in comparison to usually available care, this intervention can be scaled up to expand coverage and improve outcomes for persons with schizophrenia and their caregivers in low income countries. TRIAL REGISTRATION: The trial is registered with the International Society for the Registration of Clinical Trials and the allocated unique ID number is ISRCTN 56877013

Randomised control trial of the effectiveness of an integrated psychosocial health promotion intervention aimed at improving health and reducing substance use in established psychosis (IMPaCT)

© 2017 The Author(s). Background: People with psychosis have a reduced life expectancy of 10-20years, largely due to cardiovascular disease. This trial aimed to determine the effectiveness of a modular health promotion intervention (IMPaCT Therapy) in improving health and reducing cardiovascular risk in psychosis. Methods: A multicentre, two arm, parallel cluster RCT was conducted across five UK mental health NHS trusts. Community care coordinators (CC) were randomly assigned to training and supervision in delivering IMPaCT Therapy or treatment as usual (TAU) to current patients with psychosis (cluster). The primary outcome was the physical and mental health subscales of the Short form-36 (SF-36) questionnaire. Results: Of 104 care coordinators recruited, 52 (with 213 patients) were randomised to deliver IMPaCT therapy and 52 (with 193 patients) randomised to TAU. Of 406 patients, 318 (78%) and 301 (74%) attended 12- and 15-month follow-up respectively. IMPaCT therapy showed no significant effect on the physical or mental health component SF-36 scores versus TAU at 12 or 15months. No effect was observed for cardiovascular risk indicators, except for HDL cholesterol, which improved more with IMPACT therapy than TAU (Treatment effect (95% CI); 0.085 (0.007 to 0.16); p= 0.034). The 22% of patients who received > 180min of IMPACT Therapy in addition to usual care achieved a greater reduction in waist circumference than did controls, which was clinically significant. Conclusion: Training and supervising community care coordinators to use IMPaCT therapy in patients with psychosis is insufficient to significantly improve physical or mental health quality of life. The search for effective, pragmatic interventions deliverable in health care services continues. Trial registration: The trial was retrospectively registered with ISRCTN registry on 23/4/2010 at ISRCTN58667926 ; recruitment started on 01/03/2010 with first randomization on 09.08.2010 ISRCTN58667926

Implementation of a Family Intervention for Individuals with Schizophrenia

Families are rarely included in clinical care despite research showing that family involvement has a positive effect on individuals with schizophrenia by reducing relapse, improving work functioning, and social adjustment. The VA QUERI study, EQUIP (Enhancing QUality of care In Psychosis), implemented family services for this population. At two VA medical centers, veterans with schizophrenia and their clinicians were interviewed separately at baseline and 15 months. A family intervention was implemented, and a process evaluation of the implementation was conducted. Veterans with schizophrenia (n = 173) and their clinicians (n = 29). Consent to contact family was obtained, mailers to engage families were sent, families were prioritized as high need for family services, and staff volunteers were trained in a brief three-session family intervention. Of those enrolled, 100 provided consent for family involvement. Seventy-three of the 100 were sent a mailer to engage them in care; none became involved. Clinicians were provided assessment data on their patients and notified of 50 patients needing family services. Of those 50, 6 families were already involved, 34 were never contacted, and 10 were contacted; 7 new families became involved in care. No families were referred to the family psychoeducational program. Uptake of the family intervention failed due to barriers from all stakeholders. Families did not respond to the mailer, patients were concerned about privacy and burdening family, clinicians had misperceptions of family-patient contact, and organizations did not free up time or offer incentives to provide the service. If a full partnership with patients and families is to be achieved, these barriers will need to be addressed, and a family-friendly environment will need to be supported by clinicians and their organizations. Applicability to family involvement in other disorders is discussed