Comparative efficacy of two primary care interventions to assist withdrawal from long term benzodiazepine use: A protocol for a clustered, randomized clinical trial

<p>Abstract</p> <p>Background</p> <p>Although benzodiazepines are effective, long-term use is not recommended because of potential adverse effects; the risks of tolerance and dependence; and an increased risk of hip fractures, motor vehicle accidents, and memory impairment. The estimated prevalence of long-term benzodiazepine use in the general population is about 2,2 to 2,6%, is higher in women and increases steadily with age. Interventions performed by General Practitioners may help patients to discontinue long-term benzodiazepine use. We have designed a trial to evaluate the effectiveness and safety of two brief general practitioner-provided interventions, based on gradual dose reduction, and will compare the effectiveness of these interventions with that of routine clinical practice.</p> <p>Methods/Design</p> <p>In a three-arm cluster randomized controlled trial, general practitioners will be randomly allocated to: a) a group in which the first patient visit will feature a structured interview, followed by visits every 2-3 weeks to the end of dose reduction; b) a group in which the first patient visit will feature a structured interview plus delivery of written instructions to self-reduce benzodiazepine dose, or c) routine care. Using a computerized pharmaceutical prescription database, 495 patients, aged 18-80 years, taking benzodiazepine for at least 6 months, will be recruited in primary care health districts of three regions of Spain (the Balearic Islands, Catalonia, and Valencia). The primary outcome will be benzodiazepine use at 12 months. The secondary outcomes will include measurements of anxiety and depression symptoms, benzodiazepine dependence, quality of sleep, and alcohol consumption.</p> <p>Discussion</p> <p>Although some interventions have been shown to be effective in reducing benzodiazepine consumption by long-term users, the clinical relevance of such interventions is limited by their complexity. This randomized trial will compare the effectiveness and safety of two complex stepped care interventions with that of routine care in a study with sufficient statistical power to detect clinically relevant differences.</p> <p>Trial Registration</p> <p>Current Controlled Trials: <a href="http://www.controlled-trials.com/ISRCTN13024375">ISRCTN13024375</a></p

Cruise Summary Report - MEDWAVES survey. MEDiterranean out flow WAter and Vulnerable EcosystemS (MEDWAVES)

The MEDWAVES (MEDiterranean out flow WAter and Vulnerable EcosystemS) cruise targeted areas under the potential influence of the MOW within the Mediterranean and Atlantic realms. These include seamounts where Cold-water corals (CWCs) have been reported but that are still poorly known, and which may act as essential “stepping stones” connecting fauna of seamounts in the Mediterranean with those of the continental shelf of Portugal, the Azores and the Mid-Atlantic Ridge. During MEDWAVES sampling has been conducted in two of the case studies of ATLAS: Case study 7 (Gulf of Cádiz-Strait of Gibraltar-Alboran Sea) and Case study 8 (Azores). The initially targeted areas in the Atlantic were: the Gazul Mud volcano, in the Gulf of Cádiz (GoC) area, included in the case study 7, and the Atlantic seamounts Ormonde (Portuguese shelf) and Formigas (by Azores), both part of the case study 8. In the Mediterranean the targeted areas were The Guadiaro submarine canyon and the Seco de los Olivos (also known as Chella Bank) seamount. Unfortunately it was not possible to sample in Guadiaro due to time constraints originated by adverse meteorological conditions which obligate us to reduce the time at sea focusing only in 4 of the 5 initially planned areas. MEDWAVES was structured in two legs; the first leg took place from the 21st September (departure from Cádiz harbour in Spain) to the 13th October 2016 (arrival in Ponta Delgada, São Miguel, Azores, Portugal took place the 8th of October due to the meteorological conditions that obligated to conclude the first leg earlier as planned). during the Leg 1 sampling was carried out in Gazul, Ormonde and Formigas. The second leg started the 14th October (departure from Ponta Delgada) and finished the 26th October (arrival in Málaga harbour, Spain). MEDWAVES had a total of 30 effective sampling days, being 6 days not operative due to the adverse meteorological conditions experienced during the first leg which forced us to stay in Ponta Delgada from the 08th to the 13th October. During MEDWAVES the daily routine followed a similar scheme, depending of course on the weather and sea conditions. The main activity during the day, starting early in the morning (around 08:00 AM, once the night activities were finished), was the ROV deployment. Generally a single ROV dive of around 8 hours was performed, however in several occasions two dives were carried out in the same day (see General station list, Appendix II). After the ROV (and sometimes between two dives) the Box Corer and/or Van Veen Grab and/or Multicore was deployed. After these activities, during the night CTD-Rosette deployments and MB was conducted. Accordingly to this schema the scientific personnel worked in the day or in the night watch. A total of 215 sampling stations have been covered in MEDWAVES, using the following sampling gears: Multibeam echosounder, CTD-Rosette, LADCP, Box Corer, Van Veen Grab, Multicorer and a Remotely Operated Vehicle (ROV). Table 1 sumamrised the number of sampling stations conducted with each gear in each sampling zone. Additionally MB surveys have been conducted during the transits between area

Comparative analysis of epiphytic foraminifera in sediments colonized by seagrass Posidonia oceanica and invasive macroalgae Caulerpa spp.

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Characterization of nitrogen and carbon stable isotopes in epiphytic foraminiferal morphotypes

Epiphytic foraminifera are important components of the seagrass-meadow biota. These foraminifera previously were categorized, based upon their ecological and feeding strategies, into four morphotypes that were subsequently modified to include a new morphotype for the symbiont-bearing foraminifera. We propose further modifications to increase the ecological resolution. Thus, the A* morphotype splits into leaf-encrusting forms (AF*) and rhizome encrusting taxa (AR*). Similarly, the symbiont-bearing morphotype has been separated into Large Miliolids (LM) that host a variety of algal symbionts, and Large Rotalids (LR) that exclusively host diatoms. B and C morphotypes remain as they were originally defined, whilst D* morphotype does not include symbiont-bearing taxa and represents opportunistic forms. To determine the trophic strategy of the epiphytic morphotypes, the cytoplasmic nitrogen and carbon stable-isotope signals from two localities of Mallorca (Sa Foradada and Sant Elm) and one from Madagascar were analysed. The most abundant morphotype reported in Mallorca localities was B (38% ± 4.3 in Sa Foradada and 45% ± 4.2 in Sant Elm), followed by AF* (34% ± 4.6 in Sa Foradada and 41% ± 1.0 in Sant Elm). In Madagascar, the most abundant morphotype is D* (45% ± 10), and symbiont-bearing morphotypes (LM and LR) were considerably more abundant than at the Mediterranean locations. Among all samples, the δ15N values ranged between 0.5 and 3‰; δ13C values varied between −18 and −0.9‰. An MDS statistical analysis showed that variability in the δ15N and δ13C isotopes is associated with differences among the morphotypes and likely reflects their feeding strategies. A SIMPER analysis of the isotopic composition revealed minimal differences within the sessile (AF* and AR*) and within the symbiont-bearing (LM and LR) morphotypes, indicating similar trophic strategies within each pair, largely based upon cyanobacteria as a food source. These foraminifera perform “farming” of (cyano)bacteria, fungi and diatoms, which constitute the essential components of their diet. The LM-LR morphotypes also receive organic carbon from their algal symbionts. The δ15N and δ13C values of the motile B and D* morphotypes are highly variable, indicative of diverse food sources, including cyanobacteria, fungi, microalgae and particulate organic matter (phytodetritus). The δ15N in the C morphotype are more enriched and δ13C more depleted (3‰ and −10‰, respectively) than in the sessile morphotypes. Consistent with observations of other epiphytic, sessile organisms, cyanobacteria seem to be a very important food sourceVersión del editor1,617