Moving psychiatric deinstitutionalisation forward: A scoping review of barriers and facilitators

This is the author accepted manuscript. The final version is available on open access from Cambridge University Press via the DOI in this recordPsychiatric deinstitutionalisation (PDI) processes aim to transform long-term psychiatric care by closing or reducing psychiatric hospitals, reallocating beds, and establishing comprehensive community-based services for individuals with severe and persistent mental health difficulties. This scoping review explores the extensive literature on PDI, spanning decades, regions, socio-political contexts, and disciplines, to identify barriers and facilitators of PDI implementation, providing researchers and policymakers with a categorization of these factors. To identify barriers and facilitators, three electronic databases (Medline, CINAHL, and Sociological Abstracts) were searched, yielding 2250 references. After screening and reviewing, 52 studies were included in the final analysis. Thematic synthesis was utilized to categorize the identified factors, responding to the review question. The analysis revealed that barriers to PDI include inadequate planning, funding, and leadership, limited knowledge, competing interests, insufficient community-based alternatives, and resistance from the workforce, community, and family/caregivers. In contrast, facilitators encompass careful planning, financing and coordination, available research and evidence, strong and sustained advocacy, comprehensive community services, and a well-trained workforce engaged in the process. Exogenous factors, such as conflict and humanitarian disasters, can also play a role in PDI processes. Implementing PDI requires a multifaceted strategy, strong leadership, diverse stakeholder participation, and long-term political and financial support. Understanding local needs and forces is crucial, and studying PDI necessitates methodological flexibility and sensitivity to contextual variation. At the same time, based on the development of the review itself, we identify four limitations in the literature, concerning 'time', 'location', 'focus', and 'voice'. We call for a renewed research and advocacy agenda around this neglected aspect of contemporary global mental health policy is needed

Metallic elements in foliar material and fruits of three tree species as bioindicators

This study aimed to determine the presence of metal elements in fruits and leaves of three tree species as bioindicators in San Luis Potosi, Mexico. Ninety fruit and 90 leaf samples (30 per tree species) were collected at five sites (agricultural, suburban, commercial and services, urban, and mining), using the site and the presence of P. laevigata, S. molle, and A. farnesiana as references. Total concentrations of 13 metal elements were determined using an inductively coupled plasma mass spectrometer (ICP-MS). The species were significantly affected by Co, As, and Pb (ANOVA, p≤0.05). Considering the land use and the species, the contents determined in the leaves and fruits of the three species had sufficient and phytotoxic contents of Al, Cd, Co, Ni, Mn, Ti, and Cr, and excessive ranges with the possible phytotoxic effect of As, Cu, Pb, Zn, V, and Fe. The A. farnesiana had the highest concentrations of 12 heavy metals analyzed (HM). The variation in total metal concentrations between leaves and fruits ranged from 84.70 to 99.06%, with V, As, and Cr being prominent. The functionality of these tree species as phytoremediators and bioindicators is reviewed to evaluate environmental impacts on land use. Highlights Tree species represent a potential bioindicator for studying environmental pollutants due to their ability to accumulate heavy metals. The variation in total metal concentrations between leaves and fruits ranged from 84.70 to 99.06% The contents determined in the leaves and fruits of the three species trees had sufficient and phytotoxic HM contents. The tree species have phytoremediators capacity to evaluate environmental impacts and environmental contamination of land use.This study aimed to determine the presence of metal elements in fruits and leaves of three tree species as bioindicators in San Luis Potosi, Mexico. Ninety fruit and 90 leaf samples (30 per tree species) were collected at five sites (agricultural, suburban, commercial and services, urban, and mining), using the site and the presence of P. laevigata, S. molle, and A. farnesiana as references. Total concentrations of 13 metal elements were determined using an inductively coupled plasma mass spectrometer (ICP-MS). The species were significantly affected by Co, As, and Pb (ANOVA, p≤0.05). Considering the land use and the species, the contents determined in the leaves and fruits of the three species had sufficient and phytotoxic contents of Al, Cd, Co, Ni, Mn, Ti, and Cr, and excessive ranges with the possible phytotoxic effect of As, Cu, Pb, Zn, V, and Fe. The A. farnesiana had the highest concentrations of 12 heavy metals analyzed (HM). The variation in total metal concentrations between leaves and fruits ranged from 84.70 to 99.06%, with V, As, and Cr being prominent. The functionality of these tree species as phytoremediators and bioindicators is reviewed to evaluate environmental impacts on land use. Highlights Tree species represent a potential bioindicator for studying environmental pollutants due to their ability to accumulate heavy metals. The variation in total metal concentrations between leaves and fruits ranged from 84.70 to 99.06% The contents determined in the leaves and fruits of the three species trees had sufficient and phytotoxic HM contents. The tree species have phytoremediators capacity to evaluate environmental impacts and environmental contamination of land use

Manejo de los pacientes con insuficiencia cardiaca atendidos en la consulta de cardiología : Estudio IC-BERG

To determine the perception and management of heart failure with reduced ejection fraction (HFrEF) by clinical cardiologists and to establish a consensus with recommendations. We employed the modified Delphi method among a panel of 150 experts who answered a questionnaire that included three blocks: definition and perception of patients with «stable» HFrEF (15 statements), management of patients with «stable» HFrEF (51 statements) and recommendations for optimising the management and follow-up (9 statements). The level of agreement was assessed with a Likert 9-point scale. A consensus of agreement was reached on 49 statements, a consensus of disagreement was reached on 16, and 10 statements remained undetermined. There was consensus regarding the definition of «stable» HF (82%), that HFrEF had a silent nature that could increase the mortality risk for mildly symptomatic patients (96%) and that the drug treatment should be optimised, regardless of whether a patient with HFrEF remains stable in the same functional class (98.7%). In contrast, there was a consensus of disagreement regarding the notion that treatment with an angiotensin receptor-neprilysin inhibitor is justified only when the functional class worsens (90.7%). Our current understanding of «stable» HF is insufficient, and the treatment needs to be optimised, even for apparently stable patients, to decrease the risk of disease progression

Movements, Habitat Use, and Diving Behavior of Shortfin Mako in the Atlantic Ocean

The shortfin mako is one of the most important shark species caught in Atlantic Ocean pelagic fisheries. Given increasing concerns for the stock status of the species, the present study was designed to fill gaps in the knowledge of habitat use and movement patterns of shortfin mako in the Atlantic Ocean. From 2015 to 2019, 53 shortfin makos were tagged with pop-up satellite archival tags within the North, Central, and Southwest Atlantic Ocean, with successful transmissions received from 34 tags. Generally, sharks tagged in the Northwest and Central Atlantic moved away from tagging sites showing low to no apparent residency patterns, whereas sharks tagged in the Northeast and Southwest Atlantic spent large periods of time near the Canary Archipelago and Northwest Africa, and over shelf and oceanic waters off southern Brazil and Uruguay, respectively. These areas showed evidence of site fidelity and were identified as possible key areas for shortfin mako. Sharks spent most of their time in temperate waters (18– 22◦C) above 90 m; however, data indicated the depth range extended from the surface down to 979 m, in water temperatures ranging between 7.4 and 29.9◦C. Vertical behavior of sharks seemed to be influenced by oceanographic features, and ranged from marked diel vertical movements, characterized by shallower mean depths during the night, to yo-yo diving behavior with no clear diel pattern observed. These results may aid in the development of more informed and efficient management measures for this species.En prens

Ancient DNA of the pygmy marmoset type specimen Cebuella pygmaea (Spix, 1823) resolves a taxonomic conundrum

The pygmy marmoset, the smallest of the anthropoid primates, has a broad distribution in Western Amazonia. Recent studies using molecular and morphological data have identified two distinct species separated by the Napo and Solimões-Amazonas rivers. However, reconciling this new biological evidence with current taxonomy, i.e., two subspecies, Cebuella pygmaea pygmaea (Spix, 1823) and Cebuella pygmaea niveiventris (Lönnberg, 1940), was problematic given the uncertainty as to whether Spix's pygmy marmoset (Cebuella pygmaea pygmaea) was collected north or south of the Napo and Solimões-Amazonas rivers, making it unclear to which of the two newly revealed species the name pygmaea would apply. Here, we present the first molecular data from Spix's type specimen of Cebuella pygmaea, as well as novel mitochondrial genomes from modern pygmy marmosets sampled near the type locality (Tabatinga) on both sides of the river. With these data, we can confirm the correct names of the two species identified, i.e., C. pygmaea for animals north of the Napo and Solimões-Amazonas rivers and C. niveiventris for animals south of these two rivers. Phylogenetic analyses of the novel genetic data placed into the context of cytochrome b gene sequences from across the range of pygmy marmosets further led us to reevaluate the geographical distribution for the two Cebuella species. We dated the split of these two species to 2.54 million years ago. We discuss additional, more recent, subdivisions within each lineage, as well as potential contact zones between the two species in the headwaters of these rivers

Design and baseline characteristics of SALT-HF trial: hypertonic saline therapy in ambulatory heart failure

Aims: Hypertonic saline solution (HSS) plus intravenous (IV) loop diuretic appears to enhance the diuretic response in patients hospitalized for heart failure (HF). The efficacy and safety of this therapy in the ambulatory setting have not been evaluated. We aimed to describe the design and baseline characteristics of the SALT-HF trial participants. Methods and results: ‘Efficacy of Saline Hypertonic Therapy in Ambulatory Patients with HF’ (SALT-HF) trial was a multicenter, double-blinded, and randomized study involving ambulatory patients who experienced worsening heart failure (WHF) without criteria for hospitalization. Enrolled patients had to present at least two signs of volume overload, use ≥ 80 mg of oral furosemide daily, and have elevated natriuretic peptides. Patients were randomized 1:1 to treatment with a 1-h infusion of IV furosemide plus HSS (2.6–3.4% NaCl depending on plasmatic sodium levels) versus a 1-h infusion of IV furosemide at the same dose (125–250 mg, depending on basal loop diuretic dose). Clinical, laboratory, and imaging parameters were collected at baseline and after 7 days, and a telephone visit was planned after 30 days. The primary endpoint was 3-h diuresis after treatment started. Secondary endpoints included (a) 7-day changes in congestion data, (b) 7-day changes in kidney function and electrolytes, (c) 30-day clinical events (need of IV diuretic, HF hospitalization, cardiovascular mortality, all-cause mortality or HF-hospitalization). Results: A total of 167 participants [median age, 81 years; interquartile range (IQR), 73–87, 30.5% females] were randomized across 13 sites between December 2020 and March 2023. Half of the participants (n = 82) had an ejection fraction >50%. Most patients showed a high burden of comorbidities, with a median Charlson index of 3 (IQR: 2–4). Common co-morbidities included diabetes mellitus (41%, n = 69), atrial fibrillation (80%, n = 134), and chronic kidney disease (64%, n = 107). Patients exhibited a poor functional NYHA class (69% presenting NYHA III) and several signs of congestion. The mean composite congestion score was 4.3 (standard deviation: 1.7). Ninety per cent of the patients (n = 151) presented oedema and jugular engorgement, and 71% (n = 118) showed lung B lines assessed by ultrasound. Median inferior vena cava diameter was 23 mm, (IQR: 21–25), and plasmatic levels of N-terminal-pro-B-type natriuretic peptide (NTproBNP) and antigen carbohydrate 125 (CA125) were increased (median NT-proBNP 4969 pg/mL, IQR: 2508–9328; median CA125 46 U/L, IQR: 20–114). Conclusions: SALT-HF trial randomized 167 ambulatory patients with WHF and will determine whether an infusion of hypertonic saline therapy plus furosemide increases diuresis and improves decongestion compared to equivalent furosemide administration alone

Ancient DNA of the Pygmy Marmoset Type Specimen \u3cem\u3eCebuella pygmaea\u3c/em\u3e (Spix, 1823) Resolves a Taxonomic Conundrum

The pygmy marmoset, the smallest of the anthropoid primates, has a broad distribution in Western Amazonia. Recent studies using molecular and morphological data have identified two distinct species separated by the Napo and Solimões-Amazonas rivers. However, reconciling this new biological evidence with current taxonomy, i.e., two subspecies, Cebuella pygmaea pygmaea (Spix, 1823) and Cebuella pygmaea niveiventris (Lönnberg, 1940), was problematic given the uncertainty as to whether Spix’s pygmy marmoset (Cebuella pygmaea pygmaea) was collected north or south of the Napo and Solimões-Amazonas rivers, making it unclear to which of the two newly revealed species the name pygmaea would apply. Here, we present the first molecular data from Spix’s type specimen of Cebuella pygmaea, as well as novel mitochondrial genomes from modern pygmy marmosets sampled near the type locality (Tabatinga) on both sides of the river. With these data, we can confirm the correct names of the two species identified, i.e., C. pygmaea for animals north of the Napo and Solimões-Amazonas rivers and C. niveiventris for animals south of these two rivers. Phylogenetic analyses of the novel genetic data placed into the context of cytochrome b gene sequences from across the range of pygmy marmosets further led us to re-evaluate the geographical distribution for the two Cebuella species. We dated the split of these two species to 2.54 million years ago. We discuss additional, more recent, subdivisions within each lineage, as well as potential contact zones between the two species in the headwaters of these rivers

Design and baseline characteristics of SALT‐HF trial: hypertonic saline therapy in ambulatory heart failure

Aims Hypertonic saline solution (HSS) plus intravenous (IV) loop diuretic appears to enhance the diuretic response in patients hospitalized for heart failure (HF). The efficacy and safety of this therapy in the ambulatory setting have not been evaluated. We aimed to describe the design and baseline characteristics of the SALT-HF trial participants. Methods and results 'Efficacy of Saline Hypertonic Therapy in Ambulatory Patients with HF' (SALT-HF) trial was a multicenter, double-blinded, and randomized study involving ambulatory patients who experienced worsening heart failure (WHF) without criteria for hospitalization. Enrolled patients had to present at least two signs of volume overload, use >= 80 mg of oral furosemide daily, and have elevated natriuretic peptides. Patients were randomized 1:1 to treatment with a 1-h infusion of IV furosemide plus HSS (2.6-3.4% NaCl depending on plasmatic sodium levels) versus a 1-h infusion of IV furosemide at the same dose (125-250 mg, depending on basal loop diuretic dose). Clinical, laboratory, and imaging parameters were collected at baseline and after 7 days, and a telephone visit was planned after 30 days. The primary endpoint was 3-h diuresis after treatment started. Secondary endpoints included (a) 7-day changes in congestion data, (b) 7-day changes in kidney function and electrolytes, (c) 30-day clinical events (need of IV diuretic, HF hospitalization, cardiovascular mortality, all-cause mortality or HF-hospitalization). Results A total of 167 participants [median age, 81 years; interquartile range (IQR), 73-87, 30.5% females] were randomized across 13 sites between December 2020 and March 2023. Half of the participants (n = 82) had an ejection fraction >50%. Most patients showed a high burden of comorbidities, with a median Charlson index of 3 (IQR: 2-4). Common co-morbidities included diabetes mellitus (41%, n = 69), atrial fibrillation (80%, n = 134), and chronic kidney disease (64%, n = 107). Patients exhibited a poor functional NYHA class (69% presenting NYHA III) and several signs of congestion. The mean composite congestion score was 4.3 (standard deviation: 1.7). Ninety per cent of the patients (n = 151) presented oedema and jugular engorgement, and 71% (n = 118) showed lung B lines assessed by ultrasound. Median inferior vena cava diameter was 23 mm, (IQR: 21-25), and plasmatic levels of N-terminal-pro-B-type natriuretic peptide (NTproBNP) and antigen carbohydrate 125 (CA125) were increased (median NT-proBNP 4969 pg/mL, IQR: 2508-9328; median CA125 46 U/L, IQR: 20-114). Conclusions SALT-HF trial randomized 167 ambulatory patients with WHF and will determine whether an infusion of hypertonic saline therapy plus furosemide increases diuresis and improves decongestion compared to equivalent furosemide administration alone

Splicing Machinery is Dysregulated in Pituitary Neuroendocrine Tumors and is Associated with Aggressiveness Features

Pituitary neuroendocrine tumors (PitNETs) constitute approximately 15% of all brain tumors, and most have a sporadic origin. Recent studies suggest that altered alternative splicing and, consequently, appearance of aberrant splicing variants, is a common feature of most tumor pathologies. Moreover, spliceosome is considered an attractive therapeutic target in tumor pathologies, and the inhibition of SF3B1 (e.g., using pladienolide-B) has been shown to exert antitumor effects. Therefore, we aimed to analyze the expression levels of selected splicing-machinery components in 261 PitNETs (somatotropinomas/non-functioning PitNETS/corticotropinomas/prolactinomas) and evaluated the direct effects of pladienolide-B in cell proliferation/viability/hormone secretion in human PitNETs cell cultures and pituitary cell lines (AtT-20/GH3). Results revealed a severe dysregulation of splicing-machinery components in all the PitNET subtypes compared to normal pituitaries and a unique fingerprint of splicing-machinery components that accurately discriminate between normal and tumor tissue in each PitNET subtype. Moreover, expression of specific components was associated with key clinical parameters. Interestingly, certain components were commonly dysregulated throughout all PitNET subtypes. Finally, pladienolide-B reduced cell proliferation/viability/hormone secretion in PitNET cell cultures and cell lines. Altogether, our data demonstrate a drastic dysregulation of the splicing-machinery in PitNETs that might be associated to their tumorigenesis, paving the way to explore the use of specific splicing-machinery components as novel diagnostic/prognostic and therapeutic targets in PitNETs