bluuebunny/crossref_metadata_2025 huggingface dataset:
Incorporation of pig back fat in restructured dry cured ham to enhance the lipase and lipoxygenase activities
Authors: Hui Teng , Zhang Yawei , Jamali Muneer Ahmed , Peng Zengqi
Published: May 2016

The aim of the present study was to evaluate the effect of incorporating pig back fat in restructured dry cured ham (RDH) on the lipase and lipoxygenase activities. Fresh raw hams were skinned, boned, cut into meat cubes (4–6 × 4–6 × 4–6 cm). The meat cubes were restructured respectively with 0, 2, and 4% pig back fat paste into raw restructured ham. After 30 days of ripening, lipase activity in RDH was determined using a fluorescence spectrometer (λex = 350 nm, λem = 445 nm), the result was expressed as µmol of released 4‐methylumbelliferone per hour per gram protein. Lipoxygenase (LOX) activity in RDH was assayed in a 96‐Well Plate Reader M200, one unit of LOX activity was defined as an absorbance increment per minute per milligram protein at 234 nm. Results showed that exogenous pig back fat incorporation from 2 to 4% gave rise to the increased neutral lipase and LOX activities (p < 0.05), and the enhanced hydrolysis of neutral lipids and phospholipids, and production of free fatty acids, suggesting that exogenous pig back fat incorporation could improve the quality of RDH.

Practical applications: Hams produced from genotypes with high intramuscular fat have more intense and persistent aroma, because intramuscular triacylglycerols are a good trap for most aroma compounds. However, traditional extensive feeding regime give rise to massive consumption of natural resource and this strategy is not always feasible because availability of natural resource is largely influenced by environment. The present work has provided a successful strategy to improve dry cured hams’ quality that incorporating exogenous pig back fat directly into raw ham from general confinement feeding, not through traditional extensive feeding, could increase the content of lipid, and enhance the neutral lipase and LOX activities in dry cured meat.

Restructured dry cured hams (RDH) with different pig back fat levels were successfully manufactured. This work shown that large differences in the neutral lipase and LOX (Lipoxygenase) activities of RDH can be caused by the exogenous pig back fat incorporation. An increase in pig back fat level from 2 to 4% in RDH significantly enhanced the neutral lipase and LOX activities during ripening.
Influence of roasting temperature of pumpkin seed on PAH and aroma formation
Authors: Potočnik Tanja , Košir Iztok Jože
Published: May 2016

Pumpkin (Cucurbita pepo L.) seed oil is an edible oil, a traditional product of eastern Slovenia, and is used for cold dishes, such as salads. After roasting at about 110°C, the pumpkin seeds are squeezed into dark green oil with typical flavor and aroma. During roasting, polycyclic aromatic hydrocarbons (PAHs) can form. In this study, the aroma composition and PAH formation in oil samples from seeds roasted at different temperatures were determined. Seeds were roasted at temperatures ranging from 90 to 200°C. High‐performance liquid chromatography with fluorescence detection for PAH determination and gas chromatography coupled with mass spectrometry for volatile compound determination were used. At 150°C, the formation of PAHs was detected. Light PAHs prevailed, especially phenanthrene. Increasing roasting temperature also significantly changed the composition of volatile compounds composition. Aldehydes and alcohols prevailed at low roasting temperatures. High temperature caused the formation of different pyrazines, which possess a roasted aroma.

Practical applications: Results of this study provide information about the influence of roasting pumpkin seeds on their quality and safety. Data indicate which temperature to use to obtain a safe product, pumpkin seed oil that does not contain PAHs. Increasing roasting temperature is responsible for changes in the volatile compound composition. The aroma varies from green and fresh to roasted and burnt. The customer expects pumpkin seed oil to possess the typical aroma; thus the choice of temperature is essential. Results of this study can be applied at all pumpkin seed oil production sites and are transferable to other edible oils for which elevated temperatures are used during production.

Thermal treatment – roasting of pumpkin seeds can cause polycyclic aromatic hydrocarbon formation and significantly influences on aroma composition of pumpkin seed oil.
4‐Nitrophenol exposure alters the AhR signaling pathway and related gene expression in the rat liver
Authors: Li Ruonan , Song Meiyan , Li Zhi , Li Yansen , Watanabe Gen , Nagaoka Kentaro , Taya Kazuyoshi , Li Chunmei
Published: May 2016

4‐Nitrophenol (PNP) is well known as an environmental endocrine disruptor. The aim of this study was to clarify the mechanism of PNP‐induced liver damage and determine the regulatory involvement of the aryl hydrocarbon receptor (AhR) signaling pathway and associated gene expression. Immature male Wistar–Imamichi rats (28 days old) were randomly divided into control and PNP groups, which consisted of 1‐ and 3‐day exposure (1 DE and 3 DE, respectively) and 3‐day exposure followed by 3‐day recovery (3 DE + 3 DR), groups. Each group was administered the vehicle or PNP (200 mg kg–1 body weight). The body and liver weight were significantly decreased in the 3 DE group. The mRNA expression levels of estrogen receptor‐α (ERα), glutathione S‐transferase (GST) and AhR exhibited a significant increase in the 1 DE group whereas, in contrast, that of cytochrome P450 (CYP) 1A1 decreased significantly in the 3 DE +3 DR group. AhR and CYP1A1 proteins were detected in the cytoplasm of hepatocytes of the 1 DE and 3 DE +3 DR groups whereas the ERα protein was found in the hepatocyte nuclei of the 1 DE and 3 DE groups. The present study demonstrates that PNP activated the AhR signaling pathway and regulated related CYP1A1 and GST gene expression in the liver. Copyright © 2016 John Wiley & Sons, Ltd.
Incline the Beam
Authors: Weber Patricia , Diego‐Vallejo David , Schlüter Holger
Published: May 2016

Modern ultra‐short‐pulse (USP) laser systems are fostering new micro‐machining technologies. Hole drilling with high aspect ratios has become a particularly important application in several industries. But drilling straight walls with high aspect ratios is not feasible if the laser beam impacts specimens at a normal incidence angle. The beam caustic affects hole corners and limits the maximum aspect ratio — that's why new solutions are needed. A novel 5‐axis technology allows beam inclination and enables straight walls, as well as negatively tapered holes.
Determination of the motor unit behavior of lumbar erector spinae muscles through surface EMG decomposition technology in healthy female subjects
Authors: Silva Mariana Felipe , Dias Josilainne Marcelino , Pereira Ligia Maxwell , Mazuquin Bruno Fles , Lindley Steven , Richards Jim , Cardoso Jefferson Rosa
Published: May 2016

Introduction: The aims of this study were to determine the motor unit behavior of the erector spinae muscles and to assess whether differences exist between the dominant/nondominant sides of the back muscles. Methods: Nine healthy women, aged 21.7 years (SD = 0.7), performed a back extension test. Surface electromyographic decomposition data were collected from both sides of the erector spinae and decomposed into individual motor unit action potential trains. The mean firing rate for each motor unit was calculated, and a regression analysis was performed against the corresponding recruitment thresholds. Results: The mean firing rate ranged from 15.9 to 23.9 pps and 15.8 to 20.6 pps on the dominant and nondominant sides, respectively. However, the early motor unit potentials of the nondominant lumbar erector spinae muscles were recruited at a lower firing rate. Conclusions: This technique may further our understanding of individuals with back pain and other underlying neuromuscular diseases. Muscle Nerve 55: 28–34, 2017
Recognize 6 signs it's time for a web redesign or redevelopment
Authors: Talarico Donna
Published: May 2016

A shiny, new, state‐of‐the‐art website stays that way for only so long. Rapidly changing technology and a constant evolution of how people interact with online content challenge us to keep up with our digital identity.
Consider advantages, challenges of implementing competency‐based transcripts
Authors: Sutton Halley
Published: May 2016

PHOENIX — Many employers don't see a direct connection between credit hours and job skills. Various solutions have been proposed to translate the experience of a student enrolled in a four‐year institution to tangible knowledge for the work force.
Embrace change to meet your adult students' needs
Authors: Sutton Halley
Published: May 2016

Jonathan Talley wasn't content with merely attending Drury University on the GI Bill after serving in the army. A first‐generation nontraditional aged student, Talley certified student‐veteran enrollment for off‐campus students as part of his VA work‐study program. In his spare time, he would visit Drury's admissions and financial aid offices and ask if there was any extra work he could help pick up. There, he learned the university computer system, as well as how to write reports and navigate financial aid paperwork. “I wanted to work and stay busy and learn new things,” Talley said of his extracurricular experience working with the admissions office and financial aid, all of which came in handy once he transitioned to a position as director of Adult and Non‐Traditional Student Resources at Missouri State University.
Some Aspects on Safety and Environmental Impact of the German Green Gel Propulsion Technology
Authors: Ciezki Helmut K. , Naumann Karl Wieland
Published: May 2016

This article gives a short introduction into the technology of gelled propellant rocket motors and gas generators. A brief introduction outlines the specific features of the German green gelled propellant rocket motor technology and the family of monopropellants that cover a variety of requirements with respect to smoke, combustion temperature, and combustion pressure ranges. The discussion of the hazard potential comprises military insensitive munitions (IM) and civil classifications as well as a comparative assessment of the environmental and health impacts from manufacturing over use and finally to disposal. Summarizing the properties over all categories shows that gelled propellants provide a unique combination of good insensitivity and low environmental and health hazard potential compared to other liquid propellants, fuels, and oxidizers or solid rocket propellants.
Testing treatment effect in schizophrenia clinical trials with heavy patient dropout using latent class growth mixture models
Authors: Kong Fanhui , Chen Yeh‐Fong
Published: May 2016

By examining the outcome trajectories of the dropout patients with different reasons in the schizophrenia trials, we note that although patients are recruited from the same protocol that have compatible baseline characteristics, they may respond differently even to the same treatment. Some patients show consistent improvement while others only have temporary relief. This creates different patient subpopulations characterized by their response and dropout patterns. At the same time, those who continue to improve seem to be more likely to complete the study while those who only experience temporary relief have a higher chance to drop out. Such phenomenon appears to be quite general in schizophrenia clinical trials. This simultaneous inhomogeneity both in patient response as well as dropout patterns creates a scenario of missing not at random and therefore results in biases when we use the statistical methods based on the missing at random assumption to test treatment efficacy. In this paper, we propose to use the latent class growth mixture model, which is a special case of the latent mixture model, to conduct the statistical analyses in such situation. This model allows us to take the inhomogeneity among subpopulations into consideration to make more accurate inferences on the treatment effect at any visit time. Comparing with the conventional statistical methods such as mixed‐effects model for repeated measures, we demonstrate through simulations that the proposed latent mixture model approach gives better control on the Type I error rate in testing treatment effect. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.
Investigation of the Co‐Dependence of Morphology and Fluorescence Lifetime in a Metal‐Organic Framework
Authors: Schrimpf Waldemar , Ossato Giulia , Hirschle Patrick , Wuttke Stefan , Lamb Don C.
Published: May 2016

Porous materials, due to their large surface‐to‐volume ratio, are important for a broad range of applications and are the subject of intense research. Most studies investigate the bulk properties of these materials, which are not sensitive to the effect of heterogeneities within the sample. Herein, a new strategy based on correlative fluorescence lifetime imaging and scanning electron microscopy is presented that allows the detection and localization of those heterogeneities, and connects them to morphological and structural features of the material. By applying this method to a dye‐modified metal‐organic framework (MOF), two independent fluorescence quenching mechanisms in the MOF scaffold are identified and quantified. The first mechanism is based on quenching via amino groups, while the second mechanism is influenced by morphology. Furthermore, a similar correlation between the inherent luminescence lifetime and the morphology of the unmodified MOF structure is demonstrated.
Transanal hemorrhoidal dearterialization (THD): a safe procedure for the anticoagulated patient?
Authors: Atallah S. , Maharaja G. K. , Martin-Perez B. , Burke J. P. , Albert M. R. , Larach S. W.
Published: May 2016

Background

Approximately one in five persons living in the USA is maintained on oral anticoagulation. It has typically been recommended that anticoagulation be withheld prior to hemorrhoidal procedures. Transanal hemorrhoidal dearterialization (THD) is a minimally invasive treatment for symptomatic hemorrhoids, and outcomes with patients on anticoagulation who have undergone this procedure have not been previously reported. Here, we report our preliminary results of patients who underwent THD while on anticoagulation.

Methods

During a 53-month period (February 2009–July 2015), patients with symptomatic hemorrhoids refractory to medical management who underwent surgical treatment with THD were retrospectively reviewed. The subset of patients who underwent THD while anticoagulated was compared to a cohort of patient who were not taking anticoagulation and who otherwise demonstrated normal coagulation profiles and who did not have a known predisposition to bleeding or inherited coagulopathy. The primary study endpoint was to assess postoperative bleeding in patients who were maintained on anticoagulation before and after surgery.

Results

During the 53-month study period, 106 patients underwent the THD procedure for symptomatic hemorrhoids. Of these, seventy patients underwent THD without anticoagulation therapy, while 36 patients underwent THD while taking one or more oral anticoagulants. The postoperative morbidity between the two cohorts was similar, and specifically there was no statistical difference in the rate of postoperative hemorrhage (19.4 vs. 15.7 %; odds ratio 1.295, 95 % CI 0.455–3.688, p = 0.785). No patient, in either cohort, required re-intervention for any reason during the study period. Patients who underwent THD while on anticoagulation were less likely to have recurrent hemorrhoidal disease during the study’s 6-month median follow-up period (2.8 vs. 7.1 %, p = 0.049).

Conclusions

These preliminary data reveal that THD can be performed on anticoagulated patients without cessation of oral agents without increasing morbidity from postoperative bleeding.
25I-NBOMe: The legal LSD
Authors: Ezquiaga I. , Grifell M. , Galindo L. , Martínez L. , Palma Á. , Quintana P. , Ventura M. , Ribera E. , Pujol L. , Fornís I. , Torrens M. , Farré M.
Published: May 2016

Introduction

Novel psychoactive substances (NPS) use is progressively increasing year on year. A new group of phenethylamines sold as legal stimulants and hallucinogens is being reported increasingly since 2012. Within this group, 25I-NBOMe is an outstanding substance with powerful effects and high affinity with the serotonin 2a (5HT2a) receptor. Several toxicity cases have been reported so far.

Objectives

To describe the presence of 25I-NBOMe and its characteristics in samples delivered to Energy Control from 2009 to 2015 in Spain.

Methods

Among the samples, 21,198 analyzed from august 2009 to august 2015 and only those samples containing 25I-NBOMe were studied (n = 56). Samples were analyzed by Energy Control, a Spanish harm-reduction NGO that offers users the possibility of analyzing the substances they intend to consume. Analysis was done by Gas Chromatography–Mass Spectrometry.

Results

From 56 samples were 25I-NBOMe was found, 24 were bought as LSD (42.8%), 12 as 25I-NBOMe (21.4%), 4 as 25C-NBOMe (7.1%), 4 as 25I-NBOH (7.1%) and 12 as other substances (21.4%), gummy bears included. All samples were received from 2012 on, having the highest peak on 2013 (19 samples).

Conclusions

25I-NBOMe consumption represents an emerging issue with potential harmful effects, especially when the substance used is not the expected. Further pharmacokinetic, pharmacodynamic, clinical and epidemiological researches should be conducted to deepen knowledge about 25I-NBOMe and the management of its possible toxic effects. Physicians should be aware of NPS, their increasing use and the clinical differences between them.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Trends of hospitalization for bipolar I in USA: A nationwide analysis
Authors: Mansuri Z. , Mansuri U. , Rathod M. , Shambhu S. , Karnik K.
Published: May 2016

Objectives

Bipolar I (B-I) is an important cause of morbidity and mortality in hospitalized patients. While B-I has been extensively studied in the past, the contemporary data for impact of B-I on cost of hospitalization are largely lacking.

Methods

We queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (HCUP-NIS) dataset between 1998–2011 using the ICD-9 codes. Severity of comorbid conditions was defined by Deyo modification of Charlson comorbidity index. Primary outcome was in-hospital mortality and secondary outcome was total charges for hospitalization. Using SAS 9.2, Chi2 test, t-test and Cochran-Armitage test were used to test significance.

Results

A total of 1,80,681 were analyzed; 56.29% were female and 43.71% were male (P < 0.0001); 70.63% were white, 17.14% black and 12.23% of other race (P < 0.0001). Rate of hospitalization increased from 7469.65/million to 9375.27/million from 1998–2011. Overall mortality was 0.12% and mean cost of hospitalization was 19,821.50$. The in-hospital mortality increased from 0.13% to 0.16% (P < 0.0001) and mean cost of hospitalization increased from 12,091.31$ to 29,292.97$. Total yearly spending on B-I related admissions increased from $0.72 million/year to $2.16 billion/year.

Conclusions

While mortality has slightly increased from 1998 to 2011, the cost has significantly increased from $0.72 million/year to $2.16 billion/year, which leads to an estimated $1.46 billion/year additional burden to US health care system. In the era of cost conscious care, preventing B-I related Hospitalization could save billions of dollars every year. Focused efforts are needed to establish preventive measures for B-I related hospitalization.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Trends of hospitalization for major bipolar I (most recent episode-manic) in USA: A nationwide analysis
Authors: Sutaria A. , Mansuri Z. , Rathod M. , Shambhu S. , Mansuri U.
Published: May 2016

Objectives

Bipolar I most recent episode-manic (BP-I-M) is an important cause of morbidity and mortality in hospitalized patients. While BP-I-M has been extensively studied in the past, the contemporary data for impact of BP-I-M on cost of hospitalization are largely lacking.

Methods

We queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (HCUP-NIS) dataset between 1998–2011 using the ICD-9 codes. Severity of comorbid conditions was defined by Deyo modification of Charlson comorbidity index. Primary outcome was in-hospital mortality and secondary outcome was total charges for hospitalization. Using SAS 9.2, Chi2 test, t-test and Cochran-Armitage test were used to test significance.

Results

A total of 10,875 patients were analyzed; 57.13% were female and 42.87% were male (P < 0.0001); 74.78% were white, 14.51% black and 10.71% of other race (P < 0.0001). Rate of hospitalization increased from 528.71/million to 588.76/million from 1998–2011. Overall mortality was 0.42% and mean cost of hospitalization was 22,215.77$. The in-hospital mortality increased from 0.37% to 0.82% (P < 0.0001) and mean cost of hospitalization increased from 10,580.54$ to 40,737.65$. Total spending on BP-I-M related admissions have increased from $44.24 million/year to $187.00 million/year.

Conclusions

While mortality has slightly decreased from 1998 to 2011, the cost has significantly increased from $44.24 million/year to $187.00 million/year, which leads to an estimated $ 142.76 million/year additional burden to US health care system from. In the era of cost conscious care, preventing BP-I-M related hospitalization could save billions of dollars every year. Focused efforts are needed to establish preventive measures for BP-I-M related hospitalization.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A novel protocol to assess dual task cost as a potential measure of cognitive reserve
Authors: Oliveira-Maia A. , Coelho I. , Barahona-Corrêa J.B. , Paixão V. , Camacho M. , Costa R.M.
Published: May 2016

Introduction

Methods for measuring cognitive reserve (CR) are limited and controversial. Dual task cost (DTC) paradigms, assessing links between gait and cognition, are increasingly regarded as robust measures of CR.

Objectives

Here, we aimed to validate a simplified methodology for a DTC paradigm in healthy volunteers for application in clinical settings as a measurement of CR.

Methods

We tested if subtracting by 7's (cognitive task) while walking (motor task) induced a DTC in a sample of 39 healthy young adults. For the cognitive task, we recorded the number of correct and incorrect subtractions, as well as the latency between subtractions. Gait parameters were recorded on a tri-axial accelerometer fixed to the left ankle. Both tasks were performed separately (single task) and simultaneously (double task) to assess the DTC. A battery for neuropsychological assessment and questionnaires to assess quality of life and affective symptoms were also applied, to measure possible correlations with the DTC.

Results

Subtracting 7's while walking caused significant changes in gait parameters and in cognitive task performance. A significant decrease in the autocorrelation of the accelerometer signal during the dual task was also found (DTC = 37.92 ± 7.56%; P < 0.0001). This measure has not been previously used and may be a more sensitive measure of the dual task induced disturbance of the gait periodic signal pattern. Correlations between DTC and quality of life, affective or cognitive measures were not significant.

Conclusion

Our study provides an effective, portable and non-intrusive DTC experimental protocol that can be easily applied in clinical settings.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Role of metabolic, atherogenetic and psychological factors in patients with colorectal adenomas: Preliminary results of the psycho-Neuro-Endocrino-Immunology Modena (PNEI-MO) Research Group
Authors: Ferrari S. , Mancini S. , Alboni S. , Artoni C. , Fabbrizzi A. , Feltri L. , Galli G. , Guicciardi A. , Marchi M. , Mariani F. , Mattei G. , Pollutri G. , Saraceni S. , Sena P. , Spiga G. , Tassi S. , Visentini C. , Roncucci L. , Merighi A. , Marsico M.
Published: May 2016

Introduction

Pro-inflammatory states of the large bowel have a multifactorial aetiology, including metabolism, atherogenesis, and psychological determinants. Inflammation plays a role in depressive and anxiety disorders, is tightly associated with early pro-atherogenetic alterations and metabolic dysregulation, and is also a key factor for the development of colorectal cancer.

Aim

To investigate the association between pro-atherogenetic factors, metabolic status, psychological assessment and presence of colorectal adenomas.

Methods

Case-control study, approved by the local Ethic Committee. Patients aged 40 or more and undergoing colonoscopy for positive faecal blood test and/or abdominal symptoms, with a negative history for neoplasia or inflammatory bowel diseases, were enrolled. For each patient the following data were collected: waist and hip circumferences, BMI, arterial pressure, fasten serum glycemia, current medications. Beside colonoscopy, carotid intima-media thickness (IMT) was assessed by means of echographic evaluation. Psychometric assessment included HADS, TCI, IMSA, SF-36. Statistics performed with SigmaPlot v.12 Platform.

Results

Preliminary results are available for 18 patients (male/female 8/10) Mean age 62.6 ± 8.4. Ten patients had at least one adenoma, 8 patients had no lesions. The following differences were noticeable: HADS-depression (mean ± SD) adenoma vs. no-adenoma: 4.9 ± 3.2 vs. 1.7 ± 1.8 (P < .01); IMT median value adenoma vs. no-adenoma: 793 vs. 638 micrometers (P = .04); Body weight (mean ± SD) adenoma vs. no-adenoma: 66.4 ± 8.7 kg vs. 80.9 ± 15.3 kg (P = .03); waist circumference (mean ± SD) adenoma vs. no-adenoma: 105.2 ± 13.4 cm vs. 89.5 ± 4.7 cm (P < .01).

Conclusions

Preliminary data from PNEI-MO Research Group support the relation between systemic inflammation, psychological status and development of precancerous colorectal cancer lesions. Depression seems associated with the presence of colorectal adenomas.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Pilot Project: Sound pillow treatment to improve sleep quality for patients with depression or bipolar diagnosis with sleeping problems
Authors: Lund H.N. , Pedersen I.N.
Published: May 2016

A well-known symptom for patients with depression and bipolar diagnosis is poor quality of sleep. This has a major impact on the quality of life for the individual. Most recently, an article in the Cochrane Review, Music for insomnia in adults, concludes that music may be effective for improving sleep quality in adults with insomnia symptoms [1].

A Research Project at Aalborg University Hospital, Psychiatry, in Denmark has been initiated involving psychiatrists and nurses from an outpatient unit and researchers and music therapists from the Music Therapy Research Clinic at the hospital in an innovative collaboration. A pilot project is started, where patients with depression are given a sound pillow with special designed playlists, offering selected calm music for the patients to use at home for a period of 30 days. The listening periods are registered by the patients. Questionnaires are filled out before and after the listening period. A short semi-structured interview is taking place four times throughout the listening period and as a follow-up, when patients come in for control.

The aim is to investigate, whether music listening is helpful to improve sleep quality and quality of life, and to investigate if music listening can limit or replace medication. Discussion of first results.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
A quality improvement intervention in geriatric psychiatry care: Results of a pre-post design study
Authors: Albuquerque E. , Fernandes S. , Cerejeira J.
Published: May 2016

Introduction

Innovative approaches are needed to respond to the increasing number of elderly subjects with complex psychiatric conditions who require flexible and rapid responses, avoiding unnecessary hospital admissions. A new organizational model was implemented in our psychogeriatric service in September 2011 consisting of:

– a comprehensive multidisciplinary geriatric assessment;

– a helpline for caregivers for management of acute behavioral problems;

– programmed visits to nursing homes.

Aims

To evaluate whether the implementation of this program was associated with a reduction in hospital admissions and emergency department visits.

Methods

This is a pre-post test design study, involving 1197 patients who attended the Old Age Psychiatric (OAP) Unit three years before and three years after the implementation of the organizational intervention (1.09.2008 to 1.10.2014). An index of patient × year was calculated considering the period during which the patient was followed in OAP Unit. Data was obtained from the medical files of all eligible patients regarding demographic variables, number and type of hospital admissions and emergency department visits.

Results

During the 3 years before the intervention 671.2 patients × years were included (mean age of 75.8 years) while after the intervention this reached 2010.1 patients × years (mean age of 77.8 years). The intervention was associated with a decrease of 44% in psychiatry emergency visits, 48% in general emergency visits, 44% in psychiatric ward admissions and 51% in geriatric ward admissions.

Conclusions

The implementation of this new model was associated with significant reduction of hospital-based service utilization. Future research should determine if this was coupled with increased health outcomes.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Antidepressants and mortality risk in a dementia cohort – data from SveDem, the Swedish Dementia Registry
Authors: Enache D. , Fereshtehnejad S.M. , Cermakova P. , Garcia-Ptacek S. , Kåreholt I. , Johnell K. , Religa D. , Jelic V. , Winblad B. , Ballard C. , Aarsland D. , Fastbom J. , Eriksdotter M.
Published: May 2016

Background

The association between mortality risk and use of antidepressants in people with dementia is unknown.

Objective

To describe the use of antidepressants in people with different dementia diagnoses and to explore mortality risk associated with use of antidepressants 3 years before a dementia diagnosis.

Methods

Study population included 20,050 memory clinic patients from Swedish Dementia Registry diagnosed with incident dementia. Data on antidepressants dispensed at the time of dementia diagnosis and during three-year period before dementia diagnosis was obtained from the Swedish Prescribed Drug Register. Cox regression models were used.

Results

During a median follow-up of 2 years from dementia diagnosis, 25.8% of dementia patients died. A quarter (25.0%) of patients were on antidepressants at the time of dementia diagnosis while 21.6% used antidepressants at some point during a three-year period before a dementia diagnosis. Use of antidepressant treatment for 3 consecutive years before a dementia diagnosis was associated with a lower mortality risk for all dementia disorders (HR: 0.82, 95% CI: 0.72–0.94) and in Alzheimer's disease (HR: 0.61, 95% CI: 0.45–0.83). There were no significant associations between use of antidepressant treatment and mortality risk in other dementia diagnoses.

Conclusion

Antidepressant treatment is common among patients with dementia. Use of antidepressants during prodromal stages may reduce mortality in dementia and specifically in Alzheimer's disease.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Validity of the Geriatric Depression Scale-30 against the gold standard diagnosis of depression in older age: The GreatAGE Study
Authors: Lozupone M. , Veneziani F. , Galizia I. , Lofano L. , Montalbò D. , Arcuti S. , Tortelli R. , Barulli M.R. , Capozzo R. , Bonfiglio C. , Panza F. , Seripa D. , Todarello O. , Logroscino G.
Published: May 2016

Introduction

Depression is a common disorder in late-life. Structured clinical interviews may be less efficient compared to self-administered questionnaires, but provide more accurate findings in terms of diagnosis. No population-based studies with both these depression assessment instruments have been ever performed.

Objectives

To estimate the GDS-30 accuracy for depression assessment against the gold standard [Semi-structured Clinical Diagnostic Interview for DSM-IV-TR Axis I Disorders (SCID)] in subjects 65+ years in a random sampling of the general population.

Methods

The sample was collected in a population-based study (GreatAGE) conducted among elderly residents in Castellana, Southeast Italy. It includes 597 participants (57.62% males, mean age 73 years). Depression was assessed through the GDS-30 and the SCID, both double-blinded administered respectively by a trained neuropsychologist and psychiatrist. The GDS-30 screening performances were analyzed using ROC curves.

Results

According to the gold standard SCID, the rate of depressive disorder was 10.22% (15.81% of women; 6.1% of men) while with GDS-30 instrument 12.06% of the residents met the depression cutoff. Only 36.1% of GDS cases were true positive. At the optimal cutoff score (> 5), GDS had 62% sensitivity and 81% specificity. Using a more conservative cutoff (> 9), the GDS-30 specificity reached 91% while sensitivity dropped to 43%.

Conclusions

These preliminary results from the first population-based study that compares GDS-30 and SCID showed that the GDS-30 identified adequate levels of screening accuracy (AUC 0.76) compatible with scores established in community settings.

Funding

PRIN2009E4RM4Z.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Changes in prescribing patterns of benzodiazepines after training of general practitioners
Authors: Alves-dos-Reis T. , Papoila A.L. , Gusmão R.
Published: May 2016

Introduction

Benzodiazepines are the most utilized anxiolytic and hypnotic drugs. The high consumption of benzodiazepines has been a concern due to reported side effects of long-term use and dependence. Portugal has the highest benzodiazepine utilization in Europe.

Objectives

To analyze the change in general practitioners’ (GPs) benzodiazepine prescription pattern after an intervention period.

Methods

An educational session was delivered to a group of intervened GPs. The benzodiazepine prescription pattern of intervened group was compared to the pattern of a non-intervened matched group from the same region, and of another non-intervened matched group from a different region. The research time frame was 12 months before and after intervention. The analysis of the prescription trends used the defined daily dose (DDD) and defined daily dose per 1000 patients per day (DHD) methodology. The statistical methods consisted of segmented regression analysis.

Results

There was a decrease in benzodiazepine prescription pattern of intervened GPs after intervention (P = 0.005). There was also a decrease in benzodiazepine prescription pattern for the non-intervened group from the same region (P = 0.037) and for the non-intervened group from a different region (P = 0.010). Concerning an analysis by gender, female gender prescribed a higher amount of benzodiazepines. The intervened female gender prescribers presented the highest decrease in prescription trend after intervention (P = 0.008).

Conclusions

Intervention was effective in reducing benzodiazepine prescription after intervention. It demonstrates that a single intervention has a positive impact on improving prescription trends. The replication of this intervention might be an opportunity for changing the worrying benzodiazepine utilization in Portugal.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Alteration in creatine phosphate behavior in excited visual cortex of early-stage schizophrenia patients measured by phosphorus magnetic resonance spectroscopy
Authors: Manzhurtsev A. , Semenova N. , Ublinskiy M. , Akhadov T. , Varfolomeev S. , Lebedeva I. , Kaleda V.
Published: May 2016

Introduction

31P MRS is a unique way of in vivo energy metabolism research. This method allowed revealing schizophrenia-induced disturbances of energy exchange in resting state [1]. We use 31P MRS in presence of visual stimulation that allows neuronal energy-consuming processes studying.

Objective

Revealing of stimulation effects on high-energy phosphates (PCr, ATP) in early-stage schizophrenia.

Aim

Discovery of energy processes contribution in schizophrenia pathogenesis.

Methods

Twelve right-handed 18–26 years old male patients with early-staged schizophrenia (F20, ICD-10) and 20 age-matched healthy right-handed controls. Spectra were acquired on Philips Achieva 3.0 T using Rapid Biomed 31P/1H birdcage coil and 2D ISIS pulse sequence. fMRI was used for accurate 2D slice positioning, spectroscopy voxels containing primary visual cortex (V1) were averaged (see Fig. 1). Two 31P spectra of V1 were obtained: firstly in resting state and then during 6 minutes of continuous stimulation by 6 Hz flashing checkerboard. Spectra were processed in jMRUI.

Results

Excitation reduced PCr in the norm and had no effect on schizophrenia (see Fig. 2). No excitation-induced ATP changes in both groups were revealed.

Conclusion

Alteration in PCr behavior in this study witnesses for deviations in energy-consuming processes in schizophrenia. A new scheme of neuronal response to stimulation in schizophrenia is offered.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Trimodal approach (PET/MR/EEG) of response inhibition as a possible biomarker for schizophrenia
Authors: Wyss C. , Heekeren K. , Del Guerra A. , Shah N.J. , Neuner I. , Wolfram K.
Published: May 2016

Introduction

The aim of the FP7-European funded project TRIMAGE is to create a trimodal, cost-effective imaging tool consisting of PET/MR/EEG to enable effective early diagnosis of schizophrenia.

Objective

In the scope of this project we are interested in the multimodal assessment of response inhibition. The loudness dependence of auditory evoked potential (LDAEP) is a suitable biomarker of inhibitory action in signal processing. Variations in response inhibition can have great impact on different aspects of life. Individuals with reduced capability of inhibitory control have a tendency to impulsive behavior. Studies showed that they have stronger LDAEP values. Patients with schizophrenia may exhibit alterations in the responsiveness to sensory stimuli. Thus, a reduced LDAEP was found in these patients. However, these deviances differed in clinical features of the disorder. Therefore, we would like to further elucidate the relationship between multimodal neuroimaging methods and dimensions of symptoms, observable behavior, personality traits and general psychopathological dysfunction.

Methods

A sample of 20 healthy controls and 20 patients with manifest schizophrenia will be examined with the LDAEP paradigm in a trimodal approach with customary imaging tools. PET measurements with the radiotracer [11C]-flumazenil will be used to assess the binding potentials of GABA-A receptors. MRS will provide data about GABA concentrations. Simultaneously recorded EEG-fMRI data will permit new insight in the relationship between LDAEP and impulsivity.

Discussion

The project will use alternative approaches to psychiatric classification. Response inhibition in sensory processing will be investigated from different angles (biochemical, neurophysiological, and neuroanatomical) and combined with psychological characteristic values.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Actions speak louder than words: Enhanced action tendencies in obsessive-compulsive disorder: An ERP study
Authors: Dayan Riva A. , Berger A. , Anholt G.
Published: May 2016

Obsessive-compulsive disorder (OCD) is characterized by repeated thoughts and behaviors. Several studies have detected deficient response inhibition ability in individuals with OCD, leading researchers to suggest this deficit as an endophenotype of OCD. However, other researchers maintain that the effect size of this deficit is modest and that it lacks clinical significance. The current investigation examines a potential alternative explanation for difficulties in response inhibition, namely enhanced action tendencies in response to stimuli. Therefore, early processes of motor response preparation preceding action performance (or inhibition) were studied with the event-related potential (ERP) component of readiness potential (RP). RP measures brain reactions related to motor activity in response to external stimuli. ERPs were recorded while 15 participants with OCD and 16 healthy controls performed a variation of a go/no-go task and a stop-signal task using schematic faces (angry and neutral). The OCD group presented with a greater RP slope gradient and amplitude over bilateral parietal areas corresponding to the motor cortex. The amplitude effect was further enhanced under negative valence, compared with the neutral condition. Differences in RP between the OCD and control groups remained significant when controlling for levels of trait anxiety. Results support the hypothesis that a stronger readiness for action might characterize OCD, especially in the presence of threatening stimuli. This finding, specific to OCD and not to anxiety symptoms, may underlie habitual tendencies in OCD. This study suggests that early-stages of motor preparation might be important to the etiology and maintenance of OCD.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
The net suppression effect of pain catastrophic cognition on anxiety sensitivity
Authors: Wong W. , Lam J. , Lim H. , Wong S. , Chen P. , Chow Y. , Fielding R.
Published: May 2016

Introduction

The existing literature on chronic pain points to the effects anxiety sensitivity, pain hypervigilance, and pain catastrophizing on pain-related fear; however, the nature of the relationships remains unclear. The three dispositional factors may affect one another in the prediction of pain adjustment outcomes. The addition of one disposition may increase the association between another disposition and outcomes, a consequence known as suppressor effects in statistical terms.

Objective

This study examined the possible statistical suppressor effects of anxiety sensitivity, pain hypervigilance and pain catastrophizing in predicting pain-related fear and adjustment outcomes (disability and depression).

Methods

Chinese patients with chronic musculoskeletal pain (n = 401) completed a battery of assessments on pain intensity, depression, anxiety sensitivity, pain vigilance, pain catastrophizing, and pain-related fear. Multiple regression analyses assessed the mediating/moderating role of pain hypervigilance. Structural equation modeling (SEM) was used to evaluate suppression effects.

Results

Our results evidenced pain hypervigilance mediated the effects of anxiety sensitivity (Model 1: Sobel z = 4.86) and pain catastrophizing (Model 3: Sobel z = 5.08) on pain-related fear. Net suppression effect of pain catastrophizing on anxiety sensitivity was found in SEM where both anxiety sensitivity and pain catastrophizing were included in the same full model to predict disability (Model 9: CFI = 0.95) and depression (Model 10: CFI = 0.93) (all P < 0.001) (see Figs. 3 and 4, Figs. 1 and 2).

Conclusions

Our findings evidenced that pain hypervigilance mediated the relationship of two dispositional factors, pain catastrophic cognition and anxiety sensitivity, with pain-related fear. The net suppression effects of pain catastrophizing suggest that anxiety sensitivity enhanced the effect of pain catastrophic cognition on pain hypervigilance.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Prevalence, mortality and healthcare utilization of cluster B personality disorders in Quebec: A province cohort study, 2001–2012
Authors: Cailhol L. , Pelletier E. , Rochette L. , Villeneuve E. , Laporte L. , David P. , Lesage A.
Published: May 2016

Background

Cluster B personality disorder (PD) is a highly prevalent mental health condition in general population (1 to 6% depending on the subtype and study). Patients affected are known to be heavier users of both mental and medical healthcare than other clinical conditions such as depression. Few studies have highlighted their elevated mortality rate compared to general population.

Methods

The estimates were produced using data from the integrated monitoring system for chronic disease of Quebec. It provides annual and life prevalence, mortality rate, years of and healthcare utilization profile Quebec inhabitants.

Results

A total of 7,995,963 people were included in the study. The life prevalence of cluster B PD is 2.6%. The mean years of lost life is 13 for men and 9 for women when they are compared to general population. The 3 most important causes of death are: suicide (20.4%), cardiovascular diseases (19.1%) and cancers (18.6%). The standardized mortality ratio (SMR) for each medical condition is superior in cluster B personality disorders than general population. The most important SMR is for suicide (male: 10.2 and female: 21). In the year 2011–2012, 78% had consulted a general practitioner, 62% a psychiatrist, 41% were admitted in an emergency department and 21% were hospitalized.

Disclosure of interest

The authors have not supplied their declaration of competing interest.
Prevalence of the metabolic syndrome in patients at risk of psychosis
Authors: Cordes J. , Bechdolf A. , Moebus S.
Published: May 2016

The metabolic syndrome (MetS) is one of the most frequent reasons for the higher mortality in patients with schizophrenia. It is difficult to separate between effects of medication or the disorder itself on the development of MetS. In the present study, patients at clinical high risk for first-episode psychosis (CHR) were examined and the prevalence of the MetS was assessed. One hundred and sixty-three unmedicated antipsychotic naïve CHR patients aged between 18 and 42 years and suffering from unmanifested prodromal symptoms were compared to 35,869 patients of the “German Metabolic and Cardiovascular Risk Study” (GEMCAS). We observed a slightly higher prevalence of single MetS criteria in CHR group compared to the GEMCAS sample, in particular: high blood pressure (35.0 vs. 28.0%), waist circumference (17.6 vs. 15.1%), and high fasting blood glucose (9.4 vs. 4.0%). We assume the higher risk for MetS in schizophrenia patients or CHR patients to derive from genetic factors.

Disclosure of interest

In cooperation with Joachim Cordes, Andreas Bechdolf, Christina Engelke, Kahl KG, Chakrapani Balijepalli, Christian Lösch, Joachim Klosterkötter, Michael Wagner, Wolfgang Maier, Andreas Heinz, Walter de Millas, Wolfgang Gaebel, Frank Schneider, Martin Lambert, Georg Juckel, Thomas Wobrock, Michael Riedel, Susanne Moebus.