Chemical disinfection as a simple and reliable method to control the amphibian chytrid fungus at breeding points of endangered amphibians.

Chytridiomycosis caused by the fungal pathogen Batrachochytrium dendrobatidis (Bd) is pushing amphibians towards extinction. Whilst mitigation methods were suggested a decade ago, we lack field trials testing their efficacy. We used the agrochemical fungicide, tebuconazole, to treat Bd infected breeding waterbodies of an endangered species that is highly susceptible to the fungus. Just two applications of tebuconazole led to a significant reduction in infection loads in the vast majority of sites, and at six sites the disinfection remained one/two-years post-application. Tebuconazole values drastically decreased in the waterbodies within a week after application, with no significant effects on their hydrochemical and hydrobiological characteristics. Although the use of chemicals in natural populations is undesirable, the growing existential threat to amphibians all over the world indicates that effective interventions in selected populations of endangered species are urgently needed.

The timing and widespread effects of the largest Holocene volcanic eruption in Antarctica.

The caldera collapse of Deception Island Volcano, Antarctica, was comparable in scale to some of the largest eruptions on Earth over the last several millennia. Despite its magnitude and potential for far-reaching environmental effects, the age of this event has never been established, with estimates ranging from the late Pleistocene to 3370 years before present. Here we analyse nearby lake sediments in which we identify a singular event produced by Deception Island's caldera collapse that occurred 3980 ± 125 calibrated years before present. The erupted tephra record the distinct geochemical composition of ejecta from the caldera-forming eruption, whilst an extreme seismic episode is recorded by lake sediments immediately overlying the collapse tephra. The newly constrained caldera collapse is now the largest volcanic eruption confirmed in Antarctica during the Holocene. An examination of palaeorecords reveals evidence in marine and lacustrine sediments for contemporaneous seismicity around the Antarctic Peninsula; synchronous glaciochemical volcanic signatures also record the eruption in ice cores spread around Antarctica, reaching >4600 km from source. The widespread footprint suggests that this eruption would have had significant climatic and ecological effects across a vast area of the south polar region.

Ecology under lake ice.

Winter conditions are rapidly changing in temperate ecosystems, particularly for those that experience periods of snow and ice cover. Relatively little is known of winter ecology in these systems, due to a historical research focus on summer 'growing seasons'. We executed the first global quantitative synthesis on under-ice lake ecology, including 36 abiotic and biotic variables from 42 research groups and 101 lakes, examining seasonal differences and connections as well as how seasonal differences vary with geophysical factors. Plankton were more abundant under ice than expected; mean winter values were 43.2% of summer values for chlorophyll a, 15.8% of summer phytoplankton biovolume and 25.3% of summer zooplankton density. Dissolved nitrogen concentrations were typically higher during winter, and these differences were exaggerated in smaller lakes. Lake size also influenced winter-summer patterns for dissolved organic carbon (DOC), with higher winter DOC in smaller lakes. At coarse levels of taxonomic aggregation, phytoplankton and zooplankton community composition showed few systematic differences between seasons, although literature suggests that seasonal differences are frequently lake-specific, species-specific, or occur at the level of functional group. Within the subset of lakes that had longer time series, winter influenced the subsequent summer for some nutrient variables and zooplankton biomass.

Toma de decisión compartida y tratamiento antipsicótico: adaptación transcultural de la escala COMRADE / Shared decision making and antipsychotic treatment: transcultural adaptation of the COMRADE scale

Uno de los elementos característicos del modelo de salud mental comunitaria es la orientación de las intervenciones hacia la recuperación funcional del paciente con trastorno mental grave. La escala COMRADE es un instrumento que evalúa los distintos aspectos de la comunicación interpersonal en el momento de la interacción del clínico con el usuario. El objetivo de este trabajo es presentar el proceso de traducción y adaptación a lengua española de la escala COMRADE en una población de pacientes psicóticos, así como explorar la comprensibilidad del mismo por parte de sus destinatarios. Para la elaboración de la versión española preliminar empleamos un procedimiento de 'traducción en grupo" y "traducción-re-trotraducción". Para la verificación de la aplicabilidad transcultural de la COMRADE utilizamos una de las denominadas "técnicas inespecíficas", en concreto la denominada "estudio piloto" ("field pretest"). Para ello se realizó un muestreo de conveniencia de 35 pacientes con trastornos del espectro psicótico procedentes de distintos dispositivos de salud mental de la Unidad de Gestión Clínica de Salud Mental del Área de Gestión Sanitaria Norte de Cádiz. La mayoría de los ítems obtienen porcentajes altos o muy altos en la categoría A, correspondiente al máximo nivel de comprensión, siendo mínimo el observado en la categoría C. En función de ello se realizaron ajustes que permitieron configurar la versión definitiva de esta escala. Pensamos que la escala COMRADE será una herramienta útil en el trabajo con estos pacientes para una toma de decisión compartida sobre sus tratamientos (AU)

Functional recovery for patients with severe mental disorder is one main feature of community mental health. COMRADE scale is an assessing tool for different aspects about interpersonal communication between clinicians and users. Introducing the process followed for adapting and translating (from English to Spanish language) this scale is the main objective of this paper, as much as exploring its comprehension. We chose a procedure of "group translation" and "translation-backtranslation" for elaborating the preliminary Spanish version. "Field pretest" was the specific technique we used for the verification of COMRADE transcultural applicability. A sample of 35 patients with psychotic spectrum disorder was arranged throughout "The Area de Gestión Sanitaria Norte de Cádiz". Most of items obtained "high" or "very high" percentages on "A" category, (maximum level of comprehension), while those obtained in "C" category (minimum level of comprehension) were "low" or "very low". Later arrangements were done for obtaining the definitive version of the scale based on these results. Therefore, we think that the COMRADE scale will become a useful tool for shared decisions about treatments between clinicians and patients (AU)

Aspectos conceptuales sobre el proceso de decisión compartida en salud mental / Conceptual analysis of shared decision-making process in mental health

Uno de los cambios más importantes en la atención sanitaria de las últimas décadas, en lo que a las decisiones terapéuticas se refiere, ha sido la transición desde un modelo centrado en la enfermedad a uno centrado en el paciente. Esto conlleva la progresiva sustitución de una aproximación paternalista por una más deliberativa y, en relación a los tratamientos farmacológicos, del concepto de cumplimiento o adherencia al de concordancia o acuerdo terapéutico. El concepto de concordancia, por su parte, ha sido contemplado como el objetivo final de un proceso de negociación y corresponsabilidad en la decisión de elegir un tratamiento al que se ha denominado proceso de decisión compartida (PDC) (shared decision making). Hasta el momento, el PDC ha sido escasamente implantado en trastornos mentales graves, cuando no contestado como inadecuado dada la presunta alteración de la capacidad del paciente psiquiátrico gravemente enfermo para tomar decisiones. Sin embargo, esta incapacidad no siempre está presente por lo que la decisión compartida debe contemplarse como premisa y no como excepción. El PDC implica la implantación de un procedimiento en etapas (asociación médico paciente, información sobre opciones, pros y contras, deliberación sobre las mismas y su relación con valores y preferencias del paciente, decisión consensuada). Un de las barreras más importantes para la aplicación del proceso de decisión compartida en salud mental es la cuestión de la capacidad del enfermo mental. Por ello, la evaluación de la capacidad debe hacerse central en la práctica clínica psiquiátrica (AU)

One of the most important changes in health care in recent decades, regarding the therapeutic decisions, has been the transition from a model focused on the disease to other one focused on the patient. This entails the progressive replacement of a paternalistic approach by a more deliberative one and, in relation to pharmacological treatments, the concept of compliance or adherence to the therapeutic agreement. The concept of therapeutic agreement, on the other hand, has been referred to as the ultimate goal of a process of negotiation and co-responsibility in the decision to choose a treatment which has been called 'shared decision making process' (SDM). So far, the SDM has been poorly implemented in severe mental disorders, when not answered as inadequate given the alleged alteration of the seriously ill psychiatric patient’s ability to make decisions. However, this inability is not always present so shared decision should be viewed as a premise and not as an exception. SDM involves the introduction of a procedure in stages (doctor-patient partnership, information about options, pros and cons, deliberation about them and their relationship with the values and preferences of the patient, consensual decision). One of the most important barriers for the implementation of the shared mental health decision-making process is the question of the capacity of the mentally ill. Therefore, the evaluation of the capacity must be central in psychiatric clinical practice (AU)

El proceso de decisión compartida en el tratamiento del paciente psiquiátrico: estudios empíricos y evaluación de la capacidad / The shared decision-making process in the treatment of psychiatric patient: empirical studies and capacity assessment

Existe investigación empírica sobre experiencias de decisión compartida en salud mental, preferentemente en depresión y esquizofrenia, y algo menos en adicciones. La evidencia disponible a partir de los estudios llevados a cabo en los últimos años muestra que esta práctica mejora la calidad de las decisiones y parece efectiva en el proceso decisorio (aumenta el conocimiento y la participación, favorece una mayor congruencia con los valores y preferencias del paciente), aumentando, generalmente, la satisfacción del usuario. Sin embargo, existe escasa o mínima evidencia acerca de su eficacia sobre indicadores de resultados de salud. Uno de los elementos claves de los procesos de decisión compartida es la determinación de la capacidad del paciente para tomar la decisión clínica en cuestión. Se trata de un juicio clínico que posee un papel relevante en el difícil equilibrio entre autonomía y beneficencia/no maleficencia en la atención sanitaria. Así, una adecuada evaluación de la capacidad de tomar decisiones del paciente debe servir para proteger ambos principios y evitar dos tipos de errores: por un lado, el soslayar injustificadamente la autonomía del paciente para salvaguardar su bienestar; por otro, el injustificable respeto a su autonomía al precio de su bienestar (AU)

There is empirical research on shared decision making in mental health, above all in depression and schizophrenia, and somewhat less in addictions. Studies carried out in recent years produce evidence showing that it improves the quality of decisions and it seems to be effective in decision making (increased knowledge and participation, promotes greater consistency with the patient values and preferences), increasing user satisfaction mostly. However, there is tiny evidence of its effectiveness on health outcomes. One of the key elements of shared decision-making processes is the determination of the patient’s capacity to make the clinical decisions in question. This is an assessment that has a core role in the delicate balance between autonomy and beneficence / non-maleficence in health care. Thus, a proper assessment of the capacity of the patient to make decisions might be useful to protect both principles and to avoid two types of errors: first, to ignore unjustifiably the patient autonomy to safeguard their welfare, and secondly, the unwarranted respect for their autonomy for the price of their welfare (AU)