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BACKGROUND: Carers' satisfaction with psychiatric services related to information and advice is generally poor. This may be particularly true for services trying to meet the needs of ethnically diverse communities. It is important that services attempt to ameliorate carers' concerns as early as possible. The authors aimed to assess the impact of a brief educational and advice support service on carers of patients with a first episode of psychotic illness. METHOD: Carers of all patients identified with a first episode of psychosis in a defined psychiatric catchment area of North London were invited to participate. Following consent from patients and relatives, relatives were randomly allocated to receive (in addition to usual services) a brief intervention comprising education and advice about the disorder from a support team or to usual care from community psychiatric services. RESULTS: One hundred and six carers were recruited to the study. Take-up of the intervention was less than expected and the intervention had little impact. The authors found no differences over time between the randomized arms for relatives' satisfaction (F = 23, p = 0 .4, df = 1) or number of days spent by patients in hospital over nine months from entry to the trial (F= 1.7, p= 0.18, df = 1). CONCLUSIONS: It was found that the support and advice intervention for families had little impact on their satisfaction or on patients' outcomes. However, failure to take up the intervention threatens the conclusions as the power to show an effect was reduced. Although family interventions, in general, are considered an important adjunct to the treatment of patients with chronic psychosis, there may be difficulties in providing an educational and support intervention shortly after first onset. How and when psychiatric services provide information and advice to carers of people newly diagnosed with a psychosis requires further study. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known about the subject: Caring for a family member with a mental illness induces a burden on the caregiver, an impact on their quality of life and premature ageing of more than ten years. What the paper adds to existing knowledge: We conducted systematised and individualised nursing interviews with family members, on the first days of a relative's hospitalisation, during hospitalisation and three months after discharge.We observed persistent depressive symptoms during and after hospitalisation. Burden and depression were higher, and quality of life was lower, for women caregivers and when the caregivers admitted the patients involuntarily in the hospital ward. When the caregivers were experiencing a patient's first hospitalisation, we also found higher depressive symptoms and lower quality of life. What are the implications for practice: This study emphasises the need for new interventions such as psychoeducation to alleviate the suffering of families. Considering the burden of families could become a prevention objective from the patient's first hospitalisation and prevent them from mental or physical health problems. Introduction: The burden consequent to providing care to patients with psychiatric chronic conditions is often overlooked by health professionals. Aim: We assessed the impact of patients' psychiatric hospitalisation on their caregivers, through evaluating their suffering, burden and quality of life, in three stages: upon the patients' admission, their discharge and 3 months after their discharge. Method: In total, 127 caregivers of adult patients whose first hospitalisation was less than 5 years ago were assessed using the 36‐item Short‐Form Health Survey, the Zarit Burden Interview and the Center for Epidemiologic Studies Depression scale. Results: Females and caregivers who admitted patients against their will experienced higher burden and depression and lower mental quality of life. We also found higher depressive symptoms and lower quality of life among caregivers during a patient's first hospitalisation. The caregiver's familial relationship to the patient was not associated with these outcomes. Finally, burden decreased and quality of life increased over time. Discussion: Results suggest that several variables associated with patient hospitalisations were correlated with burden, depression or quality of life. Implications for Practice: Burden could be targeted with interventions such as group psychoeducation for caregivers during or after the patient's hospitalisation, in order to reduce their distress and improve their quality of life. Psychiatric and mental health nurses can provide support to caregivers with systematic assessments of their burden and quality of life, so as to better meet their needs and promote their ability to cope with mental illness. [ABSTRACT FROM AUTHOR]

Objectives: This study sought to determine whether combined assessment of autonomic tone plus cardiac electrical substrate identifies most patients at risk of serious events after myocardial infarction (MI) and to compare assessment at 2 to 4 weeks versus 10 to 14 weeks after MI., Background: Methods to identify most patients at risk of serious events after MI are required., Methods: Patients (n = 322) with an ejection fraction (EF) <0.50 in the initial week after MI were followed up for a median of 47 months. Serial assessment of autonomic tone, including heart rate turbulence (HRT), electrical substrate, including T-wave alternans (TWA), and EF was performed, interpreted blinded, and categorized using pre-specified cut-points where available. The primary outcome was cardiac death or resuscitated cardiac arrest. All-cause mortality and fatal or nonfatal cardiac arrest were secondary outcomes., Results: Mean EF significantly increased over the initial 8 weeks after MI. Testing 2 to 4 weeks after MI did not reliably identify patients at risk, whereas testing at 10 to 14 weeks did. The 20% of patients with impaired HRT, abnormal exercise TWA, and an EF <0.50 beyond 8 weeks post-MI had a 5.2 (95% confidence interval [CI] 2.4 to 11.3, p < 0.001) higher adjusted risk of the primary outcome. This combination identified 52% of those at risk, with good positive (23%; 95% CI 17% to 26%) and negative (95%; 95% CI 93% to 97%) accuracy. Similar results were observed for the secondary outcomes., Conclusions: Impaired HRT, abnormal TWA, and an EF <0.50 beyond 8 weeks after MI reliably identify patients at risk of serious events. (Assessment of Noninvasive Methods to Identify Patients at Risk of Serious Arrhythmias After a Heart Attack; http://www.clinicaltrials.gov/ct/show/NCT00399503?order=1; NCT00399503).

Common Bean (Phaseolus vulgaris) is considered one of the most affordable sources to tackle hunger in underdeveloped countries. However, its cultivation takes place in regions that suffer from water deficiency, which limits plant growth and crop yield. Therefore, it is necessary to seek sustainable alternatives that mitigate the deleterious effects of water shortage. The aim of this study was to evaluate the potential for mitigating the effects of water deficit with the application of the chlorophyte microalga Asterarcys quadricellularis (CCAP 294/1) in two bean cultivars (IAC 1850 and BRS ESTEIO). The plants were grown in pots, with foliar application of microalgae at stage of third fully expanded trefoil at concentrations of 0.5 mL L−1 and 1.0 mL L−1. The water deficit lasted for 7 days and, after that, the rehydration of the plants was performed. Evaluations were carried out in three periods: i. on the third day after the start of water restriction, ii. one day after rehydration, iii. 10 days after rehydration. The levels of chlorophyll, sugars, protein and antioxidant enzymes were increased in plants treated with microalgae. At ten days after rehydration, there was an increase in leaf area, fresh mass, and leaf thickness in the treated plants, characterizing the biostimulant effect of microalgae. Our results demonstrate the effects of A. quadricellularis in mitigating the deleterious effects of water deficit, accelerating the recovery of the two common bean cultivars, which demonstrates its potential as a sustainable alternative to support food production under changing environment. [ABSTRACT FROM AUTHOR]

Introduction: Water intake is known to be effective in preventing orthostatic hypotension (OH). However, it is unknown whether water intake would be effective in acutely preventing exercise-induced OH., Methods: Fourteen adults (men/women: 7/7, age: 20 ± 8 years) were recruited. Each subject underwent two protocols with and without 500 ml water intake using a randomized crossover design (Water vs. Control). Participants underwent 30 min of cycle ergometry at the 60-70% predicted VO 2 max. OH and hemodynamics were assessed before and after exercise, and immediately (Water 1) and 20 min (Water 2) after the water intake. OH was evaluated with a 1-min standing test as the criteria for systolic blood pressure (SBP) < 90 mmHg. A cross-spectral analysis for RR and SBP variability was used to evaluate the cardiac autonomic activity and baroreflex sensitivity., Results: In both protocols, the incidence of OH increased after the exercise. The incidence of OH was lower in Water than in Control at Water 1 (OR: 0.093, 95% CI: 0.015-0.591). Heart rate was lower and SBP was higher in Water than in Control at Water 1 and 2 (P < 0.05). High-frequency power of RR variability and transfer function gains in Water were normalized and higher than in Control at Water 1 and 2 (P < 0.05). The ratio of low- to high-frequency power of RR variability in Water was normalized and lower in Water than in Control at Water 1 (P < 0.05)., Conclusion: Our findings indicate that water intake may prevent acute exercise-induced OH, accompanied by normalized cardiac autonomic activity and baroreflex sensitivity., (© 2024. Springer-Verlag GmbH Germany.)

Background: We aimed to investigate the association between ventricular repolarization instability and sustained ventricular tachycardia and ventricular fibrillation (VT/VF) occurring within 48 h (acute‐phase VT/VF) after the onset of acute coronary syndrome (ACS) and the prognostic role of repolarization instability and heart rate variability (HRV) after discharge from the hospital. Methods: We studied 572 ACS patients with a left ventricular ejection fraction >35%. The ventricular repolarization instability was assessed by the beat‐to‐beat T‐wave amplitude variability (TAV) using high‐resolution 24‐h Holter ECGs recorded at a median of 11 days from the date of admission. We calculated the HRV parameters including the deceleration capacity (DC) and non‐Gaussian index calculated on a 25 s timescale (λ25s). The DC and λ25s were dichotomized based on previous studies' thresholds. Results: Acute‐phase VT/VF developed in 43 (7.5%) patients. In‐hospital mortality was significantly higher among VT/VF patients (4.7% vs. 0.9%, p =.03). An adjusted logistic model showed that the maximum TAV (odds ratio 1.02, 95% confidence interval [CI] 1.00–1.29, p =.04) was associated with acute‐phase VT/VF. During a median follow‐up period of 2.1 years, 19 (3.3%) patients had cardiac deaths or resuscitated cardiac arrest. Acute‐phase VT/VF (p =.12) and TAV (p =.72) were not significant predictors of survival. An age and sex‐adjusted Cox model showed that the DC (p <.01), λ25s (p <.01), and emergency coronary intervention (p <.01) were independent predictors. Conclusion: T‐wave amplitude variability was associated with acute‐phase VT/VF, but the TAV was not predictive of survival post‐discharge. The DC, λ25s, and emergency coronary intervention were independent predictors of survival. [ABSTRACT FROM AUTHOR]

Styrene‐maleic acid copolymers (SMAs), and related amphiphilic copolymers, are promising tools for isolating and studying integral membrane proteins in a native‐like state. However, they do not exhibit this ability universally, as several reports have found that SMAs and related amphiphilic copolymers show little to no efficiency when extracting specific membrane proteins. Recently, it was discovered that esterified SMAs could enhance the selective extraction of trimeric Photosystem I from the thylakoid membranes of thermophilic cyanobacteria; however, these polymers are susceptible to saponification that can result from harsh preparation or storage conditions. To address this concern, we herein describe the development of α‐olefin‐maleic acid copolymers (αMAs) that can extract trimeric PSI from cyanobacterial membranes with the highest extraction efficiencies observed when using any amphiphilic copolymers, including diisobutylene‐co‐maleic acid (DIBMA) and functionalized SMA samples. Furthermore, we will show that αMAs facilitate the formation of photosystem I‐containing nanodiscs that retain an annulus of native lipids and a native‐like activity. We also highlight how αMAs provide an agile, tailorable synthetic platform that enables fine‐tuning hydrophobicity, controllable molar mass, and consistent monomer incorporation while overcoming shortcomings of prior amphiphilic copolymers. [ABSTRACT FROM AUTHOR]

Tillandsia recurvata L. may show morphophysiological plasticity in response to radiation availability, since this species is found in different environments. This work aimed to evaluate the anatomical and physiological modifications of T. recurvata isolated individuals under different shading levels and the consequences of these changes on the growth of this species. The individuals were exposed for 60 days to treatments as follows: full sun (unshaded) and shading of 35%, 75%, and 85%. Growth analyses were performed, and the leaf anatomy and water content were assessed. All plants submitted to full sun or 35% shading died, whereas those under 75% and 85% shading survived. The water content in leaves and rhizomes was higher under 85% shading, and this treatment increased the leaf area and the number of leaves in T. recurvata. Leaf dry mass, leaf elongation rate, biomass allocation to rhizomes, and net assimilation rate were higher under 85% shading. The leaves had a thicker hypodermis, lower proportions of both epidermis and vascular bundles, and a higher proportion of chlorophyll parenchyma under 85% shading. Tillandsia recurvata individuals behave as sciophytic, while the formation of clusters may change microclimate conditions; the behavior of clumped plants must be further investigated. [ABSTRACT FROM AUTHOR]

Background: Family psychoeducation supports schizophrenia patients and their families with education, skills, and communication training, aiming to prevent relapse and improve outcomes. Aim: To understand long-term effect of brief family psychoeducation on personal experiences, family burden, Depression, Anxiety and Stress among the caregivers of patients with schizophrenia. Methods: The study, comprising 128 participants split into intervention and treatment-as-usual groups, intervention was a six sessions brief psychoeducation for caregivers during the patients' hospitalization, assessments were made on pre-post intervention and followup assessment was done after six months. Results: Research demonstrates that psychoeducation extends benefits over time, with sustained reductions in depression, anxiety, stress, and family burden for caregivers of schizophrenia patients compared to standard treatment. Conclusion: Family psychoeducation offers long-lasting benefits for patients and caregivers. [ABSTRACT FROM AUTHOR]

Aim: While drought and shade are critical factors that determine seedling survival and growth, whether the responses of woody seedlings to drought are facilitated, aggravated or unaffected by shade remains uncertain. Location: Global. Time period: 1993 to 2021. Major taxa studied: Woody plants. Methods: We compiled 58 studies (including 75 woody species from 33 families) in which water and light availability were simultaneously manipulated, and conducted a meta‐analysis on the acclimation and adaptive responses of biomass production and allocation and leaf traits to drought and/or shade. Results: Shade alleviated the adverse impact of drought on photosynthesis (A) by decreasing stomatal limitation and photoinhibition, and increasing leaf relative water content, and thus facilitated biomass production, but shade aggravated the effect of drought on osmotic adjustment as evidenced by the lack of responses of osmotic potential at the full turgor and modulus elasticity at the maximum turgor to drought under shade. The effects of drought and shade on biomass allocation and specific leaf area were orthogonal. Biomass responses to drought and its interaction with shade were least responsive for drought‐tolerators, but the individual and interactive effects of shade and drought on most traits showed little dependence on shade tolerance. Drought–shade interaction increased root biomass and root mass fraction more for deciduous angiosperms than for evergreen angiosperms. Main conclusions Both shade and drought had negative impacts on biomass production and photosynthesis, but their interaction had positive effects that were less significant for drought‐tolerators and evergreen angiosperms. In contrast to shade, drought increased biomass allocation to roots, but shade and drought had orthogonal effects on biomass allocation and leaf morphology. These acclimation and adaptive responses of woody seedlings to drought and shade individually and interactively have important implications for predicting woody plant growth and distribution under global climate changes. [ABSTRACT FROM AUTHOR]

Social isolation is common among individuals with schizophrenia spectrum and other psychotic disorders. Research indicates that social isolation relates to poorer mental health outcomes, depression, and negative symptoms, with less known about its relationship with positive symptoms. This study examined depression as a mediator in the relationships between positive symptoms (i.e. hallucinations and delusions) and social isolation among an early treatment phase sample in the United States. Data were obtained from the Recovery After an Initial Schizophrenia Episode project of the National Institute of Mental Health's Early Treatment Program. Participants (N = 404) included adults between ages 15 and 40 in a first episode of psychosis. Data were analyzed using structural equation modeling in Mplus (Version 8). The study showed that delusions (b =.095, SE = 0.04, p <.05) and hallucinations (b =.076, SE = 0.03, p <.01) were directly related to depression, and that both delusions (b =.129, SE = 0.06, p <.05) and depression (b =.254, SE = 0.09, p <.05) were directly related to social isolation. Findings of this study determined that depression functioned as a mediator in the relationships between positive symptoms and social isolation. Targeting psychosis symptomatology and depression in treatment, improving social skills and social support networks, and considering the role of stigma in social isolation are of great importance in the prevention of poorer mental health outcomes. [ABSTRACT FROM AUTHOR]

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Dust is the collection of fine particles of solid matter, and it is a major issue of atmospheric pollution. Dust particles are becoming the major pollutants of the urban environment due to hyperbolic manufacturing and automobile pollution. These atmospheric pollutants are not only hazardous for human beings, but they also affect tree growth, particularly in urban environments. This study was designed to examine the changes in morphological and physiological traits of three tree species seedlings (Eucalyptus camaldulensis, Conocarpus erectus, and Bombax ceiba) in response to different dust types. In a pot experiment under controlled conditions, three-month-old seedlings of selected trees species were subjected to four treatments of dust: T1 = controlled; T2 = wood dust; T3 = soil dust; and T4 = carbon dust. During the whole experiment, 10 g/plant/dose was applied in 8 doses with a one-week interval. The results depicted that the growth was the maximum in T1 (control) and the minimum in T4 (carbon dust). In our findings, B. ceiba performed better under the same levels of dust pollution as compared with the other two tree species. The B. ceiba tree species proved to be the most tolerant to dust pollution by efficiently demolishing oxidative bursts by triggering SOD, POD, and CAT under different dust types compared to controlled conditions. Stomatal conductance, photosynthetic rate, and transpiration rate were negatively influenced in all three tree species in response to different dust applications. Based on the findings, among these three tree species, B. ceiba is recommended for dust polluted areas followed by E. camaldulensis and Conocarpus erectus due to their better performance and efficient dust-foraging potential. [ABSTRACT FROM AUTHOR]

Background: In the PRESERVE‐EF study, a two‐step sudden cardiac death (SCD) risk stratification approach to detect post‐myocardial infarction (MI) patients with left ventricle ejection fraction (LVEF) ≥40% at risk for major arrhythmic events (MAEs) was used. Seven noninvasive risk factors (NIRFs) were extracted from a 24‐h ambulatory electrocardiography (AECG) and a 45‐min resting recording. Patients with at least one NIRF present were referred for invasive programmed ventricular stimulation (PVS) and inducible patients received an Implantable Cardioverter ‐ Defibrillator (ICD). Methods: In the present study, we evaluated the performance of the NIRFs, as they were described in the PRESERVE‐EF study protocol, in predicting a positive PVS. In the PRESERVE‐EF study, 152 out of 575 patients underwent PVS and 41 of them were inducible. For the present analysis, data from these 152 patients were analyzed. Results: Among the NIRFs examined, the presence of signal averaged ECG‐late potentials (SAECG‐LPs) ≥ 2/3 and non‐sustained ventricular tachycardia (NSVT) ≥1 eposode/24 h cutoff points were important predictors of a positive PVS study, demonstrating in the logistic regression analysis odds ratios 2.285 (p =.027) and 2.867 (p =.006), respectively. A simple risk score based on the above cutoff points in combination with LVEF < 50% presented high sensitivity but low specificity for a positive PVS. Conclusion: Cutoff points of NSVT ≥ 1 episode/24 h and SAECG‐LPs ≥ 2/3 in combination with a LVEF < 50% were important predictors of inducibility. However, the final decision for an ICD implantation should be based on a positive PVS, which is irreplaceable in risk stratification. [ABSTRACT FROM AUTHOR]

Plants develop mechanisms that confer tolerance to sun or shade exposure and the knowledge of their responses may help to devise strategies for the conservation of natural populations and their propagation. We study the effect of shading on the ecophysiology and anatomy of Epiphyllum phyllanthus to determine its plasticity and tolerance. Specimens of E. phyllanthus were subjected to full sun, 35%, 75%, and 85% shading for 60 days. The growth characteristics, phylloclade anatomy and water content in the plants were quantified and compared. All individuals subjected to full sun and 35% shading had died. A shading of 85% produced the highest fresh and dry mass of the stems. Higher shading caused no effect in the allocation of biomass to stems or roots or on the relative growth rate, net assimilation rate, leaf area ratio or water content. The thickness of the phylloclade increased with increased shading. The highest stomatal density on both surfaces was observed in the treatment with 75% shading. E. phyllanthus is a sciophytic plant that requires shade to survive. Its main strategy appears to be the greater accumulation of water in its phylloclade under more shaded conditions, which stimulates plant growth. [ABSTRACT FROM AUTHOR]

In Acacia , 90% of species have drought-tolerant phyllodes as their adult foliage, the remaining species have bipinnate leaves. We conducted tests for relationships between foliage type and 35 bioclimatic variables at the continental scale and found significant correlations of both 'moisture seasonality' and 'radiation in the coldest quarter' with foliage type. Bipinnate species have lower species mean values of each variable, growing in stable soil moisture and generally darker environments (longer nights and lower incident radiation), on average. Evolutionary transformations between bipinnate and phyllodinous adult foliage exhibit asymmetry across the Acacia phylogeny, with transformations from bipinnate leaves to phyllodes occurring times faster than the reverse. At least three (and up to seven) transitions from phyllode to bipinnate adult foliage were inferred. Foliage type in the most recent common ancestor of extant Acacia is unresolved, some analyses favour a phyllodinous ancestor, others a bipinnate ancestor. Most ancestral nodes inferred as having bipinnate adult foliage had median age estimates of less than 5 million years (Ma), half having ages between 3 and 1.5 Ma. Acacia lineages with bipinnate adult foliage diversified during the Pliocene, perhaps in response to wetter climatic conditions experienced by the continental margin during this period. We reconstruct the evolution of phyllodinous and bipinnate adult foliage in Acacia , and examine the environmental correlates of these foliage types at a continental scale. Transformations between bipinnate and phyllodinous adult foliage exhibit asymmetry across the Acacia phylogeny, with transformations from bipinnate leaves to phyllodes occurring 30 times faster than the reverse. Tests for relationships between foliage type and 35 bioclimatic variables at the continental scale, corrected for phylogeny, identified two variables significantly correlated with foliage type, namely, moisture seasonality and radiation in the coldest quarter, with bipinnate species having lower species mean values of each. [ABSTRACT FROM AUTHOR]

With invasive grasses increasing wildfire occurrence worldwide, a better understanding of the relationships between native plants, fire, and invasive grass is needed to help restoration plans facilitate ecosystem resilience. Invasive grasses are particularly problematic for altering fire regimes in the tropics, yet in Hawai'i, restoration sites are often planted with monocultures of the native tree Acacia koa, which can promote grass growth via nitrogen fixation. This, combined with the difficulty of estimating pre-fire grass cover under thick canopies, complicates attempts to restore Hawaiian ecosystems. We studied the 2018 Keauhou Ranch Fire in Hawai'i to investigate three questions: (1) at what level of precision can pre-fire grass cover be accurately estimated from oblique aerial photos? (2) how are post-fire A. koa regeneration densities affected by fire severity? and (3) how are post-fire A. koa regeneration densities affected by pre-fire grass cover and its interaction with fire severity? We collected burn severity and post-fire regeneration data from 30 transects stratified across mid-elevation woodland, montane woodland, and montane shrubland communities. We evaluated visual estimates of pre-fire grass cover from oblique aerial imagery with quantitative in situ data from 60 unburned transects of the same cover types. Pre-fire estimates of grass cover categories were 67% accurate in montane woodland (n = 9) and 100% accurate in montane shrubland (n = 11), but only 20% accurate in mid-elevation woodland (n = 10). In montane woodlands with low pre-fire tree densities, A. koa regeneration densities were higher with increased fire severity, but this trend reversed when pre-fire tree densities were high. We detected no effect of pre-fire grass cover, nor its interaction with fire severity, on A. koa regeneration density. This indicates that restoration through the planting of A. koa may be successful in promoting fire-resilient A. koa forest, although there are potential issues to consider regarding the effects that A. koa's grass promotion may have on other species within the ecosystem. [ABSTRACT FROM AUTHOR]

Pterocarpus indicus, commonly known as narra, is one of the native leguminous trees in the Philippines that has occupied wide geographic distribution resulting in variability of its morphological and structural characteristics. In this study, the morphological and leaf anatomical features of four P. indicus variants (smooth narra -- SN, short prickly narra -- PNS, medium prickly narra -- PNM, and long prickly narra -- PNL) in Mount Makiling Forest Reserve (MMFR) were characterized. Based on seven morphological parameters, the mean root length, mean leaf number, and mean leaf area significantly separated the two major P. indicus forms. SN has a higher mean leaf number but shorter mean root length and smaller mean leaf area compared to the three variants of prickly narra (PNS, PNM, and PNL). Within the prickly narra (PN) variants, PNS and PNM showed distinct similarities based on six morphological parameters. At the same time, PNL seedlings have higher root-shoot ratio and mean biomass, indicating the greater capacity of this variant to store photosynthate material in its roots. The leaf anatomical parameters confirmed the similar features of two PN variants (PNS and PNM). Furthermore, the SN and PNL were significantly distinguished by the palisade and spongy mesophyll, xylem, and phloem area, where SN was considerably higher in all parameters except in the phloem area. This indicates that SN has a higher photosynthetic rate and has high storage capacity and ease of transport of water and organic matter. Thus, the morphological attributes and anatomical parameters contribute to further differentiating the two major forms of P. indicus. [ABSTRACT FROM AUTHOR]

Pfaffia glomerata possesses potential pharmacological and medicinal properties, mainly owing to the secondary metabolite 20-hydroxyecdysone (20E). Increasing production of biomass and 20E is important for industrial purposes. This study aimed to evaluate the influence of irradiance on plant morphology and production of 20E in P. glomerata grown in vitro. Nodal segments of accessions 22 and 43 (Ac22 and Ac43) were inoculated in culture medium containing MS salts and vitamins. Cultures were maintained at 25 ± 2 °C under a 16-h photoperiod and subjected to irradiance treatments of 65, 130, and 200 μmol m−2 s−1 by fluorescent lamps. After 30 days, growth parameters, pigment content, stomatal density, in vitro photosynthesis, metabolites content, and morphoanatomy were assessed. Notably, Ac22 plants exhibited 10-fold higher 20E production when cultivated at 200 μmol m−2 s−1 than at 65 μmol m−2 s−1, evidencing the importance of light quantity for the accumulation of this metabolite. 20E production was twice as high in Ac22 as in Ac43 plants although both accessions responded positively to higher irradiance. Growth under 200 μmol m−2 s−1 stimulated photosynthesis and consequent biomass accumulation, but lowered carotenoids and anthocyanins. Furthermore, increasing irradiance enhanced the number of palisade and spongy parenchyma cells, enhancing the overall growth of P. glomerata. [ABSTRACT FROM AUTHOR]

Aims To determine whether the combination of standard electrocardiographic (ECG) markers reflecting domains of arrhythmic risk improves sudden and/or arrhythmic death (SAD) risk stratification in patients with coronary heart disease (CHD). Methods and results The association between ECG markers and SAD was examined in a derivation cohort (PREDETERMINE; N  = 5462) with adjustment for clinical risk factors, left ventricular ejection fraction (LVEF), and competing risk. Competing outcome models assessed the differential association of ECG markers with SAD and competing mortality. The predictive value of a derived ECG score was then validated (ARTEMIS; N  = 1900). In the derivation cohort, the 5-year cumulative incidence of SAD was 1.5% [95% confidence interval (CI) 1.1–1.9] and 6.2% (95% CI 4.5–8.3) in those with a low- and high-risk ECG score, respectively (P for Δ < 0.001). A high-risk ECG score was more strongly associated with SAD than non-SAD mortality (adjusted hazard ratios = 2.87 vs. 1.38 respectively; P for Δ = 0.003) and the proportion of deaths due to SAD was greater in the high vs. low risk groups (24.9% vs. 16.5%, P for Δ = 0.03). Similar findings were observed in the validation cohort. The addition of ECG markers to a clinical risk factor model inclusive of LVEF improved indices of discrimination and reclassification in both derivation and validation cohorts, including correct reclassification of 28% of patients in the validation cohort [net reclassification improvement 28 (7–49%), P  = 0.009]. Conclusion For patients with CHD, an externally validated ECG score enriched for both absolute and proportional SAD risk and significantly improved risk stratification compared to standard clinical risk factors including LVEF. Clinical Trial Registration https://clinicaltrials.gov/ct2/show/NCT01114269. ClinicalTrials.gov ID NCT01114269. Open in new tab Download slide Open in new tab Download slide [ABSTRACT FROM AUTHOR]

Schizophrenia guidelines list family interventions as an efficient means in reducing relapses. Interventions aim to help families cope with their relative's problems more effectively, provide support and education, and reduce levels of distress and improve the family communication (see deHaan et al., 2002). [ABSTRACT FROM AUTHOR]

Background Relapse risk during the early years of first-episode psychosis (FEP) considerably increases the risk of chronicity. The effectiveness of family intervention for psychosis (FIp) for preventing relapse after FEP remains unknown. We assessed the effectiveness of FIp until 24 months of follow-up for preventing relapse and other relapse-related outcomes in patients following FEP. Methods We searched the Cochrane, PubMed, PsycINFO, and ProQuest databases in June 2018. A systematic review with meta-analysis of randomized controlled trials (RCTs), sensitivity analyses, and publication bias were performed, comparing to treatment as usual (TAU) or TAU plus other psychosocial interventions. Outcomes assessed were relapse rates, duration of hospitalization, psychotic symptoms, and functionality. Risk ratios (RRs) and (standardized) mean differences (SMD; MD) were calculated. Results Of the 2109 records retrieved, 14 (11 RCTs) were included. Pooled results showed that FIp was effective for preventing relapse (RR = 0.42; 95% CI = 0.29 to 0.61) compared to TAU and/or other psychosocial interventions. It also proved effective when compared to TAU alone (RR = 0.36) and TAU plus other psychosocial interventions (RR = 0.48). FIp showed benefits in reducing duration of hospitalization (TAU, MD = −3.31; other interventions, MD = −4.57) and psychotic symptoms (TAU, SMD = −0.68), and increased functionality (TAU, SMD = 1.36; other interventions, SMD = 1.41). Conclusions These findings suggest that FIp is effective for reducing relapse rates, duration of hospitalization, and psychotic symptoms, and for increasing functionality in FEP patients up to 24 months. The study's main limitations were the inclusion of published research only; authors were not contacted for missing/additional data; and high heterogeneity regarding relapse definition was observed. [ABSTRACT FROM AUTHOR]

Objective: Carers play an important role within the UK mental health system. Those carers who support persons with psychosis can experience a reduction in their own physical and mental health. As part of the Caring for Caregivers (C4C) trial, we piloted a writing intervention (Positive Written Disclosure) that has been shown to improve wellbeing in other populations. Although we reached our recruitment target, we encountered several barriers that made recruitment slower than anticipated. This paper synthesises the process data collected during the C4C trial that relates to the barriers to recruiting and retaining psychosis carers. Results: We encountered four main carer-specific barriers to the recruitment and retention of participants in our study. These were: (1) poor relationship with mental health clinicians, (2) conflicting with the care recipient's (CR) needs, (3) lack of spare time, and (4) lack of services for mental health carers. The interventions to assist carers need to be informed by robust evidence and this requires trials that reach their recruitment targets. By sharing our practical experiences other researchers and clinicians can modify their practices to minimise recruitment difficulties and delay. Trial registration ISRCTN79116352. Retrospectively registered (before the final participant was recruited) on 23rd January 2017 [ABSTRACT FROM AUTHOR]

Aims Sudden cardiac death (SCD) annual incidence is 0.6–1% in post-myocardial infarction (MI) patients with left ventricular ejection fraction (LVEF)≥40%. No recommendations for implantable cardioverter-defibrillator (ICD) use exist in this population. Methods and results We introduced a combined non-invasive/invasive risk stratification approach in post-MI ischaemia-free patients, with LVEF ≥ 40%, in a multicentre, prospective, observational cohort study. Patients with at least one positive electrocardiographic non-invasive risk factor (NIRF): premature ventricular complexes, non-sustained ventricular tachycardia, late potentials, prolonged QTc, increased T-wave alternans, reduced heart rate variability, abnormal deceleration capacity with abnormal turbulence, were referred for programmed ventricular stimulation (PVS), with ICDs offered to those inducible. The primary endpoint was the occurrence of a major arrhythmic event (MAE), namely sustained ventricular tachycardia/fibrillation, appropriate ICD activation or SCD. We screened and included 575 consecutive patients (mean age 57 years, LVEF 50.8%). Of them, 204 (35.5%) had at least one positive NIRF. Forty-one of 152 patients undergoing PVS (27–7.1% of total sample) were inducible. Thirty-seven (90.2%) of them received an ICD. Mean follow-up was 32 months and no SCDs were observed, while 9 ICDs (1.57% of total screened population) were appropriately activated. None patient without NIRFs or with NIRFs but negative PVS met the primary endpoint. The algorithm yielded the following: sensitivity 100%, specificity 93.8%, positive predictive value 22%, and negative predictive value 100%. Conclusion The two-step approach of the PRESERVE EF study detects a subpopulation of post-MI patients with preserved LVEF at risk for MAEs that can be effectively addressed with an ICD. Clinicaltrials.gov identifier NCT02124018 Open in new tab Download slide Open in new tab Download slide [ABSTRACT FROM AUTHOR]

Background and Aims Heteroblastic plant species, whose morphology or growth habit changes suddenly during development, offer unique opportunities to investigate the role of selection in canalizing development or increasing the adaptive importance of plasticity. Leaf forms of the Hawaiian tree Acacia koa (koa) change morphologically and physiologically during the first year of growth, providing time to study abiotic factors influencing transition rates relative to other Acacia species. Methods The roles of light and water availability in triggering transition to the mature leaf form in contrasting (wet/dry) ecotypes of koa were investigated using a novel modelling technique to distinguish between chronological and ontogenetic controls in triggering transition. A light quality treatment was included to test interactions of heterophylly (the presence of multiple leaf forms) with heteroblastic processes on the resulting phenotype at transition. Key Results Increased light intensity increased transition rates, but reduced red to far-red light (R:FR) ratios did not affect transition rates, solidifying the current paradigm of heteroblasty. However, evidence was found for earlier transition ontogenetically under water stress, which is not part of the current paradigm and could differentiate the role of heteroblasty in some Acacia species versus other heteroblastic species. Ecotypic responses also indicate that plasticity of development could vary across koa's range and the adaptive significance of heteroblasty could be marginalized or amplified dependent on the disparate selective pressures present across koa's range. Conclusions The use of novel survival functions and a species with an elongated transition time helped to elucidate abiotic modifiers of ontogenetic trajectories. Differences in ontogenetic trajectories between contrasting ecotypes suggest that ongoing climate and land use change will have non-uniform effects on koa regeneration and establishment dynamics across its range. [ABSTRACT FROM AUTHOR]

Young adults experiencing first-episode psychosis have historically been difficult to retain in mental health treatment. Communities across the United States are implementing Coordinated Specialty Care to improve outcomes for individuals experiencing first-episode psychosis. This mixed-methods research study examined the relationship between program services and treatment retention, operationalized as the likelihood of remaining in the program for 9 months or more. In the adjusted analysis, male gender and participation in home-based cognitive behavioral therapy were associated with an increased likelihood of remaining in treatment. The key informant interview findings suggest the shared decision-making process and the breadth, flexibility, and focus on functional recovery of the home-based cognitive behavioral therapy intervention may have positively influenced treatment retention. These findings suggest the use of shared decision-making and improved access to home-based cognitive behavioral therapy for first-episode psychosis patients may improve outcomes for this vulnerable population. [ABSTRACT FROM AUTHOR]

Aim: Brief psychoeducation for families of psychotic patients has been shown to significantly increase family members' knowledge of the disorder. This increase is associated with reductions in relapse and rehospitalization. The aim of this study was to assess the effectiveness of brief psychoeducation about schizophrenia to caregivers of patients in early phases of psychotic disorders in Yogyakarta, Indonesia. Methods: This study was a prospective, randomized trial with 2 parallel groups. Subjects were patients in the early phase of psychotic disorders and their respective caregivers. Inclusion criteria included a diagnosis of acute and transient psychotic disorders, schizophrenia, schizoaffective disorder or delusional disorder. Participants were randomly assigned to either control or intervention groups by means of paired simple randomization. A brief psychoeducation was conducted for both the patients and caregivers. The interventions were conducted in 4 interactive sessions, once per week. Effectiveness was measured using standardized instruments before the intervention, and at 1 and 6 months post‐intervention. Assessment instruments included the Knowledge of Psychosis (KOP), the Compliance and Relapse Assessment, the Brief Psychiatric Rating Scale and the Positive and Negative Symptoms of Schizophrenia scale. Results: Interventions improved KOP scores significantly in the intervention group. The intervention group had increased regularity of follow‐up with health providers and improved compliance. No statistically significant difference in relapses/rehospitalization was observed. Conclusions: This study demonstrated that brief psychoeducation with caregivers of patients with early phase psychosis was feasible in our setting, significantly improved caregivers' knowledge, and resulted in improved regularity of contact with health providers and compliance with pharmacotherapy. [ABSTRACT FROM AUTHOR]

Aim: A brief family‐inclusive practice model, single session family consultation (SSFC), was introduced at 4 youth mental health service sites to determine the extent to which the model could be implemented in this context and its acceptability as a means of engaging families of young people. Methods: Within an action research paradigm, both quantitative and qualitative measures were used for this implementation project with the former reported here. There were 2 components: (1) evaluation of the experiences of young people and their families and (2) evaluation of the extent of implementation of SSFC. Quantitative data were analysed descriptively (item scores, range and any changes over time). Results: Twenty practitioners who were trained and supported in the use of SSFC participated in the 6‐month implementation evaluation. In 6 months, 131 SSFC sessions were conducted across the 4 sites and the young people and their families were very satisfied with sessions (overall mean = 5.2, range = 0‐6). Six months post‐training, there were statistically significant improvements in the practitioners' confidence in providing family interventions (mean improvement = −0.47 (95% confidence interval (CI) = −0.91, −0.04), P = .035) and familiarity with approaches to working with families (mean improvement = −0.61 (95% CI = −1.13, −0.10, P = .023). Practitioners perceived significant improvement in organizational support for working with families. Conclusions: SSFC was acceptable to clients and their families, was adopted by practitioners and was successfully implemented in the participating sites. This suggests that SSFC, when appropriately implemented, is useful to engage families in the treatment of young people facing mental health issues. [ABSTRACT FROM AUTHOR]

Aims: This systematic review examines the effectiveness of the psycho-educational interventions (PEIs) targeted at people diagnosed with schizophrenia and their primary caregivers on improving knowledge level of schizophrenia and health-related outcomes. Methods: A total of 28 studies were reviewed from December 1999 to May 2015. The methods described by Centre for Reviews and Dissemination were used to guide this review. Results: The PEIs showed consistent improvement in the knowledge level of schizophrenia among participants for various follow-up intervals. In addition, PEIs were found to be superior to treatment as usual in influencing health-related outcomes. Conclusions: Implications of the findings for mental health care practice and education and recommendations are discussed. [ABSTRACT FROM AUTHOR]

Aims: This literature review examines the effectiveness of the family interventions (FIs) targeted at the primary caregivers of people diagnosed with schizophrenia on improving the knowledge level of schizophrenia and health‐related outcomes. Methods: A total of nine studies were reviewed from December 1999 to May 2017. The methods described by the Center for Reviews and Dissemination were used to guide this review. Results: The FIs showed consistent improvement in the knowledge level of schizophrenia among participants for various follow‐up intervals. In addition, FIs were found to be superior to treatment as usual in influencing health‐related outcomes. Conclusions: Implications of the findings for mental healthcare practice to include primary caregivers with the patient in the treatment process. [ABSTRACT FROM AUTHOR]

Although a growing body of evidence supports the effectiveness of behavioral family therapies for patients with schizophrenia, few studies have been carried out on the effectiveness of such programs for Egyptian patients. The current study translated and culturally adapted the Behavioral Family Psycho-Education Program (BFPEP) and conducted a preliminary efficacy evaluation for outpatients suffering from schizophrenia. Thirty patients received 14 sessions of culturally adapted Program (CA-BFPEP) and 30 received treatment as usual; all were followed up for 6 months. Pre- and post-intervention assessment included primary outcome measures that assessed the clinical, social, quality of life and attitude towards medications. The CA-BFPEP group demonstrated significant treatment effects as they had greater reductions in psychotic symptoms (PANSS), improvement of social function (SFQ), quality of life (QoL), and attitude towards medications (DAI), compared to patients in the control group. These results demonstrate the feasibility of implementing family therapy interventions in different cultural settings with relatively minor modifications. These promising findings invite further efforts to maximize the benefits of family therapy interventions internationally and to encourage mental health policy makers to integrate this mode of therapy in routine care management plans for patients with schizophrenia. [ABSTRACT FROM AUTHOR]

Camellia japonica (Naidong), a Tertiary relict species with a unique biological and cultural characteristic, is a special ecotype of C. japonica and is the northernmost distributed populations of C. japonica in the world. This study investigated the interactive responses of C. japonica (Naidong) to shade and nitrogen deposition focusing on seedling growth, leaf morphology and leaf physiology under two light regimes (15% and 65% of full sunlight to represent deep shade and slight shade respectively) and three nitrogen deposition regimes (0, 6 and 12 g N m-2 year-1) in a greenhouse. After 123 d of treatment, the results showed that the deep shade reduced the growth of seedlings significantly compared to slight shade, but improved the specific leaf area, leaf water content, chlorophyll content and Fv/Fm of plants. Moderate nitrogen (6 g N m-2 year-1) supply increased the crown area, specific leaf area, leaf water content, chlorophyll content and water use efficiency of seedlings. However, high nitrogen (12 g N m-2 year-1) supply reduced the basal diameter, crown area, specific leaf area and leaf water content. No significant interaction of shade and nitrogen deposition on C. japonica (Naidong) was found. There is a threshold of nitrogen deposition for the growth of C. japonica (Naidong). Camellia japonica (Naidong) populations should be protected by collecting of germplasm resources and carrying out the ex situ conservation. [ABSTRACT FROM AUTHOR]

Aim: We aimed to systematically review the evidence of the effectiveness of family interventions for caregivers of people with recent‐onset psychosis compared with usual psychiatric care. A secondary objective was to directly compare the effects of different types of family interventions. Methods: MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL Complete and EBSCOhost were searched to identify relevant randomized controlled trials. Trial data were extracted following the procedures described in the Cochrane Handbook of systematic reviews. Random‐effects models were used to pool the intervention effects. Results: Twelve studies including 1644 participants were included in this review. With the exception of a high risk of performance bias inherent to the nature of the psychosocial interventions, the studies had an overall low or unclear risk of bias, suggesting that sources of bias are unlikely to lower confidence in the estimate of intervention effects. Meta‐analyses were conducted for 4 different participant outcomes reported in 9 studies. Compared with usual psychiatric care, family intervention was more effective in reducing care burden over all follow‐up periods. Family intervention was also superior to usual care with regards to caregiving experience in the short term and improved utilization of formal support and family functioning over longer‐term follow up. Mutual support is more effective than psychoeducation in improving family functioning when measured 1 to 2 years after the intervention but had equivalent effects on utilization of formal support services. Conclusions: This review provides evidence that family intervention is effective for caregivers of recent‐onset psychosis, especially for care burden where the positive effects are enhanced over time. [ABSTRACT FROM AUTHOR]

Background: Information gaps hinder the management of psychotic patients. Incorporating mental health services into primary care might solve the problem. Health workers can be trained to provide psycho-education for caregivers of psychotic patients. Methods: This study was a two stage experimental study. In the first stage, 43 health workers were trained to provide a psycho-education for caregivers of psychotic patients. Next, 10 health workers were selected to provide the psycho-education. Participants were family caregivers of psychotic patients (n = 113) randomly assigned to control and intervention groups. Pre- and post-tests were conducted to assess the results. Statistical analyses were conducted using paired t tests and analysis of covariance (ANCOVA). Results: The intervention group scored higher for Knowledge of Psychosis at post-test. Both groups showed significant increase of knowledge (paired t tests: P< 0.001; P< 0.001; respectively) and the increases were not significantly different between the groups (ANCOVA: P = 0.057). Conclusion: Psycho-education was applicable in primary care settings. Training primary care health workers is a feasible method to address information gaps in the management of mental health problems. [ABSTRACT FROM AUTHOR]

Retrospective research from patients with schizophrenia suggests that remission becomes increasingly less likely the longer psychosis goes untreated. Yet symptoms of schizophrenia are insidious and disease evolution varies between patients, requiring an ongoing diagnostic process. One way of justifying early treatment is by focusing on functionality rather than symptomatology. Most patients are diagnosed with schizophrenia between the ages of 17 and 25—when many young adults are undergraduates or pursuing post-graduate education. The extent to which schools partner with mental health services has implications for the short-term success of students' recovery and their future employability. Translating study findings on schizophrenia to the college setting remains an important area of investigation. [ABSTRACT FROM PUBLISHER]

Family support is a core component of the Early Psychosis Intervention ( EPI) model, yet it continues to have relatively low rates of implementation in practice. This paper reports results of a literature review on facilitators and barriers to delivering family interventions in EPI programmes. A search was conducted of 4 electronic databases, Medline, EMBASE, PsycINFO and Joanna Briggs, from 2000 to 2015 using terms related to early onset psychosis, family work and implementation. Four thousand four hundred and two unique studies were identified, 7 of which met inclusion criteria. Barriers and facilitators were coded and aggregated to higher-level themes using a consensus approach. Five of 7 studies examined structured multifamily psychoeducation. Uptake by families was affected by: family/client interest and readiness to participate; ability to access supports; and support needs/preferences. Implementation by programmes was affected by staff access to training and resources to provide family support. A key finding across the identified studies was that families have different needs and preferences regarding the timing, length, intensity and content of the intervention. One size does not fit all and many families do not require the intensive psychoeducational programmes typically provided. The reviewed literature suggests that flexible, tiered approaches to care may better meet family needs and increase rates of uptake of family support. However, more research is needed on the effectiveness of different models of family support in early psychosis and how they can be successfully implemented. [ABSTRACT FROM AUTHOR]

Family interventions in chronic psychosis are well established through systematic reviews and meta-analyses. Such reviews report that family intervention might reduce relapse and improve compliance with medication and reduction in levels of expressed emotion (EE). However, most of the previous research has been conducted in caregivers with chronic schizophrenia, and the effects of family interventions in the early stages are largely unknown. Using a quasi-experimental nonequivalent comparison group design, we evaluated the effectiveness of a 7-session group intervention among 59 caregivers of patients with first episode psychosis. Outcome variables measured were carers’ EE and social support. Carers were recruited from inpatient psychiatry units of a tertiary mental health center in South India. Follow-up assessments were carried out after one and three months of intervention. Descriptive and inferential statistics were applied to the data. Carers in the intervention group reported reduction of EE and improvements in social support at a one-month follow-up assessment. However, these benefits were not sustained at the three-month follow-up. Overall, both groups showed significant changes in all outcome variables over the time period. [ABSTRACT FROM PUBLISHER]

Stomata modulate the exchange of water and CO2 between plant and atmosphere. Although stomatal density is known to affect CO2 diffusion into the leaf and thus photosynthetic rate, the effect of stomatal density and patterning on CO2 assimilation is not fully understood., We used wild types Col-0 and C24 and stomatal mutants sdd1-1 and tmm1 of Arabidopsis thaliana, differing in stomatal density and pattern, to study the effects of these variations on both stomatal and mesophyll conductance and CO2 assimilation rate. Anatomical parameters of stomata, leaf temperature and carbon isotope discrimination were also assessed., Our results indicate that increased stomatal density enhanced stomatal conductance in sdd1-1 plants, with no effect on photosynthesis, due to both unchanged photosynthetic capacity and decreased mesophyll conductance. Clustering (abnormal patterning formed by clusters of two or more stomata) and a highly unequal distribution of stomata between the adaxial and abaxial leaf sides in tmm1 mutants also had no effect on photosynthesis., Except at very high stomatal densities, stomatal conductance and water loss were proportional to stomatal density. Stomatal formation in clusters reduced stomatal dynamics and their operational range as well as the efficiency of CO2 transport. [ABSTRACT FROM AUTHOR]

Drought stress promotes biochemical and physiological alterations in plant metabolism that limit growth and yield. This study investigated the accumulation of γ-aminobutyric acid (GABA) in plant tissue, the stomatal conductance (gs) and changes in leaf anatomy in Eucalyptus following drought stress situation. In this study, eight Eucalyptus clones were evaluated under normal water supply (control) and drought stress conditions (stress). For the control treatment, plants were irrigated every day with an automated system until the soil was saturated, and for the stress treatment, drought stress was imposed by non-irrigation of plants, and pots were covered using plastic sheeting to avoid rainfall and humidity. This study has shown that: (1) all clones decreased gs with increasing vapor pressure deficit ( D) in both treatments. All plastics and drought-tolerant clones (except GG) presented lower stomatal sensitivity to D under stress conditions than drought-sensitive clones; (2) GABA concentrations increased fast after drought stress, but we could not find correlation with these changes and resistance to water stress; and (3) all clones increased the number of stomata and reduced leaf thickness after water stress. The finding is that GABA is a fast stress-signaling molecule in Eucalyptus, but the response of gs to D is a best physiological variable to differentiate drought-tolerant and drought-sensitive Eucalyptus clones. [ABSTRACT FROM AUTHOR]

Background Recruitment to clinical research studies can prove complex. This is particularly true of mental health research, given factors such as confidentiality, capacity and consent, or when attempting to recruit family members as opposed to service users themselves. Aim This study investigated the challenges experienced and strategies employed in the recruitment of siblings of people with first episode psychosis using Early Intervention in Psychosis Services ( EIPS) in England. Methods As part of a randomized controlled trial ( RCT) of an e-health intervention for siblings, we conducted a process evaluation study whereby semistructured interview was undertaken with clinical and research staff involved in recruitment of siblings. Data were analysed thematically. Results Twelve participants from six EIPS were interviewed. Data analysis revealed seven key themes: (i) limited comprehensive family data available; (ii) data governance and consent issues; (iii) organizational factors; (iv) convoluted recruitment methods; (v) concerns about service users' opinions; (vi) fluidity in siblings' needs and expectations; and (vii) strategies to enhance recruitment. Conclusions Recruitment challenges identified in this study concerned administrative, organizational, process and attitudinal issues. These are similar to other studies recruiting mental health service users as well as family members. Failure to recruit to target implies that studies are underpowered to detect potential statistically or clinically meaningful changes. Future studies should establish how best to enhance family inclusiveness in clinical practice and research. [ABSTRACT FROM AUTHOR]

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