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Abstract Background Antipsychotic medication is effective for symptomatic treatment in schizophrenia-spectrum disorders. After symptom remission, continuation of antipsychotic treatment is associated with lower relapse rates and lower symptom severity compared to dose reduction/discontinuation. Therefore, most guidelines recommend continuation of treatment with antipsychotic medication for at least 1 year. Recently, however, these guidelines have been questioned as one study has shown that more patients achieved long-term functional remission in an early discontinuation condition—a finding that was not replicated in another recently published long-term study. Methods/design The HAMLETT (Handling Antipsychotic Medication Long-term Evaluation of Targeted Treatment) study is a multicenter pragmatic single-blind randomized controlled trial in two parallel conditions (1:1) investigating the effects of continuation versus dose-reduction/discontinuation of antipsychotic medication after remission of a first episode of psychosis (FEP) on personal and social functioning, psychotic symptom severity, and health-related quality of life. In total 512 participants will be included, aged between 16 and 60 years, in symptomatic remission from a FEP for 3–6 months, and for whom psychosis was not associated with severe or life-threatening self-harm or violence. Recruitment will take place at 24 Dutch sites. Patients are randomized (1:1) to: continuation of antipsychotic medication until at least 1 year after remission (original dose allowing a maximum reduction of 25%, or another antipsychotic drug in similar dose range); or gradual dose reduction till eventual discontinuation of antipsychotics according to a tapering schedule. If signs of relapse occur in this arm, medication dose can be increased again. Measurements are conducted at baseline, at 3, and 6 months post-baseline, and yearly during a follow-up period of 4 years. Discussion The HAMLETT study will offer evidence to guide patients and clinicians regarding questions concerning optimal treatment duration and when to taper off medication after remission of a FEP. Moreover, it may provide patient characteristics associated with safe dose reduction with a minimal risk of relapse. Trial status Protocol version 1.3, October 2018. The study is active and currently recruiting patients (since September 2017), with the first 200 participants by the end of 2019. We anticipate completing recruitment in 2022 and final assessments (including follow-up 3.5 years after phase one) in 2026. Trial registration European Clinical Trials Database, EudraCT number 2017-002406-12. Registered 7 June 2017.

Let R be a noncommutative ring with identity. Let φ : S(R) -- S(R) → { Φ} be a function where S(R) denotes the set of all subsets of R. The aim of this paper is to generalize the concept of prime radical √I of an ideal I of R to φ-prime radical Pφ (I). A proper ideal Q of R is called φ-prime if whenever a, b ∈ R, aRb ⊆ Q and aRb ... φ (Q) implies that either a ∈ Q or b ∈ Q. In this paper, first we study the properties of several generalizations of prime ideals of R. Then, we verify that P φ(I) is equal to the intersection of all minimal φ-prime ideals of R containing I, and we show that this notion inherits many of the essential properties of the usual notion of prime radical of an ideal. [ABSTRACT FROM AUTHOR]

Heavy substance use (SU) and substance use disorders (SUD) have complex etiologies and often severe consequences. Certain personality traits have been associated with an increased risk for SU(D), but far less is known about personality changes related to SU(D). This review aims to synthesize the existing literature on this research question. A systematic literature search was conducted from November 2022 to February 2023 in PubMed, EbscoHost, and Web of Science. Peer-reviewed original papers on SU(D)-related personality changes were included. Of 55 included studies, 38 were observational population-based studies and 17 were intervention studies. Overall, personality and SU measures, samples, study designs, and statistical approaches were highly heterogenous. In observational studies, higher SU was most consistently related to increases in impulsivity-related traits and (less so) neuroticism, while interventions in the context of SU(D) were mostly associated with increases in conscientiousness and self-efficacy and lasting decreases in neuroticism. Findings for traits related to extraversion, openness, conscientiousness, and agreeableness were mixed and depended on SU measure and age. Studies on bidirectional associations suggest that personality and SU(D) both influence each other over time. Due to their strong association with SU(D), impulsivity-related traits may be important target points for interventions. Future work may investigate the mechanisms underlying personality changes related to SU(D), distinguishing substance-specific effects from general SU(D)-related processes like withdrawal, craving, and loss of control. Furthermore, more research is needed to examine whether SU(D)-related personality changes vary by developmental stage and clinical features (e.g. initial use, onset, remission, and relapse). [ABSTRACT FROM AUTHOR]

Abstract Background Parasite attachment structures are critical traits that influence effective host exploitation and survival. Morphology of attachment structures can reinforce host specificity and niche specialisation, or even enable host switching. Therefore, it is important to understand the determinants of variation in attachment structures. Cymothoid isopods are striking ectoparasites of fishes that include the infamous ‘tongue-biters.’ They are known to parasitise hosts in one of four qualitatively distinct anatomical regions. Here, we quantify variation in cymothoid attachment structures — hook-like appendages called dactyli — and test whether differences in dactylus shape are correlated with parasite mode (where they attach), allometry, or both, using multivariate ordinary least squares regression. We also assess the influence of shared ancestry on shape using a molecular phylogeny to weight our models using phylogenetic generalised least squares regression. Results We find clear differences in shape between externally-attaching and internally-attaching cymothoids but also between anterior and posterior dactyli across various species with the same attachment mode. Allometric effects are significant for anterior but not posterior dactyli. Mouth-attaching species show greater shape variability than gill- and mouth-attaching species. We find no evidence that there are clade-specific patterns of association between parasite mode and dactylus shape. Conclusions Parasite mode appears to be the main driver of attachment morphology. This likely reflects several components of parasite ecology including feeding and functional demands of attachment in different microhabitats. Geometric morphometric approaches to the quantification of shape variation of simple structures is an effective tool that provides new insights into the evolvability of parasite attachment.

Bambalocra intwala gen. et sp. nov. is described from Sodwana Bay, north-eastern South Africa. The monotypic genus is characterised by the broadly truncate anterior margin of the head with a ventral rostrum, coxae 2–5 being ventral in position not forming part of the body outline and not or barely visible in dorsal view, and the posterolateral margins of pereonites 6 and 7 are posteriorly produced and broadly rounded. The antennulae bases are widely separated, with both antennula and antenna slender. The species is known only from the type locality and the known hosts are species of Pomacanthidae (Angelfish). A revised key to the externally attaching genera of Cymothoidae is provided.

Abstract Background Anilocra capensis Leach, 1818 is the only named species of Anilocra Leach, 1818 from South Africa. Anilocra is a large genus (> 40 species) with high levels of diversity reported from the Caribbean and Indo-West Pacific. Considering it is highly unlikely that all records of Anilocra from South Africa can be of a single species, the aim of this study was to better understand the diversity of Anilocra from this region and continent. Methods To redescribe A. capensis, the syntypes of A. capensis and specimens recorded as A. capensis from Africa were borrowed from the Natural History Museum, London, UK, and The iZiko South African Museum, Cape Town. Newly collected fresh samples of A. capensis were collected from off Cape Town, South Africa. Morphological redescriptions of the syntypes, and other museum and fresh material were conducted. Fresh samples were used to characterise molecularly A. capensis using the mitochondrial cytochrome c oxidase subunit 1 gene (cox1). Results Morphological analyses demonstrated that apart from A. capensis there are six Anilocra species new to science from Africa: Anilocra ianhudsoni n. sp., Anilocra bunkleywilliamsae n. sp., Anilocra paulsikkeli n. sp., Anilocra jovanasi n. sp., Anilocra angeladaviesae n. sp. and Anilocra hadfieldae n. sp. Of the species under study, specimens of A. capensis appear to demonstrate the most individual variation, which occurs in pleonite width, pleotelson form and uropod length. We determined that African species of Anilocra can be primarily differentiated by the proportional shape and size of the full body in dorsal view and pereonites 1, 6 and 7. Other defining morphological traits include proportional shape and size of the pereopods, and the antenna and antennula peduncles. Lastly, the molecular characterisation of A. capensis is provided and the interspecific divergence with Mediterranean species is smaller than that with Caribbean species. Conclusions The results of this study provide a detailed redescription of A. capensis and the first molecular barcode for this organism. Six new species of Anilocra from Africa are described, establishing that the diversity of Anilocra in this region is greater than previously known. With this new understanding of species differences, we can accurately conduct detailed molecular and ecological analyses of Anilocra from Africa with certainty of the organism under study.

Abstract Background Hospital boards have the responsibility to ensure compliance of hospital staff with guidelines and other norms, but they have struggled to do so. The current study aims to identify possible solutions that address the whole chain of guideline and norm production, use and enforcement and that could help hospital boards and management cope with norms and guidelines. Methods We performed a qualitative study of three focus groups involving a total of 28 participants. In the third focus group, no new themes emerged, indicating that saturation was achieved. Focus group discussions were audiotaped and transcribed verbatim. Results were coded, and three themes emerged from the results. Thick description with selected key quotes is used to display the items in the result section. Results In the first instance, norm developers, norm enforcers, and norm users acknowledged and reformulated the problem before they suggested solutions. The proposed concrete solutions, such as a clear description of the division of tasks within guidelines, clarity about the purpose of guideline recommendations, a maximum number of quality indicators for hospitals and implementation of an ensuring proper Information Technology (IT) infrastructure. Conclusions This study aimed to find solutions for the problems that hospitals encounter in managing a multitude of norms and guidelines. Participants in this study acknowledged the fact that norms and guidelines have become difficult to manage at the hospital level and four potential solutions were identified. Trial registration The study was retrospectively registered on the 21st of July in 2016 in the Dutch Trial Register as NL4061.

The branchial-attaching cymothoid genus, Elthusa Schioedte & Meinert, 1884 is a genus with a worldwide distribution of 36 species, including the three species described here. Elthusa raynaudii (Milne Edwards, 1840) is the only species that has been described from southern Africa. All South African material held at the National Museum of Natural History, Paris, France (MNHN) and the Iziko South African Museum, Cape Town (SAMC) identified as, or appearing to belong to, Elthusa was examined. Four species were identified, Elthusa raynaudii and three species that proved to be undescribed. Elthusa xena sp. n. can be distinguished by an evenly rounded pereonite 1 anterior margin, a roughly rectangular pleotelson, and narrowly rounded uropod apices that extend to more than half the length of the pleotelson. Elthusa acutinasa sp. n. is identified by the produced and narrowly rounded cephalon anterior margin, acute uropods that are shorter than half the length of the pleotelson, and pereonite 1 anterior margin with medial projection. Elthusa rotunda sp. n. is characterised by the round body shape, broadly rounded uropod apices, and protrusions on the proximal and lateral margins of the merus and carpus of pereopod 7. A key to the South African Elthusa species is provided, together with a table summarising the hosts and localities of the 33 previously known species of Elthusa.

Reptiles are hosts for various tick species and tick-associated organisms, many of which are zoonotic. However, little is known about the presence and diversity of tick-borne bacteria infecting reptiles and their ticks in South Africa. Amblyomma ticks (n = 253) collected from reptiles were screened for the presence of Coxiella, Anaplasma, Rickettsia, and Borrelia species by amplification, sequencing and phylogenetic analysis of the 16S rRNA, 23S rRNA, gltA, OmpA, and Flagellin genes, respectively. This study recorded the presence of reptile associated Borrelia species and Coxiella-like endosymbiont in South Africa for the first time. Furthermore, a spotted fever group Rickettsia species was observed in 7 Amblyomma marmoreum and 14 Amblyomma sylvaticum from tortoises of genera Kinixys and Chersina. Francisella-like endosymbiont was observed from 2 Amblyomma latum collected from the Mozambique spitting cobra, Naja mossambica. Coxiella burnetii and Anaplasma spp., were not detected from the current samples. Although the direct evidence that reptiles can act as reservoir hosts remains to be determined, observations from this study provide indications that reptilian ticks may play a role in the transmission of pathogenic bacteria to homothermic animals. Furthermore, the absence of Anaplasma spp., and C. burnetii does not mean that these pathogens should be completely neglected.