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Describe and validate the CHROME (CHemical Restraints avOidance MEthodology) criteria.
Observational prospective longitudinal study.
Single nursing home in Las Palmas de Gran Canaria, Spain.
288 residents; mean age: 81.6 (SD 10.6). 77.4% had dementia.
Multicomponent training and consultancy program to eliminate physical and chemical restraints and promote overall quality care. Clinicians were trained in stringent diagnostic criteria of neuropsychiatric syndromes and adequate psychotropic prescription.
Psychotropic prescription (primary study target), neuropsychiatric syndromes, physical restraints, falls, and emergency room visits were semi-annually collected from December 2015 to December 2017. Results are presented for all residents and for those who had dementia and participated in the five study waves (completer analysis, n=107).
For the study completers, atypical neuroleptic prescription dropped from 42.7% to 18.7%, long half-life benzodiazepines dropped from 25.2% to 6.5%, and hypnotic medications from 47.7% to 12.1% (p<0.0005). Any kind of fall evolved from 67.3 to 32.7 (number of falls by 100 residents per year). Physicians’ diagnostic confidence increased, while the frequency of diagnoses of neuropsychiatric syndromes decreased (p<0.0005).
Implementing the CHROME criteria reduced the prescription of the most dangerous medications in institutionalized people with dementia. Two independent audits found no physical or chemical restraint and confirmed prescription quality of psychotropic drugs. Adequate diagnosis and independent audits appear to be the keys to help and motivate professionals to optimize and reduce the use of psychotropic medication. The CHROME criteria unify, in a single compendium, neuropsychiatric diagnostic criteria, prescription guidelines, independent audit methodology, and minimum legal standards. These criteria can be easily adapted to other countries.
The rocky shores of the north-east Atlantic have been long studied. Our focus is from Gibraltar to Norway plus the Azores and Iceland. Phylogeographic processes shape biogeographic patterns of biodiversity. Long-term and broadscale studies have shown the responses of biota to past climate fluctuations and more recent anthropogenic climate change. Inter- and intra-specific species interactions along sharp local environmental gradients shape distributions and community structure and hence ecosystem functioning. Shifts in domination by fucoids in shelter to barnacles/mussels in exposure are mediated by grazing by patellid limpets. Further south fucoids become increasingly rare, with species disappearing or restricted to estuarine refuges, caused by greater desiccation and grazing pressure. Mesoscale processes influence bottom-up nutrient forcing and larval supply, hence affecting species abundance and distribution, and can be proximate factors setting range edges (e.g., the English Channel, the Iberian Peninsula). Impacts of invasive non-native species are reviewed. Knowledge gaps such as the work on rockpools and host–parasite dynamics are also outlined.
Although executive and other cognitive deficits have been found in patients with borderline personality disorder (BPD), whether these have brain functional correlates has been little studied. This study aimed to examine patterns of task-related activation and de-activation during the performance of a working memory task in patients with the disorder.
Sixty-seven DSM-IV BPD patients and 67 healthy controls underwent fMRI during the performance of the n-back task. Linear models were used to obtain maps of within-group activations and areas of differential activation between the groups.
On corrected whole-brain analysis, there were no activation differences between the BPD patients and the healthy controls during the main 2-back v. baseline contrast, but reduced activation was seen in the precentral cortex bilaterally and the left inferior parietal cortex in the 2-back v. 1-back contrast. The patients showed failure of de-activation affecting the medial frontal cortex and the precuneus, plus in other areas. The changes did not appear to be attributable to previous history of depression, which was present in nearly half the sample.
In this study, there was some, though limited, evidence for lateral frontal hypoactivation in BPD during the performance of an executive task. BPD also appears to be associated with failure of de-activation in key regions of the default mode network.
The Spanish National Network (REDETS) is a group of eight agencies, units and services, depending on National and Regional Governments that coordinate their work within a common methodological framework, guided by the principles of mutual recognition and cooperation. The necessity of considering a Quality Management System has been detected and, consequently, a common tool for all the members needs to be developed. We describe in this study the process to achieve that goal.
Based on both a review of previous literature and the proposal for a self-evaluating tool, a group of experts from each agency through consensus have developed a tool for self-evaluation in Health Technology Assessment (HTA) agencies. Through the structure described in the handbook of the Andalusian Agency for Healthcare Quality (ACSA), each standard should have a statement or proposal that needs to also include evidence or good practices, and the corresponding evaluation questions. In separate workgroups, the definition of these proposals, evidence and evaluation questions were developed. One face-to-face meeting and two meetings via teleconference were necessary to achieve a final document with all the quality standards.
From a proposed structure of sixty-six standards, the titles, definitions, statements and evidence as well as good practices and evaluation questions were established in workgroups with consensus among all of the members (1 - 3). The final version of the self-assessment tool was composed of sixty-eight standards, grouped in twelve quality criteria structured in four dimensions: I Responsibility, II Clients and Stakeholders, III Production Process, and IV Resources.
Quality management requires an evaluation tool and this version, based on a systematic review and consensus, is a useful and practical instrument for developing a handbook by each member of REDETS. An online version of the tool is in process of development.
Background: The mechanisms and triggers of the attentional bias in social anxiety are not yet fully determined, and the modulating role of personality traits is being increasingly acknowledged. Aims: Our main purpose was to test whether social anxiety is associated with mechanisms of hypervigilance, avoidance (static biases), vigilance-avoidance or the maintenance of attention (dynamic biases). Our secondary goal was to explore the role of personality structure in shaping the attention bias. Method: Participants with high vs low social anxiety and different personality structures viewed pairs of faces (free-viewing eye-tracking task) representing different emotions (anger, happiness and neutrality). Their eye movements were registered and analysed for both whole-trial (static) and time-dependent (dynamic) measures. Results: Comparisons between participants with high and low social anxiety levels did not yield evidence of differences in eye-tracking measures for the whole trial (latency of first fixation, first fixation direction, total dwell time), but the two groups differed in the time course of overt attention during the trial (dwell time across three successive time segments): participants with high social anxiety were slower in disengaging their attention from happy faces. Similar results were obtained using a full-sample, regression-based analysis. Conclusion: Our results speak in favour of a maintenance bias in social anxiety. Preliminary results indicated that personality structure may not affect the maintenance (dynamic) bias of socially anxious individuals, although depressive personality structures may favour manifestations of a (static) hypervigilance bias.
We prove that the k-truncated microsupport of the specialization of a complex of sheaves F along a submanifold is contained in the normal cone to the conormal bundle along the k-truncated microsupport of F. In the complex case, applying our estimates to , where is a coherent -module, we obtain new estimates for the truncated microsupport of real analytic and hyperfunction solutions. When is regular along Y we also obtain estimates for the truncated microsupport of the holomorphic solutions of the induced system along Y as well as for the nearby-cycle sheaf of when Y is a hypersurface.
Suppose we are given complex manifolds X and Y together with substacks
of modules over algebras of formal deformation
on X and
on Y, respectively. Also, suppose we are given a functor Φ from the category of open subsets of X to the category of open subsets of Y together with a functor F of prestacks from
. Then we give conditions for the existence of a canonical functor, extension of F to the category of coherent
-modules such that the cohomology associated to the action of the formal parameter
takes values in
. We give an explicit construction and prove that when the initial functor F is exact on each open subset, so is its extension. Our construction permits to extend the functors of inverse image, Fourier transform, specialisation and micro-localisation, nearby and vanishing cycles in the framework of
-modules. We also obtain the Cauchy–Kowalewskaia–Kashiwara theorem in the non-characteristic case as well as comparison theorems for regular holonomic
-modules and a coherency criterion for proper direct images of good
Migratory wader populations face global threats, mainly related to increasing rates of habitat loss and disturbance driven by human activities. To a large extent, the long-term survival of these populations requires the conservation of networks of sites along their migratory flyways. The Tagus estuary, Portugal, is among the most important wetlands for waders in the East Atlantic Flyway. Annual winter wader counts have been carried in this wetland since 1975 and a monthly roost-monitoring programme was implemented in 2007. Wintering populations of three out of the five most abundant species, Dunlin Calidris alpina, Grey Plover Pluvialis squatarola and Redshank Tringa totanus, showed significant population declines over the past three decades, which are most likely due to the loss and degradation of roost sites as a result of increasing human activity. The situation is unlikely to improve, as a high proportion of the wintering waders use roost sites that are situated in highly urbanised areas with no legal protection. The use of different roost sites by waders is highly variable both temporally and spatially, thus emphasizing the need for a network of good quality roost sites. Additionally, during migration, 60–80% of all the waders of the Tagus estuary concentrate at a single refuge, thus increasing the risk for wader populations during these periods.