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Andalusia is the most highly populated (7,849,799 hab.) region of the Spanish State. It has all the sanitary domains under its own Health Service (Consejería de Salud), and it has undertaken a deep reorganization of the psychiatric services, establishing a new model based on the mental health communitarian alternative that is already completely implanted. Rates of readmission are a method to assess the quality of care and an important tool in the planning of services of mental health.
The aim of this study is to establish if readmission rates are influenced by Human Resources in Psychiatric Community Devices.
Part of FIS Project PI05/90061 ‘Patterns of General Hospital Psychiatric Units Overuse’.
MBDS is a system of hospital register that gathers all the discharges produced in the andalusian hospitals. It is totally trustworthy from 1995, and we have processed data up to 2004.
Our Data Set register 101234 hospital admissions of psychiatric patients.
The number of admissions from patients who enter three times or more throughout the year has been: 22.66%(1995); 24.66% (1996); 31.01%(1997); 30.72%(1998); 34.07%(1999); 35.35%(2000); 36.92%(2001); 32.93%(2002); 31.20%(2003) and 29.36%(2004).
On the other hand, it has been an increase in Mental Health Human Resources Rates: 24.23-100.000 inhab-(1998); 24.19 (1999); 26.01(2000); 28.04(2001); 29.83(2002); 29.16(2003); 29.34(2004) and 29.90(2005).
Increasing human resources in psychiatric community devices do not change revolving-door rates in general hospital acute psychiatric units in a community mental health system.
Alcohol dependence belongs to one of the major risk factors to health worldwide. Alcohol consumption is a significant factor for mortality in the world: 6.3% in men and 1.1% in women. The alcohol use disorder is also very common: 5.4% in men, 1.5% in women. Despite its high frequency and severity of this disorder, only 8% of all alcohol dependents are treated once.
An interesting treatment option is geared toward reducing alcohol intake. Some patients in treatment for alcohol use disorder prefer an initial target of reducing consumption. Nalmefene, an antagonist naltrexone associated with opioid receptors, has been authorized in the European Union to help alcohol-dependent patients reduce their consumption. Antagonists’ opiate receptors are associated with reduced reward in relation to alcohol consumption, thus helping patients in reducing energy consumption.
A man of 39 years old, with a diagnosis of alcohol use disorder and depressive disorder and poor outcome despite different types of treatment (as aversive agents) was treated with nalmefene.
After a few months, nalmefene had a beneficial effect on the patient, with a significant reduction in the number of days of excessive alcohol consumption and total consumption in the sixth month. In addition, treatment was well tolerated, with no observed secondary effects.
Nalmefene appears to be effective and safe in reducing heavy drinking. Drugs such as nalmefene have demonstrated efficacy in association with a biopsychosocial approach to help patients achieve their personal objectives for this disorder.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
More than 60% of patients receiving intensive treatment with first generation antipsychotic manifest some type of clinically significant extrapyramidal side effects. Parkinsonian syndrome is the most common and is characterized by rigidity, tremors, akinesia and bradykinesia and usually improves with discontinuation of antipsychotic drug or anticholinergic association.
It is a 60-year-old man, married with two children. Initiates contact with mental health in 2013 with a diagnosis of adjustment disorder. In February 2014 he requires hospitalisation, establishing the diagnosis of delusional disorder and starting treatment with long-acting injectable paliperidone palmitate (100 mg/month) with remission of psychotic symptoms in a few days. When we receive the patient in our clinic, he presents parkinsonian extrapyramidal symptoms (UKU subscale: 18), with significant functional limitation. We decrease the dose to 75 mg/month and an anticholinergic was added without improvement of Parkinsonian clinic, so we decided to switch to long-acting injectable aripiprazole 400 mg/month, objectifying complete remission of extrapyramidal syndrome (UKU subscale: 0).
The mechanism of action of aripiprazole m LAI (partial agonist of D2 receptors in the brain) without decreases in the nigrostriatal dopamine pathway, of improving extrapyramidal effects associated one other antipsychotics.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The major depression is associated with decreased cognitive functions in a range of areas, including attention, memory and executive functions. The cognitive symptoms of depression can have a profound effect on the ability of patients to keep out the tasks of daily living, and are significant factors that affect the ability to function both interpersonal and occupational level.
Vortioxetina have a multimodal action acting on various serotonin receptors in addition to inhibiting serotonin reuptake. Vortioxetina, is a new therapeutic tool seems to have shown efficacy in the treatment of cognitive symptoms of depression.
To evaluate this action we have evaluated the cognitive decline in patients with major depression before receiving treatment vortioxetina (whether state or not previously treated with other antidepressants) and at 2, 6 and 12 months after starting treatment with the drug. For that, we’ve used the Verbal Hearing Test King (RAVLT), which evaluates the auditory verbal short-term memory, the learning rate, the retention of information, and the differences between learning and recovery, and testing Digit substitution by symbols (DSST) that perform quick detection of brain dysfunctions by a conventional task.
The results of this study are still under analysis.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The overall incidence of spinal tuberculosis (TB) appears to be stable or declining in most European countries, but with an increasing proportion of cases in the foreign-born populations. We performed a retrospective observational study (1993–2014), including all cases of spinal TB diagnosed at a Barcelona hospital to assess the epidemiological changes. Fifty-four episodes (48·1% males, median age 52 years) of spinal TB were diagnosed. The percentage of foreign-born residents with spinal TB increased from 14% to 45·2% in the last 10 years (P = 0·017). Positive Mycobacterium tuberculosis testing in vertebral specimens was 88·2% (15/17) for GeneXpert MTB/RIF. Compared with natives, foreign-born patients were younger (P < 0·01) and required surgery more often (P = 0·003) because of higher percentages of paravertebral abscess (P = 0·038), cord compression (P = 0·05), and persistent neurological sequelae (P = 0·05). In our setting, one-third of spinal TB cases occurred in non-native residents. Compared with natives, foreign-born patients were younger and had greater severity of the disease. The GeneXpert MTB/RIF test may be of value for diagnosing spinal TB.
Over the last few decades the number of radiocarbon dates available for West Central Africa has increased substantially, even though it is still meagre compared with other areas of the continent. In order to contribute to a better understanding of the Iron Age of this area we present and analyze a total of 22 radiocarbon dates obtained from sites from the island of Corisco (Equatorial Guinea). By comparing them with those from Equatorial Guinea, southern Cameroon, and coastal Gabon and Congo we intend to clarify the picture of the West Central African Iron Age and propose a more accurate archaeological sequence.
Mesolithic hunter-gatherer settlements generally leave ephemeral archaeological traces and are notoriously difficult to detect. Nowhere is this more so than on the northern coast of Spain, despite a long tradition of Mesolithic research. In this project, evidence of Mesolithic activity together with the geomorphological and topographical suitability of particular locations were used to select areas for large-scale geophysical survey. The results demonstrate the potential of the new methodology: magnetometry survey at El Alloru revealed the very first Asturian open-air settlement site to be discovered.
The objective of this study was to estimate the relationship between serum vitamin D (VitD) status and tuberculosis (TB) infection conversion (TBIC), measured by the tuberculin skin test (TST) and an interferon-gamma release assay, the QuantiFERON-TB Gold In-Tube (QFT-GIT) test, in the contacts of pulmonary TB patients in Castellon (Spain) in a prospective cohort study from 2010 to 2012. Initially, the participants were negative to latent TB infection after a screening that included TST and QFT-GIT tests, and other examinations. A baseline determination of 25-hydroxyvitamin D [25(OH)D] was obtained by chemiluminescence immunoassay. After 8–10 weeks, participants were screened for a second time to determine TB infection conversion (TBIC). Poisson regression models were used in the statistical analysis. Of the 247 participants in the cohort, 198 (80·2%) were screened twice and 18 (9·1%) were TBIC cases. The means of VitD concentration in the TBIC cases and the non-cases were 20·7±11·9 and 27·2±11·4 ng/ml (P = 0·028), respectively. Adjusted for high exposure and TB sputum acid-fast bacilli (AFB)-positive index case, higher serum VitD concentration was associated with low incidence of TBIC (Ptrend = 0·005), and an increase of 1 ng/ml VitD concentration decreased the incidence of TBIC by 6% (relative risk 0·94, 95% confidence interval 0·90–0·99, P = 0·015). The results suggest that sufficient VitD level could be a protective factor of TBIC.
Patagonia in southern South America is among the few world regions where direct human impact is still limited but progressively increasing, mainly represented by tourism, farming, fishing and mining activities. The sanitary condition of Patagonian wildlife is unknown, in spite of being critical for the assessment of anthropogenic effects there. The aim of this study was the characterization of Salmonella enterica strains isolated from wild colonies of Magellanic penguins (Spheniscus magellanicus) located in Magdalena Island and Otway Sound, in Chilean Patagonia. Eight isolates of Salmonella were found, belonging to Agona and Enteritidis serotypes, with an infection rate of 0·38%. Resistance to ampicillin, cefotaxime, ceftiofur and tetracycline antimicrobials were detected, and some of these strains showed genotypic similarity with Salmonella strains isolated from humans and gulls, suggesting inter-species transmission cycles and strengthening the role of penguins as sanitary sentinels in the Patagonian ecosystem.
Previous geochronological and archaeological studies on the rock shelter Jarama VI suggested a late survival of Neanderthals in central Iberia and the presence of lithic assemblages of Early Upper Paleolithic affinity. New data on granulometry, mineralogical composition, geochemical fingerprints and micromorphology of the sequence corroborate the previous notion that the archaeological units JVI.2.1 to JVI.2.3 are slackwater deposits of superfloods, which did not experience significant post-depositional changes, whereas the artifact-rich units JVI.3 and JVI.1 mainly received sediment inputs by sheetwash and cave spall. New AMS radiocarbon measurements on three samples of cut-marked bone using the ultrafiltration technique yielded ages close to, or beyond, the limit of radiocarbon dating at ca. 50 14C ka BP, and hence suggest much higher antiquity than assumed previously. Furthermore, elevated temperature post-IR IRSL luminescence measurements on K feldspars yielded burial ages for subunits JVI.2.2 and JVI.2.3 between 50 and 60 ka. Finally, our reappraisal of the stone industry strongly suggests that the whole sequence is of Mousterian affinity. In conclusion, Jarama VI most probably does not document a late survival of Neanderthals nor an Early Upper Paleolithic occupation in central Iberia, but rather indicates an occupation breakdown after the Middle Paleolithic.
Starting from a sketch of the s-process concept formulated 50 years ago, the nuclear physics data for s-process calculations are briefly reviewed with emphasis on the status of neutron capture cross sections and beta decay rates. Accurate and comprehensive experimental data are mandatory as direct input for s-process calculations as well as for improving the complementary information from nuclear theory. The current challenges of the field are discussed in the light of new or optimized methods and state-of-the-art facilities, indicating the potential for accurate measurements and the possibility to study cross sections of radioactive isotopes. These opportunities will be considerably enriched by the enormous improvements provided by new facilities.
An efficient technique for determining the small-signal equivalent-circuit model of a Metal collector-up Heterojunction Bipolar Transistor (C-up MHBT) is presented. The technique employs analytically derived expressions for direct calculation of HBT T-Model equivalent circuit element values in terms of the measured S-parameters. This approach avoids errors due to uncertainty in fitting to large, over determined equivalent circuits and does not require the use of test structures and extra measurement steps to evaluate parasitics. Physically realistic results are demonstrated under various biasing conditions for the n-p-n InP/InGaAs HBT with metallic collector up structure. The agreement between the measured and model-produced data is excellent over the large frequency range and for several polarizations conditions for devices.
Not long after the arrival of the Mendicant orders in New Spain, a view emerged among the friars that the subjection of the Mexican Indians to Spanish law might not be a goal as practical and desirable as the Crown expected, at least not for the immediate future. Franciscans, in particular, thought that the transfer and application of long-established legal principles to the Mexican Indians, such as the customary distinction of jurisdictions, could ultimately hurt rather than facilitate their full conversion to Christianity. For them, the administration of justice was but a natural extension of the enterprise of evangelization, a point that they made repeatedly in letters and reports throughout the sixteenth century.1 In part, their opposition to seeing the new converts subject to secular law stemmed from a general dissatisfaction with the state of legal affairs in the Peninsula, where an alarming increase in lawsuits and legal costs leading to the further consolidation of a class of letrados appeared to threaten the fabric of social life.
CASPER (Concordia Atmospheric SPectroscopy of Emitted Radiation)
is a spectrometer proposed for installation at Dome C, devoted to
measurements of atmospheric emission in the spectral region
between 180 μm and 3 mm (3–55 cm-1). This
instrument will be able to perform continuous spectral sampling at
different altitudes at angular scales of ~1°. From the
recorded data it is possible to extract atmospheric transmittance
within 1% in the whole wide operating band, together with water
vapour content and O2 and O3 concentrations. CASPER will
allow us to characterize the site for future FIR/mm telescopes.
Atmospheric data recorded by CASPER will allow for correction of
astrophysical and cosmological observations without the need for
telescope-specific procedures and further loss of observation time
with more precision in the observations themselves. Calibration of
ground-based telescopes on known sky sources is strongly affected
by atmospheric absorption. CASPER has this as its primary goal.
The spectrometer is based on a Martin-Puplett interferometer. Two
data sampling solutions will be performed: phase modulation &
fast scan strategy. Sky radiation is collected towards the
interferometer by an optical setup that allows the field of view,
to explore the full 0° ÷ 90° range of elevation angles. With
a low spurious polarization instrument, monitoring of polarized
atmospheric contribution will be possible.
L134N is a cold, starless cloud, very high above the galactic plane,
close to us and well delineated in continuum dust emission maps. This
cloud is considered to be representative of oxygen rich dark clouds
(with the presence of SO, SO2, NO, ...). It is thus a good
reference together with TMC-1 to test astrochemical models. Thanks to
ISO, SCUBA and near IR wide field cameras, the detailed study of the
dust has become possible in such cold and dark clouds. In parallel,
progress in radiotelescope receiver sensitivity now allows to map weak
lines on large surfaces. We have thus started a project to study both
dust and a few gaseous key species (CO, CS, SO and N2H+) to
address several questions. We want to assess the quantity of dust and
gas all over the cloud, study possible C18O and/or C17O
depletion towards dense cores, evaluate the structure of the gas, the
abundance of CS and SO to possibly estimate the chemical age of the
cloud (time dependent models show that the CS/SO ratio diminishes with
time) and evaluate the rare isotope abundances, especially 17O
and 34S in a first step. To constrain the molecular abundances
with the highest possible confidence, we have observed several
transitions for each species and each isotopomer. Though we have
observed far less species than Dickens et al. , we
have done it on a larger area, including thus the strongest C18O
peak and two other peaks, with a better signal-to-noise ratio. Most of
the data are already acquired. We present here preliminary results.
A preliminary purification has been carried out by continuous elution electrophoresis of a 49.5 kDa protease of crude extracts from Dicrocoelium dendriticum eggs. The enzyme showed a high capacity to degrade the collagen derivative azocoll at acidic pH. Although it is necessary to carry out further experiments to confirm any physiological role, this protease could be implicated in penetration mechanisms.
A 24-kDa collagenase was localized in the Gymnorhynchus gigas plerocercoid immunohistochemically by peroxidase complex staining using polyclonal antibodies from NMRI mouse sera immunized with purified enzyme. Immunoreactivity was determined at different parts of the body (scolex, vesicle and caudal region) and mainly localized in microtriches and parenchymal tissues of the scolex and vesicle. These results, along with the absence of the enzyme in the plerocercoid excretion–secretion products, suggest that the 24-kDa collagenase is produced by parenchymal cells in the anterior region and transported to the outer regions of the worm It is possible that the enzyme plays an important role in degrading parasite tissues during the moulting process.