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Although mild to moderate major depressive disorder (MDD) is one of the main reasons for consulting a general practitioner (GP), there is still no international consensus on the most appropriate therapeutic approach.
The aim of this study is to evaluate the clinical effectiveness of watchful waiting (WW) compared with the use of antidepressants (ADs) for the treatment of mild to moderate depressive symptoms in 263 primary care (PC) usual-practice patients in a 12-month pragmatic non-randomised controlled trial. Both longitudinal and per-protocol analyses were performed, through a multilevel longitudinal analysis and a sensitivity analysis.
We observed a statistically significant time x treatment interaction in the severity of depression (Patient Health Questionnaire, PHQ-9) and disability (World Health Organization Disability Assessment Schedule, WHODAS) in favour of the AD group at 6 months but not at 12 months. The effect size of this difference was small. No statistically significant differences were observed between groups in severity of anxiety (Beck Anxiety Inventory, BAI) or health-related quality-of-life (EuroQol-5D, EQ-5D). Sensitivity analysis and per-protocol analysis showed no differences between the two groups in any of the evaluated scales.
Superiority of either treatment (WW and AD) was not demonstrated in patients treated for depression in PC after one year of follow-up.
The main objective of our study was to describe the epidemiological and microbiological features of an oligoclonal hospital-wide outbreak caused by OXA-48-producing Enterobacteriaceae (OXA-48-PE). OXA-48 is a carbapenemase belonging to Ambler class D beta-lactamases, identified frequently in the Mediterranean and Southern European countries, and associated with several Enterobacteriaceae species. An outbreak of OXA-48-PE with a complex epidemic pattern was detected in January 2011. Initial control measures included contact precautions and the reinforcement of infection control practices, but despite all efforts made, the epidemiological situation hardly changed and new measures were implemented during 2013. An observational retrospective study was performed to describe the main features of the outbreak and to analyse the cumulative incidence (CI) trends. Eight hundred and 16 patients colonised or infected by OXA-48-PE were identified during the 2-year period (January 2013–December 2014), female 46%, mean age (s.d.), 71.6 (15.2). The samples isolated in the incident cases were rectal swabs (80%), urine samples (10.7%), blood samples (2.8%) and other clinical samples (6.6%). The most frequent OXA-48-PE was Klebsiella pneumoniae. Eleven different clones were identified, but K. pneumoniae sequence types 11 and 405 were predominant: ST11 (64.2%) and ST405 (29.3%). OXA-48-PE CI trend suffered a statistically significant change in August 2013, which continued the following months. Though we could not eradicate the outbreak, we observed a statistically significant drop in CI after an intervention for OXA-48-PE control, based on patient cohort, active surveillance, electronic alerts and reinforcement of infection control measures in a tertiary hospital.
We used the Gaia data release 1 to study the proper motion fields of the Large and Small Magellanic Clouds (LMC, SMC) on the basis of the Tycho-Gaia Astrometric Solution (van der Marel & Sahlmann 2016). The Gaia LMC and SMC proper motions have similar accuracy and agree to within the uncertainties with existing HST proper motion measurements. Since Gaia probes the young stellar population and uses different methods with different systematics, this provides an external validation of both data sets and their underlying approaches.
The stellar occultation technique is a powerful tool to study distant small solar system bodies. Currently, around 2 500 trans-neptunian objects (TNOs) and Centaurs are known. With the astrometry from Gaia and large surveys like the Large Synoptic Survey Telescope (LSST), accurate predictions of occultation events will be available to tens of thousands of TNOs and Centaurs and boost the knowledge of the outer solar system.
Because of to its exceptional resolving power, Gaia should detect a few thousands gravitational lensed systems. These consist in multiple images of background quasars. The estimated number of lens phenomena in the sky, however, depends on the cosmological model considered. By taking into account the observational bias that will restrict the detection of lensed quasars, identification of these up to a given limiting magnitude will constrain the cosmological parameters.
We have investigated the known gravitationally lensed quasars present in the Gaia DR1, and found that a significant number of components of these systems have been measured and are present in the Gaia DR1 catalogue although quasi none of them have all their components detected. We additionally examined the immediate surroundings of QSOs from the large Quasar catalogue, LQAC3, and detected several configurations compatible with gravitational lensing phenomena. A more global strategy to systematically detect the potential candidates in the various releases of the Gaia catalogue is presented.
Alpha lipoic acid (ALA) C8H14O2S2 is a naturally occurring compound that is synthesized in small amounts by plants and animals, including humans. ALA is covalently bound to specific proteins, which function as cofactors for several important mitochondrial enzyme complexes and studies suggest that they might help with type 2 diabetes. In the Cambridge Structural Database, there are four entries related to this compound: two for lipoic acid and two for complexes. In the Powder Diffraction File-4, two experimental unindexed patterns are reported. The material crystallizes in a monoclinic crystal system, space group P21/a and cell parameters a = 9.237 (1) Å, b = 9.960 (1) Å, c = 11.787 (2) Å, β = 109.13 (1)°, and V = 1024.6 (2) Å3.
Individual-level measures of acculturation (e.g. age of immigration) have a complex relationship with psychiatric disorders. Fine-grained analyses that tap various acculturation dimensions and population subgroups are needed to generate hypotheses regarding the mechanisms of action for the association between acculturation and mental health.
Study participants were US Latinos (N = 6359) from Wave 2 of the 2004–2005 National Epidemiologic Survey of Alcohol and Related Conditions (N = 34 653). We used linear χ2 tests and logistic regression models to analyze the association between five acculturation dimensions and presence of 12-month DSM-IV mood/anxiety disorders across Latino subgroups (Mexican, Puerto Rican, Cuban, ‘Other Latinos’).
Acculturation dimensions associated linearly with past-year presence of mood/anxiety disorders among Mexicans were: (1) younger age of immigration (linear χ21 = 11.04, p < 0.001), (2) longer time in the United States (linear χ21 = 10.52, p < 0.01), (3) greater English-language orientation (linear χ21 = 14.57, p < 0.001), (4) lower Latino composition of social network (linear χ21 = 15.03, p < 0.001), and (5) lower Latino ethnic identification (linear χ21 = 7.29, p < 0.01). However, the associations were less consistent among Cubans and Other Latinos, and no associations with acculturation were found among Puerto Ricans.
The relationship between different acculturation dimensions and 12-month mood/anxiety disorder varies across ethnic subgroups characterized by cultural and historical differences. The association between acculturation measures and disorder may depend on the extent to which they index protective or pathogenic adaptation pathways (e.g. loss of family support) across population subgroups preceding and/or following immigration. Future research should incorporate direct measures of maladaptive pathways and their relationship to various acculturation dimensions.
This paper aims to present the Integrated Atlas of Mental Health of Catalonia (2010) focusing on: (a) the importance of using a taxonomy-based coding and standard system of data collection when assessing health services; and (b) its relevance as a tool for evidence-informed policy.
This study maps all the care-related services for people with mental disorders available in Catalonia in 2010, using the ‘Description and Evaluation of Services and Directories in Europe for long-term care’ (DESDE-LTC). The unit of analysis is the Basic Stable Input of Care (BSIC), which is the minimal organisation unit composed by a set of inputs with temporal stability. We presented data on: (a) availability of BSICs and their capacity; (b) the adequacy of the provision of care, taking into account availability and accessibility; (c) the evolution of BSCIs from 2002 to 2010; and (d) the perceived relevance of Atlas of Mental Health as a tool for evidence-informed policy.
We identified a total of 639 BSICs. A lack of Health services was detected in highly rural areas, although there was moderate availability of Social Services. Overall, more than 80% of the small mental health areas in Catalonia had an adequate core mental health service. Since 2002 the availability of mental health services has increased. Decision makers found the Atlas a useful and relevant tool for evidence informed policy.
Policy makers can use Atlases to detect gaps and inequities in the provision of care for people with mental health needs.
Fifty male Merino lambs (6 to 8 weeks, 14.1 kg; n=10 per group) were used to study the effect of feeding system: barley straw in long form and concentrate pellets in separate troughs (Control), ad libitum alfalfa supplemented with concentrate in separate troughs (Alfalfa) or including various levels of ground barley straw in concentrate pellets (B05, B15 and B25 for 50, 150 and 250 g barley straw/kg), on rumen characteristics, acid-base status, blood cell counts and lymphocyte stimulation. Alfalfa lambs had the heaviest digestive tract contents, highest rumen pH values, lowest volatile fatty acid concentration, highest papillae counts and best mucosa colour and the greatest blood pCO2 values, lowest sodium and chloride and highest potassium concentrations (P<0.05). Including ground barley straw in the concentrate pellet or providing straw in long form separately from the concentrate reduces rumen pH and darkens ruminal mucosa as compared with alfalfa-fed lambs, thus affecting acid-base status.
Non-linear regression (NLR) techniques are used widely to fit weed field emergence patterns to soil microclimatic indices using S-type functions. Artificial neural networks (ANNs) present interesting and alternative features for such modelling purposes. In the present work, a univariate hydrothermal-time based Weibull model and a bivariate (hydro-time and thermal-time) ANN were developed to study wild oat emergence under non-moisture restriction conditions using data from different locations worldwide. Results indicated a higher accuracy of the neural network in comparison with the NLR approach due to the improved descriptive capacity of thermal-time and the hydro-time as independent explanatory variables. The bivariate ANN model outperformed the conventional Weibull approach, in terms of RMSE of the test set, by 70·8%. These outcomes suggest the potential applicability of the proposed modelling approach in the design of weed management decision support systems.
The overall aim of the present study was to analyse and compare organic beef cattle farming in Spain with intensive and conventional systems. An on-farm study comparing farm management practices and animal health was carried out. The study also focussed on a slaughterhouse analysis by comparing impacts on the safety and quality of the cattle products. Twenty-four organic and 26 conventional farms were inspected, and farmers responded to a questionnaire that covered all basic data on their husbandry practices, farm management, veterinary treatments and reproductive performance during 2007. Furthermore, data on the hygiene and quality of 244, 2596 and 3021 carcasses of calves from organic, intensive and conventional farms, respectively, were retrieved from the official yearbook (2007) of a slaughterhouse. Differences found between organic and conventional farms across the farm analysis did not substantially reflect differences between both farm types in the predominant diseases that usually occur on beef cattle farms. However, calves reared organically presented fewer condemnations at slaughter compared with intensive and to a lesser extent with conventionally reared calves. Carcass performance also reflected differences between farm type and breed and was not necessarily better in organic farms.
Renewable energy can provide a host of benefits to society. In addition to the reduction of carbon dioxide (CO2) emissions, governments have enacted renewable energy (RE) policies to meet a number of objectives including the creation of local environmental and health benefits; facilitation of energy access, particularly for rural areas; advancement of energy security goals by diversifying the portfolio of energy technologies and resources; and improving social and economic development through potential employment opportunities. Energy access and social and economic development have been the primary drivers in developing countries whereas ensuring a secure energy supply and environmental concerns have been most important in developed countries.
An increasing number and variety of RE policies–motivated by a variety of factors–have driven substantial growth of RE technologies in recent years. Government policies have played a crucial role in accelerating the deployment of RE technologies. At the same time, not all RE policies have proven effective and efficient in rapidly or substantially increasing RE deployment. The focus of policies is broadening from a concentration almost entirely on RE electricity to include RE heating and cooling and transportation.
RE policies have promoted an increase in RE capacity installations by helping to overcome various barriers. Barriers specific to RE policymaking (e.g., a lack of information and awareness), to implementation (e.g., a lack of an educated and trained workforce to match developing RE technologies) and to financing (e.g., market failures) may further impede deployment of RE.
We have chosen the name of GYES, one of the mythological giants with one hundred arms,
offspring of Gaia and Uranus, for our instrument study of a multifibre spectrograph for
the prime focus of the Canada-France-Hawaii Telescope. Such an instrument could provide an
excellent ground-based complement for the Gaia mission and a northern complement to the
HERMES project on the AAT. The CFHT is well known for providing a stable prime focus
environment, with a large field of view, which has hosted several imaging instruments, but
has never hosted a multifibre spectrograph. Building upon the experience gained at GÉPI
with FLAMES-Giraffe and X-Shooter, we are investigating the feasibility of a high
multiplex spectrograph (about 500 fibres) over a field of view one degree in diameter. We
are investigating an instrument with resolution in the range 15 000 to 30 000, which
should provide accurate chemical abundances for stars down to 16th magnitude and radial
velocities, accurate to 1 km s-1 for fainter stars. The study is led by
GÉPI-Observatoire de Paris with a contribution from Oxford for the study of the
positioner. The financing for the study comes from INSU CSAA and Observatoire de Paris.
The conceptual study will be delivered to CFHT for review by October 1st 2010.
The partial contributions of reductions in fetal nutrition and oxygenation to slow fetal growth and a developmental origin of cardiovascular disease remain unclear. By combining high altitude with the chick embryo model, we have previously isolated the direct effects of high-altitude hypoxia on growth. This study isolated the direct effects of high-altitude hypoxia on cardiovascular development. Fertilized eggs from sea-level or high-altitude hens were incubated at sea level or high altitude. Fertilized eggs from sea-level hens were also incubated at high altitude with oxygen supplementation. High altitude promoted embryonic growth restriction, cardiomegaly and aortic wall thickening, effects which could be prevented by incubating eggs from high-altitude hens at sea level or by incubating eggs from sea-level hens at high altitude with oxygen supplementation. Embryos from high-altitude hens showed reduced effects of altitude incubation on growth restriction but not on cardiovascular remodeling. The data show that: (1) high-altitude hypoxia promotes embryonic cardiac and vascular disease already evident prior to hatching and that this is associated with growth restriction; (2) the effects can be prevented by increased oxygenation; and (3) the effects are different in embryos from sea-level or high-altitude hens.
We describe the behavior of the rotational velocity in metal-poor stars ([Fe/H] ~ −0.5 dex) at different evolutionary stages, based on v sin i values from the literature. Our sample is composed of stars in the field and in some Galactic globular clusters, including stars on the main sequence (MS), red-giant branch (RGB), and horizontal branch (HB). The metal-poor stars are mainly slow rotators, and their v sin i distribution along the Hertzsprung–Russell diagram is quite homogeneous. Nevertheless, a few moderate to high values of v sin i are found for stars located on the MS and the HB. We show that the overall distribution of v sin i values is basically independent of metallicity for the stars in our sample. In particular, the fast-rotating MS stars in our sample exhibit similar rotation rates as their metal-rich counterparts, suggesting that some may actually be fairly young, in spite of their low metallicity, or else that at least some would be better classified as blue straggler stars. We do not find significant evidence of evolution in v sin i values as a function of position on the RGB. In particular, we do not confirm previous suggestions that stars close to the RGB tip rotate faster than their less-evolved counterparts. While the presence of fast rotators among moderately cool blue-HB stars has been suggested as due to angular-momentum transport from a stellar core that has retained significant angular momentum during its prior evolution, we find that any such transport mechanisms must likely operate very fast as the star arrives on the zero-age HB (ZAHB), since we do not find a link between evolution off the ZAHB and v sin i values.
We present an experimental study of pattern formation in a Dielectric
Barrier Discharge in Neon at 100 torr and 1 mm gap. An intensified CCD camera
is used to analyze the time evolution of the patterns during one cycle of
the voltage waveform. The formation of a hexagonal pattern of filaments in a
transient, glow-like regime is observed, followed by a honeycomb structure
that corresponds to a Townsend discharge occurring outside the regions
delimited by the previous filaments. A 2D fluid model can qualitatively
reproduce these features and is used to help interpreting the experimental
Depression is a frequent mood disorder that affects around 33% of stroke patients and has been associated with both poorer outcome and increased mortality. Our aim was to test the possible association between inflammatory and neurotrophic molecular markers and the development of post-stroke depression.
We studied 134 patients with a first episode of ischemic stroke without previous history of depression or speech disorders. We screened for the existence of major depression symptoms in accordance with DSM-IV criteria and a Yesavage Geriatric Depression Scale (GDS) score >11 at discharge and 1 month after stroke. At these times, serum levels of molecular markers of inflammation [interleukin (IL)−1β, IL-6, intracellular adhesion molecule 1 (ICAM-1), tumor necrosis factor (TNF)-α, leptin and high-sensitivity C-reactive protein (hs-CRP)] and neurotrophic factors [brain-derived neurotrophic factor (BDNF)] were measured by enzyme-linked immunosorbent assay (ELISA).
Twenty-five patients (18.7%) were diagnosed as having major depression at discharge. Out of 104 patients who completed the follow-up period, 23 were depressed at 1 month (22.1%). Patients with major depression showed higher serum leptin levels at discharge [43.4 (23.4–60.2) v. 6.4 (3.7–16.8) ng/ml, p<0.001] and at 1 month after stroke [46.2 (34.0–117.7) v. 6.4 (3.4–12.2) ng/ml, p<0.001). Serum levels of leptin >20.7 ng/ml were independently associated with post-stroke depression [odds ratio (OR) 16.4, 95% confidence interval (CI) 5.2–51.5, p<0.0001]. Leptin levels were even higher in the eight patients who developed depression after discharge [114.6 (87.6–120.2) v. 7.2 (3.6–13.6) ng/ml, p<0.0001].
Serum leptin levels at discharge are found to be associated with post-stroke depression and may predict its development during the next month.