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Although many mental health care systems provide care interventions that are not related to direct health care, little is known about the interfaces between the latter and core health care. ‘Core health care’ refers to services whose explicit aim is direct clinical treatment which is usually provided by health professionals, i.e., physicians, nurses, psychologists. ‘Other care’ is typically provided by other staff and includes accommodation, training, promotion of independence, employment support and social skills. In such a definition, ‘other care’ does not necessarily mean being funded or governed differently. The aims of the study were: (1) using a standard classification system (Description and Evaluation of Services and Directories in Europe for Long Term Care, DESDE-LTC) to identify ‘core health’ and ‘other care’ services provided to adults with mental health problems; and (2) to investigate the balance of care by analysing the types and characteristics of core health and other care services.
The study was conducted in eight selected local areas in eight European countries with different mental health systems. All publicly funded mental health services, regardless of the funding agency, for people over 18 years old were identified and coded. The availability, capacity and the workforce of the local mental health services were described using their functional main activity or ‘Main Types of Care’ (MTC) as the standard for international comparison, following the DESDE-LTC system.
In these European study areas, 822 MTCs were identified as providing core health care and 448 provided other types of care. Even though one-third of mental health services in the selected study areas provided interventions that were coded as ‘other care’, significant variation was found in the typology and characteristics of these services across the eight study areas.
The functional distinction between core health and other care overcomes the traditional division between ‘health’ and ‘social’ sectors based on governance and funding. The overall balance between core health and other care services varied significantly across the European sites. Mental health systems cannot be understood or planned without taking into account the availability and capacity of all services specifically available for this target population, including those outside the health sector.
The risks of polypharmacy can be far greater than the benefits, especially in the elderly. Comorbidity makes polypharmacy very prevalent in this population; thus, increasing the occurrence of adverse effects. To solve this problem, the most common strategy is to use lists of potentially inappropriate medications. However, this strategy is time consuming.
In order to minimize the expenditure of time, our group devised a pilot computer tool (Polimedication) that automatically processes lists of medication providing the corresponding Screening Tool of Older Persons’ potentially inappropriate Prescriptions alerts and facilitating standardized reports. The drug lists for 115 residents in Santa Marta Nursing Home (Fundación San Rosendo, Ourense, Spain) were processed.
The program detected 10.04 alerts/patient, of which 74.29% were not repeated. After reviewing these alerts, 12.12% of the total (1.30 alerts/patient) were considered relevant. The largest number of alerts (41.48%) involved neuroleptic drugs. Finally, the patient's family physician or psychiatrist accepted the alert and made medication changes in 62.86% of the relevant alerts. The largest number of changes (38.64%) also involved neuroleptic drugs. The mean time spent in the generation and review of the warnings was 6.26 minute/patient. Total changes represented a saving of 32.77 € per resident/year in medication.
The application of Polimedication tool detected a high proportion of potentially inappropriate prescriptions in institutionalized elderly patients. The use of the computerized tool achieved significant savings in pharmaceutical expenditure, as well as a reduction in the time taken for medication review.
The clinical and pathologic characterisation of two fatal cases of tick-borne rickettsiosis in rural (El Valle) and urban (City of Panama) Panama are described. Clinical and autopsy findings were non-specific, but the molecular analysis was used to identify Rickettsia rickettsii in both cases. No ticks were collected in El Valle, while in the urban case, R. rickettsii was detected in Rhipicephalus sanguineus s.l., representing the first molecular finding in this tick in Panama and Central America.
There is a need of more quantitative standardised data to compare local Mental Health Systems (MHSs) across international jurisdictions. Problems related to terminological variability and commensurability in the evaluation of services hamper like-with-like comparisons and hinder the development of work in this area. This study was aimed to provide standard assessment and comparison of MHS in selected local areas in Europe, contributing to a better understanding of MHS and related allocation of resources at local level and to lessen the scarcity in standard service comparison in Europe. This study is part of the Seventh Framework programme REFINEMENT (Research on Financing Systems’ Effect on the Quality of Mental Health Care in Europe) project.
A total of eight study areas from European countries with different systems of care (Austria, England, Finland, France, Italy, Norway, Romania, Spain) were analysed using a standard open-access classification system (Description and Evaluation of Services for Long Term Care in Europe, DESDE-LTC). All publicly funded services universally accessible to adults (≥18 years) with a psychiatric disorder were coded. Care availability, diversity and capacity were compared across these eight local MHS.
The comparison of MHS revealed more community-oriented delivery systems in the areas of England (Hampshire) and Southern European countries (Verona – Italy and Girona – Spain). Community-oriented systems with a higher proportion of hospital care were identified in Austria (Industrieviertel) and Scandinavian countries (Sør-Trøndelag in Norway and Helsinki-Uusimaa in Finland), while Loiret (France) was considered as a predominantly hospital-based system. The MHS in Suceava (Romania) was still in transition to community care.
There is a significant variation in care availability and capacity across MHS of local areas in Europe. This information is relevant for understanding the process of implementation of community-oriented mental health care in local areas. Standard comparison of care provision in local areas is important for context analysis and policy planning.
Precision agriculture (PA) requires reasonably homogeneous areas for site-specific management. This work explores the applicability of digital terrain classes obtained from a digital elevation model derived from UAV-acquired images, to define management units in in a relative flat area of about 6 ha. Elevation, together with other terrain variables such as: slope degree, profile curvature, plan curvature, topographic wetness index, sediment transport index, were clustered using the Fuzzy Kohonen Clustering Network (FKCN). Four terrain classes were obtained. The result was compared with a map produced by a classification of soil properties previously interpolated by ordinary kriging. The results suggest that areas for site-specific management can be defined from terrain classes based on environmental covariates, saving time and cost in comparison with interpolation of soil variables.
Clinical manifestations of acute bronchiolitis (AB) vary from minimal disease to severe respiratory failure. The response to respiratory viral infections is possibly influenced by genetic polymorphisms linked to the regulation of the inflammatory response. In the present study, we investigated whether interleukin-8 (IL-8) and interleukin-17 (IL-17) genetic variants are associated with the severity of AB. A group of Brazilian infants hospitalized with AB and a control group (infants with no or mild AB, without hospitalization) were genotyped for four IL-8/IL-17 variations. For replication, we studied an Argentinean population sample of infants with mild and severe AB. IL-8 polymorphism (rs 2227543) and IL-17 (rs2275913) variants showed significant associations with the severity of AB. The effect of the IL-8 variation could be replicated in the Argentinean sample. This finding suggests that IL-8 variations may influence the severity of AB in young infants. Further genetic association studies in low- or middle-income populations are necessary with the aim of expanding knowledge in this area.
The upper mass limit of stars remains an open question in astrophysics. Here we discuss observations of the most massive stars (greater than 100 solar masses) in the local universe and how the observations fit in with theoretical predictions. In particular, the Large Magellanic Cloud plays host to numerous very massive stars, making it an ideal template to study the roles that environment, metallicity, and multiplicity play in the formation and evolution of the most massive stars. We will discuss the work that is instrumental in laying the groundwork for interpreting future observations by James Webb of starburst regions in the high redshift universe.
We present VLT/MUSE observations of NGC 2070, the dominant ionizing nebula of 30 Doradus in the LMC, plus HST/STIS spectroscopy of its central star cluster R136. Integral Field Spectroscopy (MUSE) and pseudo IFS (STIS) together provides a complete census of all massive stars within the central 30×30 parsec2 of the Tarantula. We discuss the integrated far-UV spectrum of R136, of particular interest for UV studies of young extragalactic star clusters. Strong He iiλ1640 emission at very early ages (1–2 Myr) from very massive stars cannot be reproduced by current population synthesis models, even those incorporating binary evolution and very massive stars. A nebular analysis of the integrated MUSE dataset implies an age of ~4.5 Myr for NGC 2070. Wolf-Rayet features provide alternative age diagnostics, with the primary contribution to the integrated Wolf-Rayet bumps arising from R140 rather than the more numerous H-rich WN stars in R136. Caution should be used when interpreting spatially extended observations of extragalactic star-forming regions.
CARMENES is a pair of high-resolution (R ≳ 80, 000) spectrographs covering the wavelength range from 0.52 to 1.71 μm with only small gaps. The instrument has been optimized for precise radial velocity measurements. It was installed and commissioned at the 3.5 m telescope of the Calar Alto observatory in Southern Spain in 2015. The first large science program of CARMENES is a survey of ~300 M dwarfs, which started on Jan 1, 2016. We present an overview of the instrument, and provide a few examples of early science results.
The σ Orionis cluster (~3 Myr, 350 pc) is an ideal site to investigate the early evolution of substellar (brown dwarf and planetary mass) objects. To date, the cluster photometric and spectroscopic sequence of free-floaters is known for a wide mass range from 1 M⊙ down to roughly 3 MJup. The substellar domain covers spectral types that go from mid-M classes to the recently defined “methane” T-types, i.e., surface temperatures between ~3000K and 800 K. We derive a rising initial substellar mass function in the mass interval of 150–5 MJup (dN/dM ~ M-α, with α = 0.9 ± 0.4). We also find evidence for a extension of this mass function toward lower masses down to 2–3 MJup. This indicates that the population of isolated planetary mass objects with masses below the deuterium burning threshold is rather abundant in the cluster.
We present a detailed study of the kinematics of M dwarfs in the CARMENES (Calar Alto high-Resolution search for M dwarfs with Exoearths with Near-infrared and optical Échelle Spectrographs) input catalog. We have selected all M dwarfs with known parallactic distance or a good photometric distance estimation, precise proper motion in the literature or as determined by us, and radial velocity measurements. Using these parameters, we computed the M dwarfs galactic space motions (U, V, W). For the stars with U and V velocity components inside or near the boundaries that determine the young disk population, we have analyzed the possible membership in the classical moving groups and nearby loose associations with ages between 10 and 600 Myr. For the candidate members, we have compiled information available in the literature in order to constrain their membership by applying other age-dating methods.
CARMENES (Calar Alto high-Resolution search for M dwarfs with Exo-earths with Near-infrared and optical Echelle Spectrographs) is a new instrument currently undergoing commissioning at the 3.5 m telescope of the Calar Alto Observatory. It has been constructed by a consortium of eleven Spanish and German institutions. The scientific goal of the project is a 600-night radial-velocity survey targeting 300 M dwarfs with sufficient precision to detect terrestrial planets in their habitable zones. The CARMENES instrument consists of two separate échelle spectrographs covering the wavelength range from 0.55 to 1.7 μm at a spectral resolution of R = 82,000, fed by fibers from the Cassegrain focus of the telescope. Both spectrographs are housed in a temperature-stabilized environment in vacuum tanks, to enable a long-term radial velocity precision of 1 m s−1. The wavelength calibration will be done with Th-Ne and U-Ne emission line lamps, and with Fabry-Pérot etalons.
The objective of this work was to study the postmortem evolution of potential biomarkers of autophagy (Beclin 1, LC3-II/LC3-I ratio) and oxidative stress (total antioxidant activity, TAA; superoxide dismutase activity, SOD and catalase activity, CAT) in the Longissimus dorsi muscle of entire male ((Large White×Landrace)×Duroc) pigs subjected to different management treatments that may promote stress, such as mixing unfamiliar animals at the farm and/or during transport and lairage before slaughter. During the rearing period at the farm, five animals were never mixed after the initial formation of the experimental groups (unmixed group at the farm, UF), whereas 10 animals were subjected to a common routine of being mixed with unfamiliar animals (mixed group at the farm, MF). Furthermore, two different treatments were used during the transport and lairage before slaughter: 10 pigs were not mixed (unmixed group during transport and lairage, UTL), whereas five pigs were mixed with unfamiliar animals on the lorry and during lairage (mixed group during transport and lairage, MTL). These mixing treatments were then combined into three pre-slaughter treatments – namely, UF-UTL, MF-UTL and MF-MTL. The results show that MF-UTL and MF-MTL increased significantly the muscle antioxidant defense (TAA, SOD and CAT) at short postmortem times (4 and 8 h; P<0.001), followed by an earlier depletion of the antioxidant activity at 24 h postmortem (P<0.05). We also found that mixing unfamiliar animals, both at the farm and during transport and lairage, triggers postmortem muscle autophagy, which showed an earlier activation (higher expression of Beclin 1 and LC3-II/LC3-I ratio at 4 h postmortem followed by a decreasing pattern of this ratio along first 24 h postmortem) in the muscle tissues of animals from the MF-UTL and MF-MTL groups, as an adaptive strategy of the muscle cells for counteracting induced stress. From these results, we propose that monitoring the evolution of the main biomarkers of autophagy (Beclin 1, LC3-II/LC3-I ratio) and muscle antioxidant defense (TAA, SOD, CAT) in the muscle tissue within the first 24 h postmortem may help the detection of animal stress and its potential effect on the postmortem muscle metabolism.
Atrioventricular valve regurgitation is widely known as a risk factor for Fontan completion in patients with univentricular physiology. To date, indications and timing for atrioventricular valve repair remain unclear and different surgical techniques have been advocated. Since 2013, 50 consecutive patients underwent extracardiac Fontan completion in our institution. Atrioventricular valve repair, by avoiding the use of a prosthetic ring, was performed as a concomitant procedure in three of them, with excellent short-term results. Beating-heart repair was performed in one of the patients with hypoplastic left heart syndrome as the underlying disease. Valve repair when moderate or severe regurgitation is present may be performed at a low risk. Both the staged approach of atrioventricular valve repair followed by the Fontan as a separate operation and the combined approach of simultaneous atrioventricular valve repair and Fontan have a role in the management of these complex patients. We highlight the importance of the use of “easy and simple” surgical techniques for repairing the atrioventricular valve in order to provide a better life prognosis in Fontan patients.
This study describes the incidence rate of reported lymphogranuloma venereum (LGV) in men who have sex with men (MSM) in Barcelona from 2007 to 2012. Epidemiological, clinical and sexual behaviour characteristics of LGV cases are described. Seroadaptive behaviours as a transmission risk factor were assessed by a telephone questionnaire during 2012. Data were handled on a strictly confidential basis. LGV annual rate ratios in MSM were compared with cases from 2007. Differences were statistically analysed with a Poisson test. The incidence rate of LGV in MSM aged 15–69 years ranged from 32·1/105 MSM per year in 2007 to 182·7/105 MSM per year in 2012. In 2012, 31/51 LGV cases (61%) answered the telephone questionnaire, of which 84% (26/31) were HIV positive, 39% (12/31) reported having sex according to their partners’ serostatus and 7% (2/31) used strategic positioning. The incidence of LGV has increased since 2007 and mainly affects HIV-positive MSM. It is probable that seroadaptation has facilitated LGV transmission.
For a fixed positive integer m, factorial m is defined by
The problem of finding a formula extending the factorial m! to positive real values of m was posed by D. Bernoulli and C. Goldbach and solved by Euler. In his letter of 13 October 1729 to Goldbach , Euler defined a function (which we denote as Γ (x + 1)) by means of
and showed that Γ (m + 1) = m! for positive integers m. After that, Euler found representations for the so-called gamma function (1) in terms of either an infinite product or an improper integral. We refer the reader to the classical (and short) treatise  for a brief introduction and main properties of the gamma function.
We evaluated the effect of feeding dietary tannins from Lysiloma latisiliquum fresh forage on the saliva tannin-binding capacity of hair sheep lambs without previous exposure to tannin-rich (TR) fodder. Twenty-four hair sheep lambs (13.6±3.04 kg LW) were fed a tannin-free diet at the beginning of the experimental period (from day 10 to 13). On day 14, lambs were distributed into three groups (n=8): control group (CG), fed with the tannin-free diet (from D10 to D112); tannin short-term group (TST), fed the basal diet and 650 g of L. latisiliquum forage (from D14 to D55); tannin long-term group (TLT), fed the basal diet and 650 g of L. latisiliquum forage (from D14 to D112). Saliva samples were collected from the mouth of each lamb in the morning before feeding time on D10 and D14 (baseline period), on D49 and D56 (period 1) and on D97 and D112 (period 2). The tannin binding response of salivary protein (∆% turbidity) was determined with the haze development test (HDT) using either tannic acid or L. latisiliquum forage acetone extract. A turbidity protein index (TPI) was calculated as (∆% turbidity/[salivary protein (mg)]). Differences in HDT and TPI in the different groups were compared by repeated measures ANOVA using Proc Mixed. All groups had similar ∆% turbidity throughout the experiment (P>0.05). At baseline and period 1, the TPI of the different groups was similar (P>0.05). On period 2 the TLT group showed higher TPI compared with CG (P<0.05). Meanwhile, CG and TST showed similar salivary TPI. The saliva of hair sheep lambs consuming TR L. latisiliquum fresh fodder (TLT group) increased their TPI compared with control lambs not exposed to tannins.