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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.
Tubular pottery comprises certain peculiar artifacts that were produced by late Holocene complex hunter-gatherer societies in southeastern South America for unknown purposes. Some authors have related them to mortuary behaviour which has also been suggested by historical sources, while others have considered domestic use. In this paper, the technical, compositional and functional properties of these artifacts are explored in order to contrast both hypotheses, given an example of how technical analysis allows the identification of special pottery within archeological contexts. This analysis includes a study of the fabrics involved using low and high magnification, thin sections, Scanning Electron Microscopy, Energy Dispersive X-ray Spectroscopy, Mössbauer Spectroscopy, Laser Induced Breakdown Spectroscopy and fatty acid profiles. The results show that these tubular artifacts are not fit structurally for utilitarian purposes and show no evidence of domestic use. Based on these results and on historical data, it can be postulated that they were used as part of mortuary rituals, thus becoming part of the select global group of pottery manufactured exclusively for mortuary purposes.
New global history studies have provided theoretical models related to different paths of economic growth and consumer behaviour between East Asia (mainly China and Japan) and Europe during the period of the first industrialisation. However, more research challenging the Eurocentric views of the origins of globalisation is needed. In this article, I examine the exchanges of Chinese silks and porcelains and European wines and liquors for American silver through the Swedish Grill Company. This company had extensive business activities in Canton and Macao establishing strategic links and intermediation with other relevant companies from China, Manila, Seville and Marseille. On the global level, such exchanges played a crucial role for the accumulation of American silver in China during the Qing dynasty, and the outflows of Chinese goods to the Americas and Europe fostered market integration and globalisation that occurred earlier than 1820.
Preliminary evidence suggests that hoarding disorder (HD) and obsessive-compulsive disorder (OCD) may show distinct patterns of brain activation during executive performance, although results have been inconclusive regarding the specific neural correlates of their differential executive dysfunction. In the current study, we aim to evaluate differences in brain activation between patients with HD, OCD and healthy controls (HCs) during response inhibition, response switching and error processing.
We assessed 17 patients with HD, 18 patients with OCD and 19 HCs. Executive processing was assessed inside a magnetic resonance scanner by means of two variants of a cognitive control protocol (i.e. stop- and switch-signal tasks), which allowed for the assessment of the aforementioned executive domains.
OCD patients performed similar to the HCs, differing only in the number of successful go trials in the switch-signal task. However, they showed an anomalous hyperactivation of the right rostral anterior cingulate cortex during error processing in the switch-signal task. Conversely, HD patients performed worse than OCD and HC participants in both tasks, showing an impulsive-like pattern of response (i.e. shorter reaction time and more commission errors). They also exhibited hyperactivation of the right lateral orbitofrontal cortex during successful response switching and abnormal deactivation of frontal regions during error processing in both tasks.
Our results support that patients with HD and OCD present dissimilar cognitive profiles, supported by distinct neural mechanisms. Specifically, while alterations in HD resemble an impulsive pattern of response, patients with OCD present increased error processing during response conflict protocols.
We consider three point positive masses moving on
. An Eulerian-relative equilibrium is a relative equilibrium where the three masses are on the same geodesic. In this paper we analyze the spectral stability of these kind of orbits where the mass at the middle is arbitrary and the masses at the ends are equal and located at the same distance from the central mass. For the case of
, we found a positive measure set in the set of parameters where the relative equilibria are spectrally stable, and we give a complete classification of the spectral stability of these solutions, in the sense that, except on an algebraic curve in the space of parameters, we can determine if the corresponding relative equilibrium is spectrally stable or unstable. On
, in the elliptic case, we prove that generically all Eulerian-relative equilibria are unstable; in the particular degenerate case when the two equal masses are negligible, we get that the corresponding solutions are spectrally stable. For the hyperbolic case we consider the system where the mass in the middle is negligible; in this case the Eulerian-relative equilibria are unstable.
A one-dimensional evolution equation for the slope-normal velocity profile of a streamwise uniform avalanche over an entrainable bed is derived. The boundary conditions are no slip at the bed, a stress-free surface and constant bed shear stress equal to the shear strength of the snow cover. The resulting equation is solved numerically by means of finite differences on a regular grid with a superposed fine grid near the erosion front that is adjusted at each time-step. The first exploratory simulations yield realistic entrainment rates and show that the entrainment rate tends towards a constant value while the flow depth and the velocity increase linearly with time for all investigated rheologies. It is shown that there indeed exists a rheology-independent asymptotic solution to the equation of motion of an entraining slab if the bottom friction is equal to the bed shear strength; the asymptotic acceleration is found to be half the downslope gravitational acceleration. The model can easily be extended to general path profiles, non-uniform flows and variable snow properties.
Leishmaniasis is one of the world's most neglected diseases, and it has a worldwide prevalence of 12 million. There are no effective human vaccines for its prevention, and treatment is hampered by outdated drugs. Therefore, research aiming at the development of new therapeutic tools to fight leishmaniasis remains a crucial goal today. With this purpose in mind, we present 20 arylaminoketone derivatives with a very interesting in vitro and in vivo efficacy against Trypanosoma cruzi that have now been studied against promastigote and amastigote forms of Leishmania infantum, Leishmania donovani and Leishmania braziliensis strains. Six out of the 20 Mannich base-type derivatives showed Selectivity Index between 39 and 2337 times higher in the amastigote form than the reference drug glucantime. These six derivatives affected the parasite infectivity rates; the result was lower parasite infectivity rates than glucantime tested at an IC25 dose. In addition, these derivatives were substantially more active against the three Leishmania species tested than glucantime. The mechanism of action of these compounds has been studied, showing a greater alteration in glucose catabolism and leading to greater levels of iron superoxide dismutase inhibition. These molecules could be potential candidates for leishmaniasis chemotherapy.
A high incidence of burnout has been reported in health professionals working in palliative care units. Our present study aims to determine whether there are differences in the secretion of salivary cortisol between palliative care unit health professionals with and without burnout, and to elucidate whether there is a relationship between burnout syndrome and perceived stress and psychopathological status in this population.
A total of 69 health professionals who met the inclusion criteria participated in our study, including physicians, nurses, and nursing assistants. Some 58 were women (M = 29.65 years, SD = 8.64) and 11 men (M = 35.67 years, SD = 11.90). The level of daily cortisol was registered in six measurements taken over the course of a workday. Burnout syndrome was evaluated with the Maslach Burnout Inventory–Human Services Survey (MBI–HSS), the level of perceived stress was measured using the Perceived Stress Scale, and psychopathological status was gauged using the SCL–90–R Symptoms Inventory.
There were statistically significant differences in secretion of cortisol in professionals with high scores on a single subscale of the MBI–HSS [F(3.5) = 2.48, p < 0.03]. This effect was observed 15–30 minutes after waking up (p < 0.01) and at bedtime (p < 0.06). Moreover, the professionals with burnout showed higher scores on the psychopathology and stress subscales than professionals without it.
Significance of results:
A higher score in any dimension of the burnout syndrome in palliative care unit health professionals seems to be related to several physiological and psychological parameters. These findings may be relevant for further development of our understanding of the relationship between levels of burnout and cortisol secretion in the health workers in these units.
The MentDis_ICF65+ Project is an epidemiological study of mental disorders in people 65 to 85 years old in several European cities, including Madrid. Its aim is to determine the lifetime, 12-month, and 1-month prevalence of the main mental disorders in the elderly. The relationship of age and sex with each mental disorder was examined. The sample was collected through random sampling of people over 65 in Madrid, and consisted of 555 persons between 65 and 85 years old. The CIDI65+ was administered. Estimates of prevalence and odds ratios (OR) were made using sample frequencies and according to sex and age. Excluding nicotine dependence, 40.12% of the sample was found to have suffered a mental disorder at some time in their lives, 29.89% in the past year, and 17.70% were currently suffering from a mental disorder. The disorders with the highest prevalence rates were anxiety disorders, alcohol-related disorders, and mood disorders. Elderly women had a higher risk of suffering an anxiety disorder (OR men/women 0.42; CI 0.25–0.68) with a significance level of p < .001, while elderly men were more affected by any substance-related disorder (OR men/women 3.96; CI 1.62–11.07) with a significance level of p < .001. Each disorder’s prevalence decreased with age (OR 65–74/75–85, 1.85; CI 1.25–2.75) with a significance level of p < .01. Results show higher prevalence rates than previous studies reported. The main implications of this study, and the need to adapt mental health services for people over 65, are highlighted.
As is well known, the corrosion of embedded steel reinforced depends strongly of the concrete resistivity, which is related directly with the water contained into its porous network. Environment plays an important role on resistivity, due to have a direct correspondence with the relative humidity and temperature. In these terms, ingress or output of water is favored or hampered by the environmental parameters, as well as its fluctuations. This work presents a proposal of instrumented system to generate a map of electrical resistivity at concrete samples by using superficial and embedded electrodes. Mathematical analysis of equivalent circuit revealed the importance of the impedance of electrodes utilized, to simplify measures. Concrete samples were exposed to different relative humidity focused to try to obtain the relation between relative humidity and resistivity. An array of two electrodes distributed in a matrix was manufactured to apply a signal of direct current at first electrode and measure the resultant current at second electrode. The system applies a programmed sequence of switch to turn on and turn off to realize measurements over established zone and, in this form, allows identify zones with potentials gradients. Also, do easy the monitoring of concrete resistivity evolution in function of time and humidity conditions.
The Endangered Cuvier's gazelle Gazella cuvieri is an endemic ungulate of north-western Africa. Information on the species has been based primarily on non-systematic surveys, and the corresponding status estimates are of unknown quality. We evaluate the effectiveness and efficiency of two field methods for systematic surveys of populations of Cuvier's gazelle in arid environments: distance sampling (based on sightings) and sampling indirect sign (tracks and scats). The work was carried out in the north-western Sahara Desert, in Morocco, where what is possibly the largest population of Cuvier's gazelle persists. A logistically viable survey was conducted over a total area of c. 20.000 km2 in 10 expeditions during 2011–2014. A total of 67 sites were surveyed, with 194 walking surveys (2,169 km in total). Gazelle signs were detected at 50 sites, and gazelles were sighted at 21 sites (61 individuals). We found a relationship between sightings and abundance indices based on indirect sign, which could be useful for population monitoring or ecological studies. Additionally, the data could be used in occupancy modelling. Density estimates based on distance sampling required considerable effort; however, it is possible to survey large areas during relatively short campaigns, and this proved to be the most useful approach to obtain data on the demographic structure of the population.
This work presents a series of three-dimensional computational methods with the objective of analyzing and quantifying some important structural characteristics in a collection of low-density polyolefin-based foams. First, the solid phase tortuosity, local thickness, and surface curvature, have been determined over the solid phase of the foam. These parameters were used to quantify the presence of wrinkles located at the cell walls of the foams under study. In addition, a novel segmentation technique has been applied to the continuous solid phase. This novel method allows performing a separate analysis of the constituting elements of this phase, that is, cell struts and cell walls. The methodology is based on a solid classification algorithm and evaluates the local topological dissimilarities existing between these elements. Thanks to this method it was possible to perform a separate analysis of curvature, local thickness, and corrugation ratio in the solid constituents that reveals additional differences that were not detected in the first analysis of the continuous structure. The methods developed in this work are applicable to other types of porous materials in fields such as geoscience or biomedicine.
The diversity and prevalence of malaria parasites of the genera Plasmodium and Haemoproteus were determined in the globally-threatened Aquatic Warbler Acrocephalus paludicola. Birds were sampled during migration in Portugal and at the wintering quarters in Senegal and parasites were detected using molecular methods. Only three generalist parasite lineages (Plasmodium) were found. There were no significant differences in the prevalence of parasites between sexes in Europe, but adults had higher prevalence than first-year birds, and birds in Europe had higher prevalence than those captured in Africa. When comparing with other Acrocephalus species and taking sample size into account, Aquatic Warblers had the lowest prevalence and, together with another threatened species, the Seychelles Warbler Acrocephalus sechellensis, the lowest diversity of malaria parasites. We hypothesize that the low diversity of parasites and absence of specialist lineages of Aquatic Warblers are caused by its small population size and fragmented distribution. Furthermore, Aquatic Warblers’ extreme habitat specialization may decrease their exposure to malaria parasites, but other explanations such as high mortality (which would constraint the sampling of infected birds) or, in contrast, very efficient immunological system in clearing the infections cannot be ruled out. This study contributes to explain variation in prevalence and diversity of malaria parasites among hosts.
Rare neuromuscular diseases (NDs) are a group of inherited or acquired neurological pathologies affecting the muscles and the nervous system. Their low prevalence and high geographical dispersion can cause isolation and difficulties in social interaction between affected equals. New technologies, such as videoconferencing, offer a complementary option for improving the health of this population. The purpose of this study was to assess the effectiveness of a teleassistance program at improving health-related quality of life (HRQoL) through social interaction in adults with NDs. The sample consisted of 45 participants affected by rare NDs. Twenty-four participants were assigned to the experimental group (EG), which participated in the videoconferencing sessions, and 21 to the control group. Three questionnaires were administered: WHO-DAS II, Sickness Impact Profile, and SF-36 Health Survey. Effectiveness was assessed by a pre-post design. An online psychosocial program was applied over three-month period. Data revealed an improvement of the EG in psychosocial variables, e.g. “Getting along with people” (z = –2.289, r = –.47, p ≤ .05) or “Psychosocial Domain” (z = –2.404, r = –.49, p ≤ .05), and in physical variables, e.g. “Life activities” (z = –2.844, r = –.58, p ≤ .05). Social interaction appeared as a relevant factor at improving HRQoL levels. High levels of satisfaction about the teleassistance program were reported.
Through the process of globalization, food has experienced an intense territorial restructuring process. Local agric-food links have weakened at the same time as daily products arrived from distant lands. There is presently a wide international debate on the importance of transport in the configuration of the agric-food system and its contribution in terms of greenhouse gas (GHG). The direct environmental costs of the transport of imported food, that is the ‘external food miles’, have been estimated in kilometer (km), ton (t), ton-kilometer (t-km) and GHG in Spain between 1995 and 2011. The analysis is made by ten food groups including 136 products, with special attention to the most important ones (cereals and animal feed), as well as by means of transport (air, rail, road and water) and from 113 different countries belonging to six geographical areas. Two phases are identified during this period: an expansive phase (1995–2007), in which the t-km of imported food increased from 81.8 to 147.8 million t-km and environmental pressure rose from 3.1 to 5.4 million CO2-eq t, and a recession phase (2007–2011), in which environmental pressure subsided as a consequence of the reduction of imports, even though it still remained above the 1995 level. The article reveals a clear interrelation between amounts, distances and modal distribution when it comes to determining the environmental cost of transporting food imports in the two periods studied. It also reflects on the role of the external food miles in the Spanish agri-food system from a sustainability perspective.
A real-time polymerase chain reaction (PCR) assay was developed for the identification and quantification of two oyster species: Ostrea edulis and Crassostrea gigas. Two sets of primers and TaqMan-MGB probes were designed, based on partial sequences of the 16S rRNA gene. An amplification positive control system was also located in the 18S rRNA gene sequences. Closely related species of oysters and other bivalves, known to co-occur with the target species in European waters, were used to test the assay for cross-reactivity. The assay designed was specific for the target species and no signal or no significant signal was detected for all non-target species tested. The high sensitivity of this method was demonstrated since it is possible to detect just one larva (150–200 μm size) of each species even when it is present with others. Furthermore, this assay provided an acceptable quantification of the number of spiked larvae (1, 10 and 100 larvae) in plankton samples employing a standard curve for larvae.
Introduction. In recent decades,
there has been increased interest in developing natural non-caloric
sweeteners, providing sensory properties similar to sucrose. One
of the most promising alternatives is the steviol glycosides, high-sweetness
compounds extracted from the leaves of Stevia rebaudiana Bertoni.
Characteristics and properties. In this review article,
the characteristics of this plant are described. According to the
relevant literature data, this review provides insight into the
major steviol glycosides as well as their main characteristics and
properties. Toxicity and legislation. We describe the
current situation on the toxicity and the legal framework of the
above sweeteners. Extraction techniques. This review
describes the techniques developed for extraction and purification,
including conventional extraction with water/solvent, ion exchange,
enzymatic extraction, supercritical fluid and with a focus on membrane
filtration, for its proven advantages in the purification of aqueous extract
obtained by leaching of the leaves. Applications. This review
also presents various evidence relating to the implementation of
steviol glycosides in the food industry, with an emphasis on their
use in the formulation of fruit juices. Conclusions. Finally, the future
prospects of these natural sweeteners are presented. They highlight
the need for research in this area, and the great appeal and commercial potential
of such compounds, which should be focused on continuous assessment
in relation to issues such as the intensity, persistence of sweetness
and the absence of other residual flavors, in order to ensure their acceptance,
preference and choice by the general public.