To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Up to 30% of the current tidewater mass loss in Svalbard corresponds to frontal ablation through submarine melting and calving. We developed two-dimensional (2-D) glacier–line–plume and glacier–fjord circulation coupled models, both including subglacial discharge, submarine melting and iceberg calving, to simulate Hansbreen–Hansbukta system, SW Svalbard. We ran both models for 20 weeks, throughout April–August 2010, using different scenarios of subglacial discharge and crevasse water depth. Both models showed large seasonal variations of submarine melting in response to transient fjord temperatures and subglacial discharges. Subglacial discharge intensity and crevasse water depth influenced calving rates. Using the best-fit configuration for both parameters our two coupled models predicted observed front positions reasonably well (±10 m). Although the two models showed different melt-undercutting front shapes, which affected the net-stress fields near the glacier front, no significant effects on the simulated glacier front positions were found. Cumulative calving (91 and 94 m) and submarine melting (108 and 118 m) along the simulated period showed in both models (glacier–plume and glacier–fjord) a 1:1.2 ratio of linear frontal ablation between the two mechanisms. Overall, both models performed well on predicting observed front positions when best-fit subglacial discharges were imposed, the glacier–plume model being 50 times computationally faster.
Though a unique and indissoluble state (Art. 2 Spanish Constitution, SC), Spain is administratively structured into 17 self-governing communities (Comunidades Autónomas) enjoying a wide margin of legislative, administrative and executive power (Arts. 147–148 SC). However, the judicial administration system is unique for the whole country (Arts. 117 and 149(1) No. 5 SC).
Beyond the possibility of appealing to the Constitutional Court in cases of alleged breach of fundamental rights (Art. 53(2) SC), the Spanish judicial system has three instances. For civil and commercial law cases, these instances are the first instance courts (juzgados de primera instancia) or the labour courts (juzgados de lo social), the Provincial Audiences (Audiencias Provinciales) or the Superior Courts of Justice of the Autonomous Communities (Tribunales Superiores de Justicia de las Comunidades Autónomas), and finally the Supreme Court. At the first instance level, there are a number of courts specialising in commercial claims (juzgados de lo mercantil). No other specialisation can be found within the private law jurisdiction, despite the fact that some of the first instance courts are designated as family courts.
The Spanish courts’ work in civil and commercial litigation is implemented by judges and justice attorneys. They are governed, respectively, by the General Council for the Judiciary (Consejo General del Poder Judicial, CGPJ) and by the General Secretary for the Administration of Justice (Ministry of Justice). In order to litigate before Spanish courts, a person must generally be assisted by a representative ad litem and defended by a lawyer.
To facilitate the implementation of Regulations 805/2004 (EEO), 1896/2006 (EOP), 861/2007 (ESCP), and 655/2014 (EAPO), known as the secondgeneration Regulations, the Spanish legislature progressively introduced specific rules in the final provisions of the Civil Procedural Law. These instruments are designed to ease the enforcement of monetary claims. While the first three Regulations focus on obtaining European enforcement orders, the last one refers to the adoption of a provisional measure.
There are no official statistics on the use of these Regulations beyond a partial reference to the EEO and the EOP in the Annual Report on Justice in Spain prepared by the CGPJ (the last published report covers the year 2018) and in the study prepared by the Spanish Network of Judicial Secretaries for International Cooperation for the period 2008–2013.
Data on short-term peripheral intravenous catheter–related bloodstream infections per 1,000 peripheral venous catheter days (PIVCR BSIs per 1,000 PVC days) rates from Latin America are not available, so they have not been thoroughly studied.
International Nosocomial Infection Control Consortium (INICC) members conducted a prospective, surveillance study on PIVCR BSIs from January 2010 to March 2018 in 100 intensive care units (ICUs) among 41 hospitals, in 26 cities of 9 countries in Latin America (Argentina, Brazil, Colombia, Costa Rica, Dominican-Republic, Ecuador, Mexico, Panama, and Venezuela). The Centers for Disease Control and Prevention (CDC) National Health Safety Network (NHSN) definitions were applied, and INICC methodology and INICC Surveillance Online System software were used.
In total, 10,120 ICU patients were followed for 40,078 bed days and 38,262 PVC days. In addition, 79 PIVCR BSIs were identified, with a rate of 2.06 per 1,000 PVC days (95% confidence interval [CI], 1.635–2.257). The average length of stay (ALOS) of patients without a PIVCR BSI was 3.95 days, and the ALOS was 5.29 days for patients with a PIVCR BSI. The crude extra ALOS was 1.34 days (RR, 1.33; 95% CI, 1.0975–1.6351; P = .040).
The mortality rate in patients without PIVCR BSI was 3.67%, and this rate was 6.33% in patients with a PIVCR BSI. The crude extra mortality was 1.70 times higher. The microorganism profile showed 48.5% gram-positive bacteria (coagulase-negative Staphylococci 25.7%) and 48.5% gram-negative bacteria: Acinetobacter spp, Escherichia coli, and Klebsiella spp (8.5% each one), Pseudomonas aeruginosa (5.7%), and Candida spp (2.8%). The resistances of Pseudomonas aeruginosa were 0% to amikacin and 50% to meropenem. The resistance of Acinetobacter baumanii to amikacin was 0%, and the resistance of coagulase-negative Staphylococcus to oxacillin was 75%.
Our PIVCR BSI rates were higher than rates from more economically developed countries and were similar to those of countries with limited resources.
Dementia caregiving is associated with a variety of negative outcomes including poor caregiver mental and physical health and low relationship satisfaction. Prior research has linked these negative caregiver outcomes to patients’ cognitive and psychiatric symptoms. However, few studies have examined the link between patients’ socioemotional functioning and caregiver outcomes. We examined how patients’ socioemotional functioning was related to caregiver marital satisfaction, physical health, and psychopathology in a sample of 103 caregivers of dementia patients (with a wide range of diagnoses). Measures included: (a) patient socioemotional functioning (Caregiver Assessment of Socioemotional Functioning), (b) patient cognitive functioning (Mini-Mental State Exam), (c) patient psychiatric symptomatology (Neuropsychiatric Inventory), (d) caregiver marital satisfaction (Locke-Wallace Marital Adjustment Test), (e) caregiver physical health (Medical Outcomes Study Health Survey), and (f) caregiver psychopathology (Symptom Checklist-90 -Revised). Results indicated that poor patient socioemotional functioning predicted lower levels of caregiver marital satisfaction (beta= −.45, p < .001) and physical health (beta= −.25, p < .05), and greater caregiver psychopathology (beta= .41, p < .001), above and beyond patient cognitive functioning and psychiatric symptoms. These findings suggest that low levels of socioemotional functioning in patients make important and unique contributions to negative caregiver outcomes.
Equity and efficiency are crucial issues behind any tax reform, but they are particularly relevant in countries with high inequality and large shares of poverty. This paper provides a comprehensive socio-economic empirical assessment of Mexico's proposed (and partially implemented) tax reforms in the energy domain, and of a hypothetical partial removal of existing electricity subsidies. Using a rich household income and expenditure survey within the context of a demand system adjustment of non-durable goods, the article provides the public-revenue, environmental and distributional impacts from the simulation of different combinations of energy taxation, subsidy-removal and distributive offsets. The paper also provides detailed ex-ante evidence on the effects of compensatory devices that may contribute to the successful implementation of energy reform packages and significant poverty alleviation in Mexico.
In his outstanding book Knowledge and its Limits (2000), Williamson (a) claims that we have inductive evidence for some negative theses concerning the prospects of defining knowledge, like this: knowing cannot be defined in accordance with a determinate traditional conjunctive scheme; (b) defends a theory of mental states, mental concepts and the relations between the two, from which we would obtain additional, not merely inductive, evidence for this negative thesis; and (c) presents an alternative (non-traditional-conjunctive) definition of knowledge. Here I consider these issues and extract two relevant conclusions: (i) Williamson's theory of states and concepts only supports the negative thesis because this theory would explain too much, since it imposes implausible necessary limitations on possible uses of concepts and linguistic expressions. So, there is no appropriate non-inductive evidence for the negative thesis. (ii) Williamson's own definition of knowledge is at risk.
What causes stark differences in living standards between subnational units? What can countries do to lessen such variations? This article argues that there is an aspect of national policy frameworks that impacts subnational provision of social services: the sensitivity of policy to the particularities of place. Place-sensitive policies make adaptations to the way social services are organized and provided across a country, so that they are better equipped to deal with the different characteristics of places and better support their well-being. When policies are place-sensitive, subnational provision is facilitated in poor, rural, and marginal locations in a country. In contrast, place-blind policies employ a one-size-fits-all approach that excludes people in vulnerable areas and aggravates inequalities in social service provision and social outcomes. By studying the Colombian case, this article demonstrates that a key placeblind feature of its healthcare model disproportionately affects small localities.
The current coronavirus disease (COVID-19) has a great impact worldwide. Healthcare workers play an essential role and are one of the most exposed groups. Information about the psychosocial impact on healthcare workers is limited.
3109 healthcare workers completed a national, internet-based, cross-sectional 45-item survey between 9 and 19 April 2020. The objective is to assess the psychological impact of the COVID-19 pandemic in Spanish healthcare workers. A Psychological Stress and Adaptation at work Score (PSAS) was defined combining four modified versions of validated psychological assessment tests (A) Healthcare Stressful Test, (B) Coping Strategies Inventory, (C) Font-Roja Questionnaire and (D) Trait Meta-Mood Scale.
The highest psychosocial impact was perceived in Respiratory Medicine, the mean (S.D.) PSAS was 48.3 (13.6) and Geriatrics 47.6 (16.4). Higher distress levels were found in the geographical areas with the highest incidence of COVID-19 (>245.5 cases per 100 000 people), PSAS 46.8 (15.2); p < 0.001. The least stress respondents were asymptomatic workers PSAS, 41.3 (15.4); p < 0.001, as well as those above 60 years old, PSAS, 37.6 (16); p < 0.001. Workers who needed psychological therapy and did not receive it, were more stressed PSAS 52.5 (13.6) than those who did not need it PSAS 39.7 (13.9); p < 0.001.
The psychological impact in healthcare workers in Spain during COVID-19 emergency has been studied. The stress perceived is parallel to the number of cases per 100 000 people. Psychotherapy could have a major role to mitigate the experimented stress level.
Platelet serotonin-binding (Bmax), using tritiated-seroionin as the ligand, was determined in 75 patients suffering from major depression with melancholia and in 26 patients diagnosed from dysthymic disorder. Twenty-five normal subjects were used as a control group. The melancholic group had significantly lower Bmax values (mean: 6.7 ± 6.1 pmol/108 platelets) than either dysthymic (9.3 ± 3.9 pmol/108 platelets) or control (9.2 ± 4.8 pmol/108 platelets) groups, while there were no significant differences between the two latter groups. There was also a significant difference on postdexamethasone Cortisol between melancholic (6.3 ± 7.1 μg/dL) and dysthymic (1.4 ± 1.4 μg/dL) groups, with a higher rate of nonsuppressors in melancholic groups. Although both tests were abnormal in the melancholic group, no relationship was found between platelet serotonin-binding and the dexaniethasone suppression test.
The main problem of depression is not only the high prevalence of the disorder but also its serious consequences on the patient’s quality of life and the associated social costs in terms of health care resource utilization and productivity losses. In recent years, there has been a considerable improvement in the knowledge of depression from the pathogenic, clinical and therapeutic perspectives. The present study analyzes whether such advances are reflected in a positive evolution of the treatment of depression in Spain. To this effect we have contrasted the results of two socio-sanitary studies published in this country: the White Book editions of 1982 and 1997 (WB82 and WB97, respectively). From the methodological perspective, the physician selection criteria employed were very uniform (structured questionnaires delivered to 128 (WB82) and 300 (WB97) randomly selected psychiatrists). The origin of patients consulting for specialized care has varied over this 15-year period. In effect, WB82 patients were essentially referred by friends (87.5%) and from the primary care setting (44.5%), whereas in the WB97 study referral from primary care predominated (50.1%), followed by the patient’s personal decision (24.8%). In turn, 40.7% and 51.7% of the psychiatrists in WB97 respectively considered the diagnostic and therapeutic means available in primary care to be insufficient. The priorities for improving patient quality of life, as reflected by both editions of the study, were the training of primary care physicians and the adequate provision of means in the mental health care centers. On the other hand, fewer problems for establishing a correct diagnosis were referred in the 1997 edition of the study (28.7%) than in 1982 (48.4%). In this sense, the main problem reported in WB82 was the lack of specialized training, whereas the masking of depression by some other disease process or symptoms was the main problem in WB97 (67.6% vs 21.1% according to WB82). The main symptoms upon which the diagnosis of depression are based do not seem to have evolved much in the past 15 years. The most frequently cited manifestations were a worsening of mood, loss of interest and leisure capacity, sleep alterations and diminished vitality. A comparative analysis of the therapeutic resources used was not possible, for prior to 1982 the only drugs available to physicians were the classical tricyclic agents and some MAO inhibitors; the selective serotonin reuptake inhibitors (SSRIs) – possibly the greatest advance in the treatment of depression in these 15 years – had not yet been introduced. Nevertheless, it should be pointed out that 98% of the psychiatrists consulted in WB97 considered pharmacologic treatment to be the most widely adopted form of management once depression has been diagnosed.
The UK NICE technology guidance “Structural Neuroimaging in First-Episode Psychosis” concludes that CT/MRI is not routinely recommended as an initial investigation for first-episode psychosis.
To evaluate the use of CT/MRI in a group of Early Intervention Service (EIS) patients with a first-episode psychosis aged 18–35 years at presentation.
To develop practice guidelines for use of neuroimaging in first-episode psychosis.
All 107 patients registered with the EIS in Hounslow, London, UK, were eligible for inclusion in this review. Data was collected from the medical records and the Picture Archiving and Communications System. Data was analysed using a microsoft excel data analysis tool. Additionally, comparisons were made between the group of patients with normal scans and that with abnormal scans. Statistical significance was determined using the chi-squared method with a significance of P < 0.05.
17 patients had documented neuroimaging results. 4 scans were abnormal. There was no significant difference between the group with normal and abnormal scans in terms of gender, abnormalities of physical/neurological health, blood tests and whether the patient had any additional medical conditions. Abnormal scan results did not influence treatment or outcome for any patient.
The abnormal scans were not correlated to clinical indices of history, examination and laboratory tests. Abnormal scans appear to have a low yield in terms of clinical effectiveness. The findings support selective use of neuroimaging in this cohort of patients. The indications for it usage would appear to rely on clinical judgement as well clinical findings.
Since clinical practice suggests that panic disorder may not be a homogeneous condition, a study was carried out to test the possible existence of different groups or subgroups of panic patients.
Subjects and methods
Thirty-two panic patients (DSM-III-R) underwent lactate challenge in our laboratory and were assessed for heart rate, blood pressure, sweating and Acute Panic Inventory.
During the lactate challenge, patients complaining mainly of ‘cardiorespiratory’ symptoms (N = 12) showed tachycardia and localized sweating. Conversely, patients complaining mainly of ‘pseudoneurological’ symptoms (N = 16) showed bradycardia and generalized sweating. In both groups, Acute Panic Inventory scores were significantly higher during than before the panic attack, but the distribution of the scores was markedly different.
Discussion and Conclusion
The results suggest that panic disorder may be a heterogeneous condition. Implications of these results to other phobic disorders, to Klein’s false suffocation alarm theory and to the ‘extended amygdala model’ are discussed.
One hundred and sixteen patients with RDC unipolar recurrent depressive disorder, melancholic subtype, were treated with imipramine or phenelzine and followed-up for six months. None of the patients had a first-degree relative with bipolar I disorder. Twenty-six patients (22.4%) presented an hypomanic episode (‘hypomanic group’). This group of patients, when depressed, had a significantly lower age of onset of the disorder and higher response to antidepressant therapy than patients who did not present an hypomanic episode. Significantly more patients (88%) of the ‘hypomanic group’ had at least one first-degree relative with a history of major depressive disorder. These patients displayed some of the typical features of bipolar II disorder. Overall results support the continuum in clinical phenomena between unipolar and bipolar disorders.
The presence of mental illness in any of the parents can be a stressful factor in the child and be in certain way generator of disease. AIMS describe and quantify the psychiatric family history in patients who were consecutively referred to the outpatient department of children and adolescent psychiatry,mental health community center of collado villalba, Madrid
Material and method:
Obtain data of a series of cases filing a card of the 18-year-old minor patients who in September, October, November and December, 2007 come for the first time to our mental health community center.
The total number of patients were 114. There were psychiatric family history in 36,8% (N=42), the mother was or had been in psychiatric treatment in 28% (N=31)) of the cases, the father in 15% (N=17) and the brothers in 7 % (N=8), the most frequent diagnoses in mothers it were neurosis in 21 % (N=24), toxic abuse in 3,5% (N=4) and personality disorder in 1,8% (N=2), toxic abuse was the most frequent with 8,8% (N=10) in parents, followed by neurosis diagnosed in 4,4% (N=5), the most frequent diagnoses in brothers was the emotional disorder in 4,4,% (N=5). The mean age of parents was 41,34 (SE =6,34), in mothers was 38,43 (SE=6,59).
We have to consider the existence of some kind of psychiatric family history in the therapeutic plan of the patient.
Brain volume abnormalities and oxidative cell damage have been reported to be pathological characteristics of schizophrenia patients. This study aims to assess a potential relationship between these two characteristics in child and adolescent patients with first-episode psychosis.
26 child and adolescent patients with first-episode early-onset schizophrenia, and 78 age- and gender-matched healthy controls were assessed. Magnetic resonance imaging (MRI) scans were used for volumetric measurements of five cerebral regions: gray matter of the frontal, parietal, and temporal lobes, sulcal cerebrospinal fluid (CSF), and lateral ventricles. Oxidative cell damage was traced by means of a systemic increase in lipid hydroperoxides (LOOH).
Lateral ventricle volumes were significantly higher in schizophrenia patients than in controls. In schizophrenia patients, a significant positive relationship was found between oxidative cell damage (LOOH levels) and the abnormal enlargement of the lateral ventricles, after controlling for total intracranial volume, age, gender, daily smoking status, intelligence quotient (IQ), psychopathology, and time since onset of psychotic symptoms. No association was found between brain volumes and oxidative cell damage in control subjects.
Our results suggest that, in patients with first-episode early-onset schizophrenia, enlargement of the lateral ventricles is associated with chronic oxidative cell damage.
Cortisol-binding globulin (CBG) is an alpha-1-glycoprotein with high affinity for cortiso that could be a potential biological marker of chronic stress, according to several previous studies. In order to examine CBG concentrations in bipolar disorder, we determined serum CBG levels by radioimmunoassay with monoclonal antibodies in a sample of 39 RDC bipolar I patients in remission and 21 healthy age-, sex- and weight-matched control subjects. Only lithium treatment was permitted. Plasma cortisol and serum lithium levels were also determined. Bipolar males showed statistically significant lower serum CBG levels than controls, whereas women showed very similar values. No correlation was found between CBG levels and cortisol or lithium concentrations. It is concluded that CBG levels are affected by chronic affective illness, even during remission periods, at least in bipolar males.