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 firstname.lastname@example.org
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.
Kuhn has been hailed as one of the main critics of logical positivism since the publication of Structure of Scientific Revolutions. But the image of science he criticizes in the published version of the book is not considered sufficiently clear and has left room for doubt as to whether or not positivism, rarely directly cited, is a real target of this criticism. In the first manuscript of the work, written in 1958, the traditional image of science becomes clearer due to the contrast Kuhn makes between science and art. This chapter shows that the traditional image of science that Kuhn presents through the contrast with art in the first manuscript is the same as the one logical positivists present in the contrast with philosophy, particularly in the context of one of their most important and characteristic ideas, the proposal of a scientific philosophy. This allows a proper assessment of the share of responsibility of logical positivism in the construction of the traditional image of science Kuhn criticizes and, thus, a better understanding of Kuhn’s relationship with positivism.
This study evaluated the effect of roughage:concentrate (R:C) ratio associated with a variable particle size of physically effective neutral detergent fibre (peNDF8) in the forage (Tifton-85 hay) on the performance, carcass traits and meat quality of lambs. Seventy-two 4-month-old, non-castrated Santa Ines male lambs (23.5 ± 2.32 kg BW) were distributed in a completely randomized design, in a 2 × 2 factorial arrangement [two peNDF8 hay particle sizes (13 and 6 mm) and two R:C ratios (700:300 and 500:500 g/kg DM total)]. DMI, DM, NFC and TDN digestibility's, N-intake and N-faecal excretion were affected by the R:C ratio (P < 0.05). However, the N-retained was not affected by the studied variables (P > 0.05). It was observed an interaction (P < 0.05) between the peNDF8 and R:C ratios for final BW, average daily gain (ADG), colour parameters and pH 24 h. The lower roughage ratio provided greater (P < 0.05) concentrations of C14:1, C16:1–cis9, C18:1–cis9, ΣMUFA, Σn–6:Σn–3 and hypocholesterolemic/hypercholesterolemic index, enzymatic activity Δ9desaturase-C16 and -C18. Lambs fed a lower roughage diet had improved performance and feed efficiency, however, presented reduced polyunsaturated fatty acids (PUFA) concentrations in the meat, especially Σn–3 family. Higher roughage diet and larger peNDF8 particle size improved the concentrations of PUFA while decreased Σn–6:Σn–3 ratio in meat. Larger peNDF8 particle size associated with higher roughage proportion, have reduced animal performance however, it increased protein concentration, a* and C* colour parameter without affecting fatty acids profile of Longissimus lumborum muscle.
There is controversy regarding whether the addition of cover gowns offers a substantial benefit over gloves alone in reducing personnel contamination and preventing pathogen transmission.
Simulated patient care interactions.
To evaluate the efficacy of different types of barrier precautions and to identify routes of transmission.
In randomly ordered sequence, 30 personnel each performed 3 standardized examinations of mannequins contaminated with pathogen surrogate markers (cauliflower mosaic virus DNA, bacteriophage MS2, nontoxigenic Clostridioides difficile spores, and fluorescent tracer) while wearing no barriers, gloves, or gloves plus gowns followed by examination of a noncontaminated mannequin. We compared the frequency and routes of transfer of the surrogate markers to the second mannequin or the environment.
For a composite of all surrogate markers, transfer by hands occurred at significantly lower rates in the gloves-alone group (OR, 0.02; P < .001) and the gloves-plus-gown group (OR, 0.06; P = .002). Transfer by stethoscope diaphragms was common in all groups and was reduced by wiping the stethoscope between simulations (OR, 0.06; P < .001). Compared to the no-barriers group, wearing a cover gown and gloves resulted in reduced contamination of clothing (OR, 0.15; P < .001), but wearing gloves alone did not.
Wearing gloves alone or gloves plus gowns reduces hand transfer of pathogens but may not address transfer by devices such as stethoscopes. Cover gowns reduce the risk of contaminating the clothing of personnel.
Functional impairment is a defining feature of psychotic disorders. A range of factors has been shown to influence functioning, including negative symptoms, cognitive performance and cognitive reserve (CR). However, it is not clear how these variables may affect functioning in first-episode psychosis (FEP) patients. This 2-year follow-up study aimed to explore the possible mediating effects of CR on the relationship between cognitive performance or specific clinical symptoms and functional outcome.
A prospective study of non-affective FEP patients was performed (211 at baseline and 139 at follow-up). CR was entered in a path analysis model as potential mediators between cognitive domains or clinical symptoms and functioning.
At baseline, the relationship between clinical variables or cognitive performance and functioning was not mediated by CR. At follow-up, the effect of attention (p = 0.003) and negative symptoms (p = 0.012) assessed at baseline on functioning was partially mediated by CR (p = 0.032 and 0.016), whereas the relationship between verbal memory (p = 0.057) and functioning was mediated by CR (p = 0.014). Verbal memory and positive and total subscales of PANSS assessed at follow-up were partially mediated by CR and the effect of working memory on functioning was totally mediated by CR.
Our results showed the influence of CR in mediating the relationship between cognitive domains or clinical symptoms and functioning in FEP. In particular, CR partially mediated the relationship between some cognitive domains or clinical symptoms and functioning at follow-up. Therefore, CR could improve our understanding of the long-term functioning of patients with a non-affective FEP.
For patients with methicillin-resistant Staphylococcus aureus (MRSA) colonization, a traditional fist-bump greeting did not significantly reduce MRSA transfer in comparison to a handshake. However, transfer was reduced with a modified fist bump that minimized the surface area of contact and when hand hygiene was performed before the handshake.
Previous literature supports antipsychotics’ (AP) efficacy in acute first-episode psychosis (FEP) in terms of symptomatology and functioning but also a cognitive detrimental effect. However, regarding functional recovery in stabilised patients, these effects are not clear. Therefore, the main aim of this study is to investigate dopaminergic/anticholinergic burden of (AP) on psychosocial functioning in FEP. We also examined whether cognitive impairment may mediate these effects on functioning.
A total of 157 FEP participants were assessed at study entry, and at 2 months and 2 years after remission of the acute episode. The primary outcomes were social functioning as measured by the functioning assessment short test (FAST). Cognitive domains were assessed as potential mediators. Dopaminergic and anticholinergic AP burden on 2-year psychosocial functioning [measured with chlorpromazine (CPZ) and drug burden index] were independent variables. Secondary outcomes were clinical and socio-demographic variables.
Mediation analysis found a statistical but not meaningful contribution of dopaminergic receptor blockade burden to worse functioning mediated by cognition (for every 600 CPZ equivalent points, 2-year FAST score increased 1.38 points). Regarding verbal memory and attention, there was an indirect effect of CPZ burden on FAST (b = 0.0045, 95% CI 0.0011–0.0091) and (b = 0.0026, 95% CI 0.0001–0.0006) respectively. However, only verbal memory post hoc analyses showed a significant indirect effect (b = 0.009, 95% CI 0.033–0.0151) adding premorbid IQ as covariate. We did not find significant results for anticholinergic burden.
CPZ dose effect over functioning is mediated by verbal memory but this association appears barely relevant.
Mixed Bipolar patients are those who have co-existing depressive symptoms during mania. These patients are supposed to have a worse evolution.
The objective of this study was to compare the long-term outcomes of patients who had at least one mixed episode with those who experienced only pure manic episodes.
169 outpatients diagnosed of Bipolar I disorder and treated at least during two years were included. 120 patients (71%) complited the follow-up over 10 years. Baseline demographic and clinical variables were included.
The patients with mixed episodes (37%) had a significantly younger mean age at onset comparing with those with manic episodes (25.3 years vs. 30.8 years; p=0.025) they also had more previous mood- incongruent psychotic symptoms χ2= 6.77, p=0.034), more number of hospitalizations (OR= 1.36, 95% CI = 1.14; -1.63; p< 0.001), and more number of episodes (OR= 1.21, 95% CI = 1.10-1.31; p< 0.001). There were no significant differences relating to depressive episodes, alcohol use, drug abuse, suicidal behaviour and suicide attempts.
Age at onset differed significantly between the mixed episode and pure mania groups, with mixed episode patients having a younger age of onset. This is interesting as one of the major results of the study we have found that age at onset mediates some of the factors classically related to outcome in mixed episodes like alcohol abuse and suicide attempts. However, independently of age at onset, these patients represent a especially severe type of bipolar disorder.
Contrasting with the invalidation social phobia with an early beginning may have, research on cognitive-behavioural conceptualization and treatment in children and adolescents with social phobia is scarce.
In our presentation, we will propose a new treatment protocol for adolescents with social phobia, based on the most widely accepted conceptualization model of social phobia in adulthood - Clark & Wells, 1995 - taking into consideration idiosyncrasies in this age group, and also incorporating a positive and acceptant attitude towards themselves and their symptoms, and a curiosity attitude in the changing process. The aim is not only to overcome their social phobia but also to enable the adolescents with a positive view of themselves and of their strengths to empower them to overcome other difficulties and to promote their self-determination, in order to pursue their life-long projects and values.
Allelic variation in the promoter region of the serotonin transporter (5-HTTpro) contributes for the risk of alcohol dependence (AD). The short allele (S) of this polymorphism has been associated with co-occurring clinical features in severe AD such as depression, early onset or impulsivity. We studied the putative link between this allele and relapse in AD.
60 male alcohol dependent patients were followed for 3 months after withdrawal. Persistent abnormalities in lab tests (GGT and CDT) or failure to show up at scheduled interviews were considered as relapse. PCR amplifying the 5-HTTpro polymorphism from genomic DNA were performed. The impact of the S allele on relapse was assessed by a non-parametric Pearson χ2 test.
67.27 % of the patients relapsed during follow-up. The S allele of the 5-HTTpro was significantly associated with relapse (χ2 = 7.66 ; p < .006) while no other factor influenced relapse.
Responsible for a 5-HT hypo-functioning, the S allele of the 5-HTTpro may be associated with relapse in abstinent alcohol dependent patients, possibly through intermediate phenotypes such as personality features or lack of behavioral inhibition.
To introduce mindfulness pointing out its potentialities when applied in the psychopatology scope.
The authors had proceeded to a research on this third generation cognitive therapy through the bibliographical retraction, from scientific articles and publications. Trying and describing what he is one practical regular one of Mindfulness.
The practice of Mindfulness Practical of Mindfulness divulged in multiple publications, disclosing to be about a new generation of the Cognitive Therapy. It describes its possible clinical applicability in some psycopathologic features, with bigger emphasis in the disturbances of the anxiety. It is proceeded a summary revision from some conceptual boardings and more recent scientific studies.
Psicotherapeutic thechniques based in the practice of Mindfulness can be applied in clinical context complementing the cognitive theory based in the restructuring of the thought with the essential component of acceptance. However it would be very important to appear more randomized control trials that allow to prove its therapeutical effectiveness.
Cloninger's type II is a severe, early-onset, male-limited, genetically influenced, impulsive form of alcoholism. We assessed the association of two gene polymorphisms (TaqI A DRD2 and 5-HTTpro) with Cloninger's typology, as defined by age at onset of alcohol-related problems, and family history of alcohol abuse, which is thought to be more frequent in type II alcoholics.
58 male alcohol dependent patients were discriminated according to age at onset of alcohol-related problems and interviewed about family history of alcoholism. Genomic DNA was extracted and PCR amplifying the studied polymorphisms were performed. The associations between DRD2 (A1 or A2 alleles), 5-HTTpro (L and S alleles), family history and typology were assessed by Pearson chi2 analyses.
While typology was not influenced by any of the studied polymorphisms, a higher rate of general family history of alcohol abuse was still observed in type II patients (χ2= 4.53; p = 0.033). Furthermore, the A1 allele of the DRD2 was significantly associated with paternal history of alcoholism (χ2= 4.66; p = 0.031) and male, first-degree, collateral history of alcoholism (χ2= 4.40; p = 0.036).
Age at onset as main discriminator between type I and type II does not seem to be influenced by TaqI A DRD2 and 5-5HTTpro polymorphisms. However, the A1 allele of the DRD2 may be a marker of male familial alcoholism, which is in line with previous studies showing association between TaqI A DRD2 with some clinical features of type II alcoholism.
P300 is an event-related brain potential (ERP) particularly interesting to the study of cognitive processes in normal subjects and in psychopathology. P300 has been applied in depression with controversial results. A major source for these controversial results could result from the diversity of depressed patients included in the different studies. Supporting this assumption, impulsivity, blunted affect, suicidal behavior and psychotic features significantly influence P300 amplitude. However, no data are available on the possible influences of the personality of depressed patients on P300. Since personality is related to P300 in normal subjects, the aim of the present study is to investigate the relationship between ERPs (P200, N200, and P300) and the Temperament and Character Inventory (TCI) in 54 depressed patients. The main results of the study concern the absence of major correlations between personality dimensions as assessed by the TCI and ERP parameters among depressed patients. Only weak partial positive correlations relate N200 latency with harm avoidance, and P300 amplitude (Pz) with the self-directedness dimension. N200 amplitude is also negatively correlated to persistence. However, the preliminary nature of the presented results with respect to the weak statistical significance should be underlined.
To evaluate the 12-months prospective evolution of metabolic and cardiovascular risk factors in patients with types I or II Bipolar Disorder (BD) in Spain.
The BIMET study is a 12-month, prospective, multicentre, naturalistic study which enrolled patients with type I or II BD according to DSM-IV TR criteria. Fasting blood levels of glucose, total, HDL, LDL cholesterol and triglycerides as well as weight, height, waist circumference and blood pressure were recorded. The National Cholesterol Educational Program (NCEP)-ATP III definition was applied to consider presence of metabolic syndrome (MS).
A total of 524 patients were enrolled; 73% type I and 27% type II. 61.9% women, mean age 46.3 years. 28.4% of subjects work regularly. Smokers were 42.2%, 15.1% had a substance abuse history, 34.2% were obese according with WHO criteria (obesity class I; 23.2%, class II; 7.5%, and class III; 3.5%) and overweight was found in 37.4% of sample. Prevalence of diabetes was 7.3%, hypertension was present in 24.7%, 18.5% had cholesterol ≥240 mg/dL and 36.2% had triglycerides ≥150 mg/dL. Overall prevalence of MS was 27.0% (95% CI: 22.7%-31.3%), with 27.3% (22.2%-32.3%) in type I BD and 27.1% (19.0%-36.6%) in type II (p=0.973).
The prevalence of metabolic syndrome in type I / II BD patients was considerably higher than in the general population. As an excess of mortality due to metabolic and cardiovascular reasons pointed out in these patients, it is recommended a close clinical monitoring of such parameters in the routine medical practice.
The possibility of detention for treatment of mental patients may be controversial since introduces the possibility of the judicial power to dominate one's private life.
It is made an analysis of the legal problems in compulsory internment and treatment in mental patients in Portugal.
Material and Methods
The diplomas mainly analysed were the Portuguese mental health law, Constitution and Penal Code. The study was based in four legal principles: necessity, proportionality, subsidiary and adequacy whenever a compulsory detention for mental treatment is imposed and the requisites for that decision.
Compulsory internment may only be determined when it is the only way to guarantee that patient is submitted to treatment, and when is deemed proportional to the danger of the legally protected value in question. Restrictions on patient’s fundamental rights shall be those strictly necessary and suitable to the effectiveness of treatment. Compulsory internment may be petitioned by the Public Attorney, patient's legal representative, public health authorities or any person.
In spite of the diversity of criteria for compulsory mental health care across several countries, Portuguese mental health law emphasizes the need for treatment as an essential condition for detaining patients with mental illness. The compulsory treatment is based on the judge decision supported in the psychiatric report. However, how can we be certain that a mental patient is going to practice a specific crime? Is it fair to punish without crime? Are there scientific criteria capable of ensuring that mental patients cause always violent behavior?
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.