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In recent years, there has been an increase in the prevalence of illicit use of fentanyl and other opioids in the United States population. This has led to an increase in medical, psychopathological and abuse-associated comorbidity, an increase in deaths and a decrease in the age of consumption, and has become a serious emerging problem in young people.
We present the case of an 18-year-old woman from the United States who recently settled in Spain and started a follow-up in Mental Health due to opioid and other substance abuse problems.
Objectives
To address the growing problem surrounding the illicit use of fentanyl and opioids as drugs of abuse based on the presentation of the clinical case mentioned above.
Methods
Bibliographic search and description of a clinical case of a patient under follow-up by Mental Health at the “Hospital Clínico Universitario de Valladolid”.
Results
An 18-year-old woman from the United States who has been living with her father in Spain since the summer of 2023, having moved to Spain due to problems related to substance abuse.
With no previous medical or surgical history and with a history of follow-up in Mental Health in her country of origin for depressive symptomatology, dysfunctional personality traits and abuse of different toxic substances since adolescence.
After a brief and erratic follow-up in Psychiatry for anxious-depressive symptoms reactive to a complex and conflictive relationship with his mother and marked academic difficulties during the first years of adolescence, at the age of 15 he started using cannabis and alcohol, thus beginning a period marked by relationships with marginalized sectors of the population, substance abuse and school failure.
As his cannabis consumption intensified, he began to consume fentanyl prescribed to his mother, as well as other opioids to which he had access illegally, for which reason he had to be admitted twice to detoxification centers without results, which is why his family finally decided to move him to Spain.
Conclusions
In recent years, fentanyl abuse has become a serious public health problem that is mainly centered in the young population.
High levels of impulsivity and lack of frustration tolerance predispose to the use of illicit substances for elusive purposes.
Substance abuse carries with it not only an important organic comorbidity, but also a marked socio-familial and economic repercussion.
Attention-deficit/hyperactivity disorder (ADHD) symptoms are associated with myriad adverse outcomes, including interpersonal difficulties, but factors that moderate the developmental course and functional impact of ADHD over time are not well understood. The present study evaluated developmental contributions of the triarchic neurobehavioral traits (boldness, meanness, and disinhibition) to ADHD symptomatology and its subdimensions from adolescence to young adulthood. Participants were twins and triplets assessed at ages 14, 17, and 19 (initial N = 1,185, 51.2% female). Path analyses using negative binomial regression revealed that boldness at age 14 was associated with more ADHD symptoms cross-sectionally (especially hyperactivity/impulsivity), but fewer symptoms (especially inattention) at age 19 in the prospective analysis. Notably, inclusion of interpersonal problems at ages 14 and 17 as covariates reduced the latter effect to nonsignificant. Disinhibition concurrently and prospectively predicted higher levels of ADHD symptoms, including both subdimensions, and the prospective effects were partially mediated by greater social impairment at age 17. Meanness prospectively (but not concurrently) predicted higher levels of hyperactivity/impulsivity symptoms. Sex moderated certain associations of meanness and disinhibition with ADHD symptoms. These findings highlight how fundamental neurobehavioral traits shape both psychopathology and adaptive outcomes in the developmental course of ADHD.
Negative symptoms has been classically associated with cognition, psychosocial functioning and quality of life in patients with schizophrenia. But negative symptoms are not a unitary construct, encompassing two different factors: diminished expression, and motivation and pleasure. Few works have studied the relationship between these two different negative symptoms factors and cognition (neuro and social cognition), psychosocial functioning and quality of life, jointly, in patients with a first psychotic episode of schizophrenia.
Objectives
The objective of the present work was to study, in a sample of patients with a first psychotic episode of schizophrenia, the relationship between the negative symptoms (diminished expression and motivation and pleasure) and neurocognition, social cognition, functioning and quality of life.
Methods
The study was carried out with 82 outpatients with a first psychotic episode of schizophrenia from two Spanish hospitals (“12 de Octubre” University Hospital, Madrid and “Virgen de la Luz” Hospital, Cuenca). The patients were assessed with the Clinical Assessment Interview for Negative Symptoms (CAINS) for evaluating diminished expression (EXP) and motivation and pleasure (MAP) symptoms, the MATRICS Consensus Cognitive Battery (MCCB) for evaluating neurocognition and social cognition, the Social and Occupational Functioning Assessment Scale (SOFAS), and the Quality of Life Scale (QLS).
Results
A negative correlation was found between neurocognition and the two negative symptoms subscales: CAINS-EXP (r=-0.458, p<0.001) and CAINS-MAP (r=-0.374, p<0.001); but with social cognition only CAINS-EXP was correlated (r=-0.236, p=0.033). Also, it was found a high negative correlation between SOFAS scores and CAINS-MAP (r=-0.717, p<0.001); and a medium negative correlation with CAINS-EXP (r=-0.394, p<0.001). Finally, QLS score was high correlated with both CAINS subscales: CAINS-EXP (r=-0.681, p<0.001) and CAINS-MAP (r=-0.770, p<0.001).
Conclusions
This study found a relationship between negative symptoms and neurocognition, social cognition, functioning and quality of life in a sample of patients with a first psychotic episode of schizophrenia. But the two different negative symptom factors, diminished expression, and motivation and pleasure, are associated differently with psychosocial functioning, but especially with social cognition where the relationship was only found with diminished expression symptoms.
To describe the genomic analysis and epidemiologic response related to a slow and prolonged methicillin-resistant Staphylococcus aureus (MRSA) outbreak.
Design:
Prospective observational study.
Setting:
Neonatal intensive care unit (NICU).
Methods:
We conducted an epidemiologic investigation of a NICU MRSA outbreak involving serial baby and staff screening to identify opportunities for decolonization. Whole-genome sequencing was performed on MRSA isolates.
Results:
A NICU with excellent hand hygiene compliance and longstanding minimal healthcare-associated infections experienced an MRSA outbreak involving 15 babies and 6 healthcare personnel (HCP). In total, 12 cases occurred slowly over a 1-year period (mean, 30.7 days apart) followed by 3 additional cases 7 months later. Multiple progressive infection prevention interventions were implemented, including contact precautions and cohorting of MRSA-positive babies, hand hygiene observers, enhanced environmental cleaning, screening of babies and staff, and decolonization of carriers. Only decolonization of HCP found to be persistent carriers of MRSA was successful in stopping transmission and ending the outbreak. Genomic analyses identified bidirectional transmission between babies and HCP during the outbreak.
Conclusions:
In comparison to fast outbreaks, outbreaks that are “slow and sustained” may be more common to units with strong existing infection prevention practices such that a series of breaches have to align to result in a case. We identified a slow outbreak that persisted among staff and babies and was only stopped by identifying and decolonizing persistent MRSA carriage among staff. A repeated decolonization regimen was successful in allowing previously persistent carriers to safely continue work duties.
All disasters are local but implementing a hyperlocal response in the midst of a public health emergency is challenging. The availability of neighborhood-level qualitative data that are both timely and relevant to evolving objectives and operations is a limiting factor. In 2020, the New York City Department of Health and Mental Hygiene (NYC DOHMH) responded to the COVID-19 emergency using a novel, hyperlocal approach. Key to the implementation of this approach was the creation of the Community Assessment to Inform Rapid Response (CAIRR), a process for rapid collection and analysis of neighborhood-specific, objective-focused, qualitative data to inform tailored response operations. This paper describes the process of developing the CAIRR and its contribution to the NYC DOHMH’s hyperlocal response in order to guide other jurisdictions seeking to employ a hyperlocal approach in future disaster responses.
Anandamide (AEA) and 2-Arachidonoylglycerol (2-AG) play a pivotal role in food intake and reward aspects of feeding. Aberrant functioning in the endocannabinoid system has been observed in patients with eating disorders (EDs). This dysfunction may influence the incentive processes stimulating behaviors towards food acquisition or the hedonic evaluation of ingested food.
Objectives
The aims of this study are to compare fasting peripheral levels of AEA and 2-AG in ED patients, obese subjects (OB) and healthy controls (HCs), and to explore their association with clinical and anthropometric variables.
Methods
The sample included a total of 63 adult women. Peripheral blood samples were collected to investigate fasting levels of AEA and 2-AG in 31 ED patients: 22 Anorexia Nervosa (AN) and 9 Binge Eating Disorder (BED), compared to 21 OB and 11 HCs. Several clinical and anthropometric variables were also assessed.
Results
Comparing groups, significant differences in AEA levels were found (p=0.001). Specifically, individuals with AN exhibited lower AEA than OB (p<0.001) and BED (p=0.007), while OB showed higher AEA than HCs (p=0.015). 2-AG was positively correlated with hostility dimension in EDs and negatively associated with impulsive traits in OB. AEA showed a direct association with body dissatisfaction in AN, contrary to OB. Finally, in AN, AEA negatively correlated with the body mass index, while 2-AG was positively associated with the fat mass.
Conclusions
These results suggest an interaction between biological and clinical factors defining a vulnerability pathway that could help fitting personalized therapeutic approaches in each condition.
The start of Child and Adolescent attention to gender dysphoria is very recent. In our Unit, it has objectified a growing increase in such demand over recent years.
As a typical example would be a patient of 13 years following gender dysphoria begins to present school failure and behavior problems at home with emotional instability.
According to the recommendations of the Group Identity and Sexual Differentiation (GIDSEEN) after early detection is to guide parents towards a comprehensive treatment at a specialized interdisciplinary teams and a psychosocial approach to improve the quality of life, decrease mental comorbidity and gender dysphoria own. Having no such care in our community has been necessary to make a referral to another community to attend this demand.
Currently it is giving adequate attention to these cases, but except for referral to another community. However, as we are seeing progression care in our area in the future could be feasible. Therefore, we consider as a first step dysphoria quantify each case in our area.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Maintaining antipsychotic therapy in mental disorder is important in preventing relapse, rehospitalization, and suicide. Lack of awareness of illness may be a leading cause for non-adherence. Long-acting depot can prevent non- adherence and thus potentially contribute to better patient outcomes.
Objective
The aim of this prospective, observational, non interventional 2-year-long study is to assess severity and post-intervention changes and attitudes toward medication of a group of patients treated paliperidone palmitate (PP).
Methods
Thirty-three outpatients stabilised with PP during the last 24 months. Inclusion criteria were: patients’ age (> 18 years), a diagnosis of schizophrenia, bipolar disorder, schizoaffective disorder stabilised during the last 12 months with PP, without a diagnostics from axis I or II (except for nicotine of caffeine) and able to sign the inform consent. Data collected: general sociodemographic and clinical data (age, sex, level of education, socioeconomic situation, family support, psychiatric diagnosis, years of evolution, use/abuse of substances, treatment, previous and later number of hospitalisations. Evaluations included disease severity (Clinical Global Impression-Severity (CGI-S) and Drug Attitude Inventory, (DAI)).
Results
Thirty-threeoutpatients were followed during 24 months [mean dose 132,58 (44,4) mg], 75,8% were men, age 45,05 years old, 87,8% with a diagnoses of paranoid schizophrenia. Antipsychotic monotherapy increased over the time with PP. Significant improvements were observed on both Clinical Global Impression and Drug Attitude Inventory. The number of rehospitalizations and mean stays decreased from the beginning until the end of these 24 months.
Conclusions
Our results suggest an improvement in the patient's clinical vision and attitude towards medication with long-acting depot.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
This study aimed to molecularly survey Bartonella in dogs from Chile. Quantitative real-time PCR (qPCR) for Bartonella spp. based on nuoG gene was performed in 139 blood samples taken from dogs belonging to rural localities of the Valdivia Province, Los Ríos region, southern Chile. nuoG qPCR-positive samples were submitted to conventional PCR assays for ftsZ, gltA, rpoB and nuoG genes and sequencing for speciation and phylogenetic analysis. Based upon qPCR results, Bartonella spp. occurrence in dogs was 4.3% (6/139). Out of six nuoG qPCR-positive samples, six, three, two and none showed positive results in cPCR assays based on gltA, ftsZ, rpoB and nuoG genes, respectively. Consistent sequencing results were obtained only for the ftsZ gene from sample #1532 (GeneBank accession number: MG252491), and gltA gene from samples #1535 (MG252490) and #1532 (148 bp fragment that was not deposited in GenBank). Phylogenetic analysis of ftsZ and gltA genes allowed speciation of two nuoG-positive samples, one as Bartonella vinsonii subsp. berkhoffii and the other as B. henselae. Bartonella vinsonii subsp. berkhoffii and B. henselae are detected for the first time in dogs from Chile, highlighting the importance of the canine population as a source of zoonotic agents and potential infection risk to humans.
The number of dengue epidemics in Brazil has increased dramatically in the last 15 years. In this study, we analysed the seasonal patterns in the incidence of hospitalisations due to dengue across the different states of Brazil and compared these with the corresponding climatic patterns. We discovered that the seasonality of dengue hospitalisations in Brazil has a clear zonal gradient, characterised by the progression of primary peaks from West to East during the first half of the year, which may be associated with the increased vapour pressure and rainfall during this period, leading to increased mosquito abundance and activity. We also found that the proportion of children among hospitalised individuals was especially high during the peak outbreaks in 2007/2008 and 2010. This may be due to the emergence and spread of the new DENV-2 Southeast Asian genotype lineage II from 2007, which has probably arrived from the Caribbean and may have caused an increase in incidence and severity of the disease, particularly among children. Our findings may allow health systems to improve control interventions and contribute to reducing dengue morbidity and mortality by using integrated vector control in conjunction with early diagnosis and prompt supportive care.
Salmonella is a leading cause of bacterial foodborne illness. We report the collaborative investigative efforts of US and Canadian public health officials during the 2013–2014 international outbreak of multiple Salmonella serotype infections linked to sprouted chia seed powder. The investigation included open-ended interviews of ill persons, traceback, product testing, facility inspections, and trace forward. Ninety-four persons infected with outbreak strains from 16 states and four provinces were identified; 21% were hospitalized and none died. Fifty-four (96%) of 56 persons who consumed chia seed powder, reported 13 different brands that traced back to a single Canadian firm, distributed by four US and eight Canadian companies. Laboratory testing yielded outbreak strains from leftover and intact product. Contaminated product was recalled. Although chia seed powder is a novel outbreak vehicle, sprouted seeds are recognized as an important cause of foodborne illness; firms should follow available guidance to reduce the risk of bacterial contamination during sprouting.
Two-dimensional group IV layers beyond graphene, as silicene, germanene and the Sn-based stanene, have been recently synthesized by molecular beam epitaxy. Density Functional Theyory (DFT) calculations predict low-buckled structures for these 2D nanosheets, with a hexagonal honeycomb conformation, typical of the graphene-like surfaces. The buckling parameter δ increases from Si to Sn-based layers, with a maximum predicted of 0.92 Å for stanene. High-buckled structures for these materials resulted to be unstable. We have previously shown that for silicene and germanene, the origin of the buckled structure resides on the pseudo Jahn-Teller puckering distortion, resulting from non-adiabatic effects. It has been shown that hexagermabenzene, the single hexagonal unit of germanene, is subject to a strong vibronic coupling whose origin is the pseudo Jahn-Teller effect. This coupling resulted to be around ten times larger than the one obtained for hexasilabenzene. For stanene, an additional effect needs to be considered to understand the origin of buckling: the spin-orbit coupling (SOC). This SOC contributes to open an electronic band gap, enabling the use of these layers as nanoelectronic components. In this work, we present an analysis based on DFT in the Zeroth-Order Regular Approximation (ZORA) for both scalar relativistic and spin-orbit versions that quantify the influence of the spin-orbit coupling in the puckering of Sn6H6. Also, under the linear vibronic coupling model between the ground and the lowest excited states, we present the pseudo Jahn-Teller contribution. The scalar ZORA approximation is used to perform time-dependent DFT calculations to incorporate the low-energy excitations contributions. Our model leads to the determination of the coupling constants and predicts simultaneously the Adiabatic Potential Energy Surface behavior for the ground and excited states around the maximum symmetry point. These values allow us to compare the Jahn-Teller relevance in buckling with the other group IV layers.
Germanene, the 2D graphene-like Ge nanosheet, has been recently the subject of many theoretical studies and experimental attempts to synthesize it on Ag(111), Au(111) and Pt(111) surfaces. The experimental and theoretical evidences of germanene show a 2D continuous honeycomb layer with a buckled conformation. Density functional theory (DFT) calculations have predicted a larger buckling for germanene than silicene whose origin is also associated with a pseudo Jahn–Teller (PJT) effect. In this work we show that despite the fact that both, silicene and germanene possess a buckled conformation with a PJT origin, their vibronic coupling have different origins. The analysis is based on the PJT puckering instability of the hexagermabenzene molecule, the single hexagonal unit of germanene. This is done through the linear vibronic coupling model between the ground and the lowest excited states, which leads to a puckering distortion of the more symmetric cluster. We study both, the multilevel superposition vibronic model and possible mixing of excited states of different irreducible representations, which have been used to show the origin of similar structural transitions in hexagonal silicon and gold ring systems respectively. We show that contrary to other cases with one six-member rings, for the hexagermabenzene molecule a mixture of both the multilevel PJT and a ground state coupling with two quasi-degenerate excited states is necessary for a satisfactory explanation of puckering. Our model allows a determination of the coupling constants and predicts simultaneously the Adiabatic Potential Energy Surface (APES) behavior for the ground and excited states around the maximum symmetry point. The analysis is based on a scalar relativistic DFT and time-dependent DFT (TD-DFT) calculations in the Zero Order Regular Approximation (ZORA) using the B3LYP hybrid functional.
The induced diffusion of tracers in a bacterial suspension is studied theoretically and experimentally at low bacterial concentrations. Considering the swimmer–tracer hydrodynamic interactions at low Reynolds number and using a kinetic theory approach, it is shown that the induced diffusion coefficient is proportional to the swimmer concentration, their mean velocity and a coefficient $\beta $, as observed experimentally. This paper shows that $\beta $ increases as a result of the interaction with solid surfaces. The coefficient $\beta $ scales as the tracer–swimmer cross-section times the mean square displacement produced by single scattering events, which depends on the swimmer propulsion forces. Considering simple swimmer models (acting on the fluid as two monopoles or as a force dipole), it is shown that $\beta $ increases for decreasing swimming efficiencies. Close to solid surfaces, the swimming efficiency degrades and, consequently, the induced diffusion increases. Experiments on wild-type Escherichia coli in a Hele-Shaw cell, under buoyant conditions, are performed to measure the induced diffusion on tracers near surfaces. The modification of the suspension pH varies the swimmers’ velocity over a wide range, allowing the $\beta $ coefficient to be extracted with precision. It is found that solid surfaces modify the induced diffusion: decreasing the confinement height of the cell, $\beta $ increases by a factor of 4. The theoretical model reproduces this increase, although there are quantitative differences, probably attributed to the simplicity of the swimmer models and to the estimates for the parameters that model E. coli.
The study of the 2D-3D structural transition in Au7+ nanocluster as a function of the number of gold atoms has been a long standing problem due to contradictory results between experiments, that show a 2D structure, and some theoretical results predicting 3D. We present a theoretical analysis, based on the pseudo Jahn-Teller effect that explains the origin of the 2D-3D structural transition controversy. It is shown that the usually assumed 2D non-degenerate ground state cluster structure with D6h symmetry is unstable due to a vibronic coupling between the ground state and one excited state, producing a puckering effect ending in a 3D stable structure with D3d symmetry. This structure presents the same surface area than the 2D, being therefore compatible with ion mobility experimental results. We discuss the effect of symmetry breaking on the Raman, IR and UV-vis spectra, which might indicate some possible sensor capabilities for this subnanometric cluster. The study is based on scalar relativistic and time-dependent DFT calculations in the Zero Order Regular Approximation (ZORA).
It is well known that Au-Ag bimetallic nanoparticles have better performance in catalytic processes compared to their counterpart pure clusters. The improvement in their catalytic properties has been attributed to a kind of synergy between the gold and silver atoms that has not been fully understood. Unlike pure clusters, there are very few studies on the catalytic behavior of the Au-Ag binary nanoparticles. From the theoretical point of view, in the subnanometer regimen, the bimetallic Au-Ag clusters present a challenging problem, since by combining the different gold and silver relativistic effects, a variety of skeletal geometric structures and homotopic distributions are obtained. In particular, pure gold has favorable planar structure even up to 16 atoms, while silver begins to favor 3D arrangements from 5-7 atoms. This dissimilar behavior produces a diverse population of 2D and 3D coexisting binary clusters, whose properties strongly depend of the Au/Ag mixing ratio. In this work we use the relativistic approach ZORA-DFT to model the AunAgm (with 4 ≤ (n + m) ≤ 12) binary nanoclusters in selected proportions (1:1, 3:1, 5:1) in the gas-phase and we study their reactivity from the descriptors based in the condensed Fukui indexes obtained from an NBO electronic population analysis.
Countries of the Wider Caribbean have committed to principled ocean governance through several multilateral environmental and fisheries agreements at both the regional (e.g., the Cartagena Convention SPAW Protocol) and international level (e.g., the Convention on Biological Diversity, the United Nations Fish Stocks Agreement, the FAO Code of Conduct for Responsible Fishing). They have also committed to the 2002 World Summit on Sustainable Development (WSSD) targets for fisheries and biodiversity conservation. However, the ongoing challenge is to put in place the measures required to give effect to these principles at the local, national and regional levels (Fanning et al. 2009). While not minimising the important role of science in an ecosystem approach to managing the living marine resources of the Wider Caribbean Region, the chapters in this book serve to highlight the importance that regional experts have placed on the role of governance to address the problems in the region.
This synthesis chapter presents the outputs of a discussion specifically relating to the role of governance in achieving and implementing a shared vision for ecosystem-based management (EBM) in the Wider Caribbean, using the process described in Chapter 1. In terms of structure, the chapter first describes a vision for governance and reports on the priorities assigned to the identified vision elements. It then discusses how the vision might be achieved by taking into account assisting factors (those that facilitate achievement) and resisting factors (those that inhibit achievement). The chapter concludes with guidance on the strategic direction needed to implement the vision, identifying specific actions to be undertaken for each of the vision elements.
The Vision
The occupational breakdown of members of the Governance Working Group reflected the diversity of affiliations present at the EBM Symposium and included governmental, intergovernmental, academic, non-governmental and private sector (fishers and fishing industry and consulting) representatives. With guidance provided by the facilitator, this diverse grouping of participants was asked to first address the question: “What do you see in place in 10 years’ time when EBM/EAF has become a reality in the Caribbean?”. This diversity provided for a fruitful and comprehensive visioning process, the results of which are summarised in Table 25.1, in terms of the key vision elements and their subcomponents, and in Figure 25.1, which illustrates the level of priority assigned to each of the vision elements.
The need for a proper interpolation method for data coming from space missions like CoRoT is emphasized. A new gap-filling method is introduced which is based on auto-regressive moving average interpolation (ARMA) models. The method is tested on light curves from stars observed by the CoRoT satellite, filling the gaps caused by the South Atlantic Anomaly.