A Change of Paradigm in the Management of Acute Psychiatric Episodes? A Retrospective Cohort Study on Trajectories of Use of Clinical Resources After the Implementation of Intensive Home-Treatment.

Intensive home treatment (IHT) has shown to be a feasible alternative to hospitalization for the management of acute psychiatric episodes, but there are no real-world studies assessing if patients with a first IHT use it again for the management of their recurrences. The objectives of this retrospective cohort study were to map the use ofacute treatment resources after the implementation of IHT in our territory through the establishment of trajectories of management, and to disentangle if there are profiles of patients who fit better each trajectory. We included the first 1000 episodes admitted to IHT, of which we selected those that corresponded to the first IHT of a patient (index admission). Trajectories after the index admission were: (T-A) absence of use of acute resources, (T-B) only IHT, and (T-C) at least one hospitalization. Follow-up ranged from 6 months to 6 years. We calculated the frequency of each trajectory and performed univariate analyses searching for associations between trajectory and clinical factors. Among those patients with psychiatric history (N = 659), 66.2% followedT-A, 11.2% T-B, and 22.6% T-C. The probability of following T-C was higher for patients with a psychotic disorder (pBonf = 0.018) and with previous hospitalizations (pBonf < 0.0001). Among those patients without psychiatric history (N = 168), 82.7% followed T-A, 6.6% T-B, and 10.7% T-C. The probability of following T-B was higher for those with a higher severity at the index admission (pBonf = 0.028). This study shows that some -or even all- recurrences of some subjects were successfully managed with IHT, providing real-world evidence for its use in acute psychiatric conditions.

Episodes of gene flow and selection during the evolutionary history of domesticated barley.

BACKGROUND: Barley is one of the founder crops of Neolithic agriculture and is among the most-grown cereals today. The only trait that universally differentiates the cultivated and wild subspecies is 'non-brittleness' of the rachis (the stem of the inflorescence), which facilitates harvesting of the crop. Other phenotypic differences appear to result from facultative or regional selective pressures. The population structure resulting from these regional events has been interpreted as evidence for multiple domestications or a mosaic ancestry involving genetic interaction between multiple wild or proto-domesticated lineages. However, each of the three mutations that confer non-brittleness originated in the western Fertile Crescent, arguing against multiregional origins for the crop. RESULTS: We examined exome data for 310 wild, cultivated and hybrid/feral barley accessions and showed that cultivated barley is structured into six genetically-defined groups that display admixture, resulting at least in part from two or more significant passages of gene flow with distinct wild populations. The six groups are descended from a single founding population that emerged in the western Fertile Crescent. Only a few loci were universally targeted by selection, the identity of these suggesting that changes in seedling emergence and pathogen resistance could represent crucial domestication switches. Subsequent selection operated on a regional basis and strongly contributed to differentiation of the genetic groups. CONCLUSIONS: Identification of genetically-defined groups provides clarity to our understanding of the population history of cultivated barley. Inference of population splits and mixtures together with analysis of selection sweeps indicate descent from a single founding population, which emerged in the western Fertile Crescent. This founding population underwent relatively little genetic selection, those changes that did occur affecting traits involved in seedling emergence and pathogen resistance, indicating that these phenotypes should be considered as 'domestication traits'. During its expansion out of the western Fertile Crescent, the crop underwent regional episodes of gene flow and selection, giving rise to a modern genetic signature that has been interpreted as evidence for multiple domestications, but which we show can be rationalized with a single origin.

Beriliosis, la enfermedad que se esconde tras algunas sarcoidosis / Chronic beryllium disease, the disease hidden under some sarcoidosis

La enfermedad crónica por berilio (BC) es una enfermedad pulmonar ocupacional causada por una reacción de hipersensibilidad retardada a dicho metal. El número de trabajadores expuestos a berilio (Be) se ha incrementado en los últimos años (en Estados Unidos ha pasado de 30.000 en 1970 a 200.000 apenas 30 años después) 1. Estudios transversales llevados a cabo en trabajadores expuestos en distintos tipos de industrias han encontrado prevalencias de la enfermedad que varían de 0% a 7,8%2. En este contexto es llamativo el escaso número de beriliosis que se diagnostican, probablemente porque muchas de ellas son erróneamente diagnosticadas de sarcoidosis

Chronic beryllium disease (CDB) is an occupational retarded hypersensitivity disease elicited by beryllium exposure. The number of exposed workers has increased in the last years. (in the USA has risen from 30,000 in the 1970s to 200,000 thirty years later)1. Cross-sectional studies of exposed workers in various industries have found that the prevalence of this illness ranged from 0.0 to 7.8%2. In this context, it is remarkable that CBD is only rarely diagnosed, probably because many of them are misdiagnosed as sarcoidosis

Ultrasound and magnetic resonance angiography features of post-traumatic ulnar artery pseudoaneurysm: a case report and review of the literature.

Ulnar artery pseudoaneurysms are very uncommon. The least common etiological mechanism is a single direct trauma. It is important to identify these lesions, which may have important clinical complications such as distal thrombosis with digital ischemia or gangrene. This report describes the features of sonography and magnetic resonance angiography of a histologically confirmed ulnar artery pseudoaneurysm.

Positron emission tomography: false positive result due to splenic uptake in an extension study in bronchial carcinoma. A case report.

Lung cancer is one of the most common malignant diseases. Many tests and techniques are used in the staging of this disease, including positron emission tomography. This is probably the most recently introduced test and is capable of providing information on all the structures affected by malignancy. We present a case of a false positive result due to increased splenic uptake of the tracer.

Positron emission tomography: a false negative result in cystic encephalic mestastases from a small cell bronchial carcinoma.

Lung cancer represents one of the most common malignant diseases. Many investigations are used in the staging study including, most recently, PET. We present a case of cystic cerebral metastases (with no oedema) from a small cell carcinoma which were not detected by PET.