EVALUACIÓN DE LOS ESQUEMAS TARIFARIOS DE ASEO APLICADOS EN COLOMBIA

The study makes an analysis of the tariff schemes developed by the public system of cleaning in Colombia. The article is reflective and analytical in nature, it analyzes several documents issued by the regulatory entity of the cleaning service (Commission for the Regulation of Drinking Water and Basic Sanitation, CRA) related to the tariff issue of cleaning in Colombia with the purpose of looking at the regulatory advances and their effectiveness in the application of these schemes. The cleaning tariff schemes applied in Colombia have been issued under the regime of regulated freedom, they have progressively covered a greater number of activities and have had in common the use of the average cost methodology, using the regulatory technique of ceiling price, combined with the reference cost and price band techniques. The latest Resolution (CRA 853 of 2018) for small providers addresses methodologies for particular situations that arise in the Colombian geographic and social reality and that had not been taken into account in the previous rate schemes such as small providers, rural populated centers, hard-to-reach areas and regional schemes.El estudio hace un análisis de los esquemas tarifarios desarrollados en el servicio público de aseo en Colombia. El artículo es de carácter reflexivo y analítico, se analizan varios documentos expedidos por la entidad reguladora del servicio de aseo (Comisión de Regulación de Agua Potable y Saneamiento Básico, CRA) relacionados con el tema tarifario de aseo en Colombia con el propósito de mirar los avances regulatorios y su efectividad en la aplicación de estos esquemas. Los esquemas tarifarios de aseo aplicados en Colombia, han sido expedidos bajo el régimen de libertad regulada, progresivamente han abarcado una mayor cantidad de actividades y han tenido en común la utilización de la metodología de costo medio, utilizando la técnica regulatoria de precio techo, combinada con las técnicas de costo de referencia y banda de precios. La última Resolución para pequeños prestadores (CRA 853 de 2018) aborda metodologías para situaciones particulares que se presentan en la realidad geográfica y social colombiana y que no habían sido tenidas en cuenta en los anteriores esquemas tarifarios como son pequeños prestadores, centros poblados rurales, áreas de difícil acceso y esquemas regionales

Detection of Cocaine Use with Wireless Electrocardiogram Sensors

In recent years, the ability to continuously monitor activities, health, and lifestyles of individuals using sensor technologies has reached unprecedented levels. Such ubiquitous physiological sensing has the potential to profoundly improve our understanding of human behavior, leading to more targeted treatments for a variety of disorders. The long terms goal of this work is development of novel computational tools to support the study of addiction in the context of cocaine use. The current paper takes the first step in this important direction by posing a simple, but crucial question: Can cocaine use be reliably detected using wearable on-body sensors and current machine learning algorithms? We select wireless ECG as the most promising sensing modality for cocaine use detection. The main contributions in this paper include the presentation of a novel clinical study of cocaine use in which a unique set of wireless ECG data were collected, the description of a computational pipeline for inferring morphological features from noisy wireless ECG waveforms, and the evaluation of cocaine use detection algorithms based on data-driven and knowledge-based feature representations. Our results show that cocaine use can be detected with AUC levels above 0.9 in both the within-subjects and between-subjects cases at the 32mg/70kg dosage level

Changes in synaptic markers after administration of ketamine or psychedelics: a systematic scoping review

BackgroundKetamine and psychedelics have abuse liability. They can also induce “transformative experiences” where individuals experience enhanced states of awareness. This enhanced awareness can lead to changes in preexisting behavioral patterns which could be beneficial in the treatment of substance use disorders (SUDs). Preclinical and clinical studies suggest that ketamine and psychedelics may alter markers associated with synaptic density, and that these changes may underlie effects such as sensitization, conditioned place preference, drug self-administration, and verbal memory performance. In this scoping review, we examined studies that measured synaptic markers in animals and humans after exposure to ketamine and/or psychedelics.MethodsA systematic search was conducted following PRISMA guidelines, through PubMed, EBSCO, Scopus, and Web of Science, based on a published protocol (Open Science Framework, DOI: 10.17605/OSF.IO/43FQ9). Both in vivo and in vitro studies were included. Studies on the following synaptic markers were included: dendritic structural changes, PSD-95, synapsin-1, synaptophysin-1, synaptotagmin-1, and SV2A.ResultsEighty-four studies were included in the final analyses. Seventy-one studies examined synaptic markers following ketamine treatment, nine examined psychedelics, and four examined both. Psychedelics included psilocybin/psilocin, lysergic acid diethylamide, N,N-dimethyltryptamine, 2,5-dimethoxy-4-iodoamphetamine, and ibogaine/noribogaine. Mixed findings regarding synaptic changes in the hippocampus and prefrontal cortex (PFC) have been reported when ketamine was administered in a single dose under basal conditions. Similar mixed findings were seen under basal conditions in studies that used repeated administration of ketamine. However, studies that examined animals during stressful conditions found that a single dose of ketamine counteracted stress-related reductions in synaptic markers in the hippocampus and PFC. Repeated administration of ketamine also counteracted stress effects in the hippocampus. Psychedelics generally increased synaptic markers, but results were more consistently positive for certain agents.ConclusionKetamine and psychedelics can increase synaptic markers under certain conditions. Heterogeneous findings may relate to methodological differences, agents administered (or different formulations of the same agent), sex, and type of markers. Future studies could address seemingly mixed results by using meta-analytical approaches or study designs that more fully consider individual differences

Severe Illness Anxiety Treated by Integrating Inpatient Psychotherapy With Medical Care and Minimizing Reassurance

Illness anxiety disorder (IAD, formerly hypochondriasis) is characterized by preoccupation with fear of serious illness despite medical reassurance. IAD is common, debilitating, challenging to treat, and results in high healthcare utilization. Outpatient management of IAD is challenging because patients can compulsively seek reassurance from numerous providers, which interferes with learning more productive coping skills. We present the case of a woman with severe IAD who presented to the emergency room with increasing frequency over several months, despite regular outpatient medical visits and escalating psychiatric care. We made the unusual decision to hospitalize her for IAD for 1 month, in the absence of typical hospitalization criteria. This hospitalization allowed us to consolidate all medical and psychiatric care into a single provider team and train all staff and family to communicate with her in a consistent manner. We successfully treated her by integrating a general cognitive-behavioral therapy (CBT) protocol into medical care and decision-making. In response to her numerous health concerns, we minimized medical work-up, reassurance, and reactive medication changes, and instead used the concerns as opportunities to reinforce the psychotherapy. This approach allowed us to simplify her medication regimen and manage her co-morbid hypertension and vitamin deficiencies. Though inpatient hospitalization is likely infeasible in most cases of IAD, outpatient providers may create similar treatment plans based on the example of our case report, without needing highly specialized expertise. Such a plan would require a straightforward understanding of IAD psychology, which we review here, combined with readily accessible tools including a universal CBT protocol, online CBT courses, and clinical symptom scales. We discuss our approach for responding to health concerns, maintaining therapeutic alliance, integrating CBT principles into patient interactions, and managing medications. Since patients with IAD share health concerns with all providers, staff, and family, we also include our own IAD communication guide, appropriate for a general audience, that demonstrates how to respond in these conversations

"Dysregulated not deficit": A qualitative study on symptomatology of ADHD in young adults.

ObjectiveAttention-deficit/hyperactivity disorder (ADHD) is a common condition that often persists into adulthood, although data suggest that the current diagnostic criteria may not represent how the condition presents in adults. We aimed to use qualitative methods to better understand ADHD symptomatology in young adults, especially regarding attentional and emotional dysregulation.MethodsNine focus groups involving young adults (aged 18-35 years; N = 43; 84% female; 86% US and Canada) with diagnoses of ADHD were conducted. Participants were asked about their perceptions of the current diagnostic criteria and how their symptoms have presented and changed over time. Data were analyzed using an interpretive phenomenological analysis framework.ResultsMost participants reported that the diagnostic criteria did not accurately capture their experiences with ADHD. They reported struggling with attention dysregulation, including hyperfocusing, and emotional dysregulation, including rejection-sensitive dysphoria. Many participants believed that their changing environments and behavioral adaptations influenced how their symptoms presented into adulthood.ConclusionCurrent diagnostic criteria for ADHD may not capture the range of symptoms present in young adults. More research is needed to characterize attentional and emotional dysregulation in this population

Participant demographics; N = 43.

ObjectiveAttention-deficit/hyperactivity disorder (ADHD) is a common condition that often persists into adulthood, although data suggest that the current diagnostic criteria may not represent how the condition presents in adults. We aimed to use qualitative methods to better understand ADHD symptomatology in young adults, especially regarding attentional and emotional dysregulation.MethodsNine focus groups involving young adults (aged 18–35 years; N = 43; 84% female; 86% US and Canada) with diagnoses of ADHD were conducted. Participants were asked about their perceptions of the current diagnostic criteria and how their symptoms have presented and changed over time. Data were analyzed using an interpretive phenomenological analysis framework.ResultsMost participants reported that the diagnostic criteria did not accurately capture their experiences with ADHD. They reported struggling with attention dysregulation, including hyperfocusing, and emotional dysregulation, including rejection-sensitive dysphoria. Many participants believed that their changing environments and behavioral adaptations influenced how their symptoms presented into adulthood.ConclusionCurrent diagnostic criteria for ADHD may not capture the range of symptoms present in young adults. More research is needed to characterize attentional and emotional dysregulation in this population.</div

Representative quotes on attention.

ObjectiveAttention-deficit/hyperactivity disorder (ADHD) is a common condition that often persists into adulthood, although data suggest that the current diagnostic criteria may not represent how the condition presents in adults. We aimed to use qualitative methods to better understand ADHD symptomatology in young adults, especially regarding attentional and emotional dysregulation.MethodsNine focus groups involving young adults (aged 18–35 years; N = 43; 84% female; 86% US and Canada) with diagnoses of ADHD were conducted. Participants were asked about their perceptions of the current diagnostic criteria and how their symptoms have presented and changed over time. Data were analyzed using an interpretive phenomenological analysis framework.ResultsMost participants reported that the diagnostic criteria did not accurately capture their experiences with ADHD. They reported struggling with attention dysregulation, including hyperfocusing, and emotional dysregulation, including rejection-sensitive dysphoria. Many participants believed that their changing environments and behavioral adaptations influenced how their symptoms presented into adulthood.ConclusionCurrent diagnostic criteria for ADHD may not capture the range of symptoms present in young adults. More research is needed to characterize attentional and emotional dysregulation in this population.</div

Psychiatric Disorders and Crime in the US Population: Results From the National Epidemiologic Survey on Alcohol and Related Conditions Wave III

Objective: Current knowledge regarding the intersection of psychiatric disorders and crime in the United States is limited to psychiatric, forensic, and youth samples. This study presents nationally representative data on the relationship of DSM-5 psychiatric disorders, comorbid substance and mental health disorders, and multimorbidity (number of disorders) with criminal behavior and justice involvement among non-institutionalized US adults. Methods: Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions Wave III (NESARC-III; 2012-2013; N = 36,309). Logistic regressions were used to examine the association of specific disorders (eg, mood, anxiety, eating, posttraumatic stress, substance use), comorbid substance use and mental health disorders, and multimorbidity with lifetime criminal behavior, incarceration experience, and past-12-month general, alcohol-related, and drug-related legal problems. Results: Overall, 28.5% of participants reported a history of criminal behavior, 11.4% reported a history of incarceration, 1.8% reported current general legal problems, 0.8% reported current alcohol-related legal problems, and 2.7% reported current drug-related legal problems. The presence of any disorder was associated with a 4 to 5 times increased risk of crime outcomes. Drug use disorders were associated with the highest risk of lifetime crime (adjusted odds ratio [AOR] = 6.8; 95% CI, 6.1-7.6) and incarceration (AOR = 4.7; 95% CI, 4.1-5.3) and current legal problems (AOR = 3.3; 95% CI, 2.6-4.2). Multimorbidity and comorbid substance use and mental health disorders were associated with additional risk. Controlling for antisocial personality disorder did not change the findings. Conclusions: Community adults with substance use disorders, comorbid substance use and mental health disorders, and increasing multimorbidity are most at risk of crime and justice involvement, highlighting the importance of community-based addiction treatment

Representative quotes on perceptions of diagnosis.

Representative quotes on perceptions of diagnosis.</p

Informed consent document distributed to participants.

Informed consent document distributed to participants.</p