Reptiles of Rancho Grande and vicinity, Estado Aragua, Venezuela

http://deepblue.lib.umich.edu/bitstream/2027.42/56372/1/MP128.pd

Assertive community treatment for elderly people with severe mental illness

Background: Adults aged 65 and older with severe mental illnesses are a growing segment of the Dutch population. Some of them have a range of serious problems and are also difficult to engage. While assertive community treatment is a common model for treating difficult to engage severe mental illnesses patients, no special form of it is available for the elderly. A special assertive community treatment team for the elderly is developed in Rotterdam, the Netherlands and tested for its effectiveness.Methods: We will use a randomized controlled trial design to compare the effects of assertive community treatment for the elderly with those of care as usual. Primary outcome measures will be the number of dropouts, the number of patients engaged in care and patient's psychiatric symptoms, somatic symptoms, and social functioning. Secondary outcome measures are the number of unmet needs, the subjective quality of life and patients' satisfaction. Other secondary outcomes include the number of crisis contacts, rates of voluntary and involuntary admission, and length of stay. Inclusion criteria are aged 65 plus, the presence of a mental disorder, a lack of motivation for treatment and at least four suspected problems with functioning (addiction, somatic problems, daily living activities, housing etc.). If patients meet the inclusion criteria, they will be randomly allocated to either assertive community treatment for the elderly or care as usual. Trained assessors will use mainly observational instruments at the following time points: at baseline, after 9 and 18 months.Discussion: This study will help establish whether assertive community treatment for the elderly produces better results than care as usual in elderly people with severe mental illnesses who are difficult to engage. When assertive community treatment for the elderly proves valuable in these respects, it can be tested and implemented more widely, and mechanisms for its effects investigated

Linear white lesion in the oral mucosa

Two unrelated patients aged 60 and 61 presented with an asymptomatic, white, slightly raised line on the buccal mucosa extending bilaterally from the commissure to the last molar teeth along their occlusal line, involving also the inner lower lip mucosa (Fig 1, A and B). The lesions could not wipe off on scratching. Medical history was unremarkable. Histopathology showed hyperparakeratosis without granular layers and regular acanthosis vacuolated cells in the upper spinous cell layer with some dyskeratotic cells in the absence of dysplasia (Fig 2). Neither inflammatory infiltrate nor bacterial colonies attached to the surface or fungal elements were seen (Fig 3)

Faecal immunochemical tests (FIT) can help to rule out colorectal cancer in patients presenting in primary care with lower abdominal symptoms:a systematic review conducted to inform new NICE DG30 diagnostic guidance

__Background:__ This study has attempted to assess the effectiveness of quantitative faecal immunochemical tests (FIT) for triage of people presenting with lower abdominal symptoms, where a referral to secondary care for investigation of suspected colorectal cancer (CRC) is being considered, particularly when the 2-week criteria are not met. __Methods:__ We conducted a systematic review following published guidelines for systematic reviews of diagnostic tests. Twenty-one resources were searched up until March 2016. Summary estimates were calculated using a bivariate model or a random-effects logistic regression model. __Results:__ Nine studies are included in this review. One additional study, included in our systematic review, was provided as 'academic in confidence' and cannot be described herein. When FIT was based on a single faecal sample and a cut-off of 10 μg Hb/g faeces, sensitivity estimates indicated that a negative result using either the OC-Sensor or HM-JACKarc may be adequate to rule out nearly all CRC; the summary estimate of sensitivity for the OC-Sensor was 92.1%, based on four studies, and the only study of HM-JACKarc to assess the 10 μg Hb/g faeces cut-off reported a sensitivity of 100%. The corresponding specificity estimates were 85.8% (95% CI 78.3-91.0%) and 76.6%, respectively. When the diagnostic criterion was changed to include lower grades of neoplasia, i.e. the target condition included higher risk adenoma (HRA) as well as CRC, the rule-out performance of both FIT assays was reduced. __Conclusions:__ There is evidence to suggest that triage using FIT at a cut-off around 10 μg Hb/g faeces has the potential to correctly rule out CRC and avoid colonoscopy in 75-80% of symptomatic patients. Systematic review registration: PROSPERO 4201603772

Keeping up with revolutions: evolution of higher education in Uzbekistan

Uzbekistan's higher education system has undergone some dramatic changes in the past century, evolving from largely traditional religious colleges to fully state-funded communist-atheist institutions. Since the end of the communist administration and subsequent market-oriented reforms, the institutions of higher education (IHE) in Uzbekistan have had to reinvent and reform themselves again, as the demand for different kind of education increased. This paper puts the current changes and trends in IHEs into an historical perspective and highlights some important effects of the market reforms on the educational scene

International Ocean Discovery Program Expedition 393 Preliminary Report South Atlantic Transect 2

The South Atlantic Transect (SAT) is a multidisciplinary scientific ocean drilling experiment designed to investigate the evolution of the oceanic crust and overlying sediments across the western flank of the Mid-Atlantic Ridge. This project comprises four International Ocean Discovery Program expeditions: fully staffed Expeditions 390 and 393 (April–August 2022) built on engineering preparations during Expeditions 390C and 395E that took place without science parties during the height of the Coronavirus Disease 2019 (COVID-19) pandemic. Through operations along a crustal flow line at ~31°S, the SAT recovered complete sedimentary sections and the upper ~40–340 m of the underlying ocean crust formed at a slow to intermediate spreading rate at the Mid-Atlantic Ridge over the past ~61 My. The sediments along this transect were originally spot cored more than 50 y ago during Deep Sea Drilling Project Leg 3 (December 1968–January 1969) to help verify the theories of seafloor spreading and plate tectonics. The SAT expeditions targeted six primary sites on 7, 15, 31, 49, and 61 Ma ocean crust that fill critical gaps in our sampling of intact in situ ocean crust with regards to crustal age, spreading rate, and sediment thickness. Drilling these sites was required to investigate the history, duration, and intensity of the low-temperature hydrothermal interactions between the aging ocean crust and the evolving South Atlantic Ocean. This knowledge will improve the quantification of past hydrothermal contributions to global biogeochemical cycles and help develop a predictive understanding of the impacts of variable hydrothermal processes and exchanges. Samples from the transect of the previously unexplored sediment- and basalt-hosted deep biosphere beneath the South Atlantic Gyre are essential to refine global biomass estimates and examine microbial ecosystems’ responses to variable conditions in a low-energy gyre and aging ocean crust. The transect is located near World Ocean Circulation Experiment Line A10, which provides a baseline for records of carbonate chemistry and deepwater mass properties across the western South Atlantic through key Cenozoic intervals of elevated atmospheric CO2 and rapid climate change. Reconstruction of the history of the deep western boundary current and deepwater formation in the Atlantic basins will yield crucial data to test hypotheses regarding the role of evolving thermohaline circulation patterns in climate change and the effects of tectonic gateways and climate on ocean acidification. During engineering Expeditions 390C and 395E, a single hole was cored through the sediment cover and into the uppermost rocks of the ocean crust with the advanced piston corer (APC) and extended core barrel (XCB) systems at five of the six primary proposed SAT sites. Reentry systems with casing were then installed either into basement or within 10 m of basement at each of those five sites. Expedition 390 (7 April–7 June 2022) conducted operations at three of the SAT sites, recovering 700 m of core (77%) over 30.3 days of on-site operations. Sediment coring, basement coring, and wireline logging were conducted at two sites on 61 Ma crust (Sites U1556 and U1557), and sediment coring was completed at the 7 Ma Site U1559. Expedition 393 operated at four sites, drilling in 12 holes to complete this initial phase of the SAT. Complete sedimentary sections were collected at Sites U1558, U1583, and U1560 on 49, 31, and 15 Ma crust, respectively, and together with 257.7 m of sediments cored during earlier operations, more than 600 m of sediments was characterized. The uppermost ocean crust was drilled at Sites U1558, U1560, and U1583 with good penetration (~130 to ~204 meters subbasement), but at the youngest ~7 Ma Site U1559, only ~43 m of basement penetration was achieved in this initial attempt. Geophysical wireline logs were aquired at Sites U1583 and U1560. Expeditions 390 and 393 established legacy sites available for future deepening and downhole basement hydrothermal and microbiological experiments at Sites U1557, U1560, and U1559 on 61, 15, and 7 Ma crust, respectively