Publications by authors named "Enrique Lopez"

34 Publications

Effect of a Coordinated Community and Chronic Care Model Team Intervention vs Usual Care on Systolic Blood Pressure in Patients With Stroke or Transient Ischemic Attack: The SUCCEED Randomized Clinical Trial.

JAMA Netw Open 2021 02 1;4(2):e2036227. Epub 2021 Feb 1.

Icahn School of Medicine at Mount Sinai, New York, New York.

Importance: Few stroke survivors meet recommended cardiovascular goals, particularly among racial/ethnic minority populations, such as Black or Hispanic individuals, or socioeconomically disadvantaged populations.

Objective: To determine if a chronic care model-based, community health worker (CHW), advanced practice clinician (APC; including nurse practitioners or physician assistants), and physician team intervention improves risk factor control after stroke in a safety-net setting (ie, health care setting where all individuals receive care, regardless of health insurance status or ability to pay).

Design, Setting, And Participants: This randomized clinical trial included participants recruited from 5 hospitals serving low-income populations in Los Angeles County, California, as part of the Secondary Stroke Prevention by Uniting Community and Chronic Care Model Teams Early to End Disparities (SUCCEED) clinical trial. Inclusion criteria were age 40 years or older; experience of ischemic or hemorrhagic stroke or transient ischemic attack (TIA) no more than 90 days prior; systolic blood pressure (BP) of 130 mm Hg or greater or 120 to 130 mm Hg with history of hypertension or using hypertensive medications; and English or Spanish language proficiency. The exclusion criterion was inability to consent. Among 887 individuals screened for eligibility, 542 individuals were eligible, and 487 individuals were enrolled and randomized, stratified by stroke type (ischemic or TIA vs hemorrhagic), language (English vs Spanish), and site to usual care vs intervention in a 1:1 fashion. The study was conducted from February 2014 to September 2018, and data were analyzed from October 2018 to November 2020.

Interventions: Participants randomized to intervention were offered a multimodal coordinated care intervention, including hypothesized core components (ie, ≥3 APC clinic visits, ≥3 CHW home visits, and Chronic Disease Self-Management Program workshops), and additional telephone visits, protocol-driven risk factor management, culturally and linguistically tailored education materials, and self-management tools. Participants randomized to the control group received usual care, which varied by site but frequently included a free BP monitor, self-management tools, and linguistically tailored information materials.

Main Outcomes And Measures: The primary outcome was change in systolic BP at 12 months. Secondary outcomes were non-high density lipoprotein cholesterol, hemoglobin A1c, and C-reactive protein (CRP) levels, body mass index, antithrombotic adherence, physical activity level, diet, and smoking status at 12 months. Potential mediators assessed included access to care, health and stroke literacy, self-efficacy, perceptions of care, and BP monitor use.

Results: Among 487 participants included, the mean (SD) age was 57.1 (8.9) years; 317 (65.1%) were men, and 347 participants (71.3%) were Hispanic, 87 participants (18.3%) were Black, and 30 participants (6.3%) were Asian. A total of 246 participants were randomized to usual care, and 241 participants were randomized to the intervention. Mean (SD) systolic BP improved from 143 (17) mm Hg at baseline to 133 (20) mm Hg at 12 months in the intervention group and from 146 (19) mm Hg at baseline to 137 (22) mm Hg at 12 months in the usual care group, with no significant differences in the change between groups. Compared with the control group, participants in the intervention group had greater improvements in self-reported salt intake (difference, 15.4 [95% CI, 4.4 to 26.0]; P = .004) and serum CRP level (difference in log CRP, -0.4 [95% CI, -0.7 to -0.1] mg/dL; P = .003); there were no differences in other secondary outcomes. Although 216 participants (89.6%) in the intervention group received some of the 3 core components, only 35 participants (14.5%) received the intended full dose.

Conclusions And Relevance: This randomized clinical trial of a complex multilevel, multimodal intervention did not find vascular risk factor improvements beyond that of usual care; however, further studies may consider testing the SUCCEED intervention with modifications to enhance implementation and participant engagement.

Trial Registration: ClinicalTrials.gov Identifier: NCT01763203.
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http://dx.doi.org/10.1001/jamanetworkopen.2020.36227DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7885035PMC
February 2021

COVID-19: hypofractionation in the Radiation Oncology Department during the 'state of alarm': first 100 patients in a private hospital in Spain.

Ecancermedicalscience 2020 28;14:1052. Epub 2020 May 28.

Radiophysics Department, Hospital Vithas Valencia Consuelo, 46007, Spain.

During the COVID-19 pandemic, Spain declared a 'state of alarm' on 14 March 2020. In our Radiation Oncology Department, experienced in administering hypofractionated treatments (partial irradiation in breast cancer, moderate hypofractionation in localized prostate cancer, etc), we have increased the hypofractionated treatment indications. We are only deferring the start of non-urgent treatments such as prostate tumours under androgen deprivation or benign brain tumours which are candidates for radiosurgery such as meningiomas or acoustic neuroma. In this hypofractionation era we find that we have decreased the number of sessions per patient and that we can evaluate the last years with the fractionation index (FI) (calculated by dividing the total number of fractions administered in the department by the total number of patients treated). We have gone from 14.4 in 2018 to 13.78 in 2019, excluding brachytherapy. We report the results of the first 100 patients who have experienced radiotherapy treatment since the state of alarm (66 women and 34 men). In these patients, the FI is 12.12-lower than previous years.
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http://dx.doi.org/10.3332/ecancer.2020.1052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7289607PMC
May 2020

Deep-UV to Mid-IR Supercontinuum Generation driven by Mid-IR Ultrashort Pulses in a Gas-filled Hollow-core Fiber.

Sci Rep 2019 Mar 14;9(1):4446. Epub 2019 Mar 14.

DTU Fotonik, Technical University of Denmark, Kgs., DK, 2800, Lyngby, Denmark.

Supercontinuum (SC) generation based on ultrashort pulse compression constitutes one of the most promising technologies towards ultra-wide bandwidth, high-brightness, and spatially coherent light sources for applications such as spectroscopy and microscopy. Here, multi-octave SC generation in a gas-filled hollow-core antiresonant fiber (HC-ARF) is reported spanning from 200 nm in the deep ultraviolet (DUV) to 4000 nm in the mid-infrared (mid-IR) having an output energy of 5 μJ. This was obtained by pumping at the center wavelength of the first anti-resonant transmission window (2460 nm) with ~100 fs pulses and an injected pulse energy of ~8 μJ. The mechanism behind the extreme spectral broadening relies upon intense soliton-plasma nonlinear dynamics which leads to efficient soliton self-compression and phase-matched dispersive wave (DW) emission in the DUV region. The strongest DW is observed at 275 nm which corresponds to the calculated phase-matching wavelength of the pump. Furthermore, the effect of changing the pump pulse energy and gas pressure on the nonlinear dynamics and their direct impact on SC generation was investigated. This work represents another step towards gas-filled fiber-based coherent sources, which is set to have a major impact on applications spanning from DUV to mid-IR.
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http://dx.doi.org/10.1038/s41598-019-39302-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6418117PMC
March 2019

Major Depressive Disorder in Patients With Doctoral Degrees: Patient-reported Depressive Symptom Severity, Functioning, and Quality of Life Before and After Initial Treatment in the STAR*D Study.

J Psychiatr Pract 2017 09;23(5):328-341

BOULOS and SMITH: Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA WRIGHT: Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA MIROCHA: Cedars-Sinai Medical Center, Biostatistics Core, Research Institute and Clinical and Translational Science Institute (CTSI), Los Angeles, CA STEINER, LÓPEZ, and ISHAK: Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA GOHAR: School of Law, University of California Davis, Davis, CA.

Objective: This study examined patients with medical or doctoral degrees diagnosed with major depressive disorder (MDD) by analyzing patient-reported depressive symptom severity, functioning, and quality of life (QOL) before and after treatment of MDD.

Methods: Analyses were conducted in a sample of 2280 adult outpatient participants with MDD from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study with complete entry and exit scores for the level 1 (citalopram monotherapy) trial. The sample contained 62 participants who had completed medical or doctoral degrees (DOCS) and 2218 participants without medical or doctoral degrees (non-DOCS). QOL was assessed with the Quality of Life Enjoyment and Satisfaction Questionnaire, functioning was assessed with the Work and Social Adjustment Scale, and depressive symptom severity was assessed with the Quick Inventory of Depressive Symptomatology-Self Report.

Results: Both groups (DOCS and non-DOCS) had significant improvement in depressive symptom severity, functioning, and QOL following treatment (with equivalent improvements in mean change values). However, the DOCS group demonstrated larger effect sizes in symptom reduction for depression, increase in functioning, and improvement in QOL compared with the non-DOCS group. Participants who achieved remission from MDD at exit showed significantly greater improvement than nonremitters on functioning and QOL.

Conclusions: Findings from this study indicated that, following citalopram monotherapy, the participants in the DOCS group achieved greater reductions in depressive symptom severity (based on effect sizes) than the participants in the non-DOCS group. For both treatment groups, the findings also showed the positive effect that remission status from MDD can have on QOL and functioning.
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http://dx.doi.org/10.1097/PRA.0000000000000251DOI Listing
September 2017

Quality of life and functioning of Hispanic patients with Major Depressive Disorder before and after treatment.

J Affect Disord 2018 01 14;225:117-122. Epub 2017 Aug 14.

Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States. Electronic address:

Background: Similar rates of remission from Major Depressive Disorder (MDD) have been documented between ethnic groups in response to antidepressant treatment. However, ethnic differences in functional outcomes, including patient-reported quality of life (QOL) and functioning, have not been well-characterized. We compared symptomatic and functional outcomes of antidepressant treatment in Hispanic and non-Hispanic patients with MDD.

Methods: We analyzed 2280 nonpsychotic treatment-seeking adults with MDD who received citalopram monotherapy in Level 1 of the Sequenced Treatment Alternatives to Relieve Depression study. All subjects (239 Hispanic, 2041 non-Hispanic) completed QOL, functioning, and depressive symptom severity measures at entry and exit.

Results: Hispanic participants had significantly worse QOL scores at entry and exit (p < 0.01). However, after controlling for baseline QOL, there was no difference between Hispanic and non-Hispanic patients' QOL at exit (p = 0.21). There were no significant between-group differences at entry or at exit for depressive symptom severity or functioning. Both groups had significant improvements in depressive symptom severity, QOL, and functioning from entry to exit (all p values < 0.01). Patients with private insurance had lower depressive symptom severity, greater QOL, and better functioning at exit compared to patients without private insurance.

Limitations: This study was a retrospective data analysis, and the Hispanic group was relatively small compared to the non-Hispanic group.

Conclusions: Hispanic and non-Hispanic participants with MDD had similar responses to antidepressant treatment as measured by depressive symptom severity scores, quality of life, and functioning. Nevertheless, Hispanic patients reported significantly worse quality of life at entry.
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http://dx.doi.org/10.1016/j.jad.2017.08.031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5626642PMC
January 2018

Remote-sensing based approach to forecast habitat quality under climate change scenarios.

PLoS One 2017 3;12(3):e0172107. Epub 2017 Mar 3.

Andalusian Center for the Assessment and Monitoring of Global Change (CAESCG), University of Almería, Almería, Spain.

As climate change is expected to have a significant impact on species distributions, there is an urgent challenge to provide reliable information to guide conservation biodiversity policies. In addressing this challenge, we propose a remote sensing-based approach to forecast the future habitat quality for European badger, a species not abundant and at risk of local extinction in the arid environments of southeastern Spain, by incorporating environmental variables related with the ecosystem functioning and correlated with climate and land use. Using ensemble prediction methods, we designed global spatial distribution models for the distribution range of badger using presence-only data and climate variables. Then, we constructed regional models for an arid region in the southeast Spain using EVI (Enhanced Vegetation Index) derived variables and weighting the pseudo-absences with the global model projections applied to this region. Finally, we forecast the badger potential spatial distribution in the time period 2071-2099 based on IPCC scenarios incorporating the uncertainty derived from the predicted values of EVI-derived variables. By including remotely sensed descriptors of the temporal dynamics and spatial patterns of ecosystem functioning into spatial distribution models, results suggest that future forecast is less favorable for European badgers than not including them. In addition, change in spatial pattern of habitat suitability may become higher than when forecasts are based just on climate variables. Since the validity of future forecast only based on climate variables is currently questioned, conservation policies supported by such information could have a biased vision and overestimate or underestimate the potential changes in species distribution derived from climate change. The incorporation of ecosystem functional attributes derived from remote sensing in the modeling of future forecast may contribute to the improvement of the detection of ecological responses under climate change scenarios.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0172107PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5336225PMC
August 2017

Screening for depression in hospitalized medical patients.

J Hosp Med 2017 02;12(2):118-125

Cedars-Sinai Medical Center, Division of General Internal Medicine, Los Angeles, CA, USA.

Depression among hospitalized patients is often unrecognized, undiagnosed, and therefore untreated. Little is known about the feasibility of screening for depression during hospitalization, or whether depression is associated with poorer outcomes, longer hospital stays, and higher readmission rates. We searched PubMed and PsycINFO for published, peer-reviewed articles in English (1990-2016) using search terms designed to capture studies that tested the performance of depression screening tools in inpatient settings and studies that examined associations between depression detected during hospitalization and clinical or utilization outcomes. Two investigators reviewed each full-text article and extracted data. The prevalence of depression ranged from 5% to 60%, with a median of 33%, among hospitalized patients. Several screening tools identified showed high sensitivity and specificity, even when self-administered by patients or when abbreviated versions were administered by individuals without formal training. With regard to outcomes, studies from several individual hospitals found depression to be associated with poorer functional outcomes, worse physical health, and returns to the hospital after discharge. These findings suggest that depression screening may be feasible in the inpatient setting, and that more research is warranted to determine whether screening for and treating depression during hospitalization can improve patient outcomes. Journal of Hospital Medicine 2017;12:118-125.
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http://dx.doi.org/10.12788/jhm.2693DOI Listing
February 2017

Diagnostic utility of the HIV dementia scale and the international HIV dementia scale in screening for HIV-associated neurocognitive disorders among Spanish-speaking adults.

Appl Neuropsychol Adult 2017 Nov-Dec;24(6):512-521. Epub 2016 Aug 15.

g Department of Psychiatry and Behavioral Sciences, Quillen College of Medicine , East Tennessee State University , Johnson City , Tennessee , USA.

Given that neurocognitive impairment is a frequent complication of HIV-1 infection in Spanish-speaking adults, the limited number of studies assessing HIV-associated neurocognitive disorders (HAND) in this population raises serious clinical concern. In addition to being appropriately translated, instruments need to be modified, normed, and validated accordingly. The purpose of the current study was to examine the diagnostic utility of the HIV Dementia Scale (HDS) and International HIV Dementia Scale (IHDS) to screen for HAND in Spanish-speaking adults living with HIV infection. Participants were classified as either HAND (N = 47) or No-HAND (N = 53) after completing a comprehensive neuropsychological evaluation. Receiver operating characteristic analyses found the HDS (AUC = .706) was more sensitive to detecting HAND than the IHDS (AUC = .600). Optimal cutoff scores were 9.5 for the HDS (PPV = 65.2%, NPV = 71.4%) and 9.0 for the IHDS (PPV = 59.4%, NPV = 59.1%). Canonical Correlation Analysis found the HDS converged with attention and executive functioning. Findings suggest that while the IHDS may not be an appropriate screening instrument with this population, the HDS retains sufficient statistical validity and clinical utility to screen for HAND in Spanish-speaking adults as a time-efficient and cost-effective measure in clinical settings with limited resources.
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http://dx.doi.org/10.1080/23279095.2016.1214835DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5938065PMC
June 2018

Candida-induced prosthetic joint infection. A literature review including 72 cases and a case report.

Infect Dis (Lond) 2017 Feb 1;49(2):81-94. Epub 2016 Sep 1.

a Department of Microbiology , Hospital Virgen de las Nieves , Granada , Spain.

Background: The clinical and microbiological characteristics of prosthetic joint infection (PJI) caused by Candida species is described, including 72 cases in the literature and a case of Candida glabrata infection handled at the present centre.

Methods: We describe one patient and using the key words 'fungal prosthetic joint infection' and 'candida prosthetic joint infection' we searched MEDLINE (National Library of Medicine, Bethesda, MD), Web of Science, CINAHL and Cochrane systematic review databases for case reports of this condition.

Results: Out of the 73 patients, 38 were female; mean age at diagnosis was 65.7 (± SD 18) yrs; 50 had risk factors for candidal infection such as systemic disease (e.g. rheumatoid arthritis, Sjogren's syndrome, systemic lupus erythematosus) and/or immunosuppressive therapy in 18 (24.6%) cases, diabetes mellitus in 14 (19.1%), immunosuppression due to malignant or chronic disease in 24 (32.8%) and long-term antibiotic use in four (5.4%) patients. Infection site was the knee in 36 patients and hip in 35; pain was present in 43 patients and swelling in 23 and the mean surgery-diagnosis interval was 32 months. The most frequent species was C. albicans, followed by C. parapsilosis. The diagnosis was obtained from joint fluid aspirate in 33 cases and intra-operative samples in 16. Susceptibility to antifungals was tested in only 21 isolates. The most frequently used antifungals were fluconazole and amphotericin B. Two-stage exchange arthroplasty was performed in 30 patients and resection arthroplasty in 31; 56 patients were cured with a combination of medical and surgical treatment; one patient died from the infection.

Conclusion: PJI caused by Candida requires a high index of suspicion; surgery with long-term antifungal therapy is recommended.
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http://dx.doi.org/10.1080/23744235.2016.1219456DOI Listing
February 2017

Discrepancies between bilinguals' performance on the Spanish and English versions of the WAIS Digit Span task: Cross-cultural implications.

Appl Neuropsychol Adult 2016 Sep-Oct;23(5):343-52. Epub 2016 Jan 19.

a Department of Psychiatry and Behavioral Neurosciences , Cedars-Sinai Medical Center , Los Angeles , California , USA.

This study explored within-subjects differences in the performance of 40 bilingual participants on the English and Spanish versions of the Wechsler Adult Intelligence Scale (WAIS) Digit Span task. To test the linguistic hypothesis that individuals would perform worse in Spanish because of its syllabic demand, we compared the number of syllables correctly recalled by each participant for every correct trial. Our analysis of the correct number of syllables remembered per trial showed that participants performed significantly better (i.e., recalling more syllables) in Spanish than in English on the total score. Findings suggest the Spanish version of the Digit Span (total score) was significantly more difficult than the English version utilizing traditional scoring methods. Moreover, the Forward Trial, rather than the Backward Trial, was more likely to show group differences between both language versions. Additionally, the Spanish trials of the Digit Span were correlated with language comprehension and verbal episodic memory measures, whereas the English trials of the Digit Span were correlated with confrontational naming and verbal fluency tasks. The results suggest that more research is necessary to further investigate other cognitive factors, rather than just syllabic demand, that might contribute to performance and outcome differences on the WAIS Digit Span in Spanish-English bilinguals.
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http://dx.doi.org/10.1080/23279095.2015.1074577DOI Listing
January 2017

The relationship between cognitive reserve and the clinical stage of HIV infection.

AIDS Care 2016 29;28(5):633-8. Epub 2015 Dec 29.

a Instituto de Neurociencias, Universidad de Guadalajara , Guadalajara , Jalisco , México.

The objective of this study was to determine whether the effect of cognitive reserve (CR) on neuropsychological functioning differs according to the clinical stage of HIV infection. A sample of 34 HIV-positive individuals aged 23-49, with a minimum of 9 years of formal education, was assessed. Participants were grouped according to the Centers for Disease Control and Prevention's (CDC) clinical stages (A = 10, B = 16, C = 8). CR was calculated for each clinical stage group in accordance with estimates of premorbid IQ, years of education, and occupational attainment. The sum of these three variables was then transformed into z-scores. Individuals above the median were classified as having "High" CR (HCR), those below the median were classified as "Low" CR (LCR). Participants completed an evaluation of cognitive and executive functions based on selected, modified tasks from the HIV University of Miami Annotated Neuropsychological test in Spanish (HUMANS). Assessment included the following domains: attention, memory (visual, verbal, and working memory), executive functions (cognitive flexibility, switching), language (naming), and visual constructive skills (block design). HCR outperformed LCR in all cognitive domains. Comparison of HCR and LCR in each clinical stage revealed that the effect of CR was stronger in stage B than in stages A and C, suggesting that this effect does indeed vary among stages.
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http://dx.doi.org/10.1080/09540121.2015.1124985DOI Listing
January 2017

Diagnostic Utility of the International HIV Dementia Scale for HIV-Associated Neurocognitive Impairment and Disorder in South Africa.

J Neuropsychiatry Clin Neurosci 2014 ;26(4):352-8

From the Dept. of Mental Health, AIDS Healthcare Foundation, Los Angeles, CA (KG); Dept. of Psychiatry and Behavioral Sciences, Quillen College of Medicine, East Tennessee State University, Johnson City, TN (KG); Dept. of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA (EL, DJH); Dept. of Psychology, Loyola Marymount University, Los Angeles, CA (DJH); Dept. of Psychiatry, McCord Hospital, Durban, South Africa (DS); and Dept. of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA (EL).

Studies in sub-Saharan Africa indicate that most HIV seropositive persons have HIV-associated neurocognitive disorder (HAND). HAND diagnosis is facilitated by specific screening. Seventy participants were recruited from an HIV voluntary counseling and testing clinic in Durban, South Africa. The diagnostic utility of the International HIV Dementia Scale (IHDS) was analyzed using a receiver operating characteristic (ROC) model. The ROC analysis comparing any HAND diagnosis (based on two neuropsychological tests) versus no diagnosis was statistically significant, with an optimal cut-off score of 10.5, sensitivity of 69%, and specificity of 74%. Sensitivity of the IHDS was highest for HIV-associated dementia.
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http://dx.doi.org/10.1176/appi.neuropsych.13080178DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5805556PMC
December 2015

Specificity data for the b Test, Dot Counting Test, Rey-15 Item Plus Recognition, and Rey Word Recognition Test in monolingual Spanish-speakers.

J Clin Exp Neuropsychol 2015 13;37(6):614-21. Epub 2015 May 13.

a California School Forensic Studies , Alliant International University , Los Angeles , CA , USA.

The current study provides specificity data on a large sample (n = 115) of young to middle-aged, male, monolingual Spanish speakers of lower educational level and low acculturation to mainstream US culture for four neurocognitive performance validity tests (PVTs): the Dot Counting, the b Test, Rey Word Recognition, and Rey 15-Item Plus Recognition. Individuals with 0 to 6 years of education performed more poorly than did participants with 7 to 10 years of education on several Rey 15-Item scores (combination equation, recall intrusion errors, and recognition false positives), Rey Word Recognition total correct, and E-score and omission errors on the b Test, but no effect of educational level was observed for Dot Counting Test scores. Cutoff scores are provided that maintain approximately 90% specificity for the education subgroups separately. Some of these cutoffs match, or are even more stringent than, those recommended for use in US test takers who are primarily Caucasian, are tested in English, and have a higher educational level (i.e., Rey Word Recognition correct false-positive errors; Rey 15-Item recall intrusions and recognition false-positive errors; b Test total time; and Dot Counting E-score and grouped dot counting time). Thus, performance on these PVT variables in particular appears relatively robust to cultural/language/educational factors.
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http://dx.doi.org/10.1080/13803395.2015.1039961DOI Listing
April 2016

Application of a model based on dual-energy X-ray absorptiometry and finite element simulation for predicting the probability of osteoporotic hip fractures to a sample of people over 60 years.

Proc Inst Mech Eng H 2015 May 11;229(5):369-85. Epub 2015 May 11.

Department of Mechanical Engineering, Engineering and Architecture School, University of Zaragoza, Zaragoza, Spain Aragon Institute of Engineering Research, University of Zaragoza, Zaragoza, Spain

The aim of this work is the application of a mechanical predictive model to a sample of people over 60 years of age, in order to analyze the fracture probability related to age and sex. A total of 223 elderly people (63 men, aged 63-88, 72.32±6.10; 157 women, aged 61-89, 73.28±5.73) participated in the study. A dual-energy X-ray absorptiometry scanner was used to measure the bone mineral content and bone mineral density at total hip and femoral neck. The application of the predictive model also required a finite element simulation of the proximal femur, obtaining the mechanical damage and fracture probability maps corresponding to each sex and age groups analyzed. Statistical analysis shows higher values of bone mineral density, and consequently of Young's modulus, for men than for women. In general, a decrease of BMD is observed since 65 years old. The maximum mechanical damage value is always located at the femoral neck. The results indicate that mechanical damage tends to increase with age. Coherently with mechanical damage, the maximum fracture probability value is always located at the femoral neck and tends to increase with age. The simulation model to determine the probability of fracture is more complete than the simple measurement of bone mineral density, because provides additional information about mechanical properties of bone, and allows for a prospective detection of fracture risk. The model may be used for risk evaluation in specific patients, if anatomical and dual-energy X-ray absorptiometry measurements are available, helping us to decide about preventive pharmacological treatment for hip fracture.
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http://dx.doi.org/10.1177/0954411915583730DOI Listing
May 2015

Surgical Multidisciplinary Rounds: An Effective Tool for Comprehensive Surgical Quality Improvement.

Am J Med Qual 2016 Jan-Feb;31(1):31-7. Epub 2014 Sep 10.

Berkshire Medical Center, Pittsfield, MA.

An analysis of outcomes, quality, and survey data was carried out to evaluate the impact of surgical multidisciplinary rounds (SMDR) at a community teaching hospital. Surgical inpatients were reviewed over a 4-year period. Real-time changes to clinical care, documentation, and programs were enacted during the rounds. SMDR contributed to reductions in length of stay (6.1 to 5.1 days), postoperative respiratory failure (15.5% to 6.8%), deep venous thrombosis/pulmonary embolism (2.8% to 2.3%), cardiac complications (7.0% to 1.6%), and catheter-associated urinary tract infection (5.2% to 1.5%), and increased Surgical Care Improvement Program All-or-None compliance (95.6% to 98.7%). Additionally, SMDR increased awareness of Accreditation Council for Graduate Medical Education core competencies among surgical residents and was associated with enhanced job satisfaction among participants. Twice-weekly SMDR is an effective care paradigm that has changed culture, improved care coordination, and facilitated rapid, sustained process improvement along multiple patient safety indicators and core measures.
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http://dx.doi.org/10.1177/1062860614549761DOI Listing
February 2017

The impact of spirituality before and after treatment of major depressive disorder.

Innov Clin Neurosci 2014 Mar;11(3-4):17-23

Dr. Peselow is from the Richmond University Medical Center and Freedom From Fear, Staten Island, New York; Ms. Pi, Dr. Lopez, Mr. Besada, and Dr. IsHak are from Cedars-Sinai Medical Center, Los Angeles, California.

Objective: The authors sought to assess spirituality in depressed patients and evaluate whether the degree of initial depressive symptoms and response to pharmacotherapy treatment has a correlation with degree of spirituality and belief in God.

Methods: Our participants included 84 patients who presented to a depression/anxiety clinic for naturalistic treatment of their depressive illness over the course of two years. All patients met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria for major depression, as confirmed by structured interviews using the Structured Clinical Interview for DSM-IV, and were treated with selective serotonin reuptake inhibitors for eight weeks.

Measurements: Patients were evaluated at baseline and after treatment using the Montgomery Asberg Depression Rating Scale, the Beck Hopelessness Scale, the Dysfunctional Attitude Scale, and the Spiritual Orientation to Life scale.

Results: At baseline, patients reporting greater spirituality had significantly lower measures of hopelessness, dysfunctional attitudes, and depressive symptoms. Those who believed in God had a greater mean change score than those who did not on the Montgomery Asberg Depression Rating Scale, the Beck Hopelessness Scale, and the Dysfunctional Attitude Scale, with the Montgomery Asberg Depression Rating Scale showing the greatest mean change score. Significant correlations were detected between the Spiritual Orientation to Life scale score and the Montgomery Asberg Depression Rating Scale, the Beck Hopelessness Scale, and the Dysfunctional Attitude Scale pre-scores, post-scores, and change scores.

Conclusion: The findings suggest that greater spirituality is associated with less severe depression. Moreover, the degree to which the measures of depressive symptom severity, hopelessness, and cognitive distortions improved over the course of eight weeks was significantly greater for those patients who were more spiritual.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008297PMC
March 2014

Reverse micelle synthesis of oxide nanopowders: mechanisms of precipitate formation and agglomeration effects.

J Colloid Interface Sci 2013 Oct 15;407:302-9. Epub 2013 Jul 15.

University of California, San Diego, Department of Mechanical and Aerospace Engineering, 9500 Gilman Drive - MC 0411, La Jolla, CA 92093-0411, USA.

We present an analysis of reverse micelle stability in four model systems. The first two systems, composed of unstable microemulsions of isooctane, water, and Na-AOT with additions of either iron sulfate or yttrium nitrate, were used for the synthesis of iron oxide or yttrium oxide powders. These oxide powders were of nanocrystalline character, but with some level of agglomeration that was dependent on calcination temperature and cleaning procedures. Results show that even though the reverse micellar solutions were unstable, nanocrystalline powders with very low levels of agglomeration could be obtained. This effect can be attributed to the protective action of the surfactant on the surfaces of the powders that prevents neck formation until after all the surfactant has volatilized. A striking feature of the IR spectra collected on the iron oxide powders is the absence of peaks in the ~1715 cm(-1) to 1750 cm(-1) region, where absorption due to the symmetric C=O (carbonyl) stretching occurs. The lack of such peaks strongly suggests the carbonyl group is no longer free, but is actively participating in the surfactant-precipitate interaction. The final two microemulsion systems, containing CTAB as the surfactant, showed that loss of control of the reverse micelle synthesis process can easily occur when the amount of salt in the water domains exceeds a critical concentration. Both model systems eventually resulted in agglomerated powders of broad size distributions or particles that were large compared to the sizes of the reverse micelles, consistent with the notion that the microemulsions were not stable and the powders were precipitated in an uncontrolled fashion. This has implications for the synthesis of nanopowders by reverse micelle synthesis and provides a benchmark for process control if powders of the highest quality are desired.
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http://dx.doi.org/10.1016/j.jcis.2013.07.003DOI Listing
October 2013

Study of the behavior of a bell-shaped colonic self-expandable NiTi stent under peristaltic movements.

Biomed Res Int 2013 6;2013:370582. Epub 2013 Jun 6.

Department of Mechanical Engineering, University of Zaragoza, Maria de Luna 3, 50018 Zaragoza, Spain.

Managing bowel obstruction produced by colon cancer requires an emergency intervention to patients usually in poor conditions, and it requires creating an intestinal stoma in most cases. Regardless of that the tumor may be resectable, a two-stage surgery is mandatory. To avoid these disadvantages, endoscopic placement of self-expanding stents has been introduced more than 10 years ago, as an alternative to relieve colonic obstruction. It can be used as a bridge to elective single-stage surgery avoiding a stoma or as a definitive palliative solution in patients with irresectable tumor or poor estimated survival. Stents must be capable of exerting an adequate radial pressure on the stenosed wall, keeping in mind that stent must not move or be crushed, guaranteeing an adequate lumen when affected by peristaltic waves. A finite element simulation of bell-shaped nitinol stent functionality has been done. Catheter introduction, releasing at position, and the effect of peristaltic wave were simulated. To check the reliability of the simulation, a clinical experimentation with porcine specimens was carried out. The stent presented a good deployment and flexibility. Stent behavior was excellent, expanding from the very narrow lumen corresponding to the maximum peristaltic pressure to the complete recovery of operative lumen when the pressure disappears.
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http://dx.doi.org/10.1155/2013/370582DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3690217PMC
December 2013

A mechanical model for predicting the probability of osteoporotic hip fractures based in DXA measurements and finite element simulation.

Biomed Eng Online 2012 Nov 14;11:84. Epub 2012 Nov 14.

Department of Design and Manufacturing Engineering, University of Zaragoza, Spain.

Background: Osteoporotic hip fractures represent major cause of disability, loss of quality of life and even mortality among the elderly population. Decisions on drug therapy are based on the assessment of risk factors for fracture, from BMD measurements. The combination of biomechanical models with clinical studies could better estimate bone strength and supporting the specialists in their decision.

Methods: A model to assess the probability of fracture, based on the Damage and Fracture Mechanics has been developed, evaluating the mechanical magnitudes involved in the fracture process from clinical BMD measurements. The model is intended for simulating the degenerative process in the skeleton, with the consequent lost of bone mass and hence the decrease of its mechanical resistance which enables the fracture due to different traumatisms. Clinical studies were chosen, both in non-treatment conditions and receiving drug therapy, and fitted to specific patients according their actual BMD measures. The predictive model is applied in a FE simulation of the proximal femur. The fracture zone would be determined according loading scenario (sideway fall, impact, accidental loads, etc.), using the mechanical properties of bone obtained from the evolutionary model corresponding to the considered time.

Results: BMD evolution in untreated patients and in those under different treatments was analyzed. Evolutionary curves of fracture probability were obtained from the evolution of mechanical damage. The evolutionary curve of the untreated group of patients presented a marked increase of the fracture probability, while the curves of patients under drug treatment showed variable decreased risks, depending on the therapy type.

Conclusion: The FE model allowed to obtain detailed maps of damage and fracture probability, identifying high-risk local zones at femoral neck and intertrochanteric and subtrochanteric areas, which are the typical locations of osteoporotic hip fractures.The developed model is suitable for being used in individualized cases. The model might better identify at-risk individuals in early stages of osteoporosis and might be helpful for treatment decisions.
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http://dx.doi.org/10.1186/1475-925X-11-84DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3549900PMC
November 2012

Observation of quantum interference as a function of Berry's phase in a complex Hadamard optical network.

Phys Rev Lett 2012 Jun 28;108(26):260505. Epub 2012 Jun 28.

Centre for Quantum Photonics, H. H. Wills Physics Laboratory & Department of Electrical and Electronic Engineering, University of Bristol, BS8 1UB, United Kingdom.

Emerging models of quantum computation driven by multiphoton quantum interference, while not universal, may offer an exponential advantage over classical computers for certain problems. Implementing these circuits via geometric phase gates could mitigate requirements for error correction to achieve fault tolerance while retaining their relative physical simplicity. We report an experiment in which a geometric phase is embedded in an optical network with no closed loops, enabling quantum interference between two photons as a function of the phase.
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http://dx.doi.org/10.1103/PhysRevLett.108.260505DOI Listing
June 2012

Vertebral fractures in patients with inflammatory bowel disease compared with a healthy population: a prospective case-control study.

BMC Gastroenterol 2012 May 14;12:47. Epub 2012 May 14.

Medicine Department, University of Seville, Seville, Spain.

Background: A prospective study was performed to compare the prevalence of morphometric vertebral fractures (MVF) between patients with inflammatory bowel disease (IBD) and healthy subjects and to identify predictive factors of fracture.

Methods: A total of 107 patients with IBD (53 with Crohn's disease and 54 with ulcerative colitis) and 51 healthy subjects participated in the study. Information about anthropometric parameters, toxins, previous fractures, and parameters related to this disease were evaluated. The index of vertebral deformity, bone mass density (BMD), and biochemical parameters were calculated.

Results: A total of 72 fractures were detected in 38.32% of patients with IBD, and 10 fractures were detected in 13.73% of healthy subjects; the risk of fracture in patients with IBD was higher than that in control subjects (OR, 4.03; 95% CI, 1.652-9.847; p < 0.002). We found no correlation between fracture and BMD in patients with IBD (lumbar spine, r = -0.103, p = 0.17 and femoral neck, r = -0.138, p = 0.07). Corticosteroid treatment was not associated with prevalent vertebral fractures nor with taking corticosteroids (r = 0.135, p = 0.14) or the duration for which they were taken (r = 0.08, p = 0.38), whereas this relationship was present in the controls (r = -0.365, p = 0.01). In the multivariate analysis, none of the measured parameters were significantly predictive of fracture, only to manifested IBD. Hypovitaminosis D was observed in 55.14% of patients with IBD.

Conclusions: The prevalence of morphometric vertebral fractures is higher in patients with IBD than in the healthy population, without association with BMD or corticoid treatment. Simply having IBD was proven to be a predictive factor of fracture. We observed a high incidence of hypovitaminosis D in patients with IBD.
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http://dx.doi.org/10.1186/1471-230X-12-47DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3438096PMC
May 2012

Applications of finite element simulation in orthopedic and trauma surgery.

World J Orthop 2012 Apr;3(4):25-41

Antonio Herrera, Antonio Lobo-Escolar, Jesús Mateo, Department of Orthopaedic and Trauma Surgery, Miguel Servet University Hospital, Medicine School, University of Zaragoza, 50009 Zaragoza, Spain.

Research in different areas of orthopedic and trauma surgery requires a methodology that allows both a more economic approach and the ability to reproduce different situations in an easy way. Simulation models have been introduced recently in bioengineering and could become an essential tool in the study of any physiological unity, regardless of its complexity. The main problem in modeling with finite elements simulation is to achieve an accurate reproduction of the anatomy and a perfect correlation of the different structures, in any region of the human body. Authors have developed a mixed technique, joining the use of a three-dimensional laser scanner Roland Picza captured together with computed tomography (CT) and 3D CT images, to achieve a perfect reproduction of the anatomy. Finite element (FE) simulation lets us know the biomechanical changes that take place after hip prostheses or osteosynthesis implantation and biological responses of bone to biomechanical changes. The simulation models are able to predict changes in bone stress distribution around the implant, so allowing preventing future pathologies. The development of a FE model of lumbar spine is another interesting application of the simulation. The model allows research on the lumbar spine, not only in physiological conditions but also simulating different load conditions, to assess the impact on biomechanics. Different degrees of disc degeneration can also be simulated to determine the impact on adjacent anatomical elements. Finally, FE models may be useful to test different fixation systems, i.e., pedicular screws, interbody devices or rigid fixations compared with the dynamic ones. We have also developed models of lumbar spine and hip joint to predict the occurrence of osteoporotic fractures, based on densitometric determinations and specific biomechanical models, including approaches from damage and fracture mechanics. FE simulations also allow us to predict the behavior of orthopedic splints applied to the correction of deformities, providing the recovering force-displacement and angle-moment curves that characterize the mechanical behavior of the splint in the overall range of movement.
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http://dx.doi.org/10.5312/wjo.v3.i4.25DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3329620PMC
April 2012

Nanohardness and Residual Stress in TiN Coatings.

Materials (Basel) 2011 May 17;4(5):929-940. Epub 2011 May 17.

Centro de Innovación, Investigación y Desarrollo en Ingeniería y Tecnología (CIIDIT), Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México C.P. 66450, México.

TiN films were prepared by the Cathodic arc evaporation deposition method under different negative substrate bias. AFM image analyses show that the growth mode of biased coatings changes from 3D island to lateral when the negative bias potential is increased. Nanohardness of the thin films was measured by nanoindentation, and residual stress was determined using Grazing incidence X ray diffraction. The maximum value of residual stress is reached at -100 V substrate bias coinciding with the biggest values of adhesion and nanohardness. Nanoindentation measurement proves that the force-depth curve shifts due to residual stress. The experimental results demonstrate that nanohardness is seriously affected by the residual stress.
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http://dx.doi.org/10.3390/ma4050929DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5448585PMC
May 2011

A proposition against using the terms "Hispanic" and "Latino" in research on HIV-associated neurocognitive disorders.

Ethn Dis 2010 ;20(4):479-84

Department of Psychiatry at Cedars Sinai Medical Center, 8730 Alden Dr, E-106, Los Angeles, CA 90048, USA.

In the United States, the term "Hispanic" has been used to refer to a person or groups of persons who originate from Spanish-speaking countries. However, this term fails to account for variables such as nationality, ethnicity, race, and cultural origin as well as the extent of assimilation to a new culture. In addition, factors such as the individual's generation, specific migratory status, years of education in each country, fluency, and day-to-day language usage contribute to variance in neuropsychological testing outcomes, which are sensitive to these factors. We have noted that the usage of the terms "Hispanic" and "Latino" is problematic in HIV-associated neurocognitive disorder (HAND) research; therefore, we propose grouping individuals by nationality or by the Spanish-speaking culture to which they belong. The rationale for not using these terms is based upon the sociodemographic findings among Spanish speakers infected with HIV and how these terms inadequately describe the rich heterogeneity of this population.
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March 2011

A comparison of screening batteries in the detection of neurocognitive impairment in HIV-infected Spanish speakers.

Neurobehav HIV Med 2011;3:79-86

National Neurological AIDS Bank, Department of Neurology, David Geffen School of Medicine at UCLA.

Background: A substantial number of Spanish-speaking individuals from Mexico and Central America are now living in the United States. These individuals are at heightened risk for HIV infection and, due to late diagnosis and limited resources, for HIV-associated neurocognitive disorders (HAND). Early detection is key, yet adequate methods for detecting HAND in Spanish speakers, especially in resource-poor areas, remains problematic. Therefore, it is necessary to identify accurate yet efficient neurocognitive screening tools that are appropriate for use in resource-limited AIDS clinics serving Spanish-speaking patients.

Methods: Twenty-one Spanish-speaking, HIV-positive adults who migrated from Mexico or Central America underwent neuromedical and neurocognitive evaluation in Spanish. The concordance of three neurocognitive screening measures (the HIV Dementia Scale [HDS], the Mini-Mental State Examination [MMSE], and the NEUROPSI) with a comprehensive neuropsychological battery was examined. In addition, accuracy in detecting neurocognitive impairment using standard and alternative cutoff scores was examined.

Results: The HDS and the NEUROPSI showed high correlation with the comprehensive neuropsychological battery. The HDS and the NEUROPSI also had the highest sensitivity (67% and 75%, respectively) and specificity (50% and 38%, respectively). Both measures also showed greater sensitivity than the MMSE to very mild forms of HAND.

Conclusion: In this small sample of HIV-positive Spanish speakers from Mexico and Central America living in the United States, the HDS and the NEUROPSI demonstrated reasonable accuracy in detecting neurocognitive impairment, while the MMSE demonstrated very poor accuracy. The HDS and the NEUROPSI were equally sensitive in detecting mild HAND. Continued test development is required to capture this disorder, especially in resource-limited settings.
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http://dx.doi.org/10.2147/NBHIV.S22553DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4593057PMC
January 2011

Normative scores for a brief neuropsychological battery for the detection of HIV-associated neurocognitive disorder (HAND) among South Africans.

BMC Res Notes 2010 Jan 29;3:28. Epub 2010 Jan 29.

Department of Psychiatry, University of Kwa-Zulu Natal, Durban, South Africa.

Background: There is an urgent need to more accurately diagnose HIV-associated neurocognitive disorder (HAND) in Africa. Rapid screening tests for HIV-associated dementia are of limited utility due to variable sensitivity and specificity. The use of selected neuropsychological tests is more appropriate, but norms for HIV seronegative people are not readily available for sub-Saharan African populations. We sought to derive normative scores for two commonly used neuropsychological tests that generate four test scores -- namely the Trail-Making Test (Parts A and B) and the Digit Span Test [Forward (DSF) and Backward (DSB)]. To assess memory and recall, we used the memory item of the International HIV Dementia Scale (IHDS).

Findings: One hundred and ten HIV seronegative participants were assessed at McCord Hospital, Durban, South Africa between March 3rd and October 31st, 2008. We excluded people with major depressive disorder, substance use abuse and dependence and head injuries (with or without loss of consciousness). All the participants in this study were African and predominantly female with an average age of 28.5 years and 10 years of education. Age and gender influenced neuropsychological functioning, with older people performing worse. The effect of gender was not uniform across all the tests.

Conclusion: These two neuropsychological tests can be administered with the IHDS in busy antiretroviral clinics. Their performance can be measured against these norms to more accurately diagnose the spectrum and progression of HAND.
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http://dx.doi.org/10.1186/1756-0500-3-28DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2843737PMC
January 2010

Selection of ecological indicators for the conservation, management and monitoring of Mediterranean coastal salinas.

Environ Monit Assess 2010 Jul 29;166(1-4):241-56. Epub 2009 May 29.

Department of Ecology, Almería University, 04120, Almería, Spain.

Salinas systems are artificial wetlands which are interesting from the viewpoint of nature conservation. They play an important role both as habitats for migratory waterbird species and as nodes of biotic connectivity networks. In the Mediterranean basin, where the coastal salinas are highly significant as alternative and complementary habitats for waterbirds, a process of abandonment occurs, and many seminatural systems of this kind are disappearing. This abandonment is having serious consequences for migratory bird populations and for the ecological role these play. In the present paper, this group of waterbird species has been used to evaluate these wetlands for conservation purposes. We have developed a methodological approach for the selection of ecological indicators for the conservation and management of these Mediterranean habitats and waterbird assemblages, the main consumers therein. The stepwise procedure developed constitutes a practical tool for this task. Application thereof enabled us to differentiate the habitats available for the waterbirds and to identify the biotic and abiotic indicators for the maintenance and management of the salina ecosystems. These variables can then be incorporated into monitoring programs.
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http://dx.doi.org/10.1007/s10661-009-0998-2DOI Listing
July 2010

Report on psychoactive drug use among adolescents using ayahuasca within a religious context.

J Psychoactive Drugs 2005 Jun;37(2):141-4

Addiction Unit (PROAD ), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.

Ritual use of ayahuasca within the context of the Brazilian ayahuasca churches often starts during late childhood or early adolescence. Premature access to psychoactive drugs may represent a risk factor for drug misuse. Conversely, religious affiliation seems to play a protective role in terms of substance abuse. The objective of this study was to describe patterns of drug use in a sample of adolescents using ayahuasca within a religious setting. Forty-one adolescents from a Brazilian ayahuasca sect were compared with 43 adolescents who never drank ayahuasca. No significant differences were identified in terms of lifetime substance consumption. Throughout the previous year period, ayahuasca adolescents used less alcohol (46.31%) than the comparison group (74.4%). Recent use of alcohol was also more frequent among the latter group (65.1%) than among ayahuasca drinkers (32.5%). Although not statistically significant, slight differences in terms of patterns of drug use were definitely observed among groups. Despite their early exposure to a hallucinogenic substance, adolescents using ayahuasca in a controlled setting were mostly comparable to controls except for a considerably smaller proportion of alcohol users. Religious affiliation may have played a central role as a possible protective factor for alcohol use. Thus, ayahuasca seems to be a relatively safe substance as far as drug misuse is concerned.
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http://dx.doi.org/10.1080/02791072.2005.10399794DOI Listing
June 2005

Ayahuasca in adolescence: Qaualitative results.

J Psychoactive Drugs 2005 Jun;37(2):135-9

Department of Psychiatry and Human Behavior, University of California, Irvine, USA.

Qualitative research was conducted in Brazil among 28 ayahuasca-consuming adolescents members of the União do Vegetal Church, and 28 adolescents who never used ayahuasca. They were compared on a number of qualitative variables, including vignettes measuring moral and ethical concerns. Psychocultural studies utilizing co-occurences of variables in the realm of qualitative studies are useful in understanding and complementing quantitative studies also conducted among this population. Qualitative data show that the teens in the União do Vegetal religion appear to be healthy, thoughtful, considerate and bonded to their families and religious peers. This study examines the modern use of a powerful hallucinogenic compound within a legal religious context, and the youth who participated in these ayahuasca religious ceremonies (usually with parents and other family members) appeared not to differ from their nonayahuasca-using peers. This study helps to elucidate the full range of effects of plant hallucinogenic use within a socially-sanctioned, elder-facilitated and structured religious context.
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http://dx.doi.org/10.1080/02791072.2005.10399793DOI Listing
June 2005