119Sn Mössbauer spectroscopy is used in combination with 7Li MAS NMR spectroscopy and X-ray diffraction to resolve the details of the different Li−Sn and Li−Sb intermetallics formed during the ...electrochemical reactions of nominal “SnSb” compounds inside a lithium battery. At a Li/SnSb ratio of 2.02, the Mössbauer spectrum indicates that the initial structure of the compounds are not deeply affected during the first steps of discharging. At 4.95 Li/SnSb, each spectrum consists of three components. The hyperfine parameters agree well with those of β-Sn and a LiSn-related solid. At 7.27 Li/SnSb, the spectra reveal that no metallic Sn is present. During cell charging, the appearance of a poorly crystalline Li13Sn5 phase is detected at 8.9 Li/SnSb. NMR data show signals resulting from ionic Li of the passivating layer and from Li−Sn and Li−Sb intermetallics at downfield and upfield shifts, respectively, which depart from those observed in bulk solids. The partial recovery of the stistaite structure at the end of charging is confirmed in SnSb single-phase electrodes, whereas the opposite is true for mixtures of tin and antimony.
Purpose
Mental health is one of the priorities of the European Commission. Studies of the use and cost of mental health facilities are needed in order to improve the planning and efficiey of mental ...health resources. We analyze the patterns of mental health service use in multiple clinical settings to identify factors associated with high cost.
Subjects and methods
22,859 patients received psychiatric care in the catchment area of a Spanish hospital (2000–2004). They had 365,262 psychiatric consultations in multiple settings. Two groups were selected that generated 80% of total costs: the medium cost group (
N
= 4,212; 50% of costs), and the high cost group (
N
= 236; 30% of costs). Statistical analyses were performed using univariate and multivariate techniques. Significant variables in univariate analyses were introduced as independent variables in a logistic regression analysis using “high cost” (>7,263$) as dependent variable.
Results
Costs were not evenly distributed throughout the sample. 19.4% of patients generated 80% of costs. The variables associated with high cost were: age group 1 (0–14 years) at the first evaluation, permanent disability, and ICD-10 diagnoses: Organic, including symptomatic, mental disorders; Mental and behavioural disorders due to psychoactive substance use; Schizophrenia, schizotypal and delusional disorders; Behavioural syndromes associated with physiological disturbances and physical factors; External causes of morbidity and mortality; and Factors influencing health status and contact with health services.
Discussion
Mental healthcare costs were not evenly distributed throughout the patient population. The highest costs are associated with early onset of the mental disorder, permanent disability, organic mental disorders, substance-related disorders, psychotic disorders, and external factors that influence the health status and contact with health services or cause morbidity and mortality.
Conclusion
Variables related to psychiatric diagnoses and sociodemographic factors have influence on the cost of mental healthcare.
Objetive: To analize the impact on outcome of residual disease (RD) determined by multiparametric flow cytometry (MFC) in bone marrow (BM) before allogenic stem cell transplantation (ASCT), in ...patients with acute myeloid leukemia (AML). Patients and methods: We performed a retrospective analysis of 37 consecutive patients diagnosed with AML who underwent an ASCT in our Unit between June 1996 and April 2007. We collected data of RD on BM by MFC on the 30 days previous to the transplant procedure. The leukemia-associated phenotype was detected by MFC in all cases at diagnosis and/or in relapse and was used for monitoring RD. Results: Median age of patients in our cohort was 40 years (range 10-66), 19 males and 18 females, 32 patients received a transplant from an HLA-identical sibling donor and 5 from an HLA-identical unrelated donor. Six patients received a reduced intensity conditioning regimen. In 33 cases peripheral blood was used as source of stem cells and bone marrow in the other 4. All the patients had received at least 2 cycles of chemotherapy before transplant. Twenty nine were in complete remission (CR) (26 in first CR and 3 in second or >2ndCR) and 8 had active disease (2 in early relapse and 6 with refractory disease). Eleven patients had high-risk cytogenetics at diagnosis. With a median follow up after transplantation of 9 months (range 5-161) 10 patients (27%) relapsed. At 4 years, disease free survival (DFS) and overall survival (OS) were 59% and 75% respectively. On the group who underwent transplant with active disease (n=8). The median survival of this group was 24 months. Two of the 8 patients are alive and in CR. RD value were very varied, median 0,88% (0,2%-9%). Those patients with a RD <0,4% presented a superior DFS than patients with RD >0,4% (median not reached (MNR) versus 80 months; p=0,044). OS was higher in patients with RD <0,4%, although the survival advantage was not statistically significant (MNR versus 140 months; p>0,05). DFS and OS were better in the group of intermediate risk cytogenetics than in the group of high-risk cytogenetics (MNR versus 30,5 months; p=0,04 and MNR versus 10.sup.6 months; p=0,015). Conclusions: Detection of high levels of RD before transplantation and high-risk cytogenetics at diagnosis are associated with high risk of relapse after ASCT. These factors should be helpful to identify groups of patients who need new approaches to reduce postransplant relapses.
to assess the effectiveness of ambulatory rubber band ligation (RBL) in the treatment of symptomatic internal haemorrhoids and to identify factors related to relapse.
prospective study of 232 ...patients treated with rubber band ligation for symptomatic haemorrhoids (grade I-III or grade IV with severe contraindication for surgery) from November 1996 to November 2000 at the outpatient clinic. Ligation was performed with a Stille AB (Comedic) ligator and suction pump, placing 1-3 bands per session and with up to three sessions per patient. Effectiveness of treatment was defined as the absence of symptoms and was confirmed by anoscopy by checking the residual scar after the cushions' detachment. Categorical variables were compared using the shi-squared test, whereas Student's t-test was used for continuous variables. Logistic regression was employed to identify clinical factors related to relapse.
a total of 331 bands were placed during 235 sessions in the 163 patients who completed follow-up (70%). Mean age was 45.6 years, with males accounting for 64.4%. Most patients (86.5%) had grade II or grade III haemorrhoids. Overall morbidity was 6%. The most frequent complications were rectal tenesmus (11%), slight or mild anal pain (7.4%), dysuria (4.3%) and transient anal bleeding (3.7%). The treatment was effective in 86% of patients after a mean follow-up of 32 months. Efficacy was high for grades I and II (100% and 97.4% ) but decreased for grade III (69.8%; p<0.001) and grade IV (0%; p<0.001). Most relapses occurred within the first 24 months (87%) and were not significantly related to age, gender, duration of symptoms, itching, bleeding, pain, tenesmus or bowel habit, but were significantly related to the presence of prolapse and its grade (p<0.001), and to the involvement of left posterior, right lateral and anterior pedicles (p<0.05).
ambulatory RBL is a safe and effective treatment for grade I, II and III symptomatic haemorrhoids, and is associated with low morbidity. Recurrence is uncommon and occurs mainly within the first 24 months, being related to the presence and grade of prolapse as well as to its location, but bears little relation to the rest of factors analysed.
Introduction: performing anal endosonography in complex fistula-in-ano allows us to design a personalized surgical strategy in each case, thereby improving results. However, there are doubts in the ...literature as to its utility in recurrent complex fistulas. The aim of this study was to compare the utility of anal ultrasonography in the study of primary versus recurrent complex fistula-in-ano. Patients and method: prospective study of patients diagnosed and treated for complex fistula-in-ano. Physical examination and anal ultrasonography provided data on primary track, internal opening, horseshoe extension and the presence of secondary tracks or cavities in a protocol designed specifically for the study. These assessments were subsequently contrasted with operative findings. Results: we included 35 patients, 19 (54.3%) with primary complex anal fistulas and 16 (45.7%) with recurrent fistulas. According to the operative findings, fistulas were classified as high transsphincteric in 28 patients (80%), suprasphincteric in 6 (17.1%) and extrasphincteric in one patient (2.9%), with no differences between groups. Physical examination correctly classified 28 of the 35 fistulous tracks, in contrast to the 32 (91.4%) correctly described on ultrasonography (80%). We did not find any statistically significant differences between the primary and the recurrent fistula groups with regard to sensibility, positive predictive value and accuracy of the anal ultrasonography for any of the parameters studied. Conclusion: the accuracy of anal ultrasonography does not decrease in recurrent complex fistula-in-ano.
Polycrystalline samples of CrSb
2 have been obtained by direct synthesis and allowed to react with lithium in electrochemical cells of the type: Li
∣
LiPF
6(EC:DEC)
∣
CrSb
2. The cathode contained ...graphite additives to improve the electrical conductivity of the solid during the first steps of discharge. The discharge of the cell under galvanostatic intermittent titration and continuous discharge at C/4 revealed a main process at ca. 0.6 V leading to the simultaneous destruction of the CrSb
2 structure and formation of lithium antimonide, without direct evidence of the topotactic formation of a ternary compound containing lithium. The galvanostatic cycling of the cells reveal capacities above 300 mA h g
−1 during the first few cycles and a progressive loss of capacity on prolonged cycling. The performance of the cells shows a significant improvement from the use of pure antimony electrodes, due to the presence of the metallic side product chromium.
Observations of 28SiO v=0 J=1-0 line emission (7-mm wavelength) from AGB stars show in some cases peculiar profiles, composed of a central intense component plus a wider plateau. Very similar ...profiles have been observed in CO lines from some AGB stars and most post-AGB nebulae and, in these cases, they are clearly associated with the presence of conspicuous axial symmetry and bipolar dynamics. We present systematic observations of 28SiO v=0 J=1-0 emission in 28 evolved stars, performed with the 40~m radio telescope of the IGN in Yebes, Spain. We find that the composite core plus plateau profiles are almost always present in O-rich Miras, OH/IR stars, and red supergiants. They are also found in one S-type Mira (\(\chi\) Cyg), as well as in two semiregular variables (X Her and RS Cnc) that are known to show axial symmetry. In the other objects, the profiles are simpler and similar to those of other molecular lines. The composite structure appears in the objects in which SiO emission is thought to come from the very inner circumstellar layers, prior to dust formation. The central spectral feature is found to be systematically composed of a number of narrow spikes, except for X Her and RS Cnc, in which it shows a smooth shape that is very similar to that observed in CO emission. These spikes show a significant (and mostly chaotic) time variation, while in all cases the smooth components remain constant within the uncertainties. The profile shape could come from the superposition of standard wide profiles and a group of weak maser spikes. Alternatively, we speculate that the very similar profiles detected in objects that are axisymmetric may be indicative of the systematic presence of a significant axial symmetry in the very inner circumstellar shells around AGB stars; the presence of such symmetry would be independent of the probable weak maser effects in the central spikes.
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