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The purpose of this study was to analyse the reliability and validity of a semi-quantitative FFQ to assess food group consumption in South American children and adolescents.
The SAYCARE (South American Youth/Child cARdiovascular and Environmental) study is an observational, multicentre, feasibility study performed in a sample of 3- to 18-year-old children and adolescents attending private and public schools from six South American countries. Participants answered the FFQ twice with a two-week interval and three 24-h dietary recalls. Intraclass and Spearman’s correlations, weighted Cohen’s kappa (κw), percentage of agreement and energy-adjusted Pearson’s correlation coefficients were calculated.
Seven cities in South America (Buenos Aires, Lima, Medelin, Montevideo, Santiago, Sao Paulo and Teresina).
A sample of 200 children and 244 adolescents for reliability analyses and 252 children and 244 adolescents for validity analyses were included.
Depending on the food group, for children and adolescents, reliability analyses resulted in Spearman’s coefficients from 0·47 to 0·73, intraclass correlation coefficients from 0·66 to 0·99, κw coefficients from 0·35 to 0·63, and percentage of agreement between 72·75 and 83·52 %. In the same way, validity analyses resulted in Spearman’s coefficients from 0·17 to 0·37, energy-adjusted Pearson’s coefficients from 0·17 to 0·61, κw coefficients from 0·09 to 0·24, and percentages of agreement between 45·79 and 67·06 %.
The SAYCARE FFQ achieved reasonable reliability and slight-moderate validity for almost all food groups intakes. Accordingly, it can be used for the purpose of ranking the intake of individuals within a population.
This paper aims to critically appraise the incorporation of opium poppy into medical practice in Song-dynasty China. By analysing materia medica and formularies, along with non-medical sources from the Song period, this study sheds light on the role of Chinese Buddhist monasteries in the process of incorporation of foreign plants into Chinese medicine. It argues that Buddhist monasteries played a significant role in the evolution of the use of opium poppy in Song dynasty medicine. This is because the consumption practices in Buddhist monasteries inspired substantial changes in the medical application of the flower during the Southern Song dynasty. While, at the beginning of Song dynasty, court scholars incorporated opium poppy into official materia medica in order to treat disorders such as huangdan and xiaoke, as well as cinnabar poisoning, this study of the later Song medical treatises shows how opium poppy was repurposed to treat symptoms such as diarrhoea, coughing and spasms. Such a shift in the medical use of the poppy occurred after Chinese literati and doctors became acquainted with the role of the flower in the diet and medical practices of Buddhist monks across China. Therefore, the case study of the medical application of opium poppy during the Song dynasty provides us with insights into how the spread of certain practices in Buddhist monasteries might have contributed to the change in both professional medical practices and daily-life healthcare in local communities in that period.
Traditionally a focus on functional recovery in mental illness was seen as something that happened, if at all, after symptoms had been dealt with. In the context of staging, this would be in the later stages of more established illness. Recent research has shown that a focus on functional recovery goals is a necessary part of early stage interventions (stages 1 and 2) both as a means to the prevention of disability and for long term functional recovery. In practice, this means that young people with mental illness need attention not only to their mental health symptoms, but also to the areas of functioning that restrict their capacity to live a fulfilled life in the community from their earliest contacts with mental health services. This is because despite improvements in medications and psychological therapies, people with mental illness still have poor outcomes in functional domains such as vocation, physical health, housing, and incarceration. This chapter reviews two of these areas: vocational functioning and physical health. It examines the extent of these issues, provides guidance on evidence-based interventions, and highlights evidence gaps, and considers new modes of intervention based on better utilisation of existing and emerging technologies. For clinicians working with young people with mental ill health, it is imperative to address functional recovery as part of the core treatment of early stage illness. To this end the chapter also details the clinical and research lessons in each of these areas.
Vaccination coverage (VC) against pertussis can increase when management practices and policies at primary care centres (PCCs) are reinforced. From 2011 to 2015, we performed a case–control study to evaluate VC among pertussis patients treated at PCCs in Barcelona, Spain. We recorded pertussis in patients from 8- to 16-year-olds at 52 PCCs. Pertussis cases had laboratory diagnostic and controls were healthy outpatients visiting the same facility for reasons other than cough. DTaP/dTap VC was recorded as either proper vaccination status (five doses recorded) or improper vaccination status (<5 doses recorded). We used a logistic regression model to estimate OR and 95% CI. We included 229 cases and 576 controls. VC was higher in cases (mean 5.01, s.e.: 0.57) than in controls (4.89, s.e.: 0.73). Around 69% of the cases had received DTaP primary immunisation after 2–5 years and 31.4% of cases had the dTap booster immunisation after 7–10 years. The 87% of children 5–9 years were properly vaccinated. We found no protection from becoming ill among properly vaccinated children (OR 1.87; 95% CI 1.22–2.85). The highest VC was observed in patients with confirmed pertussis, which was likely due to a more exhaustive follow-up of the VC in these patients. Being properly vaccinated against pertussis will probably not increase VC.
Trichomonas vaginalis is an extracellular parasite that colonizes the human urogenital tract leading to trichomoniasis, the most common sexually-transmitted non-viral disease worldwide. The immune response plays a critical role in the host defense against this parasite. Trichomonas' DNA contains unmethylated CpG motifs (CpGDNA) that in other microorganisms act as modulators of the immune response. However, the molecular mechanisms responsible for CpGDNA immune modulation are still unclear. As macrophages participate in the first line of defense against infection, we investigated the type of immune response of murine macrophages to T. vaginalis DNA (TvDNA). We observed high expression of the proinflammatory cytokines IL-6 and IL-12p40 in macrophages stimulated with TvDNA. In contrast, the anti-inflammatory response, assessed by IL-10 and IL-13 mRNA expression was delayed. This suggests that the immune response induced by TvDNA is modulated through cytokine production, mediated partly by NADPH-oxidase activity, as TvDNA induced reactive species of oxygen production and a rounded morphology in macrophages indicative of an M1 phenotype. Furthermore, infected mice pretreated with TvDNA displayed persistent vulvar inflammation and decreased parasite viability consistent with higher proinflammatory cytokine levels during infection compared to untreated mice. Overall, our findings suggest that TvDNA pretreatment modulates the immune response favouring parasite elimination.
Ternary Sn-Sb-S thin films with remarkable optical, electrical and structural properties were developed by chemical bath deposition. Tin and antimony chlorides and thioacetamide were used as tin, antimony, and sulfur ion sources, respectively, while tartaric acid was used as a complexing agent. XRD analysis of as-deposited films showed a combination of binary phases of SnS, Sn2S3, and Sb2S3, while after thermal treatment in nitrogen at 400 °C, the films became crystalline showing well-defined reflections of the ternary SnSb2S4. The heating also influenced the morphology, compactness, and thickness of the films. On the other hand, all the films showed an absorption coefficient higher than 104 cm-1, while the optical band gap of the as-deposited film decreased from 1.49 to 1.37 eV after heating at 400 °C. In addition, the photoconductivity of the films prior to heating was of 10-9 Ω-1 cm-1, while after that at 400 °C was of 10-7 Ω-1 cm-1. The evaluation of the ternary film in solar cells gave an open-circuit voltage Voc of 448 mV and short-circuit current density of Jsc of 2.4 mA/cm2.
Within out-of-hospital emergencies, primary health care (PHC) nurses must face life-threatening emergencies (LTEs), which are defined as “a situation associated with an imminent life risk that entails the start-up of resources and special means to resolve the situation.”
The objectives of this study were to know the training received for out-of-hospital LTEs by PHC nurses of Asturias, Spain and the perception they have about their theoretical knowledge and practical skills in a series of emergency procedures or techniques used in LTE emergencies; as well as to analyze the differences according to the geographical area of their work.
Cross-sectional, descriptive, and observational study was conducted in 2018 of a sample of PHC service nurses of Asturias, Spain.
A total of 236 nurses from PHC service centers of Asturias, Spain, from among the total of 730 nurses who make up the staff of nurses of the PHC service of Asturias, between April and May 2018, were surveyed. The survey was designed ad hoc using the Doctrinal Body of Emergency Nursing (DBEN) proposed by the Spanish Society of Emergency Medicine (SEMES; Madrid, Spain), which indicates the theoretical and practical procedures that must be acquired by the PHC nurses. It is composed of 37 procedures or techniques employed in LTEs using an 11-point Likert scale rating to detect their self-perception about theoretical knowledge and practical skills from zero (“Minimum”) to ten (“Maximum”).
There were significant differences in the mean of theoretical knowledge and practical skills in many procedures or techniques studied, depending on the different areas of work.
All PHC nurses must be perfectly trained to provide initial quality assistance to the LTE, with both theoretical and practical knowledge of the different techniques, so that it can continue to be attended by the corresponding Emergency Service.
On 16 March 2018, a nursing home notified a possible acute gastroenteritis outbreak that affected 11 people. Descriptive and case–control studies and analysis of clinical and environmental samples were carried out to determine the characteristics of the outbreak, its aetiology, the transmission mechanism and the causal food. The extent of the outbreak in and outside the nursing home was determined and the staff factors influencing propagation were studied by multivariate analysis. A turkey dinner on March 14 was associated with the outbreak (OR 4.22, 95% CI 1.11–16.01). Norovirus genogroups I and II were identified in stool samples. The attack rates in residents, staff and household contacts of staff were 23.49%, 46.22% and 22.87%, respectively. Care assistants and cleaning staff were the staff most frequently affected. Cohabitation with an affected care assistant was the most important factor in the occurrence of cases in the home (adjusted OR 6.37, 95% CI 1.13–36.02). Our results show that staff in close contact with residents and their household contacts had a higher risk of infection during the norovirus outbreak.
Here, different tissue surfaces of tomato root were characterized employing atomic force microscopy on day 7 and day 21 of growth through Young's modulus and plasticity index. These parameters provide quantitative information regarding the mechanical behavior of the tomato root under fresh conditions in different locations of the cross-section of root [cell surface of the epidermis, parenchyma (Pa), and vascular bundles (Vb)]. The results show that the mechanical parameters depend on the indented region, tissue type, and growth time. Thereby, the stiffness increases in the cell surface of epidermal tissue with increasing growth time (from 9.19 ± 0.68 to 13.90 ± 1.68 MPa) and the cell surface of Pa tissue displays the opposite behavior (from 1.74 ± 0.49 to 0.48 ± 0.55); the stiffness of cell surfaces of Vb tissue changes from 10.60 ± 0.58 to 6.37 ± 0.53 MPa, all cases showed a statistical difference (p < 0.05). Viscoelastic behavior dominates the mechanical forces in the tomato root. The current study is a contribution to a better understanding of the cell mechanics behavior of different tomato root tissues during growth.
How does international migration affect political parties’ electoral strategies in the sending countries? This article argues that remittances help political parties decide whom to target during elections. Drawing from theories of vote targeting and those on the effects of remittances, this study addresses how political parties’ electoral strategies follow the specific characteristics of remittance recipients. Using individual-level data from Mexico’s 2006 presidential elections, the results show that receiving remittances had a significant impact on experiencing electoral targeting, especially by the then-incumbent PAN. This study reveals the importance of remittances in shaping the strategies of Mexican political parties.
To compare functional endoscopic sinus surgery with a combined approach (functional endoscopic sinus surgery plus Caldwell–Luc procedure) for the treatment of paediatric antrochoanal polyp, in terms of antrochoanal polyp recurrence and safety.
This retrospective case series comprises 27 paediatric patients with recurrent antrochoanal polyp, treated from January 2010 to January 2018.
The average age of the patients at the time of diagnosis was 10.4 ± 2.49 years. The recurrence rate after functional endoscopic sinus surgery alone was 72.9 per cent, compared with 12.5 per cent after functional endoscopic sinus surgery plus the Caldwell–Luc procedure (p < 0.00001). No complications were reported during surgery or follow up.
The correct identification of the origin of the antrochoanal polyp and an adequate returning of maxillary ventilation by widening the ostium can prevent recurrences. Although functional endoscopic sinus surgery continues to be the ‘gold standard’ for antrochoanal polyp treatment, in cases of revision surgery, a combined approach could ensure the complete removal of the polyp through the two openings.
Transposition of the great arteries is the most common cyanotic cardiac lesion in newborns. Transposition of the great arteries without surgical correction is fatal during the first year of life. Contemporary outcome studies have shown that survival rates after surgery are excellent and most patients live to adulthood.
Woman with complex transposition of the great arteries with atrial and ventricular septal defects and subvalvular and valvular pulmonary stenosis, who has survived until the age of 31 years without surgery. The diagnosis was made by echocardiography and cardiac magnetic resonance. She underwent successful corrective surgical treatment after this age, by means of a Jatene operation.
In transposition of the great arteries patients, a high index of cases dies in the first month of life. Our case represents a natural history of the complex transposition of the great arteries. Non-invasive imaging studies are very useful for the diagnosis and follow-up of patients with transposition of the great arteries, especially echocardiography and cardiac magnetic resonance. In our case, the multimodality approach and the corrective surgery allowed her to survive.
The Centro de Laseres Pulsados in Salamanca, Spain has recently started operation phase and the first user access period on the 6 J 30 fs 200 TW system (VEGA 2) already started at the beginning of 2018. In this paper we report on two commissioning experiments recently performed on the VEGA 2 system in preparation for the user campaign. VEGA 2 system has been tested in different configurations depending on the focusing optics and targets used. One configuration (long focal length
cm) is for underdense laser–matter interaction where VEGA 2 is focused onto a low density gas-jet generating electron beams (via laser wake field acceleration mechanism) with maximum energy up to 500 MeV and an X-ray betatron source with a 10 keV critical energy. A second configuration (short focal length
cm) is for overdense laser–matter interaction where VEGA 2 is focused onto a
thick Al target generating a proton beam with a maximum energy of 10 MeV and temperature of 2.5 MeV. In this paper we present preliminary experimental results.
The rules international organizations (IOs) make deviate considerably from the traditional sources of international law in Article 38 of the International Court of Justice's (ICJ) Statute and the ways those are understood: as generated, enforced, and interpreted by states based on their consent. As this panel demonstrates, IO “rules” take various forms—e.g., guidelines, recommendations, and standards—and are promulgated by not only traditional interstate organizations but public/private hybrids, transnational networks involving agencies inside states, private associations of industry or other experts, or subsidiary committees of the parties (COPs) or meetings of the parties (MOPs). These rules enjoy varying degrees of authoritativeness, often purport to have some impact on state and non-state actors, and depart, sometimes quite openly, from reliance on state consent. And even when IOs turn to the traditional sources—treaties, custom, general principles—these take untraditional forms that blur distinctions between binding and non-binding law. Whether these governance efforts are described as systems of “global administrative law,” “global constitutionalism,” or “transnational legal orders” or as new forms of “international public law,” they are certainly different from your grandmother's public international law. Like “soft” law before it, these governance efforts have drawn the ire of legal positivists who ask, with some justice, what is meant by “law” if everyone (public, private, and in-between) is a potential “lawmaker” and no one can be certain about whether their efforts entail legal responsibility and, if so, for whom.
The case law on non-precluded measures clauses, when they are successful, and the customary rule of necessity, when it fails, transfers significant risks to foreign investors and host States, respectively, during severe economic crises. Some risk-sharing mechanisms should be explored to achieve a more balanced result. This article presents the policy reasons in support of this approach and its normative basis: the principle of acceptable compensation, and illustrates that one way to introduce such mechanisms is through the determination by investor/State tribunals of the length of the breakdown, which is marked by the dates for its beginning and end. The article discusses economic research on when crises conclude, which could be useful to tribunals, and explores the determination on the beginning of economic collapses as a risk-sharing tool and shows how decisions of the Argentinean saga have achieved this result.
The aim of this study was to develop a feasible and effective strategy to involve patients in the Spanish Network of Agencies of Health Technology Assessment (RedETS).
The framework for patient involvement (PI) in the assessment activities and processes of RedETS were developed through a research project that included: (i) a systematic search of the international literature describing a strategy and/or a methodology linking health technology assessment (HTA) and PI; (ii) a qualitative study through interviews with RedETS members to analyze the perceptions of PI among HTA managers in the Spanish context; (iii) a Delphi consultation with three large platforms of patients, carers and consumer organizations in Spain about their perspectives of PI; (iv) a consensus process with the members of the RedETS Governing Council to define the final strategy.
Three main themes were identified in the literature and Web site review: (i) PI methods for the different HTA phases; (ii) Participant definition and selection; (iii) Resources needed. A three-step implementation strategy was proposed: (i) short-term actions: piloting and testing patient participation in HTA and building patients' capacity; (ii) medium-term actions: broadening the participation of patients, and building internal capacity; (iii) long-term actions: consolidating and mainstreaming patient involvement
Patient participation can be incorporated into almost all the HTA phases and products with greater or lesser degrees of difficulty. However, a progressive implementation strategy is suggested for a feasible PI process.
We have studied a series of laminated thin films by x-ray diffraction to correlate their structural and magnetic properties. Previous works have shown that the signal-to-noise characteristics of laminated magnetic films with non-magnetic interlayers can exceed that of single layer magnetic films. In the case where the magnetic layer is known to have low signal-to-noise performance, the signal has been observed to increase as the number of layers whereas the noise increases as the square root of the number of layers. This yields a net improvement of the signal-to-noise ratio, making the overall film more attractive as a magnetic recording medium. In this paper, we investigate films which are laminated layers of magnetic CoPtCr and non-magnetic Cr. The films were deposited with sputtering parameters that generally give low noise characteristics in single layer films. Up to four layers of CoPtCr films were made with Cr spacer layers of 2 nm. We observe some improvement in signal-to-noise characteristics and reduction in coercivity. X-ray diffraction analysis shows that the crystallographic c-axis, which corresponds to the magnetic easy axis, becomes more preferentially oriented perpendicular to the film plane with each additional layer. This change in preferred orientation is consistent with the reduced in-plane coercivity of the film. In the double CoPtCr layer with one Cr spacer layer experiment, we see that as the Cr spacer layer is increased from 0.5 to 8 nm, the c-axis of the CoPtCr again becomes more preferentially oriented out of the film plane, resulting in decreased in-plane coercivity. The media signal-to-noise improves once the Cr spacer layer is beyond 2 nm, consistent with previous observations.