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Conjunctival squamous cell carcinoma (SCC) is a rare tumour of the ocular region and microscopic radical surgical is difficult. There are no single guidelines for therapeutic management and the role of radiation therapy is not clearly defined although conventionally photon or electron beams are used. Proton beam radiotherapy (PBRT) is a new option for a conservative approach and allows good sparing of the organs at risk.
Materials and methods:
After surgical resection, we collected 15 cases treated at our institution with PBRT. The dose delivered was between 48 and 60 Gy relative biological effectiveness (RBE), with fractions of 12–15 Gy RBE.
After an average period of 48 months, the patients achieved excellent disease control (overall survival and disease-free survival: 86·6%), with minimal acute and late toxicity.
In this work, we present our experience on the use of PBRT technique in SCC treatment. A larger sample of patients is needed to draw conclusions about the impact of this treatment on disease recurrence and overall survival.
Background: Carbapenemase-producing organisms (CPOs) are a growing antibiotic resistance threat. Colonization screening can be used to identify asymptomatically colonized individuals for implementation of transmission-based precautions. Identifying high-risk patients and settings to prioritize screening recommendations can preserve facility resources. To inform screening recommendations, we analyzed CPO admission screens and screening conducted on point-prevalence surveys (PPSs) performed through the Antibiotic Resistance Laboratory Network’s Southeast Regional Laboratory (SE AR Lab Network). Methods: During 2017–2019, the SE AR Lab Network collected data via a REDCap survey for a subset of CPO screens on a limited set of easily determined patient risk factors. Rectal swabs were collected and tested with the Cepheid Carba-R. Specimens collected within 2 days of admission were classified as admission screening and the remainder were classified as PPS. Index cases were excluded from analyses. Odd ratios (ORs) and 95% confidence intervals were calculated, and a value of 0.1 was used for cells with a value of zero. Results: In total, 520 screens were conducted, which included 366 admission screens at 2 facilities and 154 screens from 27 PPSs at 8 facilities. CPOs were detected in 14 (2.7%) screens, including in 10 (2.7%) admission screens and in 4 (2.6%) contacts during PPSs; carbapenemases detected were Klebsiella pneumoniae carbapenemase (KPC) (n = 12), New Delhi Metallo-β-lactamase (NDM) (n = 1) and Verona Integron-Encoded Metallo-β-lactamase (VIM) (n = 1). One long-term acute care hospital (LTACH) performed universal admission screening, which accounted for 96% of admission screens and all 10 CPOs detected by admission screening. Mechanical ventilation (OR, 5.0; 95% CI, 1.4–18.0) and the presence of a tracheostomy (OR, 5.4; 95% CI, 1.5–19.4) were associated with a positive admission screen. Moreover, 8 facilities conducted PPSs: 4 acute care hospitals, 2 long-term acute care hospitals, and 2 nursing homes. CPO prevalence in long-term acute care hospitals was 4.8% (2 of 42), 2.4% (1 of 41) in acute care hospitals, and 1.5% (1 of 69) in nursing homes. Requiring assistance with bathing (OR, 4.8; 95% CI, 1.6–8.0) and stool incontinence (OR, 16.6; 95% CI, 13.4–19.8) were associated with a positive screen on PPSs. All 7 roommates of known cases tested negative for CPO colonization. Conclusions: Findings suggest that patients with certain easily assessed characteristics, such as mechanical ventilation, tracheostomy, or stool incontinence or who require bathing assistance, may be associated with CPO positivity during screening. Further data collection and analysis of such risk factors may provide insight for the development of more targeted admission and contact screening strategies.
To propose malnutrition screening methods for the elderly population using predictive multivariate models. Due to the greater risk of nutrition deficiencies in ageing populations, nutritional assessment of the elderly is necessary in primary health care.
This was a cross-sectional study. Multivariate models were obtained by means of discriminant analysis and binary logistic regression. The diagnostic accuracy of each multivariate model was determined and compared with the Chang method based on receiver operating characteristic curves. The optimal cut-point, sensitivity, specificity and Youden index were estimated for each of the models.
The province of Cordoba, Spain.
Two hundred fifty-five patients over the age of 65 years from three health centres and three nursing homes.
Fourteen models for predicting risk of malnutrition were obtained, six by discriminant multivariate analysis and eight by binary logistic regression. Sensitivity ranged from 55·6 to 93·1 % and specificity from 64·9 to 94 %. The maximum and minimum Youden indexes were 0·77 and 0·49, respectively. We finally selected a model which does not require a blood test.
The proposed models simplify nutritional assessment in the elderly and, except for number 2 of those calculated by binary logistic regression, have better diagnostic accuracy than the Spanish version of the Mini Nutritional Assessment screening tool. The selected model, whose validation is necessary for the future with other different samples, provides good diagnostic accuracy, and it can be performed by non-medical personnel, making it an accessible, easy and rapid tool in daily clinical practice.
Addictive and psychiatric disorders are a significant barrier to retention in medical care leading to worse outcomes. As part of an HIV care expansion project, the H-STAR intervention was designed to treat substance use and psychiatric disorders for minority patients receiving co-located HIV medical care.
The intervention aim was to increase access to treatment for substance abuse and psychiatric disorders in minority HIV+ patients and reduce substance use.
The H-STAR primary objective was to offer substance and psychiatric evaluation and treatment with an integrated treatment model.
All participants in H-STAR underwent substance abuse screening and evaluation, using DSM-IV-TR criteria. Substance use was measured on the Government Performance Reports Act (GPRA) form at baseline and 6 months. Intensive outpatient treatment (IOP) using the Matrix Model as the behavioral intervention was available to all patients. All patients were offered and scheduled psychiatric evaluation and treatment with an onsite psychiatrist.
Of 123 enrolled persons with both baseline and 6 month GPRAs, the prevalence of substance abuse/dependence disorders were as follows: Alcohol: 32 (24.2%); Opiate: 54 (43.9%); Cocaine: 47(38.2%); and Marijuana: 26(21.1%). Thirty (22.1%) completed IOP. At 6 month follow-up there was statistically significant reduced use of alcohol, heroin and cocaine. Of 136 enrolled participants, seventy-five (55.1%) had psychiatric evaluations; 53 (70.7%) received medication management.
There was a significant reduction in all substance use; cocaine use remained the most prevalent. Despite open access to psychiatric evaluation, not all patients completed evaluation in spite of multiple attempts to reschedule.
The induced delusional disorder or folie à deux, is a rare condition characterized by psychotic symptoms at least in two individuals in close association.
We report a case of shared psychotic disorder between mother and daughter. We briefly review both classical and current literature.
We summarized the results from articles identified via MEDLINE/PubMed using “induced delusional/shared psychotic disorder” as keywords. We report a case of a woman who develops psychotic symptoms characterized by delusions of persecution. Her daughter started, during the first high school grade with referring sexual threats and having delusions of persecution lived by her mother like a fact. They have very symbiotic relationship. Seven years later, the mother has required hospitalization for chronic delusions.
The term folie à deux was first coined by Lasègue and Falret, they assume the transmission of delusions was possible when an individual dominated the other and existed relative isolation. Recent studies found no significant differences in age and sex, although described higher comorbidity with other psychiatric diseases. Relative to treatment, separation by itself is insufficient; an effective neuroleptic treatment is required.
Our case meets criteria for shared psychotic disorder. The daughter, with a ruling attitude who dominates the relationship, was the inducer. The mother showed no resistance in accepting delusions and remains them active after separation. This leads us to consider the possible predisposition to psychotic illness by both patients.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
This article studies multi-stakeholder initiatives (MSIs) as spaces for both deliberation and contestation between constituencies with competing discourses and disputed values, beliefs, and preferences. We review different theoretical perspectives on MSIs, which see them mainly as spaces to find solutions to market problems (economic approach), as spaces of conflict and bargaining (political approach), or as spaces of consensus (deliberative approach). In contrast, we build on a contestatory deliberative perspective, which gives equal value to both contestation and consensus. We identify four types of internal contestation which can be present in MSIs—procedural, inclusiveness, epistemic, and ultimate-goal—and argue that embracing contestation and engaging in ongoing revision of provisional agreements, criteria, and goals can enhance the democratic quality of MSIs. Finally, we explore the implications of this perspective for theorizing about the democratic quality in MSIs and about the role of corporations in transnational governance.
The rocky shores of the north-east Atlantic have been long studied. Our focus is from Gibraltar to Norway plus the Azores and Iceland. Phylogeographic processes shape biogeographic patterns of biodiversity. Long-term and broadscale studies have shown the responses of biota to past climate fluctuations and more recent anthropogenic climate change. Inter- and intra-specific species interactions along sharp local environmental gradients shape distributions and community structure and hence ecosystem functioning. Shifts in domination by fucoids in shelter to barnacles/mussels in exposure are mediated by grazing by patellid limpets. Further south fucoids become increasingly rare, with species disappearing or restricted to estuarine refuges, caused by greater desiccation and grazing pressure. Mesoscale processes influence bottom-up nutrient forcing and larval supply, hence affecting species abundance and distribution, and can be proximate factors setting range edges (e.g., the English Channel, the Iberian Peninsula). Impacts of invasive non-native species are reviewed. Knowledge gaps such as the work on rockpools and host–parasite dynamics are also outlined.
Direct numerical simulations of two superposed fluids in a channel with a textured surface on the lower wall have been carried out. A parametric study varying the viscosity ratio between the two fluids has been performed to mimic both idealised super-hydrophobic and liquid-infused surfaces and assess its effect on the frictional, form and total drag for three different textured geometries: longitudinal square bars, transversal square bars and staggered cubes. The interface between the two fluids is assumed to be slippery in the streamwise and spanwise directions and not deformable in the vertical direction, corresponding to the ideal case of infinite surface tension. To identify the role of the fluid–fluid interface, an extra set of simulations with a single fluid has been carried out. Comparison with the cases with two fluids reveals the role of the interface in suppressing turbulent transport between the lubricating layer and the overlying flow decreasing the overall drag. In addition, the drag and the maximum wall-normal velocity fluctuations were found to be highly correlated for all the surface configurations, whether they reduce or increase the drag. This implies that the structure of the near-wall turbulence is dominated by the total shear and not by the local boundary condition of the super-hydrophobic, liquid infused or rough surfaces.
HD 163296 is a young star surrounded by a planet-forming disk that shows clear signatures of dust gaps and rings; likely an indication of ongoing planet formation. We use the radiation thermochemical disk code ProDiMo to investigate the impact of dust/gas gaps on the temperature, chemistry and observables. Furthermore, we model high spatial resolution gas and dust observation of HD 163296 (ALMA/DSHARP). Our first results indicate that features in the observed radial intensity profile of the 12CO line are a consequence of the dust gaps and do not require gas depletion. Those preliminary results indicate that self-consistent modelling of the gas (chemistry, heating/cooling) and dust is necessary to accurately infer the degree of gas depletion within dust gaps. Such information is crucial to understand the processes that generate the disk substructure and their relation to planet formation.
High spatial resolution observations with ALMA and VLT/SPHERE show gaps and rings in continuum emission of protoplanetary disks, possibly indicating ongoing planet formation. However, it is still unclear if the gas follows the dust distribution. We present radiation thermo-chemical models for the disk of HD 163296 to study the impact of dust and gas gaps on the chemistry and molecular line emission. We compare a model with only dust gaps to a model that also has gas gaps. In both models, rings and gaps are visible in (sub)mm molecular line emission. Due to chemistry, certain molecules are sensitive to dust gaps where others are more sensitive to gas depletion. Observations of multiple molecules might allow to accurately determine the degree of gas depletion within the dust gaps, information crucial to discriminate between gap formation theories (e.g. planets, ice lines).
The serotonin-transporter-linked polymorphic region (5-HTTLPR) polymorphisms are associated with suicidal behavior; however, prospective studies are scarce. Herein we aim to determine if 5-HTTLPR polymorphisms predict risk of short-term suicide reattempt in a high-risk suicidal sample. We also explore possible mediators or moderators of this relationship.
A multicenter prospective cohort study was designed to compare data obtained form 136 patients admitted to the emergency department for current suicidal ideation or a recent suicide attempt. Subjects were clinically evaluated, genotyped, and monitored for a new suicide attempt for 6 months.
At 6 months of follow up, 21% of the subjects had a new suicide attempt. The frequency of L-allele and L-carrier was higher in reattempters when compared with non-reattempters (55.8% vs. 35.4%, p = 0.01 and 76.9% vs. 54.2%, p = 0.04, respectively). Reattempters also differ from non-reattempters patients with respect to age, history of previous suicide attempts, and age of onset of suicidal behavior. The logistic regression model showed that L-carriers had an odds ratio of 2.8 (95% CI: 1.0–7.6) for reattempts when compared to SS genotype. The adjusted model indicates that this association is not mediated or moderated by impulsivity.
The 5-HTTLPR polymorphisms predicted short-term risk of suicidal reattempt independently of age and sex. L-carriers have almost three times more risk of relapse when compared with SS carriers.