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In this distinctive new history of the origins of the Spanish Civil War, James Simpson and Juan Carmona tackle the highly-debated issue of why it was that Spain's democratic Second Republic failed. They explore the interconnections between economic growth, state capacity, rural social mobility and the creation of mass competitive political parties, and how these limited the effectiveness of the new republican governments, and especially their attempts to tackle economic and social problems within the agricultural sector. They show how political change during the Republic had a major economic impact on the different groups in village society, leading to social conflicts that turned to polarization and finally, with the civil war, to violence and brutality. The democratic Republic failed not so much because of the opposition from the landed elites, but rather because small farmers had been unable to exploit more effectively their newly found political voice.
Drawing on the new institutional theory and the resources based view of the firm (RBV), this study tries to shed light upon the idea that isomorphic organizational changes seek legitimacy over efficiency. Using data from 102 Spanish companies and employing partial least squares, a variance-based structural equation modeling technique, this study concludes that both objectives are achievable simultaneously when firms implement total quality management (TQM) as an integrative stream of both theories. Furthermore, empirical results reveal that: (i) institutional pressures (IP) condition significantly the implementation of TQM, (ii) TQM exerts a double mediating role in the IP-legitimacy and IP-efficiency relationships, and (iii) both efficiency and legitimacy objectives are achieved by means of TQM. However, we observe a dual phenomenon: (i) while we find a significant positive effect of TQM on overall performance (OP) via efficiency and (ii) we failed to find support for the TQM-OP link via legitimacy.
Initiatives to foster a transition toward organic agriculture have drawn policy-makers' interest worldwide. However, research studies evaluating the effectiveness of policies intended to promote ‘scaling-out’ organic production systems to more farms and larger production areas are still rare. To better understand the role that public procurement and price incentive policies have in scaling-out organic transitions, we assessed the effects of the Brazilian Food Acquisition Program (PAA) in a group of municipalities. PAA offers both markets for family farmers and price incentives for certified organic products. However, our findings suggest that farmers who establish organic production systems and become certified also gain access to other markets; ones that they find more attractive than those created by the PAA. Thus, we find that the PAA offers insufficient incentives for adopting organic practices among peasant and family farmers and supports the argument that scaling-out organic production is a multilevel process that depends on different, but interrelated drivers.
State control over Greece’s agricultural institutions increased during Metaxas’s authoritarian regime (1936–41). Analysing such state control allows us to address, in the Greek context, two questions with regard to fascist agrarian regimes. First, considering the trajectory of agricultural policy before the emergence of these regimes, how much of what they did was new, and how much was not? Second, how did the cadres of agricultural specialists participate in, or at least accommodate, the new regimes? Our research shows that Metaxas received support from the agronomists who had been active in Greece under previous liberal administrations. Such support did not take the form of laudatory statements or ideology-driven activism. It was rather a discreet acceptance of the new circumstances, combined with defection from one’s previous political camp. Metaxas’s dictatorship inherited most traits that made it a fascist agricultural regime from previous liberal administrations.
Determining infectious cross-transmission events in healthcare settings involves manual surveillance of case clusters by infection control personnel, followed by strain typing of clinical/environmental isolates suspected in said clusters. Recent advances in genomic sequencing and cloud computing now allow for the rapid molecular typing of infecting isolates.
To facilitate rapid recognition of transmission clusters, we aimed to assess infection control surveillance using whole-genome sequencing (WGS) of microbial pathogens to identify cross-transmission events for epidemiologic review.
Clinical isolates of Staphylococcus aureus, Enterococcus faecium, Pseudomonas aeruginosa, and Klebsiella pneumoniae were obtained prospectively at an academic medical center, from September 1, 2016, to September 30, 2017. Isolate genomes were sequenced, followed by single-nucleotide variant analysis; a cloud-computing platform was used for whole-genome sequence analysis and cluster identification.
Most strains of the 4 studied pathogens were unrelated, and 34 potential transmission clusters were present. The characteristics of the potential clusters were complex and likely not identifiable by traditional surveillance alone. Notably, only 1 cluster had been suspected by routine manual surveillance.
Our work supports the assertion that integration of genomic and clinical epidemiologic data can augment infection control surveillance for both the identification of cross-transmission events and the inclusion of missed and exclusion of misidentified outbreaks (ie, false alarms). The integration of clinical data is essential to prioritize suspect clusters for investigation, and for existing infections, a timely review of both the clinical and WGS results can hold promise to reduce HAIs. A richer understanding of cross-transmission events within healthcare settings will require the expansion of current surveillance approaches.
Rate of treatment non-compliance in schizophrenia, like in other chronic diseases. Long-acting injectable (LAI) antipsychotics have proven to be more effective than orals in reducing the number of recurrences. Although the perception of LAIs has changed over the last few years with the introduction of new molecules, there might be prejudices regarding these formulations within the mental health professionals community. The exercise of imagining how and with which antipsychotic you would like to treat yourself or a close relative in case of suffering from schizophrenia, can help to emerge true prescription preferences.
The objective of the present work is to assess the psychiatrists antipsychotics prescribing preferences for schizophrenia, in the hypothetical case they were patients suffering a 2nd/3rd relapse. With this purpose, we performed an on-line survey in a sample of psychiatrists and trainees fromSpain.
Results showed that election of LAIs were less frequent for in Self-prescription scenario, both for the 2nd and 3rd hypothetical recurrence. Also, psychiatrist who chose LAIs for their patients are more likely to choose orals for themselves (p=0.039; p<0.001 for 2nd and 3rd recurrence respectively). The most preferred LAI for both patients and self-prescription was aripiprazole once-monthly (60% and 87% respectively).
Interestingly, nearly 70% of psychiatrist choosing a LAI different form Aripiprazole, would change the prescription for themselves; and those choosing aripiprazole once-monthly for their patients were more likely to maintain it for themselves (p<0.001). Practitioners changing from LAIs to orals in the self-treatment scenario perceive LAIs as a more coercive measure (p<0.01), being the degree of coercitivity perceived the only variable associated with a change in prescription's decisions (p=0.002). Curiously, LAIs associated coercitivity was significantly lower for oncologist vs psychiatrists (p<0.001). The level of weight gain, metabolic problems, extrapyramidal symptomatology, sexual dysfunction, sedation and cognitive problems perceived by psychiatrists is significantly lower for Aripiprazole than for the rest of LAIs (p <0.01 for all comparisons), with a comparable perceived efficacy (mean=3.95 and 4 out of possible 5, p=0.7). In light of our results, this is partially explained by a perception of LAIs as coercive measures, in contrast with perception of similar treatments for the control of somatic diseases. The fact of imagining a scene where oneself is the one suffering from a disease, shows preferences in the use of psychotropic drugs for the management of schizophrenia where the profile of side-effects and efficacy has a more equitable balance: starting from comparable effectiveness, we prefer treatments associated with a perception of fewer side-effects
Treatment of varicose veins is currently performed by different interventionist alternatives that include surgical, endothermal and non-thermal ablation therapies. The main guidelines recommended endovenous thermal treatment as the first choice therapy; however present side effects related to thermal energy. Non-tumescent endovenous ablation techniques such as cyanoacrylate ablation (CA) started to develop to avoid these problems. The objective of this study is to assess the effectiveness and safety of CA for saphenous vein incompetence.
A systematic review with meta-analysis was carried out. The search of scientific literature was performed in Medline, Embase, Cochrane library, CDR, WoS and Scopus databases. GRADE methodology was used to assess the quality of the evidence and Cochrane risk of bias tool to assess methodological quality of randomized control trials (RCT). Pooled risk ratio was calculated using a random effects model.
Two RCTs and one non-RCT comprising 1,077 participants were included. Additionally, 10 case series were included for safety assessment. Pooled analysis of closure rates by the two RCTs indicated there were not significant differences between CA and radiofrequency ablation (RFA) or endovenous laser ablation (EVLA). Improvements in venous clinical severity score were reported by all comparative studies without significant differences among groups. The most frequently reported adverse events were ecchymosis, phlebitis, paraesthesia, and thrombosis. The pooled analysis showed significant differences only in ecchymosis rates, with lower probability of ecchymosis in CA groups. CA treatment showed lower pain rates and shorter intervention times and recovery compared to endothermal therapies.
The effectiveness of CA devices in the treatment of varicose veins is comparable to EVLA and RFA, while the rates of adverse effects are lower. Despite the limitations of the evidence, CA may be a promising alternative to existing treatments, with the advantages of better patient comfort.
Worry is a common phenomenon with people who anticipate and want to be prepared for future events. Pathological worry, however, is not limited to anticipating potentially dangerous events, but it is applied to small daily events, too. This kind of worry is perceived as uncontrollable, and it is strongly associated with catastrophism. The Penn State Worry Questionnaire (PSWQ) was developed to assess pathological worry. Despite its excellent psychometric characteristics, its internal structure is still controversial. The combination of regular and reversed items and certain methodological considerations may account for the discrepancies in the results of previous investigations. With the aim to analyze worry in Portugal and the psychometric properties of the PSWQ, for the present study, methodological options were considered in order to minimize previous problems. A sample of 558 Portuguese community participants took part in this study. Exploratory and Confirmatory Factor Analysis were performed with two independent random subsamples. The results showed the unidimensionality of PSWQ and the psychometric adequacy of both the full, 16-item version and a reduced, 11-item version (without reversed scored items). Normative data are presented, the suitability of both versions is discussed, and the authors conclude by encouraging the use of the reduced, 11-item version of the PSWQ in applied settings.
While the Sun is nowadays a quiet and well-balanced star, in its first few million years it might have been often out of temper, like those young low-mass stars which episodically undergo unpredictable outbursts. The prototype of one of the two classes of young erupting stars, EX Lupi, had its historically largest outburst in 2008. It brightened by a factor of 30 for six months, due to elevated accretion from the circumstellar disk on to the star. Our group observed the system during the outburst, and discovered the crystallisation of amorphous silicate grains in the inner disk by the heat of the outburst. Our mid-infrared monitoring of the freshly produced crystals revealed that their emission in the inner disk quickly dropped already within a year after the outburst. Here we report on new observations of the 10 µm silicate feature, obtained with the MIDI and VISIR instruments at Paranal Observatory, which demonstrate that within five years practically all forsterite disappeared from the inner disk. We attempt to model this process by an expanding wind that transports the crystals from the terrestrial zone to outer disk regions where comets are supposed to form. Since the eruptions of EX Lup are recurrent, we speculate that the early Sun also experienced similar brightenings, and the forming planetary system might have incorporated some of the mineralogical and chemical yields provided by the outbursts. EX Lup, as a proxy for the proto-Sun, may be a telltale object to understand the origin of molecules and minerals we routinely encounter on Earth.
We prove the uniqueness of a solution for a problem whose simplest model is
with k ≥ 1, 0 f ∈ L∞(Ω) and Ω is a bounded domain of ℝN, N ≥ 2. So far, uniqueness results are known for k < 1, while existence holds for any k ≥ 1 and f positive in open sets compactly embedded in a neighbourhood of the boundary. We extend the uniqueness results to the k ≥ 1 case and show, with an example, that existence does not hold if f is zero near the boundary. We even deal with the uniqueness result when f is replaced by a nonlinear term λuq with 0 < q < 1 and λ > 0.
The complex morphological evolution of the bivalve Ptychomya throughout the well-studied Agrio Formation in the Neuquén Basin (west-central Argentina, lower/upper Valanginian–lowest Barremian) constitutes an ideal opportunity to study evolutionary patterns and processes occurring at geological timescales. Ptychomya is represented in this unit by four species, the morphological variation of which needs to be temporally assessed to obtain a thorough picture of the evolution of the group. Here we use geometric morphometrics to measure variation in shell outline, ribbing pattern, and shell size in these species. We bracket the ages of our samples using a combination of ammonoid biostratigraphy and absolute ages and study the anagenetic pattern of evolution of each trait by means of paleontological time-series analysis and change tracking. We find that evolution in Ptychomya is mostly speciational, as the majority of traits show stasis, with the exceptions of shell size in P. coihuicoensis and shell outline in P. windhauseni, which seem to evolve directionally toward larger and higher shells, respectively. Ptychomya displays changes in its average morphology and disparity, which are the result of a mixture of taxonomic turnover and mosaic evolution of traits. Pulses of speciation would have been triggered by ecological opportunity, as they occur during the recovery of shallow-burrowing bivalve faunas after dysoxic events affecting the basin. On the other hand, the presence of directional patterns of evolution in P. coihuicoensis and P. windhauseni seems to be the result of a general shallowing-upward trend observed in the basin during the upper Hauterivian–lowest Barremian, as opposed to the cyclical paleoenvironmental stability inferred for the early/late Valanginian–early Hauterivian, which would have prompted stasis in P. koeneni and P. esbelta.
Death from congenital heart disease (CHD) can be avoided, contributing to reduced infant mortality. The objective of this study was to identify the profile of patients undergoing surgical correction for CHD in three São Paulo State hospitals, and to determine factors that contribute to morbidity and mortality.
The Voluntary Pediatric Cardiovascular Surgery Multicenter Registry (ASSIST) was created in 2014 through a Research Grant Program for the Public Healthcare System (Pesquisas para o Sistema Único de Saúde, PPSUS)* project, a federal-state joint strategic public policies research grant, coordinated by the Hospital das Clínicas of Faculdade de Medicina of Universidade de São Paulo (InCor-HCFMUSP-SP) and Ribeirão Preto's Hospital das Clínicas, both linked to the São Paulo University Medical School.
We analyzed 1,842 patients, with an average age of 1.2 (range 0.4–8.6) years, 50.9 percent were male. Procedural complexity was classified as “Risk Adjustment in Congenital Heart Surgery” version 1 score, RACHS-1: 18.2 percent RACHS1, 25.5 percent RACHS2, 41.2 percent RACHS3, 9.6 percent RACHS4 and 5.4 percent RACHS5–6. Overall hospital mortality was 12.2 percent, and preoperative risk factors included: age <30 days (Odds Ratio, OR = 1.7 p = 0.012), prolonged ICU admission (OR = 3.3 p = 0.001). Other significant factors were RACHS score >4 (OR = 5.3 p < 0.001), heart dysfunction (OR = 3.4 p = 0.001), sepsis (OR = 3 p = 0.001), hemodynamic or surgical re-intervention required (OR = 6.2 p < 0.001), cardiorespiratory arrest (CPR, OR = 24.9 p < 0.001) and renal failure (OR = 5.4 p<0.001). The frequency of related morbidity was 16.2 heart failure, 7.1 percent arrythmia, 5.9 percent pneumonia, 5.9 percent pneumotórax, 4.2 percent pleural and pericardial effusion, 10 percent mechanical ventiation > 7 days, 13.2 percent late sternal closure, 2.8 percent had wound infection, 3.7 percent neurological alterations, 2.3 percent diaphragmatic dysfunction, 11.5 percent CPR, 3.2 percent renal failure, 4.5 percent sepsis, 55.1 percent length of hospital stay longer than 5 days with 45.8 percent postoperative hospital admission longer than 15 days and 6.1 percent needed surgical or hemodynamic re-intervention.
The information collected in the ASSIST registry was of great importance in the São Paulo State CHD surgical practice evaluation. Morbi-mortality related factors elicited critical points and allowed improvement actions. Excluding age and intrinsic procedure complexity, identified outcome modifier factors can be manageable, aiming to increase patient safety and program resolubility or performance.
We consider dynamical systems, consisting of
-actions by continuous automorphisms on shift-invariant subgroups of
is the field of order
. These systems provide natural generalizations of Ledrappier’s system, which was the first example of a 2-mixing
-action that is not 3-mixing. Extending the results from our previous work on Ledrappier’s example, we show that, under quite mild conditions (namely, 2-mixing and that the subgroup defining the system is a principal Markov subgroup), these systems are almost strongly mixing of every order in the following sense: for each order, one just needs to avoid certain effectively computable logarithmically small sets of times at which there is a substantial deviation from mixing of this order.
Individuals with late-life depression (LLD) may present cognitive symptoms. We sought to determine whether a brief cognitive battery (BCB) could identify cognitive and functional deficits in oldest-old individuals with LLD and a low level of education.
We evaluated 639 community-dwelling individuals aged 75+ years in Caeté (MG), Brazil. We used the MINI and GDS-15 to diagnose major depression and evaluate its severity, respectively. The cognitive evaluation comprised the Mini-Mental State Examination (MMSE), BCB, clock-drawing test, category fluency test (animals) and Pfeffer's Functional Activities Questionnaire (FAQ).
Fifty-four (11.6%) of the included individuals were diagnosed with LLD; on average, these participants were aged 81.0 ± 4.8 years and had 3.9 ± 3.4 years of schooling, and 77.8% of the subjects with LLD were female. Depressed individuals scored lower than subjects without dementia/depression on the MMSE overall (p < 0.001) and on several of the MMSE subscales, namely, time (p < 0.001) and spatial orientation (p = 0.021), attention/calculation (p = 0.019), and language (p = 0.004). Individuals with LLD performed worse on the incidental and (p = 0.011) immediate memory (p = 0.046) and learning tasks (p = 0.039) of the BCB. Individuals with LLD also performed worse on the category fluency test (p = 0.006), clock-drawing test (p = 0.011) and FAQ (p < 0.001). Depression severity was negatively correlated with incidental memory (ρ = −0.412; p = 0.003) and positively correlated with FAQ score (ρ = 0.308; p = 0.035). In the multiple regression analysis, only temporal orientation and FAQ score remained independently associated with LLD.
Individuals with depression and a low level of education presented several cognitive and functional deficits. Depression severity was negatively correlated with incidental memory and functionality. Our findings serve as a description of the presence of cognitive dysfunction in individuals with LLD and suggest that these deficits may be identified based on the results of a BCB.
Hunter-gatherers collected and used various woody species depending on the landscape, availability of plant communities, and sociocultural considerations. With extensive paleo-wetlands and groundwater-fed oases, the Atacama Desert was interspersed with riparian woodlands that provided vital resources (fuel, water, and game) at the end of the Pleistocene in areas such as the Pampa del Tamarugal (PdT) basin. We use anthracological analyses to determine the fuel management strategies of hunter-gatherer societies in this hyperarid environment and explore whether the “Principle of Least Effort” applies. First, we present the combustion qualities and characteristics of woody taxa from the Atacama and analyze possible exploitation strategies. Second, we use anthracological analyses from Quebrada Maní 12 (QM12), a late Pleistocene archaeological site (dated from 12,750 to 11,530 cal B.P.) located in the PdT basin, to show the prevalence of two woody species that were either freshly collected or gathered (very likely on purpose) from subfossil wood. Our results suggest that fuel selection strategies were based on prior knowledge of the qualities of these woody taxa and how they burned. Thus we conclude that fuel management was part of a number of social and economic decisions that allowed for effective colonization of this region. Furthermore, we stress the need for caution when using charcoal to exclusively date archaeological sites located in desert environments.