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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.
First-degree relatives of patients with psychotic disorder have higher levels of polygenic risk (PRS) for schizophrenia and higher levels of intermediate phenotypes.
We conducted, using two different samples for discovery (n = 336 controls and 649 siblings of patients with psychotic disorder) and replication (n = 1208 controls and 1106 siblings), an analysis of association between PRS on the one hand and psychopathological and cognitive intermediate phenotypes of schizophrenia on the other in a sample at average genetic risk (healthy controls) and a sample at higher than average risk (healthy siblings of patients). Two subthreshold psychosis phenotypes, as well as a standardised measure of cognitive ability, based on a short version of the WAIS-III short form, were used. In addition, a measure of jumping to conclusion bias (replication sample only) was tested for association with PRS.
In both discovery and replication sample, evidence for an association between PRS and subthreshold psychosis phenotypes was observed in the relatives of patients, whereas in the controls no association was observed. Jumping to conclusion bias was similarly only associated with PRS in the sibling group. Cognitive ability was weakly negatively and non-significantly associated with PRS in both the sibling and the control group.
The degree of endophenotypic expression of schizophrenia polygenic risk depends on having a sibling with psychotic disorder, suggestive of underlying gene–environment interaction. Cognitive biases may better index genetic risk of disorder than traditional measures of neurocognition, which instead may reflect the population distribution of cognitive ability impacting the prognosis of psychotic disorder.
To understand non-adherence to medically recommended diets among Mayans with diabetes.
Using partially sequential mixed methods, questionnaires, semi-structured brief and in-depth interviews were applied. Questionnaire data were analysed with Pearson’s χ2 and Student’s t tests and qualitative interviews with grounded theory microanalysis.
Rural, predominantly Mayan communities in Chiapas, Quintana Roo and Yucatan, Mexico, 2008–2012.
Purposive sample of Mayans with type 2 diabetes; using public health care; 168 women and twenty-seven men; age 21–50+ years.
Participants understood diabetes as caused by negative emotions, divine punishment, revenge via spells, chemicals in food and high sugar/fat consumption. Eliminating corn, pork, sugary beverages and inexpensive industrialized foods was perceived as difficult or impossible. More Mayans reporting not understanding physician instructions (30 v. 18 %) reported difficulty reducing red meat consumption (P = 0·051). Non-adherence was influenced by lack of patient–provider shared knowledge and medical recommendations misaligned with local culture. Men whose wives prepared their meals, women who liked vegetables and young adults whose mothers prepared their meals reported greater adherence to dietary recommendations. Partial adherents said it made life tolerable and those making no physician-recommended dietary changes considered them too restrictive (they meant ‘starving to death’). Over half (57 %) of participants reported non-adherence; the two principal reasons were dislike of recommended foods (52·5 %) and high cost (26·2 %).
Adherence to dietary regimens in diabetes treatment is largely related to social and cultural issues. Taking cultural diversity, food preferences, local food availability and poverty into consideration is essential when developing health-promotion activities related to diabetes.
In recent years, tissue engineering has helped to reduce hospital stays and deaths caused by skin wounds. Scaffolds are one of the main factors that influence the success of any tissue graft. Collagen is one of the main components of the extracellular matrix, and there has been much interest in new sources for application as a biomaterial. In this work, a tissue engineering scaffold was developed using the electrospinning technique. The chicken skin was used as an alternative source to obtain collagen. The combination of this collagen with elastin was successfully electrospun, and a distribution of diameters was obtained, less than 100 nm. In vitro tests showed the adhesion and proliferation of the cells, as well as an absence of cytotoxicity from non–cross-linked scaffolds and scaffolds that were cross-linked with carbonyldiimidazole. The structure and composition of the developed scaffolding provide a favorable environment for cell growth and generating a skin substitute.
Multiform glioblastoma (MG) represents 70% of all gliomas, with half of patients older than 65 years with median survival of 12–18 months, hypofractionation seeks to reduce the intensity and duration of treatment without impacting on survival rates. The objective was to determine the global survival and recurrence-free survival of adults over 70 years old with MG treated with hypofractionated radiotherapy and standard scheme. The review of patients older than 70 years treated with radiotherapy from 2013 to 2016 was performed.
Twenty-four patients were analysed, with a median follow-up of 239 days, and there is no difference in overall survival 12·3 versus 10·5 months (p = 0·55) and recurrence-free survival 8·3 versus 3·4 months (p = 0·48) between both schemes, conventional versus hypofractioanted, respectively.
The results in this study show that hypofractionated scheme could be comparable in overall survival and recurrence-free survival to conventional fractionation, but a longer patients’ trial should be done.
Neural electrodes have been widely used to monitor neural signals and/or deliver electrical stimulation in the brain. Currently, biodegradable and biocompatible materials have been actively investigated to create temporary electrodes that could degrade after serving their functions for neural recording and stimulation from days to months. The new class of biodegradable electrodes eliminate the necessity of secondary surgery for electrode removal. In this study, we created biodegradable, biocompatible, and implantable magnesium (Mg)-based microelectrodes for in vivo neural recording for the first time. Specifically, conductive poly-3,4-ethylenedioxythiophene (PEDOT) was first deposited onto Mg microwire substrates by electrochemical deposition, and a biodegradable insulating polymer was subsequently sprayed onto the surface of electrodes. The tip of electrodes was designed to be conductive for neural recording and stimulation, while the rest of electrodes was insulated with a polymer that is biocompatible with neural tissue. The impedance of Mg-based microelectrodes and their performance during neural recording in the auditory cortex of a mouse were studied. The results first demonstrated the capability of Mg-based microelectrodes for in vivo recording of multi-unit stimulus-evoked activity in the brain.
Dimethylformamide (DMF) has been tested as corrosion inhibitor in a metallic material like API 5LX70 in a corrosive solution of 3% of NaCl and using electrochemical technique as electrochemical impedance spectroscopy. The results showed that 20 ppm is the best concentration to protect the metallic surface of API 5L X70 with η∼ 94%. Hydrodynamic conditions (100 and 1000 rpm) demonstrated that the DMF at different concentration afforded moderate protection against corrosion with inhibition efficiency ∼70%. Finally, the adsorption of this compound follows the Langmuir isotherm with a chemisorption-physisorption process.
Establishing neurobiological markers of posttraumatic stress disorder (PTSD) is essential to aid in diagnosis and treatment development. Fear processing deficits are central to PTSD, and their neural signatures may be used as such markers.
Here, we conducted a meta-analysis of seven Pavlovian fear conditioning fMRI studies comparing 156 patients with PTSD and 148 trauma-exposed healthy controls (TEHC) using seed-based d-mapping, to contrast neural correlates of experimental phases, namely conditioning, extinction learning, and extinction recall.
Patients with PTSD, as compared to TEHCs, exhibited increased activation in the anterior hippocampus (extending to the amygdala) and medial prefrontal cortex during conditioning; in the anterior hippocampus-amygdala regions during extinction learning; and in the anterior hippocampus-amygdala and medial prefrontal areas during extinction recall. Yet, patients with PTSD have shown an overall decreased activation in the thalamus during all phases in this meta-analysis.
Findings from this metanalysis suggest that PTSD is characterized by increased activation in areas related to salience and threat, and lower activation in the thalamus, a key relay hub between subcortical areas. If replicated, these fear network alterations may serve as objective diagnostic markers for PTSD, and potential targets for novel treatment development, including pharmacological and brain stimulation interventions. Future longitudinal studies are needed to examine whether these observed network alteration in PTSD are the cause or the consequence of PTSD.
The microstructure homogeneity and variability in mechanical properties of 316L stainless steel components fabricated using selective laser melting (SLM) have been investigated. The crack free, 99.9% dense samples were made starting from SS316L alloy powder, and the melt pool morphology was analysed using optical and scanning electron microscopy. Extremely fast cooling rates after laser melting/solidification process, accompanied by slow diffusion of alloying elements, produced characteristic microstructures with colonies of cellular substructure inside grains, grown along the direction of the principal thermal gradient during laser scanning. In some areas of the microstructure, a significant number of precipitates were observed inside grains and at grain boundaries. Micro hardness measurements along the build direction revealed slight but gradual increase in hardness along the sample height. Uniaxial tensile tests of as manufactured samples showed the effect of un-melted areas causing scatter in room-temperature mechanical properties of samples extracted from the same SLM build. The ultimate tensile strength (UTS) varied from 458MPa to 509MPa along with a variation in uniform elongation from 3.3% to 14.4%. The UTS of a sample exposed to the Cl- rich corrosion environment at 46oC temperature revealed a similar strength as of the original sample, indicating good corrosion resistance of SLM samples under those corrosion conditions.
Aeronautic Pitot probes (PPs) are extremely important for airspeed and altitude measurements in aviation. Failure of the instrument due to clogging caused by ice formation can lead to dangerous situations. In this work, a commercial aeronautic PP was characterised experimentally regarding its inner composition, material properties and its thermal performance in a climatic wind tunnel. Performance runs were taken out in order to analyse the thermal response of the PP under various operating conditions with a particular emphasis on the cooling process in the case of a heating element failure. Data for the thermal conductivity, diffusivity and specific heat for each material forming the PP were obtained. A numerical model to simulate the thermal behaviour of the PP was created using Comsol Multiphysics (CM). Experimental data were compared with their numerical counterparts for model validation purposes. After the model was validated, the operation of the PP in flight conditions was simulated. The failure of the conventional heating system was analysed to obtain the time until the PP reaches a tip temperature where ice formation can be expected. The tip temperature undercut the zero degrees Celsius mark 165 seconds after the heating element was switched off. The data collected in this work can be used to implement and validate mathematical models in order to predict the thermal performance of Pitot probes in flight conditions.
One of the job resources most strongly associated with nurses’ well-being and motivation is social support. However, the psychosocial mechanisms that would explain this relationship have not been sufficiently researched. Thus, the main aim of this study was analyze whether this relationship could be mediated by two variables: role ambiguity and psychological flexibility. A total of 196 nurses from various Spanish hospitals and primary health care centers participated in this cross-sectional study. A multiple mediation analysis was run using the “PROCESS” macro script in SPSS 23.0. The results showed that co-worker support was related to higher levels of vigor and vitality through role ambiguity (Estimate = .158, 95% CI [.050, .298], and Estimate = .212, 95% CI [.076, .390], respectively). The same applied to supervisor support, (Estimate = .197, 95% CI [.059, .378], and Estimate = .212, 95% CI [.076, .390], respectively). Co-worker support was also related to higher levels of vigor and vitality through psychological flexibility, (Estimate = .132, 95% CI [.048, .271], and Estimate = .216, 95% CI [.086, .394], respectively). The same applied to supervisor support (Estimate = .092, 95% CI [.024, .208], and Estimate = .157, 95% CI [.035, .333], respectively). However, in the relationships between co-worker, supervisor support and exhaustion, only psychological flexibility played a mediating role. In conclusion, social support in nursing is a job resource that is associated with high levels of energy and motivation among nurses through the mediating role of certain job demands and personal resources.
This Research Communication describes the efficacy of etamsylate to reduce haemolactia in dairy cows. A dairy cow with haemolactia produces milk that is reddish or pinkish due to the presence of blood. Haemolactia causes economic loss because bloody milk is rejected by the industry and the consumers. A total of 58 dairy cows with haemolactia were included in the study and randomly divided into treated (n = 31) and control (n = 27) groups. Treatment consisted of three consecutive daily doses of etamsylate at 15 mg/kg, delivered intramuscularly. Milk production was recorded daily for 7 d, whether or not blood was detected in milk. The mean number of days with the presence of blood in milk in the treatment group was significantly lower (3·4 d) than in the control group (4·9 d). Treatment with etamsylate did not significantly affect milk yield. In conclusion, treatment with etamsylate reduces the number of days blood is observed in milk and it does not have any negative effect on milk production.
Objective: To characterize cognitive function in patients with antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) in comparison with other chronic conditions, and to investigate its association with disease activity, and other psychological factors. Methods: Cross-sectional study including patients with AAV, rheumatoid arthritis (RA) (n = 30), and chronic kidney disease (CKD) (n = 29). Patients underwent a standardized neuropsychological battery (NEUROPSI). Sleep quality, fatigue, depression, and anxiety levels were assessed. Results: A total of 60 patients with AAV were included, median age of 54 years, and disease duration of 5.6 years. Prevalence of cognitive dysfunction (CD) in AAV patients was similar to RA and CKD (35%, 40%, and 39.3%, respectively, p = .88). When AAV patients with (n = 21) and without (n = 39) CD were compared, significantly more patients with CD had high disease activity (67% vs. 31%, p = .009). Abnormal performance was more frequent in the executive functions in the three groups (45% AAV, 51.7% RA, and 50% CKD), followed by language (25%, 13.8%, and 25%, respectively). Verbal and visual attentional tests were more frequently impaired in patients from the CKD group (p = .021), and psychomotor functions were more frequently affected in AAV patients (p < .05). Hospital Anxiety and Depression Scale (HADS) total score (especially anxiety) was higher in patients with memory impairment than in those with normal memory function (M = 6.79, SD = 4.53 vs. M = 4.5, SD = 3.6, p < .01). Neither Sleep Quality Index nor fatigue scale scores differed between those cognitively impaired and not impaired. Conclusions: No statistically significant differences were found in the frequency of CD among the three clinical populations. (JINS, 2019, 25, 595–602)
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.
Generalized planning studies the representation, computation and evaluation of solutions that are valid for multiple planning instances. These are topics studied since the early days of AI. However, in recent years, we are experiencing the appearance of novel formalisms to compactly represent generalized planning tasks, the solutions to these tasks (called generalized plans) and efficient algorithms to compute generalized plans. The paper reviews recent advances in generalized planning and relates them to existing planning formalisms, such as planning with domain control knowledge and approaches for planning under uncertainty, that also aim at generality.