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On-boat resuscitation can be applied by lifeguards in an inflatable rescue boat (IRB). Due to Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-COV-2) and recommendations for the use of personal protective equipment (PPE), prehospital care procedures need to be re-evaluated. The objective of this study was to determine how the use of PPE influences the amount of preparation time needed before beginning actual resuscitation and the quality of cardiopulmonary resuscitation (CPR; QCPR) on an IRB.
Three CPR tests were performed by 14 lifeguards, in teams of two, wearing different PPE: (1) Basic PPE (B-PPE): gloves, a mask, and protective glasses; (2) Full PPE (F-PPE): B-PPE + a waterproof apron; and (3) Basic PPE + plastic blanket (B+PPE). On-boat resuscitation using a bag-valve-mask (BVM) and high efficiency particulate air (HEPA) filter was performed sailing at 20km/hour.
Using B-PPE takes less time and is significantly faster than F-PPE (B-PPE 17 [SD = 2] seconds versus F-PPE 69 [SD = 17] seconds; P = .001), and the use of B+PPE is slightly higher (B-PPE 17 [SD = 2] seconds versus B+PPE 34 [SD = 6] seconds; P = .002). The QCPR remained similar in all three scenarios (P >.05), reaching values over 79%.
The use of PPE during on-board resuscitation is feasible and does not interfere with quality when performed by trained lifeguards. The use of a plastic blanket could be a quick and easy alternative to offer extra protection to lifeguards during CPR on an IRB.
El Maye is a community located in the municipality of Ixmiquilpan, Hidalgo, in the central region of Mexico. During the late Postclassic period (1350–1521 AD), the Aztecs controlled the area through the establishment of a dual-headed system, one part belonging to the Aztec government and the other to the local government. El Maye was the local government center for the Ixmiquilpan territory under the Aztec domain. The residential units of El Maye archaeological site were constructed in 6 different occupational phases, with the presence of large rooms, stucco floors and walls, offerings, and a variety of ceramics belonging to the late Aztec III ceramic period (1400–1520 AD). The Axis Project of the Mezquital Valley (PEVM-ENAH) and the Accelerator Mass Spectrometry Laboratory (LEMA-UNAM) have undertaken a collaborative study of the El Maye site by performing absolute radiocarbon accelerator mass spectrometry (14C AMS) dating. For a better understanding of the emergence and development of El Maye, a series of AMS 14C dates of charcoal and bone samples recovered from different stratigraphic levels, was performed. This allowed us to locate the occupation of the site between 1320 and 1625 cal AD.
Parasomnias are involuntary behaviors or subjective experiences during sleep. Our objective was to review existing information on the presence of parasomnias in patients with addictions or during treatment for addictions. Information about parasomnias related to rapid-eye-movement (REM) and non-REM sleep in patients with addictions, while using substances or in abstinence, was reviewed. A systematic search of published articles reporting parasomnias as a consequence of drug use or abuse was conducted in the PubMed and SciELO databases. The search for the studies was performed in three phases: (1) by title, (2) by abstract, and (3) by complete text. The search was performed independently by two researchers, who then compared their results from each screening phase. Seventeen articles were found. The consumption of alcohol was reported in association with arousal disorders, such as sexsomnia and sleep-related eating disorder; and REM sleep behavior disorder was reported during alcohol withdrawal. Cocaine abuse was associated with REM sleep behavior disorder with drug consumption dream content. Overall, we found that several types of parasomnias were very frequent in patients with addictions. To avoid accidents in bedroom, legal problems, and improve evolution and prognosis; must be mandatory to include security measures related to sleep period; avoid pharmacological therapy described as potential trigger factor; improve sleep hygiene; and give pharmacological and behavioral treatments for patients with these comorbid sleep disorders.
The concept of the Anthropocene has highlighted the significant global impact of human activities on ecological systems on a geological scale (Crutzen 2002). This concept has come to significantly influence a scientific and political agenda orientated towards documenting and denouncing multiple negative anthropogenic factors that have led to global change. Nevertheless, not all large-scale environmental transformations by human societies have been intrinsically destructive. Many indigenous communities in the Neotropics, Palearctic, sub-Saharan Africa, North America, Indo-Malaya and Australasia have radically – albeit often constructively – modified the physical and biotic conditions of the ecological systems that they inhabit (Ellis 2015). It is necessary to revise the assumption that human actions always degrade the environment, through a reconceptualization that we have previously called ‘anthropogenesis’ (Rivera-Núñez et al. 2020). Instead of the naïve portrayal of the ‘good Anthropocene’ (Hamilton 2015, Fremaux & Barry 2019), anthropogenesis seeks to enrich the biodiversity debate with the historical human expressions of constructed environments that the conservation-focused ‘Edenic sciences’ and the ‘pristine syndrome’ (Robbins & Moore 2013) tend to ignore, or ‘Anthropo-not-see’ (de la Cadena 2019). The objective of this comment paper is to urge the academic community, grassroots organizations and governments to employ a concept of ‘palimpsest’ (from the Ancient Greek for ‘again scraped’, implying that something is scraped clear ready to be used again) in the reconceptualization of biodiversity conservation from a historical perspective that implements research and policy agendas that incorporate the human propensity for environmental construction in a deeper and more inclusive manner.
Our purpose was to determine the intensive care units’ (ICU’s) medical staff surge capacity during the coronavirus disease 2019 (COVID-19) outbreak in Spring 2020 in Spain.
A multicenter retrospective survey was performed addressing the medical specialties present in the ICUs and the increase in bed capacity during this period.
Sixty-seven centers (62.04%) answered the questionnaire. The ICU bed capacity during the pandemic outbreak increased by 160% (95% confidence interval [CI], 128.97-191.03%). The average number of beds per intensive care medicine (ICM) specialist was 1.5 ± 0.60 and 3.71 ± 2.44 beds/specialist before and during the COVID-19 outbreak, respectively. Non-ICM specialists and residents were present in 50 (74.63%) and 23 (34.3%) ICUs during the outbreak, respectively. The number of physicians (ICM and non-ICM residents and specialists) in the ICU increased by 89.40% (95% CI, 64.26114.53%). The increase in ICM specialists was, however, 4.94% (95% CI, −1.35-11.23%). Most non-ICM physicians were anesthetists, followed by pediatricians and cardiologists.
The majority of ICUs in our study were able to rapidly expand critical care capacity by adapting areas outside of the normal ICU to manage critically ill patients, and by extending the critical care staff with noncritical care physicians working as force multipliers.
Building on past research, we implement a hierarchical latent class model to analyze political participation from a comparative perspective. Our methodology allows simultaneously: (i) estimating citizens’ propensity to engage in conventional and unconventional modes of participation; (ii) classifying individuals into underlying “types” capturing within- and cross-country variations in participation; and (iii) assessing how this classification varies with micro- and macro-level factors. We apply our model to Latin American survey data. We show that our method outperforms alternative approaches used to study participation and derive typologies of political engagement. Substantively, we find that the distribution of participatory types is similar throughout the continent, and that it correlates strongly with respondents’ socio-demographic characteristics and crime victimization.
The coronavirus disease 2019 (COVID-19) pandemic has induced a reinforcement of infection control measures in the hospital setting. Here, we assess the impact of the COVID-19 pandemic on the incidence of nosocomial Clostridioides difficile infection (CDI).
We retrospectively compared the incidence density (cases per 10,000 patient days) of healthcare-facility–associated (HCFA) CDI in a tertiary-care hospital in Madrid, Spain, during the maximum incidence of COVID-19 (March 11 to May 11, 2020) with the same period of the previous year (control period). We also assessed the aggregate in-hospital antibiotic use (ie, defined daily doses [DDD] per 100 occupied bed days [BD]) and incidence density (ie, movements per 1,000 patient days) of patient mobility during both periods.
In total, 2,337 patients with reverse transcription-polymerase chain reaction–confirmed COVID-19 were admitted to the hospital during the COVID-19 period. Also, 12 HCFA CDI cases were reported at this time (incidence density, 2.68 per 10,000 patient days), whereas 34 HCFA CDI cases were identified during the control period (incidence density, 8.54 per 10,000 patient days) (P = .000257). Antibiotic consumption was slightly higher during the COVID-19 period (89.73 DDD per 100 BD) than during the control period (79.16 DDD per 100 BD). The incidence density of patient movements was 587.61 per 1,000 patient days during the control period and was significantly lower during the COVID-19 period (300.86 per 1,000 patient days) (P < .0001).
The observed reduction of ~70% in the incidence density of HCFA CDI in a context of no reduction in antibiotic use supports the importance of reducing nosocomial transmission by healthcare workers and asymptomatic colonized patients, reinforcing cleaning procedures and reducing patient mobility in the epidemiological control of CDI.
Nursing instruments have the potential for daily screening of delirium; however, they have not yet been evaluated. Therefore, after assessing the functional domains of the electronic Patient Assessment — Acute Care (ePA-AC), this study evaluates the cognitive and associated domains.
In this prospective cohort study in the intensive care unit, 277 patients were assessed and 118 patients were delirious. The impacts of delirium on the cognitive domains, consciousness and cognition, communication and interaction, in addition to respiration, pain, and wounds were determined with simple logistic regressions and their respective odds ratios (ORs).
Delirium was associated with substantial impairment throughout the evaluated domains. Delirious patients were somnolent (OR 6), their orientation (OR 8.2–10.6) and ability to acquire knowledge (OR 5.5–11.6) were substantially impaired, they lost the competence to manage daily routines (OR 8.2–22.4), and their attention was compromised (OR 12.8). In addition, these patients received psychotropics (OR 3.8), were visually impaired (OR 1.8), unable to communicate their needs (OR 5.6–7.6), displayed reduced self-initiated activities (OR 6.5–6.9) and challenging behaviors (OR 6.2), as well as sleep–wake disturbances (OR 2.2–5), Furthermore, delirium was associated with mechanical ventilation, abdominal/thoracic injuries or operations (OR 4.2–4.4), and sensory perception impairment (OR 3.9–5.8).
Significance of results
Delirium caused substantial impairment in cognitive and associated domains. In addition to the previously described functional impairments, these findings will aid the implementation of nursing instruments in delirium screening.
In this work, a new method to determine and correct the linear drift for any crystalline orientation in a single-column-resolved high-resolution scanning transmission electron microscopy (HR-STEM) image, which is based on angle measurements in the Fourier space, is presented. This proposal supposes a generalization and the improvement of a previous work that needs the presence of two symmetrical planes in the crystalline orientation to be applicable. Now, a mathematical derivation of the drift effect on two families of asymmetric planes in the reciprocal space is inferred. However, though it was not possible to find an analytical solution for all conditions, a simple formula was derived to calculate the drift effect that is exact for three specific rotation angles. Taking this into account, an iterative algorithm based on successive rotation/drift correction steps is devised to remove drift distortions in HR-STEM images. The procedure has been evaluated using a simulated micrograph of a monoclinic material in an orientation where all the reciprocal lattice vectors are different. The algorithm only needs four iterations to resolve a 15° drift angle in the image.
THE VATICAN LIBRARY, ever since its foundation in the mid-fifteenth century, has had as its primary tasks the protection and preservation of its collections, while also making them freely available to scholars. These cardinal concepts have been easily adapted to the new technologies for greater dissemination and preservation of the Library's cultural heritage.
Already in the nineteenth century, faced with the concrete danger of being unable to stop the ongoing deterioration of the palimpsests that had been treated with Gallic acid in order to read the undertext, photographic techniques were selected as a means to at least fix in time the status quo of the text of the most damaged manuscripts. At the beginning of the twentieth century, the internal photographic laboratory was formed, leading to the creation of a new professional figure that would develop over time. Due to the tragic circumstances of the first half of the twentieth century in Europe, the creation of photographic surrogates acquired a supplementary function: should the originals be destroyed, the images preserved in different venues could at least preserve the textual transmission for the future generations. With this purpose in mind, safe storage to collect microfilm copies of most manuscripts was created across the Atlantic Ocean. In 1975, the Vatican Library organized the interlibrary conference Conservation et reproduction des manuscrits et imprimés anciens, once again bringing to the forefront photographic surrogates of manuscripts and early printed books. In 1994, in collaboration with IBM and the Pontifical Catholic University of Rio de Janeiro, the Library took its first steps towards digitization, scanning a sample of 150 manuscripts taken from its most famous holdings. In time, the photographic campaign was gradually extended to the rest of the collections. At the dawn of this new century, a new technology is now expanding considerably the means to disseminate the Vatican's library heritage: the digitization and the publishing of the resulting images online through the web.
A Pharaonic Endeavour: The Complete Digitization of the Manuscript Holdings
The Vatican Library has planned to digitize all the manuscripts in its collections. This is a pharaonic undertaking, as there are about 82,000 manuscripts to digitize, the majority of which are bound in codex format.
To examine the effectiveness of an Internet Based Therapy (IBT) for Bulimia Nervosa (BN), when compared to a brief psychoeducational group therapy (PET) or a waiting list (WL).
93 female BN patients, diagnosed according to DSM-IV criteria. An experimental group (31 IBT patients) was compared to two groups (31 PET and 31 WL). PET and WL were matched to the IBT group in terms of age, disorder duration, previous treatments and severity. All patients completed assesment, prior and after treatment.
Considering IBT, mean scores were lower at the end of treatment for some EDI scales and BITE symptoms scale, while the mean BMI was higher at post-therapy. Main predictors of good IBT outcome were higher scores in EDI perfectionism and higher scores on reward dependence. Drop-out was related to higher SCL-obsessive/compulsive (p=0.045) and novelty seeking (p=0.044) scores and lower reward dependence (p=0.018). At the end of the treatment bingeing and vomiting abstinence rates (22.6% for IBT, 33.3% for PET, and 0.0% for WL; p=0.003) and drop-out rates (35.5% IBT, 12.9% PET and 0% WL; p= 0.001) differed significantly between groups. While the concrete comparison between the two treatments (IBT and PET) did not evidence significant differences for success proportions (p=0.375), statistical differences for drop-out rates (p=0.038) were obtained.
The results of this study suggest that an online self-help approach appears to be a valid treatment option for BN, especially for people who present lower severity of their eating disorder (ED) symptomatology and some specific personality traits.
The objective of this study was to analyze clinical and personality differences in three groups of patients with eating disorders: binge eating disorder (BED), bulimia nervosa- purging type (BN-P) and bulimia nervosa-non purging type (BN-NP).
The participants were 102 female patients (34 BED, 34 BN-P and 34 BN-NP), mean age 28.7. Assessment measures included the following tests: EDI-2, BITE, EAT-40, SCL-90-R and TCI-R, and other clinical and psychopathological indices that were collected via semi-structured interview.
When compared all three groups, BED were the oldest group, showed more frequent familial history of obesity and current or lifetime obesity. Regarding psychopathology, BN-P patients showed the most pathological scores, followed by BN-NP patients and BED patients showing the least pathological scores. Specifically, BN-P patients showed statistically higher scores than BED patients on SCL-90-R Paranoid Ideation, EAT-40 total score, EDI-2 Impulsivity subscale, and BITE Severity subscale. No statistically significant differences were observed among groups, on personality traits. A two-step cluster analysis procedure was conducted, to determine the clinical proximity among the three diagnostic groups. The relationship between cluster classification and diagnosis was statistically different (p<0.001), so we can assume that the present classification maybe does not classify accurately eating disorders.
Even when BED patients present differential characteristics with respect to family and personal antecedents when compared to BN patients, clinical and psychopathological overlapping with BN-NP makes them similar. Likewise, our results suggest deficiencies in the current nosological system, since it does not group patients’ subgroups which are homogeneous enough.
Suicide is a major public health problem in most of the countries because it has a high prevalence in young people. It has been studied that high levels of cortisol are associated with depression and increase of the suicidal risk.
To analyze the relationship between cortisol levels in a population of university students and the questionnaire results for the Beck Depression Inventory (BDI).
The sample was composed by 106 students of the Nursing School of Santiago de Compostela University. The 88.7% of the sample are women with a mean age of 21.50 + /−2.52, the 99% are unmarried. The protocol consisted in 3 sections: demographic variables, BDI questionnaire with spanish scale and determination of salivary cortisol levels. Statistical analysis was done with SPSS 15.
The are higher levels of salivary cortisol in students with a greater or equal score to 13 on the BDI with statistically significances differences (p = .000). Students with suicidal ideation (item 9 of the BDI) have highest rates of cortisol, with statistically significant differences (p = 0.001).
This study supports other researchs about the association between biological neuroendocrine markers and affective disorders. Explaining suicidal behavior could help us to prevent it by using early intervention strategies for vulnerable populations. They could also identify markers to establish the risk of suicide.
To explore gender differences on personality and clinical features in patients with eating disorders (ED) and a healthy control sample.
60 ED males and 60 ED females, consecutively admitted to our Hospital and diagnosed according to DSM-IV-R criteria, were matched for age and diagnosis. A comparison group of 120 non clinical people (60 males, 60 females) were also collected. Measures: TCI-R, SCL-90-R, EDI-2.
Female ED patients scored significantly higher than males on Drive for Thinness, Body Dissatisfaction, Interoceptive Awareness and total EDI (p < 0.002). However, these differences were not significant when compared with controls. ED women exhibited higher SCL-90-R Somatization, Interpersonal Sensitivity, Depression, Anxiety, Hostility, GSI, PSDI and PST scores (p<0.002). Regarding personality traits, high Harm Avoidance, Persistence, Cooperativeness (p<0.018) and low Self- Directedness (p=0.001) were associated with an ED diagnosis in males. Significant differences across ED subdiagnoses were also observed. Lifetime obesity was significantly associated with ED in males (p=0.008). However, when specific ED diagnosis was entered, the gender effect of obesity disappeared (p=0.081).
Although gender specific differences in clinical and psychopathological features across ED patients have been observed, there are important similarities in current ED features between ED males and females, suggesting that, in spite of having some gender-specific associated traits, EDs are not different with regard to gender. These data encourage our continued efforts toward using similar strategies to detect and treat EDs among men and women.
One of the disorders that most affects school and social performance is attention deficit disorder associated with hyperactivity or impulsivity (ADHD). The criteria established by DSM-IV-TR edition distinguish three subtypes: inattentive, hyperactive-impulsive and combined. There are other factors that increase the severity of the disorder. These factors have to do with different associated psychopathologies such as learning difficulties, depression, oppositional defiant disorder, behavior disorder, anxiety disorders and mood disorders. Mean comorbidity of ADHD with anxiety disorders is estimated at 20–25%. The main goal of this investigation is to determine whether there are differential patterns of attention (selective and concentration using D-2 attention test) and anxiety (trait and state anxiety using State-Trait Anxiety Inventory for Children) for these three types of ADHD. The sample was made up of 220 children (6–12 years): 56 in the control group, 54 with predominantly attention deficit disorder, 53 with predominantly hyperactivity-impulsivity disorder and 57 with combined inattentive-hyperactive disorder. We used a design of four groups, three corresponding to the ADHD subtypes and a control group without ADHD. The results obtained show that the four groups of subjects were significantly different in the two attentional variables and in trait and state anxiety. The combined subtype presents higher trait anxiety, whereas the inattentive subtype shows higher levels of state anxiety. The results reveal a new path of great interest concerning objective and reliable diagnostic assessment, and pharmacological and behavioral intervention adapted to each specific situation.