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Insomnia is the most frequent sleep disorder in late life. Forty-two percent of elderly people in the United States often complain about difficulties to get or maintain sleep, or awakening too early. Insomnia is frequent in old people greatly due to frequency of concomitant medical illnesses and polypharmacy, rather than because of age.
The objective of our research was to revise the current state of knowledge about management of insomnia in people above 65 years of age.
For that, a bibliographical search through PubMed.gov has been made. From the obtained results, the 14 which best suited for our goals were selected, 10 of them dealing with people above 65 years and the rest with people above 75 or 80 years of age.
Based on the literature reviewed, the current options of management of late-life insomnia are based on behavioral or pharmacological therapy. The combination of behavioral therapies shows results and is currently considered as an option, especially given the possibility of medicine interaction and the secondary effects hypnotic and sedative medicines might produce. There is a paucity of long-term safety and efficacy data for the use of non-benzodiazepine sedative-hypnotics. There are no criteria for the use of antidepressant sedatives in elderly people without diagnosed depression, although they are still used in practice.
Possibility of using behavioral therapy as first option. In case of polymedicated or multi-pathological patients, pay special attention when starting a pharmacological treatment, choose the most suitable one and supervise it closely.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Schizophrenia has traditionally been considered to strictly be an early-onset disorder. Current nosologies, including DSMV, are not restrictive with age of onset in schizophrenia and all patients that satisfy diagnostic criteria fall into the same category. Since 1998, International Late-Onset Schizophrenia Group consensus, patients after 60 are classified as very-late onset schizophrenia-like psychosis. Female overrepresentation, low prevalence of formal thought disorder, and a higher prevalence of visual hallucinations are associated with later age at onset. Atypical antipsychotics represent the election treatment because of the reduced likelihood of EPS and tardive dyskinesias, and should be started at very low doses, with slow increases.
To review the current knowledge about very late-onset schizophrenia through systematic review of the literature and the analysis of a case.
Case Report. Review. Literature sources were obtained through electronic search in PubMed database of last fifteen years.
We present a case of a 86-year-old woman suffering from delusions and hallucinations, diagnosed with very late-onset schizophrenia-like psychosis, after differential diagnosis with other disorders. We analyze ethiology, epidemiology, clinical features and treatment in geriatric patients with schizophrenia.
Reluctance to diagnose schizophrenia in old people is still present today, probably in relation with the inconsistency in diagnostic systems and nomenclature, and consideration of medical conditions in the diagnosis. Identification of these patients is really important in order to start an appropriate treatment, which can lead to patient clinical stability.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Delusional of parasitosis or Ekbom's syndrome (ES) is a psychiatric disorder in which the patient has a fixed and false belief that small organisms infest the body. The belief is often accompanied by hallucinations. It is an uncommon condition that was initially studied by dermatologists, more prevalent in the elderly and typically observed in women older than 50 years although isolated cases among men have been reported.
To review current knowledge about delusional of parasitosis in elderly patients through literature systematic review and the analysis of a case report.
We performed a literature search using electronic manuscripts available in PubMed database published during the last five years, following the description and discussion of a clinical case. We report a case of an 85-year-old man who presented a delusional parasitosis as a primary disorder.
The literature on ES consists mostly of case reports and limited series. In this paper, we analyze the etiology, demographic characteristics, clinical features and treatment in geriatric patients with delusional parasitosis.
International classifications have included this syndrome in non-schizophrenic delusions. However, it has also been reported in schizophrenia, affective disorders, and organic or induced psychosis. Treatment is based on antipsychotic agents, psychotherapy and cooperation between dermatologists and psychiatrists.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
A primary barrier to translation of clinical research discoveries into care delivery and population health is the lack of sustainable infrastructure bringing researchers, policymakers, practitioners, and communities together to reduce silos in knowledge and action. As National Institutes of Healthʼs (NIH) mechanism to advance translational research, Clinical and Translational Science Award (CTSA) awardees are uniquely positioned to bridge this gap. Delivering on this promise requires sustained collaboration and alignment between research institutions and public health and healthcare programs and services. We describe the collaboration of seven CTSA hubs with city, county, and state healthcare and public health organizations striving to realize this vision together. Partnership representatives convened monthly to identify key components, common and unique themes, and barriers in academic–public collaborations. All partnerships aligned the activities of the CTSA programs with the needs of the city/county/state partners, by sharing resources, responding to real-time policy questions and training needs, promoting best practices, and advancing community-engaged research, and dissemination and implementation science to narrow the knowledge-to-practice gap. Barriers included competing priorities, differing timelines, bureaucratic hurdles, and unstable funding. Academic–public health/health system partnerships represent a unique and underutilized model with potential to enhance community and population health.
The Rufous-throated Dipper Cinclus schulzi is endemic to the Southern Yungas of north-western Argentina and southern Bolivia. The species is categorised as ‘Vulnerable’ on the IUCN Red List on the basis of small population size and restricted range. The purpose of our study was to determine the distribution of potentially suitable habitat for the Rufous-throated Dipper, estimate its population size, and assess potential distribution within strict protected areas, in north-western Argentina. We surveyed 44 rivers in the Southern Yungas of Argentina from 2010 to 2013 to determine dipper density (i.e. the number of individuals detected per km surveyed). The dipper’s potential distribution was assessed using a maximum entropy modeling approach based on 31 occurrence points and eight bioclimatic and two topographic variables as predictors. The species is dependent on mountain forest rivers, so the potential distribution was restricted to rivers. We estimated dipper population size by multiplying density by the potential distribution along rivers. Finally, we calculated the extent of suitable habitat contained within the boundaries of Argentina´s National Parks. Dipper density was 0.94 ± 1.55 individuals/km. We estimate that within north-west Argentina there are ~2,815 km of river that are potential habitat, with an area of occupancy of 141 km2 and a population size of 2,657 ± 4,355 dippers. However, of this river extent, less than 5% is within National Parks. Our results highlight the need to create new and to enlarge existing National Parks that protect the potentially suitable habitat of the species. Although more information is needed for Bolivia, the country-level area of occupancy and population size of the dipper found in Argentina provides strong evidence that the IUCN Red List classification of this species as ‘Vulnerable’ is warranted.
Migration was a key social process contributing to the creation of the ‘Chaco World’ between AD 800 and 1200. Dynamic social network analysis allows for evaluation of several migration scenarios, and demonstrates that Chaco’s earliest ninth-century networks show interaction with areas to the west and south, rather than migration to the Canyon from the Northern San Juan. By the late eleventh century, Chaco Canyon was tied strongly to the Middle and Northern San Juan, while a twelfth-century retraction of networks separated the Northern and Southern San Juan areas prior to regional depopulation. Understanding Chaco migration is important for comprehending both its uniqueness in U.S. Southwest archaeology and for comparison with other case studies worldwide.
Air pollution in Mexico City, which has more than 22 million inhabitants, continues to be one of the main environmental issues. Aerosol samples (PM10) collected in Mexico City and the city of Cuernavaca (a clean reference site) have been characterized using different techniques. This multifaceted approach addresses the source apportionment of the carbonaceous matter in PM10, as well as the airborne elements and ions. Accelerator mass spectrometry (AMS) radiocarbon analysis of total carbon, X-ray fluorescence (XRF), and ion chromatography were performed on aerosols collected at three sites in Mexico City and one site in Cuernavaca, during 2 months of the cold-dry season (November–December) in 2012. New results obtained for Mexico City are compared with previous reports. Average levels of PM10 were higher in Mexico City sites (43.3–60.8 μg/m3) than in Cuernavaca (32.2 μg/m3). According to the material balance, PM10 collected in Mexico City had a lower contribution of crustal material (31.2–36.8%) than Cuernavaca (46.9%). Average contributions of particulate carbonaceous matter to PM10 were similar in both cities, but much higher contributions of mineral salts, trace elements, and ions were observed in Mexico City in comparison to Cuernavaca. Total organic carbon (OC) and elemental carbon (EC) contents were higher in aerosols from Mexico City than those from Cuernavaca. The temporal variation results showed that within all locations studied the OC concentration was high compared to the EC. Results from a theoretical calculation of fossil carbon (FC) and biogenic carbon (BC) concentrations showed that FC and BC levels depend on the site: at Mexico City sites, FC was equal or higher than BC. At Cuernavaca, BC was always higher than FC.
The star formation history of galaxies is a complex process usually considered to be stochastic in nature, for which we can only give average descriptions such as the color-density relation. In this work we follow star-forming gas particles in a hydrodynamical N-body simulation back in time in order to study their initial spatial configuration. By keeping record of the time when a gas particle started forming stars we can produce Lagrangian gas-star isochrone surfaces delineating the surfaces of accreting gas that begin producing stars at different times. These surfaces form a complex a network of filaments in Eulerian space from which galaxies accrete cold gas. Lagrangian accretion surfaces are closely packed inside dense regions, intersecting each other, and as a result galaxies inside proto-clusters stop accreting gas early, naturally explaining the color dependence on density. The process described here has a purely gravitational / geometrical origin, arguably operating at a more fundamental level than complex processes such as AGN and supernovae, and providing a conceptual origin for the color-density relation.
Congenital cytomegalovirus (CMV) infection rates increase with maternal seroprevalence due to transmission from maternal non-primary infection. CMV seroprevalence estimates of pregnant women are needed for planning strategies against congenital CMV transmission. We aimed to determine the age-specific prevalence of serum antibodies for CMV in a representative age-stratified sample of unselected pregnant women from a Brazilian population. A total of 985 pregnant women, aged 12–46 years (median 24 years), were enrolled. Overall CMV seroprevalence was 97% (95% confidence interval 95·8–98·0), with age-specific (years) prevalence as follows: 12–19 (96·3%), 20–24 (97·7%), 25–29 (97·1%), and 30–46 (96·7%). CMV seroprevalence is almost universal (97%) and is found at similar levels in pregnant women of ages ranging from 12 to 46 years. Because high CMV seroprevalence is found even in women of a younger age in this population, this finding suggests that the majority of primary CMV infections occur early, in infancy or childhood. As a consequence, vaccines currently under development to prevent primary infection may not be a solution for the prevention of congenital CMV infection in this population.
The Nearby Supernova Factory aims at discovering and stud- ying
a large sample of nearby (0.03 < z < 0.08) thermonuclear
supernovae. Potential targets are extracted from the unbiased
Palomar-QUEST survey, and follow-up spectro-photometric observations
are performed using the dedicated Supernovae Integral-Field
Spectrograph. The current sample comprises more than 2700
flux-calibrated optical spectra (320-1000 nm) from 181 supernovæ
followed over their full life-time. Specific operation and
data-reduction issues are discussed, and first scientific results
from this unprecedented dataset are presented.
Molecular methods for the detection and typing of hepatitis A virus (HAV) strains in sewage were applied to determine its distribution in Cairo and Barcelona. The study revealed the occurrence of different patterns of hepatitis A endemicity in each city. The circulating strains characterized, whether in Cairo or Barcelona, were genotype IB. The effects of a child vaccination programme and the increase in the immigrant population on the overall hepatitis A occurrence in Barcelona were evaluated. While vaccination contributed to a significant decrease in the number of clinical cases, the huge recent immigration flow has probably been responsible for the re-emergence of the disease in the last year of study, in the form of small outbreaks among the non-vaccinated population.
Genetically engineered transgenic crop varieties (TGVs) have spread rapidly in the last 10 years, increasingly to traditionally-based agricultural systems (TBAS) of the Third World both as seed and food. Proponents claim they are key to reducing hunger and negative environmental impacts of agriculture. Opponents claim they will have the opposite effect. The risk management process (RMP) is the primary way in which TGVs are regulated in the US (and many other industrial countries), and proponents claim that the findings of that process in the US and its regulatory consequences should be extended to TBAS. However, TBAS differ in important ways from industrial agriculture, so TGVs could have different effects in TBAS, and farmers there may evaluate risks and benefits differently. To evaluate some potential impacts of TGVs in TBAS we used the RMP as a framework for the case of Bt maize in Mesoamerica and Cuba. We interviewed 334 farmers in Cuba, Guatemala and Mexico about farming practices, evaluations of potential harm via hypothetical scenarios, and ranking of maize types. Results suggest high potential for transgene flow via seed, grain and pollen; differences in effects of this exposure in TBAS compared with industrial agriculture; farmers see some potential consequences as harmful. Perceptions of harm differ among farmers in ways determined by their farming systems, and are different from those commonly assumed in industrial systems. An RMP including participation of farmers and characteristics of TBAS critical for their functioning is necessary to ensure that investments in agricultural technologies will improve, not compromise these agricultural systems.
In frontier analysis, most of the nonparametric approaches (free
disposal hull [FDH], data envelopment analysis [DEA])
are based on envelopment ideas, and their statistical theory is now mostly
available. However, by construction, they are very sensitive to outliers.
Recently, a robust nonparametric estimator has been suggested by Cazals,
Florens, and Simar (2002, Journal of
Econometrics 1, 1–25). In place of estimating the full
frontier, they propose rather to estimate an expected frontier of order
m. Similarly, we construct a new nonparametric estimator of the
efficient frontier. It is based on conditional quantiles of an appropriate
distribution associated with the production process. We show how these
quantiles are interesting in efficiency analysis. We provide the
statistical theory of the obtained estimators. We illustrate with some
simulated examples and a frontier analysis of French post offices, showing
the advantage of our estimators compared with the estimators of the
expected maximal output frontiers of order m.We thank J.P. Florens for helpful discussions and C. Cazals
for providing the post office data set. We also are very grateful to the
referees for useful suggestions.
Leptogium quercicola (Collemataceae), a new corticolous species, is described from central and south-eastern Spain. It is closely related to L. lichenoides, but differs in the development of dense fruticolous cushions, with lobes narrower than the smallest known forms of L. lichenoides. Moreover, spore length and width of the two taxa are significantly different. In addition, the two species differ ecologically; L. quercicola growing directly on bark of Quercus spp., while L. lichenoides colonizes rocks, soil and bark but always among mosses.
We analyse the rest–frame (U$-$V) colour–magnitude relation for 2 clusters at redshift 0.7 and 0.8, drawn from the ESO Distant Cluster Survey. By comparing them with the population of red galaxies in the Coma cluster, we show that the high redshift clusters exhibit a deficit of passive faint red galaxies. Our results show that the red–sequence population cannot be explained in terms of a monolithic and synchronous formation scenario. A large fraction of faint passive galaxies in clusters today has moved onto the red sequence relatively recently as a consequence of the fact that their star formation activity has come to an end at $z<0.8$.To search for other articles by the author(s) go to: http://adsabs.harvard.edu/abstract_service.html