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This study explores magnetization exhibited by nanoscale platinum-based structures embedded in pure silica plates. A superposition of laser pulses in the samples produced periodic linear arrangements of micro-sized structures. The samples were integrated by PtO2 microstructures (PtOΣs) with dispersed Pt oxide nanoparticles in their surroundings. The characterization of the materials was performed by high transmission electron microscopy studies. Furthermore, topographical and magnetic effects on the sample surfaces were analyzed by atomic force microscopy and magnetic force microscopy, respectively. The magnetic measurements indicated an enhancement in the gradient phase shift and in the gradient force related to the magnetic PtOΣs. The possibility of tuning the magnetic characteristics of the samples through contact with a Nd2Fe14B magnet was demonstrated. This process corresponds to an innovative method for obtaining magnetic PtOΣs induced by laser pulses. Moreover, an increase in the compactness of the silica with platinum-based structures was confirmed by an evaluation of the effective elastic modulus with reference to pure silica. The multimodal magnetic structures studied in this work seem to be candidates for developing high-density magnetic storage media.
In cases of mass-casualty incidents (MCIs), triage represents a fundamental tool for the management of and assistance to the wounded, which helps discriminate not only the priority of attention, but also the priority of referral to the most suitable center.
The objective of this study was to evaluate the capacity of different prehospital triage systems based on physiological parameters (Shock Index [SI], Glasgow-Age-Pressure Score [GAP], Revised Trauma Score [RTS], and National Early Warning Score 2 [NEWS2]) to predict early mortality (within 48 hours) from the index event for use in MCIs.
This was a longitudinal prospective observational multi-center study on patients who were attended by Advanced Life Support (ALS) units and transferred to the emergency department (ED) of their reference hospital. Collected were: demographic, physiological, and clinical variables; main diagnosis; and data on early mortality. The main outcome variable was mortality from any cause within 48 hours.
From April 1, 2018 through February 28, 2019, a total of 1,288 patients were included in this study. Of these, 262 (20.3%) participants required assistance for trauma and injuries by external agents. Early mortality within the first 48 hours due to any cause affected 69 patients (5.4%). The system with the best predictive capacity was the NEWS2 with an area under the curve (AUC) of 0.891 (95% CI, 0.84-0.94); a sensitivity of 79.7% (95% CI, 68.8-87.5); and a specificity of 84.5% (95% CI, 82.4-86.4) for a cut-off point of nine points, with a positive likelihood ratio of 5.14 (95% CI, 4.31-6.14) and a negative predictive value of 98.7% (95% CI, 97.8-99.2).
Prehospital scores of the NEWS2 are easy to obtain and represent a reliable test, which make it an ideal system to help in the initial assessment of high-risk patients, and to determine their level of triage effectively and efficiently. The Prehospital Emergency Medical System (PhEMS) should evaluate the inclusion of the NEWS2 as a triage system, which is especially useful for the second triage (evacuation priority).
This is a case of a 30-year-old right-handed male patient who presented to the hospital in 2014 after hitting his head on the mat during a wrestling match followed by headache and temporary peripheral vision limitation. The patient’s past medical history was unremarkable. On physical examination, Glasgow Coma Scale was 15 with no focal neurological deficits. Unenhanced head computed tomography (CT) and enhanced brain magnetic resonance imaging (MRI) were performed (Figure 1). The patient was managed conservatively, and follow-up CT and MRI in 2015 (Figure 2) demonstrated significant decrease in size of the previously seen right frontoparietal lesion with also changes in its radiological features. The patient remained asymptomatic for about 3 years when in 2018 he presented to the Emergency Department with increasing headaches and peripheral vision loss. MRI demonstrated an increase in the right frontal lesion size (Figure 3). He underwent surgical resection of the lesion.
Path planning represents planning collision-free strategies to move from starting point to ending point. These strategies can be carried out for known and unknown environments. Recently, a novel and reduced CPU-time modeling and simulation methodology for path planning in known environment based on resistive grids (RGs) has been introduced. In this work, a novel modified version of Resistive Grid Path Planning Methodology (RGPPM) methodology is presented with the purpose of exploring collision-free path planning for robotic arms. This extension of the methodology allows to numerically relate positions in the RG with angular values of the robotic systems. In addition, it is possible to include obstacles in the configuration space, and therefore collision detection can be established for RGs. Finally, the variation of links for robotic arms and obstacles for configuration space is explored by simulating different scenarios.
Species distribution models (SDMs) are statistical tools used to develop continuous predictions of species occurrence. ‘Integrated SDMs’ (ISDMs) are an elaboration of this approach with potential advantages that allow for the dual use of opportunistically collected presence-only data and site-occupancy data from planned surveys. These models also account for survey bias and imperfect detection through the use of a hierarchical modelling framework that separately estimates the species–environment response and detection process. This is particularly helpful for conservation applications and predictions for rare species, where data are often limited and prediction errors may have significant management consequences. Despite this potential importance, ISDMs remain largely untested under a variety of scenarios. We performed an exploration of key modelling decisions and assumptions on an ISDM using the endangered Baird’s tapir (Tapirus bairdii) as a test species. We found that site area had the strongest effect on the magnitude of population estimates and underlying intensity surface and was driven by estimates of model intercepts. Selecting a site area that accounted for the individual movements of the species within an average home range led to population estimates that coincided with expert estimates. ISDMs that do not account for the individual movements of species will likely lead to less accurate estimates of species intensity (number of individuals per unit area) and thus overall population estimates. This bias could be severe and highly detrimental to conservation actions if uninformed ISDMs are used to estimate global populations of threatened and data-deficient species, particularly those that lack natural history and movement information. However, the ISDM was consistently the most accurate model compared to other approaches, which demonstrates the importance of this new modelling framework and the ability to combine opportunistic data with systematic survey data. Thus, we recommend researchers use ISDMs with conservative movement information when estimating population sizes of rare and data-deficient species. ISDMs could be improved by using a similar parameterization to spatial capture–recapture models that explicitly incorporate animal movement as a model parameter, which would further remove the need for spatial subsampling prior to implementation.
The aim of this study is to investigate the impact of anatomical changes in prostate cancer patients on the target coverage when using 6 MV beams-VMAT therapy and to propose strategies that allow us to evaluate the dose or correct it by normalization without having to perform a new simulation.
Methods and materials:
Ten patients of high-risk prostate cancer were chosen for the study. All test plans were delivered using the same isocenter and monitor units as the original plan and compared against the original unedited plan. The expansion and contraction of body contours due to size changes was mimicked by increasing and decreasing the body contour with depths of −2, −1·5, …, 1·5, 2 cm, in the anterior, and both lateral directions of the patient. A total of 90 plans were evaluated, 9 for each patient. Dose-volume histogram statistics were extracted from each plan and normalized to prescription dose.
Weight changes resulted in considerable dose modifications to the target and critical structures. Plans were found to be varied with 2·9% ± 0·3% per cm SSD change for VMAT treatment with a correlation index close to one. Therefore, doses variations were linear to the changes of depth. Gamma index evaluation was performed for the 10 renormalized plans. All of them passed criteria of 3%/3 mm in at least 98.2% of points. Eight of them passed criteria in 99% points. Gamma index 4%/4 mm passed 100% points in all patients for the chosen region of interest.
The dosimetry estimation presented in this study shows important data for the radiation oncology staff to justify whether a CT rescan is necessary or not when a patient experiences weight changes during treatment. Based on the results of our study, discrepancies between real dose and planned dose were >5% for 1·7 cm of difference in external contour in the anterior and both lateral directions of the patient.
Aripiprazole once-monthly is an LAI formulation of aripiprazole that is currently approved in the USA and Europe for the treatment of schizophrenia. Some studies have reported a decline in hospital admissions and emergency use after initiation on long-acting injectable (LAI) antipsychotics, but the effects of using recently commercialised LAI aripiprazole remains uncertain.
To characterize the impact of ALAI initiation on number of hospitalizations and visits to the emergency service, among patients suffering from schizophrenia attending regularly to psychiatric consultations of Gregorio Marañón University General Hospital (Madrid, Spain).
Patients initiated on (ALAI) were studied in an observational mirror-image design to assess changes in number of hospitalizations and visits to the emergency service in the 12months pre- vs 12months post-depot initiation. Other sociodemographic, physical and clinical variables such as age, gender, weight, blood pressure and presence of dual disorders were also gathered. Variables were collected reviewing clinical records.
Wilcoxon test was used to assess hospitalizations and visits to the emergency. Paired t-tests were used to assess changes in weight and blood pressure. Non parametric Mann-Whitney U test was used to compare aripiprazole doses between genders and in order to assess de influence of dual disorders. In order to perform the statistical analysis, IBM SPSS statistics v.20 was used.
31 patients were included in the final analysis. Mean age was 44.67 (SD=15.57) years. Most of the patients were male (54.8% vs 45.2%). 71% were previously receiving oral antipsychotics treatment, whereas 29% were receiving other LAI antipsychotic: no significant differences were observed when comparing hospitalizations (p=0.74) or emergency use (p=0.98) in the 12months post-initiation between these groups. Mean dosage was 352.67mg/28days (SD=0.461), and 38.7% needed an adjustment during the first year of treatment (dosage increased in 76.9%). A combination of two or more antipsychotics was prescribed in 64.5% of the patients. Mean psychiatric number of hospitalizations a year declined from 0.483/year pre-initiation to 0.224/year post-initiation (P<0.05), whereas mean visits a year to the emergency psychiatric service declined from 1.419 pre-initiation to 1.032 post-initiation (P<0.1). No significant changes in weight (p=0.82), systolic (p=0.56) or diastolic (p=0.29) blood pressure were observed. No gender differences in dosage were observed (p=0.246). Suffering from dual disorders had no influence on dosage either (p=0.68).
LAI aripiprazole initiation appears to provide a benefit decreasing hospitalization needs and emergency services consumption and it was well tolerated. This data supports previous evidence indicating superiority of LAI antipsychotics.
The twenty-first century could well become known as the populist century. No longer confined to Latin America or to the margins of European politics, populism has spread to Africa, Asia, and, with Donald Trump's election, to the cradle of liberal democracy. Even though it is uncertain what impact Trump's populism will have on American democracy, it is worth learning from Latin America, where populists have been in power from the 1930s and 1940s to the present. Even as Latin American populists like Juan Perón and Hugo Chávez included the poor and the nonwhite in the political community, they moved toward authoritarianism by undermining democracy from within. Are the foundations of American democracy and the institutions of civil society strong enough to resist US president Donald Trump's right-wing populism?
Bioactive molecules isolated from plants are promising sources for the development of new therapies against leishmaniasis. We investigated the leishmanicidal activity of cariphenone A (1), isouliginosin B (2) and uliginosin B (3) isolated from Hypericum species. Promastigotes and amastigotes of Leishmania amazonensis were incubated with compounds 1–3 at concentrations 1–100 µm for 48 h. The anti-promastigote effect of compounds was also tested in combinations. The cytotoxicity against macrophages and human erythrocytes were determined using the 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT) method and hemolysis assay, respectively. The compounds 1–3 showed high leishmanicidal activity against promastigotes, IC50 values of 10.5, 17.5 and 11.3 µm, respectively. Synergistic interactions were found to the associations of compounds 1 and 2 [Σ fractional inhibitory concentration (FIC) = 0.41], and 2 and 3 (ΣFIC = 0.28) on promastigotes. All Hypericum compounds induced mitochondrial hyperpolarization and reactive oxygen species production in promastigotes. The compounds showed low cytotoxicity toward mammalian cells, high selectivity index and killed intracellular amastigotes probably mediated by oxidative stress. These results indicate that these compounds are promising candidates for the development of drugs against leishmaniasis.
Background: Neurolymphomatosis is a process of neoplastic endoneurial invasion, most strongly associated with non-Hodgkin’s lymphoma. It must be distinguished from paraneoplastic, metabolic, nutritional and treatment-related causes of neuropathy that are common in this patient population. Methods: This brief case series illustrates the protean manifestations of neurolymphomatosis of the brachial plexus, ranging from focal distal mononeuropathy to multifocal brachial plexopathy, either as the index manifestation of lymphoma or as a complication of relapsing disease. Results: Prominent asymmetry, pain and nodular involvement on neuroimaging may help distinguish neurolymphomatosis from paraneoplastic immune demyelinating radiculoneuropathy. MR neurography criteria for the diagnosis of neurolymphomatosis include hyperintensity on T2 and STIR sequences, focal and diffuse nerve enlargement with fascicular disorganization and gadolinium enhancement. No specific anatomical distribution within the brachial plexus has, however, been found to be characteristic. Fluorodeoxyglucose-positron emission tomography (FDG-PET) imaging is the imaging modality with the highest sensitivity for detection of nodal or extranodal spread in lymphoma. Conclusions: Brachial plexus neuropathy in neurolymphomatosis is highly protean in its distribution, semiology and relation to lymphoma staging. Dedicated MRI and PET-CT imaging are leading diagnostic modalities.
Recently the use of nanomaterials for the diagnosis and detection of malignant diseases has increased due to the versatility and properties of these nanostructures. For this work 60 nm commercial gold nanoparticles (TED PELLA inc.) and Nanostars manufactured by chemical synthesis (precursor reagent: HAuCl4, cationic surfactant: CTAB) of 117 nm were used for coating. Malachite green Isotyocianate (MGITC), mPEG-SH and ortho-pyridyldisulfide-polyethylene glycol-N-succinimidyl propionate (OPSS-PEG-NHS) was used. A SERS active nanoparticle complex was obtained by addition of a solution of MGITC to the gold nanoparticles colloidal solution in a 1:6 ratio. Later, an mPEG-SH solution was added to the mix. The nanoparticle-MGITC-mPEG-SH complex stability was revised using a UV-Vis spectrophotometer and a JEOL JEM 1000 transmission electron microscope. The SERS spectra were registered with a Raman Thermoscientific DXR microscopy system. Amplified bands associated with OPSS-PEG-NHS were identified in 389, 622, 859, 929, 1080, 1283, 1360, 1443, 1490 and 1450 cm-1. The results indicate that through this methodology it is possible to identify gold nanomaterials coated with polymer through the Raman technique. In addition, greater amplification is observed with the use of nanostars compared to gold spheres. Finally, these nanomaterials are available for the marking of specific membrane for the study of different types of cancer by the SERS technique.
Leishmaniasis is a widely spread and zoonotic disease with serious problems as low effectiveness of drugs, emergence of parasite resistance and severe adverse reactions. In recent years, considerable attention has been given to secondary metabolites produced by Photorhabdus luminescens, an entomopathogenic bacterium. Here, we assessed the leishmanicidal activity of P. luminescens culture fluids. Initially, promastigotes of Leishmania amazonensis were incubated with cell free conditioned medium of P. luminescens and parasite survival was monitored. Different pre-treatments of the conditioned medium revealed that the leishmanicidal activity is due to a secreted peptide smaller than 3 kDa. The Photorhabdus-derived leishmanicidal toxin (PLT) was enriched from conditioned medium and its effect on mitochondrial membrane potential of promastigotes, was determined. Moreover, the biological activity of PLT against amastigotes was evaluated. PLT inhibited the parasite growth and showed significant leishmanicidal activity against promastigote and amastigotes of L. amazonensis. PLT also caused mitochondrial dysfunction in parasites, but low toxicity to mammalian cell and human erythrocytes. Moreover, the anti-amastigote activity was independent of nitric oxide production. In summary, our results highlight that P. luminescens secretes Leishmania-toxic peptide(s) that are promising novel drugs for therapy against leishmaniasis.
Multiwall carbon nanotubes (MWCNTs) are utilized to resolve low coupling coefficient issue by dispersing MWCNTs in poly(vinylidene fluoride) matrix to create stress reinforcing network, dispersant, and electron conducting functions for barium titanate (BT) nanoparticles. Various BT and MWCNT percentages of nanocomposite film are fabricated by FDM three-dimensional (3D) printing which can simplify the fabrication process as well as lower cost and design flexibility. Increasing MWCNTs and BT particles gradually increase piezoelectric coefficient (d31) by 0.13 pC/N with 0.4 wt%-MWCNTs/18 wt%-BT. These results provide not only a technique to print piezoelectric nanocomposites but also unique materials combination for sensor application.
Traditional land use practices declined throughout many of Europe's rural landscapes during the 20th century. Rewilding (i.e. restoring ecosystem functioning with minimal human intervention) is being pursued in many areas, and restocking or reintroduction of key species is often part of the rewilding strategy. Such programmes require ecological information about the target areas but this is not always available. Using the example of the Iberian ibex Capra pyrenaica within the Rewilding Europe framework we address the following questions: (1) Are there areas in Western Iberia that are environmentally favourable for reintroduction of the species? (2) If so, are these areas well connected with each other? (3) Which of these areas favour the establishment and expansion of a viable population of Iberian ibex in a reintroduction programme? We modelled environmental favourableness for the species in the Iberian Peninsula using a logistic regression with a forward–backward stepwise procedure, and assessed landscape connectivity using a graph analytical approach after downscaling the model to the Western Iberia region. Our results indicate that several habitat patches in the study area present favourable environmental conditions for reintroduction of the Iberian ibex. Overall, most of the habitat connectivity was concentrated in northern and central patches. We highlight the potential and practical application of the analytical protocol used, for successful integration of species distribution modelling and landscape connectivity in the design of broad-scale reintroduction and recovery programmes.
The drainage area of the Iberian Ranges (NE Spain) houses one of the most extensive Quaternary fluvial tufaceous records in Europe. In this study, tufa deposits in the Añamaza, Mesa, Piedra and Ebrón river valleys were mapped, stratigraphically described and chronologically referenced from U/Th disequilibrium series, amino acid racemization and radiocarbon methods. Tufa deposits accumulated in cascades, barrage-cascades and related damming areas developed in stepped fluvial systems. The maximum frequency of tufa deposition was identified at 120 ka (Marine Oxygen Isotope Stage [MIS] 5e), 102 ka (MIS 5c), 85 ka (~ MIS 5a) and 7 ka (MIS 1), probably under warmer and wetter conditions than today. Additional phases of tufa deposition appear at ~ 353 ka (~ end of MIS 11), 258–180 ka (MIS 7) and 171–154 ka (MIS 6). Although most tufa deposition episodes are clearly correlated with interstadial periods, the occurrence of tufa deposits during the penultimate glaciation (MIS 6) is remarkable, indicating that the onset of this stage was climatically favourable in the Iberian Peninsula. Biostatic conditions and the dynamics of karstic systems regulating tufa deposition seem to be sensitive to the precipitation regime, controlled by shifts in the position of North Atlantic atmospheric belts, and summer insolation, regulated by orbital forcing.
This study aims to examine the prevalence and characteristics of physical, emotional and sexual childhood abuse. It also examines whether other non-abuse types of childhood adversities related to maladaptive family functioning and separations during childhood can be used as markers for the presence of childhood abuse. Participants (N = 237) were women at 2–3 days after delivery that completed the Spanish-validated version of the Early Trauma Inventory Self Report (ETI-SR; Bremner, Bolus, & Mayer, 2007; Plaza et al., 2011), designed to assess the presence of childhood adversities. Results show that 29% of the women had experienced some type of childhood abuse, and 10% more than one type. Logistic regression analyses indicate that childhood parental death is a risk marker for childhood emotional abuse (OR: 3.77; 95% CI: 1.327–10.755; p <.013), childhood parental substance abuse is a risk marker for childhood sexual (OR: 3.72; 95% CI: 1.480–9.303; p < .005) and physical abuse (OR: 2.610; 95% CI: 1.000–6.812; p < .05) and that childhood family mental illness is a risk marker for childhood emotional (OR: 2.95; 95% CI: 1.175–7.441; p < .021) and sexual abuse (OR: 2.55; 95% CI: 1.168–5.580; p < .019). The high prevalence of childhood abuse indicates a need for assessment during the perinatal period. Screening for childhood family mental illness, parental substance abuse, and parental death - all identified risk factors for reporting childhood abuse - can help to identify women that should be assessed specifically regarding abuse.
Many experiments were carried out in order to evaluate the survival capacity of extremotolerant lichens when facing harsh conditions, including those of outer space or of simulated Martian environment. For further progress, a deeper study on the physiological mechanisms is needed that confer the unexpected levels of resistance detected on these symbiotic organisms. In this work, the response of the lichenized green algae Trebouxia sp. (a predominant lichen photobiont) to increasing doses of UV-C radiation is studied. UV-C (one of the most lethal factors to be found in space together with vacuum and cosmic-ionizing radiation with high atomic number and energy (HZE) particles) has been applied in the present experiments up to a maximum dose analogue to 67 days in Low Earth Orbit (LEO). For that purpose we selected two extremotolerant and space-tested lichen species in which Trebouxia sp. is the photosynthetic partner: the crustose lichen Rhizocarpon geographicum and the fruticose lichen Circinaria gyrosa. In order to evaluate the effect of the physiological state of the lichen thallus (active when wet and dormant when dry) and of protective structures (cortex and photoprotective pigments) on the resistance of the photobiont to UV-C, four different experimental conditions were tested: (1) dry intact samples, (2) wet intact samples, (3) dry samples without cortex/acetone-rinsed and (4) wet samples without cortex/acetone-rinsed. After irradiation and a 72 hours period of recovery, the influence of UV-C on the two lichen's photobiont under each experimental approach was assessed by two complimentary methods: (1) By determining the photosystem II (PSII) activity in three successive 24 hours intervals (Mini-PAM fluorometer) to investigate the overall state of the photosynthetic process and the resilience of Trebouxia sp. (2) By performing high performance liquid chromatography (HPLC)-quantification of four essential photosynthetic pigments (chlorophyll a, chlorophyll b, β-carotene and lutein) of one sample of each species and dose. Results indicate that the physiological state of the thallus is the most important factor impairing the tolerance of Trebouxia sp. to UV-C radiation in both lichen species. Desiccated thalli were demonstrated to be more resistant to UV-C. No clear influence of UV-C radiation on the carotenoid content was detected. Comparing the respective doses applied, the individuals of R. geographicum are more sensitive than C. gyrosa.