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This study aimed to assess the impact of the introduction of pneumococcal conjugate vaccine 13 (PCV13) on the molecular epidemiology of invasive pneumococcal disease (IPD) in children from Andalusia. A population-based prospective surveillance study was conducted on IPD in children aged <14 years from Andalusia (2018–2020). Pneumococcal invasive isolates collected between 2006 and 2009 in the two largest tertiary hospitals in Andalusia were used as pre-PCV13 controls for comparison of serotype/genotype distribution. Overall IPD incidence rate was 3.55 cases per 100 000 in 2018; increased non-significantly to 4.20 cases per 100 000 in 2019 and declined in 2020 to 1.69 cases per 100 000 (incidence rate ratio 2020 vs. 2019: 0.40, 95% confidence interval (CI) 0.20–0.89, P = 0.01). Proportion of IPD cases due to PCV13 serotypes in 2018–2020 was 28% (P = 0.0001 for comparison with 2006–2009). Serotypes 24F (15%) and 11A (8.3%) were the most frequently identified non-PCV13 serotypes (NVT) in 2018–2020. Penicillin- and/or ampicillin-resistant clones mostly belonged to clonal complex 156 (serotype 14-ST156 and ST2944 and serotype 11A-ST6521). The proportion of IPD cases caused by PCV13 serotypes declined significantly after the initiation of the PCV13 vaccination programme in 2016. Certain NVT, such as serotypes 24F and 11A, warrant future monitoring in IPD owing to invasive potential and/or antibiotic resistance rates.
The scientific study of Neolithic monuments holds fundamental keys to the analysis of early social complexity. This is often impeded by the challenges involved in understanding their temporality and, particularly, their initial construction dates. This problem is most severe in monuments that were not predominantly used for burial and went on to have long biographies in which activity in later periods obliterated the material record of the earliest phases. That was certainly the case of the Menga dolmen, part of the Antequera World Heritage site (Málaga, Spain), and one of the most remarkable megaliths in Europe, for which, after nearly 200 years of explorations and research, no firm chronology existed. The research presented in this paper shows how this problem was tackled through a multimethod, scientific, and geoarchaeological approach. The analysis of 29 fresh numerical ages, including radiocarbon determinations as well as optically stimulated luminescence, thermoluminescence, and uranium-thorium dates, led to the successful establishment of Menga's construction date and the subsequent contextualization of the monument within the social and cultural background it arose in. Placing the dolmen in the context of its time of “birth” introduces entirely new possibilities for its interpretation, both in terms of local and supralocal social and cultural processes.
Humans have engineered their environments throughout the Holocene, especially in the construction of hydraulic infrastructure. In many regions, however, this infrastructure is difficult to date, including the vestiges of water-management systems in the Andean highlands. Focusing on silt reservoirs in the upper Ica drainage, Peru, the authors use cores and radiocarbon dates to demonstrate the pre-Hispanic construction of walls to enhance and expand wetlands for camelid pasture. Interventions dated to the Inca period (AD 1400–1532) indicate an intensification of investment in hydraulic infrastructure to expand production capacity in support of the state. The results are discussed in the context of the hydraulic strategies of other states and empires.
New palynological results from the Gafo Formation (southern sector of the Pulo do Lobo Domain, South Portuguese Zone) are integrated with recently studied sections and drillholes from the Portuguese and Spanish sectors. A total of 44 samples were studied, 27 of which were positive for palynomorph taxonomy. This research revealed well preserved palynological assemblages, including 73 spore species allocated to 28 genera, four acritarch genera, three prasinophyte algae genera plus common chitinozoan remains. Some additional forms were retained under open nomenclature. From this, the first complete age determination for the Gafo Formation in Portugal and Spain was achieved, indicating a middle Famennian (Grandispora gracilis–Grandispora famenensis, GF Biozone) to a late Famennian (Grandispora echinata, VH Biozone) age. A greywacke sample from the same Gafo Formation was dated by U–Pb zircon geochronology and a maximum depositional age of 369 ± 2.5 Ma was obtained. A correlation between these palynological and U–Pb zircon data and the palynoflora assemblages of previous authors was made, as well as with the ages of felsic volcanic rocks found intercalated in the Gafo Formation, confirming the complex stratigraphy of Pulo do Lobo Domain. The results are consistent with stratigraphic mapping and structural interpretations, allowing a middle–late Famennian age (GF and VH Biozone) to be assigned to the Gafo Formation sedimentary rocks. This work has also contributed to a reinterpretation of Gafo Formation depositional facies correlatives (e.g. the Santa Barbara Group in Spain) as being the same lithological unit.
Identification of treatment-specific predictors of drug therapies for bipolar disorder (BD) is important because only about half of individuals respond to any specific medication. However, medication response in pediatric BD is variable and not well predicted by clinical characteristics.
A total of 121 youth with early course BD (acute manic/mixed episode) were prospectively recruited and randomized to 6 weeks of double-blind treatment with quetiapine (n = 71) or lithium (n = 50). Participants completed structural magnetic resonance imaging (MRI) at baseline before treatment and 1 week after treatment initiation, and brain morphometric features were extracted for each individual based on MRI scans. Positive antimanic treatment response at week 6 was defined as an over 50% reduction of Young Mania Rating Scale scores from baseline. Two-stage deep learning prediction model was established to distinguish responders and non-responders based on different feature sets.
Pre-treatment morphometry and morphometric changes occurring during the first week can both independently predict treatment outcome of quetiapine and lithium with balanced accuracy over 75% (all p < 0.05). Combining brain morphometry at baseline and week 1 allows prediction with the highest balanced accuracy (quetiapine: 83.2% and lithium: 83.5%). Predictions in the quetiapine and lithium group were found to be driven by different morphometric patterns.
These findings demonstrate that pre-treatment morphometric measures and acute brain morphometric changes can serve as medication response predictors in pediatric BD. Brain morphometric features may provide promising biomarkers for developing biologically-informed treatment outcome prediction and patient stratification tools for BD treatment development.
Prevention of violent behaviors (VB) in the early phase of psychosis (EPP) is a real challenge. Impulsivity was shown to be strongly related to VB, and different evolutions of impulsivity were noticed along treatments. One possible variable involved in the relationship between VB and the evolution of impulsivity is cannabis use (CU). The high prevalence of CU in EPP and its relationship with VB led us to investigate: 1/the impact of CU and 2/the impact of early CU on the evolution of impulsivity levels during a 3-year program, in violent and non-violent EPP patients.
178 non-violent and 62 violent patients (VPs) were followed-up over a 3 year period. Age of onset of CU was assessed at program entry and impulsivity was assessed seven times during the program. The evolution of impulsivity level during the program, as a function of the violent and non-violent groups of patients and CU precocity were analyzed with linear mixed-effects models.
Over the treatment period, impulsivity level did not evolve as a function of the interaction between group and CU (coef. = 0.02, p = 0.425). However, when including precocity of CU, impulsivity was shown to increase significantly only in VPs who start consuming before 15 years of age (coef. = 0.06, p = 0.008).
The precocity of CU in VPs seems to be a key variable of the negative evolution of impulsivity during follow-up and should be closely monitored in EPP patients entering care since they have a higher risk of showing VB.
The digital twin concept has developed as a method for extracting value from data, and is being developed as a new technique for the design and asset management of high-value engineering systems such as aircraft, energy generating plant, and wind turbines. In terms of implementation, many proprietary digital twin software solutions have been marketed in this domain. In contrast, this paper describes a recently released open-source software framework for digital twins, which provides a browser-based operational platform using Python and Flask. The new platform is intended to maximize connectivity between users and data obtained from the physical twin. This paper describes how this type of digital twin operational platform (DTOP) can be used to connect the physical twin and other Internet-of-Things devices to both users and cloud computing services. The current release of the software—DTOP-Cristallo—uses the example of a three-storey structure as the engineering asset to be managed. Within DTOP-Cristallo, specific engineering software tools have been developed for use in the digital twin, and these are used to demonstrate the concept. At this stage, the framework presented is a prototype. However, the potential for open-source digital twin software using network connectivity is a very large area for future research and development.
Triclosan 0.5% by scrubbing does not meet the UNE-EN12791 criteria to be used in the surgical hand preparation (SHP). Triclosan 0.5% by scrubbing followed by ethanol 70% hand rubbing is suitable without the additional characteristic of sustained effect. This limited effectiveness implies that triclosan should be avoided in SHP given the restrictions on its use in consumer antiseptic products. The trial was registered at ClinicalTrials.gov (ID: NCT04538365).
This chapter shifts to the island of Cuba and the La Escalera conspiracy in the mid-1840s. As this chapter reveals, this conspiracy between free and enslaved people of color in the Spanish colony to overthrow their oppressors takes center stage in the later novels of Martin Delany and Andrés Avelino de Orihuela, each of whom turns to La Escalera in order to develop a particular vision of Black revolution in the hemisphere.
Investigations of the Proyecto Arqueológico Tlajinga Teotihuacan (PATT) in 2019 focused on the southern neighborhood center of this cluster of non-elite residences in the southern periphery of the ancient Mexican metropolis. Our objective was to better understand the social infrastructure of public space within the district and how it tied its inhabitants together. Our methods included excavations at two large architectural complexes, geophysical prospection of these and adjacent structures and plazas, and chemical residue analysis of floors and sediments. They revealed architecturally elaborate complexes decorated with mural painting that appear to have been the loci of civic-ceremonial activities. Materials from the excavated portions of the complexes are inconsistent with residential uses, although it is possible that local elites lived elsewhere in the complexes or in others located nearby. The investigations therefore demonstrate that the semipublic spaces of neighborhood centers were distributed as distantly as this periphery of Teotihuacan and could be as elaborate as those in the urban epicenter, underscoring the city's more muted social inequality.
Perceived discrimination is associated with worse mental health. Few studies have assessed whether perceived discrimination (i) is associated with the risk of psychotic disorders and (ii) contributes to an increased risk among minority ethnic groups relative to the ethnic majority.
We used data from the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions Work Package 2, a population-based case−control study of incident psychotic disorders in 17 catchment sites across six countries. We calculated odds ratios (OR) and 95% confidence intervals (95% CI) for the associations between perceived discrimination and psychosis using mixed-effects logistic regression models. We used stratified and mediation analyses to explore differences for minority ethnic groups.
Reporting any perceived experience of major discrimination (e.g. unfair treatment by police, not getting hired) was higher in cases than controls (41.8% v. 34.2%). Pervasive experiences of discrimination (≥3 types) were also higher in cases than controls (11.3% v. 5.5%). In fully adjusted models, the odds of psychosis were 1.20 (95% CI 0.91–1.59) for any discrimination and 1.79 (95% CI 1.19–1.59) for pervasive discrimination compared with no discrimination. In stratified analyses, the magnitude of association for pervasive experiences of discrimination appeared stronger for minority ethnic groups (OR = 1.73, 95% CI 1.12–2.68) than the ethnic majority (OR = 1.42, 95% CI 0.65–3.10). In exploratory mediation analysis, pervasive discrimination minimally explained excess risk among minority ethnic groups (5.1%).
Pervasive experiences of discrimination are associated with slightly increased odds of psychotic disorders and may minimally help explain excess risk for minority ethnic groups.
A crossover trial was conducted to compare hand rub and hand scrub-brush methods for reducing bacterial loads when using propan-1-ol-60% according to European regulations. Both methods significantly reduced the bacterial load immediately after antisepsis, but only the hand rub method achieved significant bacterial load reduction 3 hours after the procedure.
Benzodiazepine (BZD) prescription rates have increased over the past decade in the United States. Available literature indicates that sociodemographic factors may influence diagnostic patterns and/or prescription behaviour. Herein, the aim of this study is to determine whether the gender of the prescriber and/or patient influences BZD prescription.
Cross-sectional study using data from the Florida Medicaid Managed Medical Assistance Program from January 1, 2018 to December 31, 2018. Eligible recipients ages 18 to 64, inclusive, enrolled in the Florida Medicaid plan for at least 1 day, and were dually eligible. Recipients either had a serious mental illness (SMI), or non-SMI and anxiety.
Total 125 463 cases were identified (i.e., received BZD or non-BZD prescription). Main effect of patient and prescriber gender was significant F(1, 125 459) = 0.105, P = 0 .745, partial η2 < 0.001. Relative risk (RR) of male prescribers prescribing a BZD compared to female prescribers was 1.540, 95% confidence intervals (CI) [1.513, 1.567], whereas the RR of male patients being prescribed a BZD compared to female patients was 1.16, 95% CI [1.14, 1.18]. Main effects of patient and prescriber gender were statistically significant F(1, 125 459) = 188.232, P < 0.001, partial η2 = 0.001 and F(1, 125 459) = 349.704, P < 0.001, partial η2 = 0.013, respectively.
Male prescribers are more likely to prescribe BZDs, and male patients are more likely to receive BZDs. Further studies are required to characterize factors that influence this gender-by-gender interaction.
Mental health problems early in life can negatively impact educational attainment, which in turn have negative long-term effects on health, social and economic opportunities. Our aims were to: (i) estimate the impacts of different types of psychiatric conditions on educational outcomes and (ii) to estimate the proportion of adverse educational outcomes which can be attributed to psychiatric conditions.
Participants (N = 2511) were from a school-based community cohort of Brazilian children and adolescents aged 6–14 years enriched for high family risk of psychiatric conditions. We examined the impact of fear- (panic, separation and social anxiety disorder, specific phobia, agoraphobia and anxiety conditions not otherwise specified), distress- (generalised anxiety disorder, major depressive disorder and depressive disorder not otherwise specified, bipolar, obsessive-compulsive, tic, eating and post-traumatic stress disorder) and externalising-related conditions (attention deficit and hyperactivity disorder, conduct and oppositional-defiant conditions) on grade repetition, dropout, age-grade distortion, literacy performance and bullying perpetration, 3 years later. Psychiatric conditions were ascertained by psychiatrists, using the Development and Well-Being Behaviour Assessment. Propensity score and inverse probability weighting were used to adjust for potential confounders, including comorbidity, and sample attrition. We calculated the population attributable risk percentages to estimate the proportion of adverse educational outcomes in the population which could be attributed to psychiatric conditions. Analyses were conducted separately for males and females.
Fear and distress conditions in males were associated with school dropout (odds ratio (OR) = 2.76; 95% confidence interval (CI) = 1.06, 7.22; p < 0.05) and grade repetition (OR = 2.76; 95% CI = 1.32, 5.78; p < 0.01), respectively. Externalising conditions were associated with grade repetition in males (OR = 1.66; 95% CI = 1.05, 2.64; p < 0.05) and females (OR = 2.03; 95% CI = 1.15, 3.58; p < 0.05), as well as age-grade distortion in males (OR = 1.66; 95% CI = 1.05, 2.62; p < 0.05) and females (OR = 2.88; 95% CI = 1.61, 5.14; p < 0.001). Externalising conditions were also associated with lower literacy levels (β = −0.23; 95% CI = −0.34, −0.12; p < 0.001) and bullying perpetration (OR = 3.12; 95% CI = 1.50, 6.51; p < 0.001) in females. If all externalising conditions were prevented or treated, we estimate that 5.0 and 4.8% of grade repetition would not have occurred in females and males, respectively, as well as 10.2 (females) and 5.3% (males) of age-grade distortion cases and 11.4% of female bullying perpetration.
The study provides evidence of the negative impact of psychiatric conditions on educational outcomes in a large Brazilian cohort. Externalising conditions had the broadest and most robust negative impacts on education and these were particularly harmful to females which are likely to limit future socio-economic opportunities.
Non-communicable chronic diseases (NCCDs) are the main cause of morbidity and mortality globally. Demographic aging has resulted in older populations with more complex healthcare needs. This necessitates a multilevel rethinking of healthcare policies, health education and community support systems with digitalization of technologies playing a central role. The European Innovation Partnership on Active and Healthy Aging (A3) working group focuses on well-being for older adults, with an emphasis on quality of life and healthy aging. A subgroup of A3, including multidisciplinary stakeholders in health care across Europe, focuses on the palliative care (PC) model as a paradigm to be modified to meet the needs of older persons with NCCDs. This development paper delineates the key parameters we identified as critical in creating a public health model of PC directed to the needs of persons with NCCDs. This paradigm shift should affect horizontal components of public health models. Furthermore, our model includes vertical components often neglected, such as nutrition, resilience, well-being and leisure activities. The main enablers identified are information and communication technologies, education and training programs, communities of compassion, twinning activities, promoting research and increasing awareness amongst policymakers. We also identified key ‘bottlenecks’: inequity of access, insufficient research, inadequate development of advance care planning and a lack of co-creation of relevant technologies and shared decision-making. Rethinking PC within a public health context must focus on developing policies, training and technologies to enhance person-centered quality life for those with NCCD, while ensuring that they and those important to them experience death with dignity.
Although evidence from psychosis patients demonstrates the adverse effects of cannabis use (CU) at a young age and that the rate of CU is high in subgroups of young violent patients with psychotic disorders, little is known about the possible effect of the age of onset of CU on later violent behaviors (VB). So, we aimed to explore the impact of age at onset of CU on the risk of displaying VB in a cohort of early psychosis patients.
Data were collected prospectively over a 36-month period in the context of an early psychosis cohort study. A total of 265 patients, aged 18–35 years, were included in the study. Logistic regression was performed to assess the link between age of onset of substance use and VB.
Among the 265 patients, 72 had displayed VB and 193 had not. While violent patients began using cannabis on average at age 15.29 (0.45), nonviolent patients had started on average at age 16.97 (0.35) (p = 0.004). Early-onset CU (up to age 15) was a risk factor for VB (odds ratio = 4.47, confidence interval [CI]: 1.13–20.06) when the model was adjusted for age group, other types of substance use, being a user or a nonuser and various violence risk factors and covariates. History of violence and early CU (until 15) were the two main risk factors for VB.
Our results suggest that early-onset CU may play a role in the emergence of VB in early psychosis.