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Old age constitutes a vulnerable stage for developing gambling-related problems. The aims of the study were to identify patterns of gambling habits in elderly participants from the general population, and to assess socio-demographic and clinical variables related to the severity of the gambling behaviours. The sample included N = 361 participants aged in the 50–90 years range. A broad assessment included socio-demographic variables, gambling profile and psychopathological state. The percentage of participants who reported an absence of gambling activities was 35.5 per cent, while 46.0 per cent reported only non-strategic gambling, 2.2 per cent only strategic gambling and 16.3 per cent both non-strategic plus strategic gambling. Gambling form with highest prevalence was lotteries (60.4%), followed by pools (13.9%) and bingo (11.9%). The prevalence of gambling disorder was 1.4 per cent, and 8.0 per cent of participants were at a problematic gambling level. Onset of gambling activities was younger for men, and male participants also reached a higher mean for the bets per gambling-episode and the number of total gambling activities. Risk factors for gambling severity in the sample were not being born in Spain and a higher number of cumulative lifetime life events, and gambling severity was associated with a higher prevalence of tobacco and alcohol abuse and with worse psychopathological state. Results are particularly useful for the development of reliable screening tools and for the design of effective prevention programmes.
Older subjects are susceptible to develop gambling problems, and researchers have attempted to assess the mechanisms underlying the gambling profile in later life. The objective of this study was to identify the main stressful life events (SLE) across the lifespan which have discriminative capacity for detecting the presence of gambling disorder (GD) in older adults. Data from two independent samples of individuals aged 50+ were analysed: N = 47 patients seeking treatment at a Pathological Gambling Outpatient Unit and N = 361 participants recruited from the general population. Sexual problems (p < 0.001), exposure to domestic violent behaviour (p < 0.001), severe financial problems (p = 0.002), alcohol or drug-related problems (p = 0.004) and extramarital sex (p < 0.001) were related to a higher risk of GD, while getting married (p = 0.005), moving to a new home (p = 0.003) and moving to a new city (p = 0.006) decreased the likelihood of disordered gambling. The accumulated number of SLE was not a predictor of the presence of GD (p = 0.732), but patients who met clinical criteria for GD reported higher concurrence of SLE in time than control individuals (p < 0.001). Empirical research highlights the need to include older age groups in evidence-based policies for gambling prevention, because these individuals are at high risk of onset and/or progression of behavioural addiction-related problems such as GD. The results of this study may be useful for developing reliable screening/diagnostic tools and for planning effective early intervention programmes aimed to reduce the harm related to the onset and evolution of problem gambling in older adults.
Telemedicine uses information and communication technologies to provide services in the field where the distance is a critical factor. The aim of the present study is to describe the experience of a synchronous telemedicine between two hospitals in Spain and Angola.
This is a retrospective observational study of all synchronous telemedicine sessions conducted between the Hospital Nossa Senhora da Paz in Angola and the Vall d'Hebron University Hospital in Spain from January 2011 to December 2014.
Seventy-two cases were discussed in the telemedicine sessions. The average age of patients was 18.02 (SD 13.75) years and mostly women (54.38 percent). Reasons to discuss the cases were 46.47 percent doubts in the diagnosis and therapeutic management, 15.47 percent were purely formative cases, and only 8.45 percent treatment doubt. At the time of presentation, 29 percent of the patients were already diagnosed, 95 percent of whom with infectious disease diagnostic, and from the undiagnosed patients 36 percent presented a febrile syndrome.
This study shows the viability of synchronous telemedicine between European and African countries without an excessively sophisticated technology.
Although deficits in affective processing are a core component of anorexia nervosa (AN), we lack a detailed characterization of the neurobiological underpinnings of emotion regulation impairment in AN. Moreover, it remains unclear whether these neural correlates scale with clinical outcomes.
We investigated the neural correlates of negative emotion regulation in a sample of young women receiving day-hospital treatment for AN (n = 21) and healthy controls (n = 21). We aimed to determine whether aberrant brain activation patterns during emotion regulation predicted weight gain following treatment in AN patients and were linked to AN severity. To achieve this, participants completed a cognitive reappraisal paradigm during functional magnetic resonance imaging. Skin conductance response, as well as subjective distress ratings, were recorded to corroborate task engagement.
Compared to controls, patients with AN showed reduced activation in the dorsolateral prefrontal cortex (dlPFC) during cognitive reappraisal [pFWE<0.05, threshold-free cluster enhancement (TFCE) corrected]. Importantly, psycho–physiological interaction analysis revealed reduced functional connectivity between the dlPFC and the amygdala in AN patients during emotion regulation (pFWE<0.05, TFCE corrected), and dlPFC-amygdala uncoupling was associated with emotion regulation deficits (r = −0.511, p = 0.018) and eating disorder severity (r = −0.565, p = .008) in the AN group. Finally, dlPFC activity positively correlated with increases in body mass index (r = 0.471, p = 0.042) and in body fat mass percentage (r = 0.605, p = 0.008) following 12 weeks of treatment.
Taken together, our findings indicate that individuals with AN present altered fronto-amygdalar response during cognitive reappraisal and that this response may serve as a predictor of response to treatment and be linked to clinical severity.
Native to southeast Asia, the spotted-wing drosophila (Drosophila suzukii (Matsumura); Diptera: Drosophilidae) has become a major pest of small fruits in the Americas and Europe. Field studies were conducted over a two-year period (2015–2016) in cultivated highbush blueberry (Vaccinium corymbosum Linnaeus; Ericaceae) fields and adjacent non-crop habitats containing wild blueberries in New Jersey (United States of America). We tracked seasonal changes in D. suzukii adult abundance and fruit infestation throughout the ripening period (June–August). In both years, D. suzukii adult counts post-harvest were generally higher in traps located in non-crop habitats compared with those located in highbush blueberry fields. Wild and cultivated fruits synchronised in maturation, and the numbers of eggs laid and of emerged adults in both fruit types were comparable for most of the season, although sometimes these numbers were higher in wild fruits post-harvest. Overall, immature success (measured as the per cent egg-to-adult survival) was also mostly higher in wild than in cultivated fruits. Altogether, these studies document that non-crop habitats, and wild hosts therein, are used by D. suzukii during fruit ripening and may serve as potential sources of infestation to nearby highbush blueberry fields. Hence, methods that reduce D. suzukii populations in non-crop habitats may help manage this pest in neighbouring highbush blueberries.
In Mexico, physicians have become part of public service prehospital care. Head injured patients are a sensitive group that can benefit from early advanced measures to protect the airway, with the objective to reduce hypoxia and maintain normocapnia.
The occurrence of endotracheal intubation to patients with severe head injuries by prehospital physicians working at Mexico City’s Service of Emergency Medical Care (SAMU) is unknown.
A retrospective analysis of five-year data (2012-2016) from Mexico City’s Medical Emergencies Regulation Center was performed. Only SAMU ambulance services were analyzed. Adult patients with a prehospital diagnosis of head injury based on mechanism of injury and physical examination with a Glasgow Coma Scale (GCS) <nine were included.
A total of 293 cases met the inclusion criteria; the mean GCS was five points. Of those, 150 (51.1%) patients were intubated. There was no difference in the occurrence of intubation among the different GCS scales, or if the patient was considered to have isolated head trauma versus polytrauma. Fifteen patients were intubated using sedation and neuromuscular blockage. Four patients were intubated with sedation alone and six patients with neuromuscular blockage alone. One patient was intubated using opioid analgesia, sedation, and neuromuscular blockage.
Patients with severe head injuries cared by prehospital physicians in Mexico City were intubated 51.1% of the time and were more likely to be intubated without the assistance of anesthetics.
DSM-5 proposed a new operational system by using the number of fulfilled criteria as an indicator of gambling disorder severity. This method has proven to be controversial among researchers and clinicians alike, due to the lack of studies indicating whether severity, as measured by these criteria, is clinically relevant in terms of treatment outcome. Additionally, numerous studies have highlighted the associations between gambling disorder and impulsivity, though few have examined the impact of impulsivity on long-term treatment outcomes.
In this study, we aimed to assess the predictive value of DSM-5 severity levels on response to cognitive-behavioral therapy (CBT) in a sample of male adults seeking treatment for gambling disorder (n = 398). Furthermore, we explored longitudinal predictors of CBT treatment response at a follow-up, considering UPPS-P impulsivity traits.
Our study failed to identify differences in treatment outcomes between patients categorized by DSM-5 severity levels. Higher baseline scores in negative urgency predicted relapse during CBT treatment, and higher levels of sensation seeking were predictive of drop-out from short-term treatment, as well as of drop-out at 24-months.
These noteworthy findings raise questions regarding the clinical utility of DSM-5 severity categories and lend support to the implementation of dimensional approaches for gambling disorder.
To estimate trajectories of the gambling disorder (GD) severity for 12 months following a manualized cognitive-behavior-therapy (CBT) program, and to identify the main variables associated with each trajectory.
Latent Class Growth Analysis examined the longitudinal changes of n = 603 treatment-seeking patients with GD.
Five separate empirical trajectories were identified: T1 (n = 383, 63.5%) was characterized by the most highest baseline gambling severity levels and positive progress to recovery during the follow-up period; T2 (n = 154, 25.5%) featured participants with high baseline gambling severity and good progress to recovery; T3 (n = 30, 5.0%) was made up of patients with high gambling baseline severity and slow progress to recovery; T4 (n = 13, 2.2%) and T5 (n = 23, 3.8%) contained participants with high baseline gambling severity and moderate (T4) and poor (T5) progress in GD severity during the follow-up. Psychopathological state and personality traits discriminated between trajectories. Poor compliance with the therapy guidelines and the presence of relapses also differed between the trajectories.
Our findings show that patients seeking treatment for GD are heterogeneous and that trends in progress following treatment can be identified considering sociodemographic features, psychopathological state and personality traits. These results could be useful in developing more efficient interventions for GD patients.
The Altamira Yellowthroat Geothlypis flavovelata is endemic to north-eastern Mexico, with a restricted distribution due to the spatial arrangement of its major habitat: wetlands. Given the lack of information regarding this vulnerable and endemic landbird, here we describe and analyse the sites where we recorded it in Northern Veracruz, as well as its population density, and natural history information. Our results show that the average density of this endemic yellowthroat is 1.006 ind/ha, with more individuals recorded in Tecolutla when compared to Tuxpan. We found a strong association between the Altamira Yellowthroat and southern cat-tail Typha domingensis, although we found scenarios under which the presence of the cat-tail was not a determinant of Altamira Yellowthroat presence. In light of the strong anthropogenic pressures on wetlands in the region, the Altamira Yellowthroat has become highly vulnerable. Thus, if we aim to preserve this endemic species, together with other wetland-dependent species, it is crucial to moderate –and even stop– human pressures on these ecosystems and mitigate past damages.
Meteorological and even human-made disasters are increasing every year in frequency and magnitude. The passage of a disaster affects a society without distinction, but groups with social vulnerability (low socioeconomic status, chronic medical, or psychological conditions, limited access to resources) face the most significant impact. As a result, psychological and behavioral symptoms (eg, depression and anxiety) can ensue, making the immediate response of mental health services crucial. Secondary data from a database of a temporary healthcare unit were analyzed. A total of 54 records were reviewed to collect information; univariate and bivariate analyses were done. The purpose of this article is to present our experience regarding the incorporation of a mental health services model, with its respective benefits and challenges, into a temporary healthcare unit, after Hurricane Maria in 2017.
Two preferred textures were observed in the Alhama de Murcia Fault rocks: (a) foliated bands (>100 µm thick) rich in well-crystallized dioctahedral micas, quartz, hematite and dolomite; and (b) ultrafine-grained bands (<100 µm thick) made of patches composed of small mica crystals (<15 µm) and dispersed Fe-oxides. In both textures, kaolinite forms intergrowths or patches of randomly oriented crystals filling gaps or opening layers of presumably inherited detrital mica crystals, which is interpreted as an epitaxial growth from fluids. The Na/K ratio of mica crystals in the thin ultrafine-grained bands shows a wider range than the micas from the foliated bands including muscovitic, intermediate Na/K and paragonitic compositions. The absence of the 0.98 nm intermediate peak in the diffractograms indicates that the small micas are submicroscopically paragonite and phengite intergrowths. The d001 values of the K-dioctahedral micas in the <2 µm and whole fractions are clearly different from each other. The d001 values of micas of the <2 µm fraction are larger, indicating a higher K and lower Na content in the small micas. Their composition corresponds to lower temperatures, suggesting their growth during a genetic episode in the fault. The textural relationships indicate a late growth of kaolinite, probably due to the fluid–rock interaction along fault planes and fractures. The neoformed clay minerals might alter the stability of the fault plane. The absence of expandable clay minerals and the relatively high frictional strength of kaolinite under wet conditions might explain the observed velocity-neutral behaviour of this gouge and earthquake propagation towards the surface.
Cognitive deficits are a core feature of early stages in schizophrenia. However, the extent to which antipsychotic (AP) have a deleterious effect on cognitive performance remains under debate. We aim to investigate whether anticholinergic loadings and dose of AP drugs in first episode of psychosis (FEP) in advanced phase of remission are associated with cognitive impairment and the differences between premorbid intellectual quotient (IQ) subgroups.
Two hundred and sixty-six patients participated. The primary outcomes were cognitive dimensions, dopaminergic/anticholinergic load of AP [in chlorpromazine equivalents (Eq-CPZ) and the Anticholinergic Risk Scale (ARS), respectively].
Impairments in processing speed, verbal memory and global cognition were significantly associated with high Eq-CPZ and verbal impairment with high ARS score. Moreover, this effect was higher in the low IQ subgroup.
Clinicians should be aware of the potential cognitive impairment associated with AP in advanced remission FEP, particularly in lower premorbid IQ patients.
This paper is focused on explaining the radiation test in temperature performed on the Engineering and Qualification Model of the Medium Gain Antenna Radiofrequency (MGA-RFA) Assembly of ESA's BepiColombo mission. The goal of this program is to observe and study Mercury and its surroundings in a very demanding environment in terms of temperature and radiation. The MGA is an X-band two-axis steerable horn, which provides bidirectional communications between spacecraft and Earth as backup of the High Gain Antenna and also operates as primary communication link at several mission stages or conditions. The paper presents the measurement set-up for the qualification campaign of the antenna, where it was necessary to characterize the antenna in a representative thermal environment, and the results obtained from this test. Results of test up to 150°C show how gain and radiation pattern shapes are slightly affected by thermal stress, but without jeopardizing mission requirements. In addition, by analyzing correlation of this test with RF analysis in the same thermal conditions, it becomes possible to accurately extrapolate the MGA-RFA behavior up to temperatures of more than 500°C. This fact allowed the successful space qualification of this model.
Direct Device-to-Device (D2D) communication, which refers to direct communication between devices (i.e. users) without data traffic going through any infrastructure node, has been widely foreseen to be an important cornerstone to improve system performance and support new services beyond 2020 in the future fifth generation (5G) system. In general, the benefits resulting from D2D operation include, among others, highly increased spectral efficiency, improved typical user data rate and capacity per area, extended coverage, reduced latency, and enhanced cost and power efficiency. These benefits are resulting from the proximity of the users employing D2D communication (proximity gain), an increased spatial reuse of time and frequency resources (reuse gain) and from using a single link in the D2D mode rather than using both an uplink and a downlink resource when communicating via the base station in the cellular mode (hop gain). The chapter starts with an overview of the fourth generation (4G) D2D development. Afterward, the challenges to be addressed in the context of 5G D2D and related key enablers are discussed. In particular, this chapter covers Radio Resource Management (RRM) for mobile broadband applications, multi-hop D2D communication, especially for public safety and emergency services, and multi-operator D2D communication.
D2D: from 4G to 5G
In the future 5G system, it is predicted that network-controlled direct D2D communication offers the opportunity for local management of short-distance communication links and allows separating local traffic from the global network (i.e. local traffic offloading). By doing this, it will not only remove the load burden on the backhaul and core network caused by data transfer and related signaling, but also reduce the necessary effort for managing traffic at central network nodes. Direct D2D communication therefore extends the idea of distributed network management by incorporating the end devices into the network management concept. In this way, the wireless user device with D2D capability can have a dual role: either acting as an infrastructure node and/or as an end-user device in a similar way as a traditional device. Further, direct D2D facilitates low-latency communication due to the local communication link between users in proximity. In fact, direct D2D has been seen as one of the necessary features to support real-time services in the future 5G system . Another important aspect is reliability, where an additional D2D link can be employed to increase reliability through a larger extent of diversity.
The presence of impurities in solids is a source of many interesting effects, particularly relevant in the conductivity, optical properties and specific heat. For instance, in nano-electronics these effects could be useful to develop molecular devices such as novel computer architectures, chemical and biomedical sensors. However, the inclusion of impurities breaks the translational symmetry, restricting the systems that can be addressed theoretically in an exact way to those of few atoms. In this work, we present an alternative way to study the electrical conductance in real-space by means of a renormalization plus convolution method applied on the Kubo-Greenwood formula for multidimensional systems of macroscopic size with site and bond impurities. The results show that the spectral average of conductivity depends strongly on the location of site and bond impurities in periodic chains. Particularly, when the distance between impurities follows the Fibonacci sequence, we find that the spectral average falls following a power law as the number of atoms in the system grows. Finally, we analyze the impurity effects on the conductance spectra of periodic core-shell nanowires with a macroscopic length and periodic and quasiperiodically located impurities.
There is little information on the population status of the ocelot Leopardus pardalis in Mexico. In the Sierra Abra-Tanchipa Biosphere Reserve, in San Luis Potosí, ocelots are affected by habitat loss and fragmentation as a result of increased agricultural development. We used photographic identification in camera-trapping capture–recapture surveys to determine population abundance and density during the dry season and subsequent early and late humid seasons during April 2011–March 2012. We recorded 80 photographs of 15 individuals (10 males, one female, and four of undetermined sex) in 7,786 camera-days. Abundance was estimated using a closed capture heterogeneity model, yielding an estimated population of 9 ± SE 3 in the dry season and 21 ± SE 8 and 15 ± SE 5 during the subsequent early and late humid seasons, respectively. Spatially explicit density estimates were 0.04 and 0.03–0.18 individuals per km2 for the dry and humid seasons, respectively, and were similar (P > 0.612) among seasons. Peaks in ocelot activity occurred during 20.00–04.00. We conclude that the ocelots of the Sierra Abra-Tanchipa Reserve have a low population density and may face geographical and biological isolation as a result of habitat conversion. Continued monitoring and improved understanding of the movements and habitat preferences of ocelots are necessary to ensure their continued persistence, and connectivity between this population and others in north-east Mexico.