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Haematogenous non-contiguous metastatic spread of remote solid tumours to the heart is rare. We describe a previously healthy 5-year-old girl who presented with extensive intracardiac involvement by metastatic pelvic sarcoma.
The eastern North Atlantic (ENA) has many highly productive areas where several species of cetaceans have been recorded, with the common dolphin (Delphinus delphis) being one of the most frequently sighted species. However, its spatial and temporal distribution in high seas is poorly known. The study presents the results from 5 years of cetacean monitoring in the ENA (2012–2016) aboard cargo ships that follow the routes from Continental Portugal to the Macaronesian archipelagos and north-west Africa. Common dolphin was the most frequently sighted cetacean with 192 occurrences registered on effort and an overall encounter rate of 0.36 sightings/100 nmi. The species was distributed in coastal and offshore waters, but absent from the Canaries and Cape Verde islands. Statistical ‘habitat’ models were developed to describe and explain the occurrence of sightings of the species: variables affecting detection of dolphins had a small impact and there were clear spatiotemporal distribution patterns, influenced to some degree by environmental variables. Predicted probability of occurrence was highest in coastal waters of continental Portugal and around the Azores. The models, combined with maps of distribution, were useful to identify important areas for the species, which could be the focus of future conservation efforts. Common dolphin presence was related to depth, distance to coast and seamounts, seabed slope, chlorophyll concentration, sea-surface temperature and sea level anomalies; the possible ecological significance of these relationships is explored.
Major depressive disorder (MDD) is a multifactorial syndrome with significant interactions between genetic and environmental factors. This study specifically investigates the association between family history of alcohol problems (FHAP) and family history of depression (FHD), and how these relate to different clusters of depressive symptoms.
Correlations between FHAP and FHD and different clusters of the Beck Depression Inventory (BDI) were studied. We sampled 333 employees from a general hospital who had been receiving a psychiatric consultation between 2005 and 2012. Analysis of variance (ANOVA) and Analysis of covariance (ANCOVA) models were conducted to explore these correlations.
There was a significant positive correlation between FHAP and BDI affective score. This result remained significant even after the adjustment for other variables considered as important factors for MDD, such as gender, age, marital status, education, ethnic group and FHD. More specifically, FHAP was correlated with dissatisfaction and episodes of crying among the affective symptoms. FHAP showed no statistical difference in any of the other clusters score or in the BDI total score. Moreover, as expected, we found a correlation between FHD and BDI total score and Somatic and Cognitive clusters.
FHAP should be routinely investigated in individuals presenting with depressive symptoms. This is especially important in cases presenting with dissatisfaction and episodes of crying in patients who do not endorse criteria for MDD. Due to study limitations, the findings require replication by neurobiological, epidemiological and clinical studies.
Studies on type-V fulgurites are very sparse in the literature. This work reports on the characterization of natural exogenic fulgurites found at the archaeological site of Cerro de la Ermita (Tiedra, Valladolid, Spain), which was firstly a Celtiberian and then a Roman locum sacrum. Data from X-ray powder diffraction, X-ray fluorescence spectroscopy, Fourier-transform infrared spectroscopy and Raman spectroscopy suggest that the fulgurites consist of naquite, piroxenes, iron oxides, shocked quartz and neo-formed cristobalite.
The aging of population is perhaps the most important problem that developed countries must face in the near future. Dependency can be seen as a consequence of the process of gradual aging. In a health context, this contingency is defined as a lack of autonomy in performing basic activities of daily living that requires the care of another person or significant help. In Europe in general and in Spain in particular, this phenomena represents a problem with economic, political, social and demographic implications. The prevalence of dependency in the population, as well as its intensity and evolution over the course of a person’s life are issues of greatest importance that should be addressed. The aim of this work is the estimation of life expectancy free of dependency (LEFD) based on functional trajectories to enhance the regular estimation of health expectancy. Using information from the Spanish survey EDAD 2008, we estimate the number of years spent free of dependency for disabled people according to gender, dependency degree (moderate, severe, major) and the earlier or later onset of dependency compared to a central trend. The main findings are as follows: first, we show evidence that to estimate LEFD ignoring the information provided by the functional trajectories may lead to non-representative LEFD estimates; second, in general, dependency-free life expectancy is higher for women than for men. However, its intensity is higher in women with later onset on dependency; Third, the loss of autonomy is higher (and more abrupt) in men than in women. Finally, the diversity of patterns observed at later onset of dependency tends to a dependency extreme-pattern in both genders.
As the interest of the Semantic Web and computational linguistics communities in linguistic linked data (LLD) keeps increasing and the number of contributions that dwell on LLD rapidly grows, scholars (and linguists in particular) interested in the development of LLD resources sometimes find it difficult to determine which mechanism is suitable for their needs and which challenges have already been addressed. This review seeks to present the state of the art on the models, ontologies and their extensions to represent language resources as LLD by focusing on the nature of the linguistic content they aim to encode. Four basic groups of models are distinguished in this work: models to represent the main elements of lexical resources (group 1), vocabularies developed as extensions to models in group 1 and ontologies that provide more granularity on specific levels of linguistic analysis (group 2), catalogues of linguistic data categories (group 3) and other models such as corpora models or service-oriented ones (group 4). Contributions encompassed in these four groups are described, highlighting their reuse by the community and the modelling challenges that are still to be faced.
When patients feel spiritually supported by staff, we find increased use of hospice and reduced use of aggressive treatments at end of life, yet substantial barriers to staff spiritual care provision still exist. We aimed to study these barriers in a new cultural context and analyzed a new subgroup with “unrealized potential” for improved spiritual care provision: those who are positively inclined toward spiritual care yet do not themselves provide it.
We distributed the Religion and Spirituality in Cancer Care Study via the Middle East Cancer Consortium to physicians and nurses caring for advanced cancer patients. Survey items included how often spiritual care should be provided, how often respondents themselves provide it, and perceived barriers to spiritual care provision.
We had 770 respondents (40% physicians, 60% nurses) from 14 Middle Eastern countries. The results showed that 82% of respondents think staff should provide spiritual care at least occasionally, but 44% provide spiritual care less often than they think they should. In multivariable analysis of respondents who valued spiritual care yet did not themselves provide it to their most recent patients, predictors included low personal sense of being spiritual (p < 0.001) and not having received training (p = 0.02; only 22% received training). How “developed” a country is negatively predicted spiritual care provision (p < 0.001). Self-perceived barriers were quite similar across cultures.
Significance of results
Despite relatively high levels of spiritual care provision, we see a gap between desirability and actual provision. Seeing oneself as not spiritual or only slightly spiritual is a key factor demonstrably associated with not providing spiritual care. Efforts to increase spiritual care provision should target those in favor of spiritual care provision, promoting training that helps participants consider their own spirituality and the role that it plays in their personal and professional lives.
For more than 60 years, Colombia experienced an armed conflict involving government forces, guerrillas, and other illegal armed groups. Violence, including torture and massacres, has caused displacement of entire rural communities to urban areas. Lack of information on the problems displaced communities face and on their perceptions on potential solutions to these problems may prevent programs from delivering appropriate services to these communities. This study explores the problems of Afro-Colombian survivors from two major cities in Colombia; the activities they do to take care of themselves, their families, and their community; and possible solutions to these problems.
This was a qualitative, interview-based study conducted in Quibdó and Buenaventura (Colombia). Free-list interviews and focus groups explored the problems of survivors and the activities they do to take care of themselves, their families, and their community. Key-informant interviews explored details of the identified mental health problems and possible solutions.
In Buenaventura, 24 free-list interviews, one focus group, and 17 key-informant interviews were completed. In Quibdó, 29 free-list interviews, one focus group, and 15 key-informant interviews were completed. Mental health problems identified included: (1) problems related to exposure to torture/violent events; (2) problems with adaptation to the new social context; and (3) problems related to current poverty, lack of employment, and ongoing violence. These problems were similar to trauma symptoms and features of depression and anxiety, as described in other populations. Solutions included psychological help, talking to friends/family, relying on God’s help, and getting trained in different task or jobs.
Afro-Colombian survivors of torture and violence described mental health problems similar to those of other trauma-affected populations. These results suggest that existing interventions that address trauma-related symptoms and current ongoing stressors may be appropriate for improving the mental health of survivors in this population.
Santaella-TenorioJ, Bonilla-EscobarFJ, Nieto-GilL, Fandiño-LosadaA, Gutiérrez-MartínezMI, BassJ, BoltonP. Mental Health and Psychosocial Problems and Needs of Violence Survivors in the Colombian Pacific Coast: A Qualitative Study in Buenaventura and Quibdó. Prehosp Disaster Med. 2018;33(6):567–574.
In this work we have conducted a study on the radiative and spectroscopic properties of the radiative precursor and the post-shock region from experiments with radiative shocks in xenon performed at the Orion laser facility. The study is based on post-processing of radiation-hydrodynamics simulations of the experiment. In particular, we have analyzed the thermodynamic regime of the plasma, the charge state distributions, the monochromatic opacities and emissivities, and the specific intensities for plasma conditions of both regions. The study of the intensities is a useful tool to estimate ranges of electron temperatures present in the xenon plasma in these experiments and the analysis performed of the microscopic properties commented above helps to better understand the intensity spectra. Finally, a theoretical analysis of the possibility of the onset of isobaric thermal instabilities in the post-shock has been made, concluding that the instabilities obtained in the radiative-hydrodynamic simulations could be thermal ones due to strong radiative cooling.
Direct polycondensation of L-lactic acid with a comonomer allows tailoring the properties of the product from the very first step. The viscous L-lactic acid co-oligomers with star-shaped architectures obtained were modified with three different acrylate monomers. Regardless the functionalization agent, UV curing was fast and all materials were cell compatible and promoted cell adhesion. The physical properties of the three star-shaped films exhibited a consistent trend as swelling capacity, hydrolytic instability, and gel content decreased simultaneously. A higher network density increased crosslinking degree and gel content among the films with an isocyanate group. The methacrylic end group functionalized material, lowest molecular weight, consistently exhibited the higher hydrolytic instability. Comparison of physical properties of these films with the corresponding linear materials reported previously confirmed the influence of precursor molecular architecture on the final material. The methodology developed herein is prone to scale-up and lead to the industrial production of new bioadhesives.
At birth, when immune responses are insufficient, there begins the development of the defence capability against pathogens. Leptin and adiponectin, adipokines that are present in breast milk, have been shown to play a role in the regulation of immune responses. We report here, for the first time, the influence of in vivo adipokine supplementation on the intestinal immune system in early life. Suckling Wistar rats were daily supplemented with leptin (0·7 μg/kg per d, n 36) or adiponectin (35 μg/kg per d, n 36) during the suckling period. The lymphocyte composition, proliferation and cytokine secretion from mesenteric lymph node lymphocytes (on days 14 and 21), as well as intestinal IgA and IgM concentration (day 21), were evaluated. At day 14, leptin supplementation significantly increased the TCRαβ+ cell proportion in mesenteric lymph nodes, in particular owing to an increase in the TCRαβ+ CD8+ cell population. Moreover, the leptin or adiponectin supplementation promoted the early development CD8+ cells, with adiponectin being the only adipokine capable of enhancing the lymphoproliferative ability at the end of the suckling period. Although leptin decreased intestinal IgA concentration, it had a trophic effect on the intestine in early life. Supplementation of both adipokines modulated the cytokine profile during (day 14) and at the end (day 21) of the suckling period. These results suggest that leptin and adiponectin during suckling play a role in the development of mucosal immunity in early life.
The main objective of our study was to describe the epidemiological and microbiological features of an oligoclonal hospital-wide outbreak caused by OXA-48-producing Enterobacteriaceae (OXA-48-PE). OXA-48 is a carbapenemase belonging to Ambler class D beta-lactamases, identified frequently in the Mediterranean and Southern European countries, and associated with several Enterobacteriaceae species. An outbreak of OXA-48-PE with a complex epidemic pattern was detected in January 2011. Initial control measures included contact precautions and the reinforcement of infection control practices, but despite all efforts made, the epidemiological situation hardly changed and new measures were implemented during 2013. An observational retrospective study was performed to describe the main features of the outbreak and to analyse the cumulative incidence (CI) trends. Eight hundred and 16 patients colonised or infected by OXA-48-PE were identified during the 2-year period (January 2013–December 2014), female 46%, mean age (s.d.), 71.6 (15.2). The samples isolated in the incident cases were rectal swabs (80%), urine samples (10.7%), blood samples (2.8%) and other clinical samples (6.6%). The most frequent OXA-48-PE was Klebsiella pneumoniae. Eleven different clones were identified, but K. pneumoniae sequence types 11 and 405 were predominant: ST11 (64.2%) and ST405 (29.3%). OXA-48-PE CI trend suffered a statistically significant change in August 2013, which continued the following months. Though we could not eradicate the outbreak, we observed a statistically significant drop in CI after an intervention for OXA-48-PE control, based on patient cohort, active surveillance, electronic alerts and reinforcement of infection control measures in a tertiary hospital.
Suckling lamb meat is traditionally produced in Mediterranean Europe. Breed can affect the quality of the lamb carcass and meat. This study is aimed at comparing the carcass and meat quality between suckling lambs from a local and a non-native dairy breed, Churra and Assaf. Churra is included in the Spanish Protected Geographical Indication (PGI) ‘Lechazo de Castilla y León’, whereas Assaf is not. However, Assaf breeders have requested the inclusion of the breed in the PGI. Carcasses and meat from 16 male lambs (eight Churra and eight Assaf) were used in this study. The lambs were all raised under an intensive rearing system and fed on a milk substitute to minimise maternal influence. The carcasses were evaluated for conformation, fatness, joint and leg tissue proportions and the meat was analysed for composition (i.e. proximate composition, iron, haematin, fatty acids and volatiles) and technological quality traits (i.e. texture, water holding capacity, colour and lipid stability). Churra carcasses were larger than Assaf carcasses. However, the proportions of commercial joints and main tissues did not differ between breeds. Cavity and intermuscular leg fat, but not total leg fat, were higher in Churra carcasses. Churra meat showed a higher proportion of n-6 fatty acids, higher redness and better colour stability during aerobic storage. In contrast, Assaf lamb was more resistant to lipid oxidation after cooking. This is a preliminary study to measure the influence of breed on a wide range of quality characteristics in Churra and Assaf suckling lamb carcass and meat. It may be of relevance for breeders, consumers and food policy makers, setting the basis for future studies that include larger commercial populations.
We present an analysis of high signal-to-noise ratio, 430-MHz total intensity single pulse observations from PSR 2303+30 recorded at the Arecibo Observatory in August 1986. We believe that the regular subpulse modulation observed in this pulsar can be explained only in terras of subpulse-associated emission beams rotating around the axis of the pulsar beam. This idea was first introduced by Ruderman and Sutherland (1975) in their spark model. We use the quantitative prediction of this model to calculate the pulsar magnetic field. For this reason we need to estimate the rotation period of a spark around the magnetic pole. We estimate this period by reproducing the observed pulse sequences within an angular beaming model of subpulse emission and fitting this model to the data.
We present 430-M Hz Arecibo single pulse polarization measurements for PSR 2303+30. Single pulses typically consist of one or two subpulses. Each subpulse is associated with circular polarization which reverses sense near the subpulse peak and with its own swing of the position angle which does not coincide with the average position-angle curve. We attempt to explain these complicated characteristics within the framework of a coherent curvature radiation model of pulsar emission.
We discuss the cross-correlation analysis of single pulses in the emission of PSR 0329+54 observed simultaneously at 102.5 and 1700 MHz. We have found that the observed correlations between the two frequencies are consistent with the model in which the subpulses in single pulses correspond to plasma excitations flowing from the neutron-star surface along dipolar magnetic field lines. The peaks of strongly correlated subpulses at the two frequencies correspond to the same field line at two different emission radii. We have found that the core (central) and the conal (outer) components of the pulse profile of PSR 0329+54 originate at the same distance from the neutron star.
Oral anti-diabetic drugs (OADs) have been associated with community-acquired pneumonia (CAP). We aimed to validate the recording of CAP in the Spanish Database for Pharmacoepidemiological Research in Primary Care (BIFAP) for the future evaluation of OAD–CAP association. The incidence rate (IR/1000 person-years) of CAP in type 2 diabetes mellitus (T2DM) was also determined. In total, 2966 pneumonia records (2040 listed as diagnosis and 926 as identified from comments added by physicians) were identified from 76 009 patients with T2DM after the first OAD in 2002–2013. Data around the CAP date were reviewed: 1803 (60·9%) were classified as ‘probable CAP’ (confirmed by X-ray/laboratory, referral letters or CAP lung site); 589 (19·8%) as ‘no-case’ (486 had other illness, 78 previous CAP, 25 cancer); and 574 (19·4%) as ‘possible CAP’ (441 without confirmatory information, 133 with uncertain diagnosis or uncertain diagnosis date). In total, 74·2% and 31·4% of pneumonia records in the diagnosis and comments, respectively, were ‘probable cases’ (IR: 6·04), which increased to 90·5% and 42·9%, respectively, when the 441 ‘possible cases’ without confirmatory information were included (IR: 7·52). In summary, diagnosis had a high positive predictive value, and adding cases automatically detected from comments decreased that value significantly.
A mechanism for generation of two concentric pulsar beams corresponding to the core and conal pulsar emission is proposed. The inner beam originates close to the star, where the radius of curvature of the dipolar magnetic field lines is suitable for coherent curvature emission at pulsar radio frequencies. Further from the star where the outer beam originates, the radius of curvature of dipolar lines is probably too large, but the actual curvature can be dominated by the toroidal component of field lines twisted back due to the pulsar rotation. One can show that for even moderate twisting the actual radius of curvature leads again to pulsar radio frequencies. Thus, the pulsar emission is a superposition of two beams originating at widely radially separated locations. When the observer's line-of-sight cuts both beams, a three-component profile should be observed. Because of the retardational time delay, the inner (core) component should appear late with respect to the profile midpoint, that is, closer to the traling component. Such an asymmetry is indeed observed in complex profile pulsars. In pulsar magnetosphere, the radius of curvature of dipolar field lines depends on the radius of the emission region in the opposite way than that of the toroidal lines. This explains why core and conal components dominate the mean profile at low and high frequencies, respectively.
Contact precautions are a traditional strategy to prevent transmission of methicillin-resistant Staphylococcus aureus (MRSA). Chlorhexidine bathing is increasingly used to decrease MRSA burden and transmission in intensive care units (ICUs). We sought to evaluate a hospital policy change from routine contact precautions for MRSA compared with universal chlorhexidine bathing, without contact precautions. We measured new MRSA acquisition in ICU patients and surveyed for MRSA environmental contamination in common areas and non-MRSA patient rooms before and after the policy change. During the baseline and chlorhexidine bathing periods, the number of patients (453 vs. 417), ICU days (1999 vs. 1703) and MRSA days/1000 ICU days (109 vs. 102) were similar. MRSA acquisition (2/453 vs. 2/457, P = 0·93) and environmental MRSA contamination (9/474 vs. 7/500, P = 0·53) were not significantly different between time periods. There were 58% fewer contact precaution days in the ICU during the chlorhexidine period (241/1993 vs. 102/1730, P < 0·01). We found no evidence that discontinuation of contact precautions for patients with MRSA in conjunction with adoption of daily chlorhexidine bathing in ICUs is associated with increased MRSA acquisition among ICU patients or increased MRSA contamination of ICU fomites. Although underpowered, our findings suggest this strategy, which has the potential to reduce costs and improve patient safety, should be assessed in similar but larger studies.
Amyotrophic lateral sclerosis (ALS) is a severe neuromuscular disease characterised by a progressive loss of motor neurons that usually results in paralysis and death within 2 to 5 years after disease onset. The pathophysiological mechanisms involved in ALS remain largely unknown and to date there is no effective treatment for this disease. Here, we review clinical and experimental evidence suggesting that dysregulation of copper homeostasis in the central nervous system is a crucial underlying event in motor neuron degeneration and ALS pathophysiology. We also review and discuss novel approaches seeking to target copper delivery to treat ALS. These novel approaches may be clinically relevant not only for ALS but also for other neurological disorders with abnormal copper homeostasis, such as Parkinson's, Huntington's and Prion diseases.