To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
A large body of research states that cognitive impairment in schizophrenia is static. Nevertheless, most previous studies lack a control group or have small study samples or short follow-up periods.
We aimed to address these limitations by studying a large epidemiological cohort of patients with first-episode schizophrenia spectrum disorders and a comparable control sample for a 10-year period.
Our results support the generalized stability of cognitive functions in schizophrenia spectrum disorders considering the entire group. However, the existence of a subgroup of patients characterized by deteriorating cognition and worse long-term clinical outcomes must be noted. Nevertheless, it was not possible to identify concomitant factors or predictors of deterioration (all Ps > 0.05).
Cognitive functions in schizophrenia spectrum disorder are stable; however, a subgroup of subjects that deteriorate can be characterized.
Mesoamerica is the world's third largest biodiversity hotspot and has c. 4,000 wildlife species protected under CITES. Despite the high biodiversity in the region, there is limited global attention, data and funding for conservation. The continued exploitation of wildlife species for the trade requires a more proactive approach to address emerging trends, and low-cost and effective solutions to prevent species decline. Over a 5-month period in 2017, we used expert-driven horizon scanning, facilitated online, to identify emerging trends of the illegal wildlife trade in Mesoamerica. We found that the main emerging trends included digital and technological advancements, greater regional access to the global community, developments in trafficking techniques and growing demand for certain species. Our findings demonstrate that horizon scanning can be used as a tool for identifying emerging trends of illegal wildlife trade in data-poor contexts. We recommend that horizon scanning is used regularly for systematic monitoring of trends and to prioritize resources for immediate and emerging trends in illegal wildlife trade.
Describe and validate the CHROME (CHemical Restraints avOidance MEthodology) criteria.
Observational prospective longitudinal study.
Single nursing home in Las Palmas de Gran Canaria, Spain.
288 residents; mean age: 81.6 (SD 10.6). 77.4% had dementia.
Multicomponent training and consultancy program to eliminate physical and chemical restraints and promote overall quality care. Clinicians were trained in stringent diagnostic criteria of neuropsychiatric syndromes and adequate psychotropic prescription.
Psychotropic prescription (primary study target), neuropsychiatric syndromes, physical restraints, falls, and emergency room visits were semi-annually collected from December 2015 to December 2017. Results are presented for all residents and for those who had dementia and participated in the five study waves (completer analysis, n=107).
For the study completers, atypical neuroleptic prescription dropped from 42.7% to 18.7%, long half-life benzodiazepines dropped from 25.2% to 6.5%, and hypnotic medications from 47.7% to 12.1% (p<0.0005). Any kind of fall evolved from 67.3 to 32.7 (number of falls by 100 residents per year). Physicians’ diagnostic confidence increased, while the frequency of diagnoses of neuropsychiatric syndromes decreased (p<0.0005).
Implementing the CHROME criteria reduced the prescription of the most dangerous medications in institutionalized people with dementia. Two independent audits found no physical or chemical restraint and confirmed prescription quality of psychotropic drugs. Adequate diagnosis and independent audits appear to be the keys to help and motivate professionals to optimize and reduce the use of psychotropic medication. The CHROME criteria unify, in a single compendium, neuropsychiatric diagnostic criteria, prescription guidelines, independent audit methodology, and minimum legal standards. These criteria can be easily adapted to other countries.
This work focuses on the mass transfer around unconfined bubbles in cylindrical microchannels when they are arranged in a train. We characterise how the mass transfer, quantified by the Sherwood number,
, is affected by the channel and bubble sizes, distance between bubbles, diffusivity, mean flow velocity, deformation of the bubble, the presence of surfactants in the limit of rigid interface and off-centred positions of the bubbles. We analyse the influence of the dimensionless numbers and especially the distance between bubbles and the Péclet number,
, which we vary over eight decades, identifying five different mass transfer regimes. We show different concentration patterns and the dependence of the Sherwood numbers. These regimes can be classified by either the importance of the diffusion along the streamlines or the interaction between bubbles. For small
the diffusion along the streamlines is not negligible as compared to convection, whereas for large
convection dominates in the streamlines direction and, thus, crosswind diffusion becomes crucial in governing the mass transfer through boundary layers or the remaining wake behind the bubbles. Interaction of bubbles occurs for very small
where the mass transfer is purely diffusive, or for very large
where long wakes eventually reach the following bubble. We also observe that the bubble deformability mainly affects the
in the regime for very large
in which bubbles interaction matters, and also that the rigid interface affects the boundary layer and the remaining wake. The effect of off-centred position of the bubble, determined by the transverse force balance, is also limited to large
. The boundary layers on rigid bubble surfaces are thicker than those on stress-free bubble surfaces, and thus the mass transfer is weaker. For centred bubbles, the influence of inertia on the mass transfer is negligible. Finally, we discuss the implication of our results on the dissolution of bubbles.
Organic farming is believed by many to be an environmentally friendly production system that promotes the use of local forage while strongly limiting the input of chemicals, including allopathic treatments. As organic dairy farming has grown, farmers have realised that many available conventional breeds of cow are not well adapted to the new situations and that more ‘robust’ cows, able to function well in the constraining organic environment, are needed to yield acceptable longevity and productivity. In this review paper, the current breed diversity in organic dairy farming is analysed with the aim of identifying the types of cow that would best fulfil organic breeding goals. Unlike the conventional sector, organic dairy farming is very heterogeneous and no single type of cow can adapt well to all scenarios. There are advantages and disadvantages to the use of existing breeds (rustic Holstein-Friesian, other rustic breeds and crosses), and strong genotype × environment interactions demand different strategies for very diverse situations. Organic dairy farms producing milk for systems that recompense milk volume would benefit from using higher milk yielding cows, and rustic Holstein-Friesian cows may be the best option in such cases. Although most Holstein-Friesian cows are currently selected for use in conventional systems, this situation could be reversed by the implementation of an organic merit index that includes organic breeding goals. Farms producing milk either for systems that recompense milk solids or for transformation into dairy products would benefit from using breeds other than Holstein-Friesian or their crosses. Organic farmers who focus on rural tourism, farm schools or other businesses in which marketing strategies must be taken into account could benefit from using local breeds (when possible) or other rustic breeds that are highly valued by consumers.
Long-acting injectable antipsychotic therapies may offer benefits over oral antipsychotics in patients with schizophrenia. However, there is still a lack of real-world studies assessing the effectiveness of these therapies.
This study aimed to explore the safety, tolerability, and treatment response of aripiprazole monohydrate (AOM) once monthly in non-acute but symptomatic adult patients switched from previous therapy with frequently used oral or injectable atypical antipsychotics.
This was a post hoc analysis of a prospective, interventional, single-arm, open-label, 6-month study.
The patients (N=54) were switched to aripiprazole monohydrate once-monthly (AOM) from daily oral treatment or monthly injectable treatment with either aripiprazole (n=25), olanzapine (n=7), paliperidone extended-release (PP1M) (n=10), quetiapine (n=4), or risperidone (n=8). In all groups, mean Positive and Negative Syndrome Scale total (p=0.0001) and Clinical Global Impression-Severity scores improved significantly (p=0.0001). A reduction of ≥50% reduction of BPRS total-score and a CGI severity-score ≤4 in the Positive and Negative Syndrome Scale total score were observed in 16.7% (aripiprazole), 21.2% (olanzapine), 35.1% (PP1M), 27.3% (quetiapine), and 37.2% (risperidone) of patients. The patients showed significant improvements involving safety features as they experienced significant overall weight loss (p=0.0001) and prolactine decrease (risperidone p=0.0001, paliperidone extended-release p=0.0001). AOM once-monthly was well tolerated, presenting no new safety signals. Patient also reported an overall significant improvement on their quality of life measured with the Quality of Life Rating Scale (QLS) (p=0.0004) as well as in sexual functioning PRSexDQ-SALSEX (p=0.0001). In addition, the all cause treatment discontinuation rate after6-month follow-up was small (n=3; 5,55%)
These data illustrate that stable, non-acute but symptomatic patients either on oral antipsychotic therapy or under monthly antipsychotic treatment may show clinically meaningful improvement of psychotic symptoms, tolerability involving relevant side effects and quality of life perception. The findings are limited by the naturalistic study design; thus, further studies are required to confirm the current findings.
Social stratification is an important mechanism of human organization that helps to explain health differences between demographic groups commonly associated with socioeconomic gradients. Individuals, or group of individuals, with similar health profiles may have had different stratification experiences. This is particularly true as social stratification is a significant non-measurable source of systematic unobservable differences in both SES indicators and health statuses of disadvantage. The goal of the present study was to expand the bulk of research that has traditionally treated socioeconomic and demographic characteristics as independent, additive influences on health by examining data from the United States. It is hypothesized that variation in an index of multi-system physiological dysregulation – allostatic load – is associated with social differentiation factors, sorting individuals with similar demographic and socioeconomic characteristics into mutually exclusive econo-demographic classes. The data were from the Longitudinal and Biomarker samples of the national Study of Midlife Development in the US (MIDUS) conducted in 1995 and 2004/2006. Latent class analyses and regression analyses revealed that physiological dysregulation linked to socioeconomic variation among black people, females and older adults are associated with forces of stratification that confound socioeconomic and demographic indicators. In the United States, racial stratification of health is intrinsically related to the degree to which black people in general, and black females in particular, as a group, share an isolated status in society. Findings present evidence that disparities in health emerge from group-differentiation processes to the degree that individuals are distinctly exposed to the ecological, political, social, economic and historical contexts in which social stratification is ingrained. Given that health policies and programmes emanate from said legal and political environments, interventions should target the structural conditions that expose different subgroups to different stress risks in the first place.
Dimethylformamide (DMF) has been tested as corrosion inhibitor in a metallic material like API 5LX70 in a corrosive solution of 3% of NaCl and using electrochemical technique as electrochemical impedance spectroscopy. The results showed that 20 ppm is the best concentration to protect the metallic surface of API 5L X70 with η∼ 94%. Hydrodynamic conditions (100 and 1000 rpm) demonstrated that the DMF at different concentration afforded moderate protection against corrosion with inhibition efficiency ∼70%. Finally, the adsorption of this compound follows the Langmuir isotherm with a chemisorption-physisorption process.
Hernia is defined as the protrusion of one or several internal organs through an opening in the cavity that contains them due to a tissue defect, abdominal wall surgery by means of synthetic meshes is the most common method used for hernia repair, however, postsurgical effects can range from some discomfort, to chronic pain and even the reappearance of the hernia due to a poor mechanical adaptability between the synthetic tissue and the host tissue. The knowledge of the mechanical properties of the materials involved in hernia repair is fundamental in the understanding and subsequent solution of this type of problems. In this work, experimental data were obtained by means of uniaxial tensile tests in two perpendicular directions of commercial meshes used in hernia repair. The tests were carried out on the UniVert® machine of the CellScale® brand. Anisotropic mechanical behavior is observed due to the structure of the mesh and the interaction between each of the yarns that make it up. The data found vary with respect to the direction of traction and also has non-linear hyperelastic behavior, so the adjustment of curves was made through a hyperelastic model in the COMSOL Multiphysics® software through the Levenberg-Marquardt Algorithm for the characterization of these materials.
The literature highlights two main approaches to designing an effective complaint management system: the mechanistic and the organic. The mechanistic approach emphasizes the establishment of guidelines for the correct processing, attention and resolution of complaints received. In contrast, the organic approach relies on creating a supportive internal environment for correct customer attention, made possible through training and empowering employees responsible for complaint management and by promoting extra-role behaviour among them. The present research aims to study the antecedents of adopting these two approaches. From a strategic perspective, we analyse the influence of organizational culture variables (the extent to which the firm is customer and innovation oriented) and the nature of the objectives pursued by complaint handling (defensive vs. improvement objectives). The proposed model is tested on a sample of 140 manufacturing firms. Findings indicate these antecedents shape the complaint management system in a diverse and significant manner.
To investigate whether amnestic mild cognitive impairment (aMCI) identified with visual memory tests conveys an increased risk of Alzheimer’s disease (risk-AD) and if the risk-AD differs from that associated with aMCI based on verbal memory tests.
4,771 participants aged 70.76 (SD = 6.74, 45.4% females) from five community-based studies, each a member of the international COSMIC consortium and from a different country, were classified as having normal cognition (NC) or one of visual, verbal, or combined (visual and verbal) aMCI using international criteria and followed for an average of 2.48 years. Hazard ratios (HR) and individual patient data (IPD) meta-analysis analyzed the risk-AD with age, sex, education, single/multiple domain aMCI, and Mini-Mental State Examination (MMSE) scores as covariates.
All aMCI groups (n = 760) had a greater risk-AD than NC (n = 4,011; HR range = 3.66 – 9.25). The risk-AD was not different between visual (n = 208, 17 converters) and verbal aMCI (n = 449, 29 converters, HR = 1.70, 95%CI: 0.88, 3.27, p = 0.111). Combined aMCI (n = 103, 12 converters, HR = 2.34, 95%CI: 1.13, 4.84, p = 0.023) had a higher risk-AD than verbal aMCI. Age and MMSE scores were related to the risk-AD. The IPD meta-analyses replicated these results, though with slightly lower HR estimates (HR range = 3.68, 7.43) for aMCI vs. NC.
Although verbal aMCI was most common, a significant proportion of participants had visual-only or combined visual and verbal aMCI. Compared with verbal aMCI, the risk-AD was the same for visual aMCI and higher for combined aMCI. Our results highlight the importance of including both verbal and visual memory tests in neuropsychological assessments to more reliably identify aMCI.
The identification of threats to migratory species of conservation concern and the relevance of protected areas for them is often biased towards breeding areas. The European Roller Coracias garrulus is a long-distance migrant experiencing a pronounced decline throughout its breeding range, which has been attributed to the degradation of open agricultural habitats. However, its conservation status in non-breeding areas in Africa remains unstudied. Land cover change is a major threat affecting migratory birds in their wintering grounds, therefore identifying important areas for their protection at this stage is a priority. Here we used occurrence data during the wintering season and ecological niche models to identify key land cover and areas used by Rollers in Africa. First, we used 33 filtered locations from six satellite-tracked birds breeding in Spain to describe suitable wintering areas for the Spanish population (westernmost part of the Eurasian breeding range). We also used 1,167 occurrence data in southern Africa from open-access databases and bird atlases to characterise the overall wintering range of the species. The Spanish population occupied a relatively small area in the north-western part of southern Africa, and a narrow range of land covers. Open grassland, less steep areas and those with sparse tree cover are correlated with suitability. In all, 18.06% of suitable wintering areas for the Spanish population overlapped with protected areas. The overall population of Rollers occupied a wider area and range of land cover. Tree cover was the most important variable affecting suitability, with areas without tree cover being the least suitable. We found that 9.58% of suitable wintering areas for the overall population overlapped with protected areas. Our results suggest that Rollers from different origins (breeding populations) use separate, but overlapping, wintering areas and may have different habitat requirements, and therefore, population-specific conservation strategies in these areas might be needed to fully protect the species.
A large collection of maize macro-specimens has been gathered from archaeological sites across the American continent, but only a few have been directly dated by accelerator mass spectrometry (AMS). We recently conducted two new excavations in several rock shelters of Tehuacán valley (San Marcos, Coxcatlán, and Purrón) and uncovered 132 non-manipulated macro-specimens of maize suitable for morphological and paleogenomic analysis, including many complete cobs, stalks, internodes, and leaves. Direct AMS dates for 43 samples found in San Marcos or Coxcatlán confirm the previously reported chronologies for these sites. By contrast, a cob found in Purrón was dated to 3060±30 before present (3360–3180 cal BP) (2σ), demonstrating that maize was present at that site at least 1500 calendar years earlier than previously expected, and suggesting that other specimens of similar age are still likely to be found in the southeastern region of the Tehuacán valley. A global comparison of macro-specimen chronology across the continent shows that the current archaebotanical record does not yet reflect the chronology of dispersal from central Mexico to northern or southern regions, opening the possibility for finding the missing links in subsequent expeditions within Mexico and Central America.
This work focuses on the dynamics of a train of unconfined bubbles flowing in a microchannel. We investigate the transverse position of the train of bubbles, its velocity and the associated pressure drop when flowing in a microchannel, depending on the internal forces due to viscosity, inertia and capillarity. Despite the small scales of the system, the inertial migration force plays a crucial role in determining the transverse equilibrium position of the bubbles. Besides inertia and viscosity, other effects may also affect the transverse migration of bubbles, such as the Marangoni surface stresses and the surface deformability. We look at the influence of surfactants in the limit of infinite Marangoni effect, which yields a rigid bubble interface. The resulting migration force may balance external body forces, if present, such as buoyancy, centrifugal or magnetic ones. This balance not only determines the transverse position of the bubbles but, consequently, the surrounding flow structure, which can be determinant for any mass/heat transfer process involved. Finally, we look at the influence of the bubble deformation on the equilibrium position and compare it with the inertial migration force at the centred position, explaining the stable or unstable character of this position accordingly. A systematic study of the influence of the parameters, such as the bubble size, uniform body force, Reynolds and capillary numbers, has been carried out using numerical simulations based on the finite element method, solving the full steady Navier–Stokes equations and their asymptotic counterparts for the limits of small Reynolds and/or capillary numbers.
To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Approach (IMA) and the INICC Surveillance Online System (ISOS) on central line-associated bloodstream infection (CLABSI) rates in 14 intensive care units (ICUs) in Argentina from January 2014 to April 2017.
This prospective, pre–post surveillance study of 3,940 ICU patients was conducted in 11 hospitals in 5 cities in Argentina. During our baseline evaluation, we performed outcome and process surveillance of CLABSI applying Centers for Disease Control and Prevention/National Health Safety Network (CDC/NHSN) definitions. During the intervention, we implemented the IMA through ISOS: (1) a bundle of infection prevention practice interventions, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback on CLABSI rates and consequences, and (6) performance feedback of process surveillance. Bivariate and multivariate regression analyses were performed using a logistic regression model to estimate the effect of the intervention on the CLABSI rate.
During the baseline period, 5,118 CL days and 49 CLABSIs were recorded, for a rate of 9.6 CLABSIs per 1,000 central-line (CL) days. During the intervention, 15,659 CL days and 68 CLABSIs were recorded, for a rate of 4.1 CLABSIs per 1,000 CL days. The CLABSI rate was reduced by 57% (incidence density rate: 0.43; 95% confidence interval, 0.34–0.6; P<.001).
Implementing IMA through ISOS was associated with a significant reduction in the CLABSI rate in ICUs in Argentina.