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On September 20, 2017, Hurricane Maria made landfall on Puerto Rico as a category 4 storm, resulting in serious widespread impact across the island, including communication and power outages, water systems impairment, and damage to life-saving infrastructure. In collaboration with the Puerto Rico Department of Health, the Public Health Branch (PHB), operating under the Department of Health and Human Services Incident Response Coordination Team, was tasked with completing assessments of health-care facilities in Puerto Rico to determine infrastructure capabilities and post-hurricane capacity. Additionally, in response to significant data entry and presentation needs, the PHB leadership worked with the Puerto Rico Planning Board to develop and test a new app-based infrastructure capacity assessment tool. Assessments of hospitals were initiated September 28, 2017, and completed November 10, 2017 (n = 64 hospitals, 97%). Assessments of health-care centers were initiated on October 7, 2017, with 186 health-care centers (87%) assessed through November 18, 2017. All hospitals had working communications; however, 9% (n = 17) of health-care centers reported no communication capabilities. For the health-care centers, 114 (61%) reported they were operational but had sustainment needs. In conclusion, health-care facility assessments indicated structural damage issues and operational capacity decreases, while health-care centers reported loss of communication capabilities post-Hurricane Maria.
Social cognition has been associated with functional outcome in patients with first episode psychosis (FEP). Social cognition has also been associated with neurocognition and cognitive reserve. Although cognitive reserve, neurocognitive functioning, social cognition, and functional outcome are related, the direction of their associations is not clear. Therefore, the main aim of this study was to analyze the influence of social cognition as a mediator between cognitive reserve and cognitive domains on functioning in FEP both at baseline and at 2 years.
The sample of the study was composed of 282 FEP patients followed up for 2 years. To analyze whether social cognition mediates the influence of cognitive reserve and cognitive domains on functioning, a path analysis was performed. The statistical significance of any mediation effects was evaluated by bootstrap analysis.
At baseline, as neither cognitive reserve nor the cognitive domains studied were related to functioning, the conditions for mediation were not satisfied. Nevertheless, at 2 years of follow-up, social cognition acted as a mediator between cognitive reserve and functioning. Likewise, social cognition was a mediator between verbal memory and functional outcome. The results of the bootstrap analysis confirmed these significant mediations (95% bootstrapped CI (−10.215 to −0.337) and (−4.731 to −0.605) respectively).
Cognitive reserve and neurocognition are related to functioning, and social cognition mediates in this relationship.
First-degree relatives of patients with psychotic disorder have higher levels of polygenic risk (PRS) for schizophrenia and higher levels of intermediate phenotypes.
We conducted, using two different samples for discovery (n = 336 controls and 649 siblings of patients with psychotic disorder) and replication (n = 1208 controls and 1106 siblings), an analysis of association between PRS on the one hand and psychopathological and cognitive intermediate phenotypes of schizophrenia on the other in a sample at average genetic risk (healthy controls) and a sample at higher than average risk (healthy siblings of patients). Two subthreshold psychosis phenotypes, as well as a standardised measure of cognitive ability, based on a short version of the WAIS-III short form, were used. In addition, a measure of jumping to conclusion bias (replication sample only) was tested for association with PRS.
In both discovery and replication sample, evidence for an association between PRS and subthreshold psychosis phenotypes was observed in the relatives of patients, whereas in the controls no association was observed. Jumping to conclusion bias was similarly only associated with PRS in the sibling group. Cognitive ability was weakly negatively and non-significantly associated with PRS in both the sibling and the control group.
The degree of endophenotypic expression of schizophrenia polygenic risk depends on having a sibling with psychotic disorder, suggestive of underlying gene–environment interaction. Cognitive biases may better index genetic risk of disorder than traditional measures of neurocognition, which instead may reflect the population distribution of cognitive ability impacting the prognosis of psychotic disorder.
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.
The care of patients with CHD remains a challenge in low- and middle-income countries. Their health systems have not been able to achieve consistently high performance in this field. The large volume of patients, manpower constraints, inconsistencies in the level and type of background training of the teams caring for this patient population, and the inadequate quality control systems are some of the barriers to achieving excellence of care. We describe three different international projects supporting the paediatric cardiac surgical and paediatric cardiac intensive care programmes in Latin America, Asia, and the Caribbean.
The main goal of this work consisted in cloning, purifying and characterizing a protein phosphatase 2C (PP2C) from promastigotes of Leishmania major. The gene was cloned and amplified by PCR using specific oligonucleotides and the recombinant protein was purified by affinity chromatography. The peak with maximal protein concentration was analysed by sodium dodecyl sulphate-polyacrylamide gel electrophoresis and revealed a protein of 44·9 kDa with PP2C activity. This activity was dependent on divalent cations (Mg+2 and Mn+2) and was optimal at pH of 8·5, using phosphothreonine as the substrate. Sanguinarine inhibited the activity of the recombinant LmPP2C, while protein tyrosine phosphatase inhibitors had no effect. The recombinant LmPP2C was used to generate polyclonal antibodies. These antibodies recognized a protein of 44·9 kDa in different Leishmania species; the LmPP2C was localized in the flagellar pocket and the flagellum of promastigotes.
In order to fully participate in informed consent, patients must understand what it is that they are agreeing, or not agreeing, to. In most cases, patients look to their clinicians to help develop the appropriate understanding required to give informed consent. Often the quality of the information available as well as the delivery methods are not optimal.
Using a visual aid as an adjunct to risk communication in a stressful setting as the Emergency Department has a clear potential in facilitating the communication process. To support more accurate and consistent presentation of risk, we formed a team with implementation scientists, patient education specialists, nurses, physicians, and professional designers to transform the information available into a 6th grade reading level visual aid tool. We applied a DMAIC (Define, Measure, Analyze, Improve and Control) process to design the tool. We measured and analyzed its effectiveness through feedback from providers, patients, and caregivers. This cycle happened 3 times until we reached the final version of the visual aid.
We utilized a DMAIC methodology as well as modified Delphi method to create and refine a visual aid tool. Several rounds of end-user feedback along with DMAIC allowed us to create a tool that was consistently better with each round of development, analysis and feedback. After arriving at the final version of the tool, we surveyed physicians in our Emergency Department. We measured the difficulty to understand the information, whether doctors think the visual aid will help patients to understand the data, and the appropriateness of the tool’s length and the amount of information in it.
We believe that our experience can be replicated by other researchers and clinicians in the endeavor of translating the evidence into clinical practice. An effort should be made to fully translate research findings until the end of the research to practice continuum in order to better translate knowledge into a useful and useable form for informed consent decisions in busy clinical practice.
The University of Georgia (USA) is partnering with the University of Padova (Italy) for a dual Master’s degree program in sustainable agriculture, promoting collaboration on some of the biggest challenges facing agriculture today. This innovative program which was launched during 2016 provides students with outstanding training and a unique opportunity to learn about the challenges, opportunities, and leading edges of precision agriculture on another continent – an experience which will serve graduates well when they enter the job market in an increasingly global economy. This paper presents the goals of the program, the curriculum, and describes the opportunities available to prospective students. In addition it describes the process of developing the dual degree which can be used as guide by others wishing to develop similar programs.
We say that a Banach space
is ‘nice’ if every extreme operator from any Banach space into
is a nice operator (that is, its adjoint preserves extreme points). We prove that if
is a nice almost
is isometrically isomorphic to
for some set
. We also show that if
is a nice Banach space whose closed unit ball has the Krein–Milman property, then
. The proof of our results relies on the structure topology.
In order to understand how galaxies form and evolve, the measurement of the parameters related to their morphologies and also to the way they interact is one of the most relevant requirements. Due to the huge amount of data that is generated by surveys, the morphological and interaction analysis of galaxies can no longer rely on visual inspection. For dealing with such issue, new approaches based on machine learning techniques have been proposed in the last years with the aim of automating the classification process. We tested Deep Learning using images of galaxies obtained from CANDELS to study the accuracy achieved by this tool considering two different frameworks. In the first, galaxies were classified in terms of their shapes considering five morphological categories, while in the second, the way in which galaxies interact was employed for defining other five categories. The results achieved in both cases are compared and discussed.
The discrepancy between abundances computed using optical recombination lines (ORLs) and collisionally excited lines (CELs) is a major, unresolved problem with significant implications for the determination of chemical abundances throughout the Universe. In planetary nebulae (PNe), the most common explanation for the discrepancy is that two different gas phases coexist: a hot component with standard metallicity, and a much colder plasma enhanced in heavy elements. This dual nature is not predicted by mass loss theories, and direct observational support for it is still weak. In this work, we present our recent findings that demonstrate that the largest abundance discrepancies are associated with close binary central stars. OSIRIS-GTC tunable filter imaging of the faint O ii ORLs and MUSE-VLT deep 2D spectrophotometry confirm that O ii ORL emission is more centrally concentrated than that of [Oiii] CELs and, therefore, that the abundance discrepancy may be closely linked to binary evolution.
Risk factors associated with admission of people with dementia to long-term care institutions need to be identified to support health-care professionals in dementia care at home. An explorative study, combining quantitative and qualitative data collection methods, was performed in people with dementia in Spain. The sample, consisting of people with dementia receiving formal care from health-care professionals but at risk of institutionalisation, and their informal care-givers; and people with dementia recently admitted to a long-term care institution, and their informal care-givers, was interviewed between November 2010 and April 2012. Perceived reasons for admission were determined through an open-ended question put to both groups. Presumed risk factors were collected with validated questionnaires and analysed using bivariate analysis. A total of 287 people with dementia and informal care-givers were studied. Reasons given by the institutionalised group were mostly related to the level of dependency of the person with dementia. People recently admitted to a long-term care institution had more cognitive impairment, a greater degree of dependency and poorer quality of life than those still living at home. Home-care services in Spain need to develop or improve interventions based on the risk factors identified in this study: informal care-giver profile, high cognitive impairment, high level of dependency and the poor quality of life of the person with dementia.
Advances in radiocarbon dating by accelerator mass spectrometry (AMS) have made it possible to date prehistoric cave paintings by sampling the pigment itself instead of relying on dates derived from miscellaneous prehistoric remains recovered in the vicinity of the paintings. The work at the Laboratoire des Sciences du Climat et de l'Environnement (LSCE) concentrated on prehistoric charcoal cave paintings from southern France and northern Spain. In most caves, pigment samples were collected from several paintings, and in some instances the sample size allowed for multiple independent measurements on the same figure, so that the coherence of the calculated dates could be tested. Before being dated, each specimen was subjected to a thermal treatment preceded by an acid and basic treatment of intensity commensurate with the sample size.
Nine bison drawings from three caves in the Cantabrian region of Spain—two from Covaciella, three from Altamira, and four from El Castillo—were sampled and dated. The 27 dates fell between 13,000 and 14,500 BP, allowing us to attribute the drawings to the Magdalenian period. The 24 dates for 13 drawings in the Cosquer cave indicated two distinct periods of painting activity—one around 28,000 BP and the other around 19,000 BP. The Chauvet cave paintings turned out to be the oldest recorded to date, as five dates fell between 32,000 and 31,000 BP. After discussing the sample preparation protocol in more detail, we will discuss the ages obtained and compare them with other chronological data.
Using Finite Element Method (FEM) simulations is possible to study the homogeneity of deformation in the Equal Channel Angular Pressing (ECAP) process. In this work an investigation about the influence of a modified die on strain distribution in an ecaped Al6060 alloy was carried out. Due to that, tensile stress occurs in the vicinity of upper surface of the specimen in the severe plastic deformation zone, which increases the cracking and fracture tendency of the specimen and impedes further ECAP processing, the conventional ECAP die was modified to eliminate the tensile stress and enhance the compressive stress in the severe plastic deformation zone and reducing the cracking and fracture tendency of the specimen. Finite element analysis demonstrated that the stress state changes from tensile to strongly compressive when using the modified die. The aim of this study is to evaluate the advantages/disadvantages of the modified ECAP die and processing conditions.
Equal channel angular pressing (ECAP) was carried out on extruded ZK60 magnesium alloy until an equivalent strain of ∼4 (corresponding to 4 passes) at 523K following route Bc. The effect of the deformation on both microstructure and texture was investigated by analysis of inverse pole figures and pole figures respectively, determined by EBSD. Additionaly, the mechanical properties were evaluated through tensile tests. The ECAPed processed ZK60 alloy showed the presence of dynamic recrystallization (DRX) process, correlated with a strong basal fiber texture. The presence of pyramidal slip was also observed, which can be correlated with the presence on twin-oriented boundaries in the material. Both the grain size reduction and the existence of texture influenced the ductility of the magnesium alloy processed by ECAP, as the ductility of the ZK60 alloy after four ECAP passes increased two times in comparation with the initial (un-processed) material.