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We study the largest exposed example of an early Cambrian palaeokarst, associated with laterites and developed during rifting of the Ossa–Morena Zone. The lithostratigraphy, biostratigraphy, facies and the genesis reflect episodes of sea-level fall (Cerro del Hierro Regression) related to tectonic events and palaeoclimate. This palaeokarst can be primarily considered as the result of early Cambrian polyphase karstification in an extensional tectonic regime, later modified by Neogene–Quaternary geomorphological processes. The event may correlate with other regressive events of a similar age in Spain, Italy, United Kingdom, South America and Australia. This episode also has local names (e.g. Cerro del Hierro Regression in the Mediterranean region; Woodlands Regression in the UK). It is sometimes accompanied by additional karst development outside of Spain that is compared and interpreted in a global context.
The aim of the current study was to explore the changing interrelationships among clinical variables through the stages of schizophrenia in order to assemble a comprehensive and meaningful disease model.
Twenty-nine centers from 25 countries participated and included 2358 patients aged 37.21 ± 11.87 years with schizophrenia. Multiple linear regression analysis and visual inspection of plots were performed.
The results suggest that with progression stages, there are changing correlations among Positive and Negative Syndrome Scale factors at each stage and each factor correlates with all the others in that particular stage, in which this factor is dominant. This internal structure further supports the validity of an already proposed four stages model, with positive symptoms dominating the first stage, excitement/hostility the second, depression the third, and neurocognitive decline the last stage.
The current study investigated the mental organization and functioning in patients with schizophrenia in relation to different stages of illness progression. It revealed two distinct “cores” of schizophrenia, the “Positive” and the “Negative,” while neurocognitive decline escalates during the later stages. Future research should focus on the therapeutic implications of such a model. Stopping the progress of the illness could demand to stop the succession of stages. This could be achieved not only by both halting the triggering effect of positive and negative symptoms, but also by stopping the sensitization effect on the neural pathways responsible for the development of hostility, excitement, anxiety, and depression as well as the deleterious effect on neural networks responsible for neurocognition.
This study was carried out on sediment cores collected with a gravity corer from Laguna Cháltel, an almost circular crater lake located in Patagonia, Argentina (49.9°S, 71°W). The main magnetic carrier was Ti-magnetite in the pseudo–single domain range. A model using magnetic grain size and concentration, previously applied to Laguna Potrok Aike to infer lake-level changes, was used for Laguna Cháltel. The main requirement to apply the model is uniform magnetic mineralogy, which is the case for Laguna Cháltel. After magnetic data were compared with previously studied lake levels, it was found that the magnetic proxies that best follow hydrologic changes are ARM/SIRM (anhysteretic remanent magnetisation/saturation of isothermal remanent magnetisation) and ARM. The concentration proxy (ARM measured with a 100 mT alternating field and 0.05 mT direct field) was also used as wind indicator. High wind strength was found at around 3650 cal yr BP, and low wind strength for the last century. ARM/SIRM and ARM were used to infer the strength of fluvial runoff into the lake for a core collected close to the shore and near a tributary. The results show that the magnetic model is promising for inferring lake-level variations, particularly in Patagonian lakes.
This study develops a decision-making procedure to help policymakers compare alternative patterns for sustainable diets by reaching a compromise among three criteria: socio-economic perspective, health and environment (including carbon and water footprints). An Analytical Hierarchy Process (AHP) was performed in several stages. First, a total of 25 stakeholders (members of organizations on the Valencia Food Policy Council) evaluated criteria that are relevant to the sustainability of diets. Secondly, a workshop with 14 experts from different backgrounds evaluated by consensus four dietary alternatives: Mediterranean, flexitarian, pescatarian and vegan. In terms of environment, experts gave priority to the vegan diet. However, the Mediterranean diet pattern (MDP) appeared, according to the process, as the most suitable pattern from the holistic perspective that integrates all relevant criteria. The MDP was ranked first in terms of the health criterion and the socio-economic perspective. These include culture, affordability, social impact and local production as decision elements that food policy advisory bodies take into consideration to define sustainable diets.
The philosophical study of human action begins with Plato and Aristotle. Their influence in late antiquity and the Middle Ages yielded sophisticated theories of action and motivation, notably in the works of Augustine and Aquinas.1 But the ideas that were dominant in 1945 have their roots in the early modern period, when advances in physics and mathematics reshaped philosophy.
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.
The purpose of this study was to analyse the reliability and validity of a semi-quantitative FFQ to assess food group consumption in South American children and adolescents.
The SAYCARE (South American Youth/Child cARdiovascular and Environmental) study is an observational, multicentre, feasibility study performed in a sample of 3- to 18-year-old children and adolescents attending private and public schools from six South American countries. Participants answered the FFQ twice with a two-week interval and three 24-h dietary recalls. Intraclass and Spearman’s correlations, weighted Cohen’s kappa (κw), percentage of agreement and energy-adjusted Pearson’s correlation coefficients were calculated.
Seven cities in South America (Buenos Aires, Lima, Medelin, Montevideo, Santiago, Sao Paulo and Teresina).
A sample of 200 children and 244 adolescents for reliability analyses and 252 children and 244 adolescents for validity analyses were included.
Depending on the food group, for children and adolescents, reliability analyses resulted in Spearman’s coefficients from 0·47 to 0·73, intraclass correlation coefficients from 0·66 to 0·99, κw coefficients from 0·35 to 0·63, and percentage of agreement between 72·75 and 83·52 %. In the same way, validity analyses resulted in Spearman’s coefficients from 0·17 to 0·37, energy-adjusted Pearson’s coefficients from 0·17 to 0·61, κw coefficients from 0·09 to 0·24, and percentages of agreement between 45·79 and 67·06 %.
The SAYCARE FFQ achieved reasonable reliability and slight-moderate validity for almost all food groups intakes. Accordingly, it can be used for the purpose of ranking the intake of individuals within a population.
OBJECTIVES/SPECIFIC AIMS: The Title V Cooperative Project between the University of Puerto Rico- Medical Sciences Campus (UPR-MSC) and Universidad Central del Caribe (UCC) has trained US, GS and F (participants) of HSPs to engage them in CTR. METHODS/STUDY POPULATION: First stage of the training sessions (TS) dealt with the theory of CTR. After TS and responding to their research interests, as answered in a questionnaire, the participants formed a CTMT, under the mentorship of a well-established CT researcher. This, as a prelude to their hands-on experiences in Intensive Development and Experiences in Advancement of Research and Increased Opportunities (IDEARIO), for which a research proposal is needed. RESULTS/ANTICIPATED RESULTS: Five (5) CTMTs were formed in different research areas – cardio, neuro, liver, renal, Zika–, as submitted in their research concept papers.Eight (8) CT researchers are currently mentoring 2 US, 7 GS and 6 F of HSPs through the CTMTs. They have submitted a research proposal, as a bridge between the theory in the TS and the practice in IDEARIO. Five (5) proposals were received and 2 of them approved, while the other 3 are in the evaluation process. We will present the composition, research topics, development of research and the feedback of participants in IDEARIO and CTMTs. DISCUSSION/SIGNIFICANCE OF IMPACT: The CTMTs and their respective proposals are effective strategies for the mentoring of US, GS and F in CTR.
OBJECTIVES/SPECIFIC AIMS: The Title V Cooperative Project of the UPR-MSC and UCC has demonstrated that educational interventions in CTR are very effective in fulfilling the objective of promoting awareness, stimulate interest and increase the knowledge, skills and opportunities, to US, GS and F (participants) in CTR. METHODS/STUDY POPULATION: The training sessions (TS) offered through the Title V initiative have become an engine for the involvement in CTR for participants from higher education institutions island-wide. TS consisted of cycles –level 1 and 2–: Research Education Towards Opportunities (RETO,I,II) and Mentorship Offering Training Opportunities for Research (MOTOR,I,II), ending in the formation of the Clinical and Translational Mentoring Teams (CTMT)s, in which participants, paired by their research interests, were mentored by a well-established CT researchers in their research project, to be developed in the Intensive Development and Experiences in Advancement of Research and Increased Opportunities (IDEARIO). RESULTS/ANTICIPATED RESULTS: Up to date, 4 TS-level 1 and 2 TS-level 2 were offered. Eighty (80) participants completed level 1, distributed: 42 (52.5%) US in RETO, 21 (26.25%) GS and 17 (21.25%) F in MOTOR and 17 participants completed level 2, distributed: 4 (23.52%) US in RETO, 6 (25.29%) GS and 7 (41.17%) F in MOTOR. From which, 15, with 8 CT researchers, formed 5 CTMTs in different research areas – cardio, neuro, liver, renal, Zika–. DISCUSSION/SIGNIFICANCE OF IMPACT: US, GS and F were integrated in the active process throughout educational levels for their development in CTR.
The aim of this investigation was to study castor, canola, and sesame vegetable oils in order to evaluate their potential use as lubricants in steel mechanical components. For this purpose, densities of each oil were evaluated using the pycnometer method, as well as their dynamic viscosities through a Brookfield DV-II rotational viscometer. Both properties were evaluated at temperatures of 25, 40 and 100 °C. Additionally, viscosity indexes were determined according to ASTM D 2270. These rheological properties were used to estimate the lubrication regime considering parameters of real contact conditions in mechanical components. Friction and wear analyses were carried out to investigate the behaviour of the vegetable oil as lubricants. Such tests were carried out at room temperature on a CSM tribometer with pin-on-disk configuration by using castor, canola and sesame oils as lubricants. AISI 4140 hardened steel against AISI 100Cr6 steel pin was used as a mechanical component. From the rheological study, it was observed that canola and sesame oils behave as dilatant fluids at the evaluated temperatures, while castor oil behaves like a Newtonian fluid at 25 and 40 °C. Castor oil showed the highest density value among oils studied, but it also exhibited the lowest value of viscosity index (271). Contrarily, sesame oil was the least dense, but it exhibited the highest viscosity index (545). On the other hand, the lubrication regime study showed that by using castor oil as a lubricant in the mechanical component (4140/100Cr6), the system worked in a mixed lubrication regime while by using canola and sesame oils the system operated in boundary lubrication conditions. Finally, the kinetic friction coefficients were different for each lubricant obtaining the lowest value with castor oil while the highest value of friction coefficient was exhibited by the sesame oil lubricant.
Conclusions and recommendations of health technology assessment (HTA) reports have an impact on all relevant actors involved in the health system (health authorities, administrators, health professionals, patients, citizens and industry). The involvement of all those relevant stakeholders in the HTA process facilitates making valid and informed decisions and an efficient allocation of resources. Improving communication, participation and transparency among all agents will lead to more efficient evaluation and decision-making processes.
To review key aspects of the relations between HTA agencies and health industries, two process were carried out: a narrative review of literature searched in Medline, PubMed, Embase, CINAHL and WOS (2007-2017) and a review of websites of international HTA agencies. References and webs with information on the framework, objectives, methodologies, impact or results of the relationships were included.
A total of 1961 references were located and forty-five were selected. From the synthesis of the selected references the following key aspects of the relationships between HTA and industry were identified: (i) the importance of early dialogues with industry to align HTA objectives with the generation of evidence; (ii) challenges of the bias in the evidence produced by industry; (iii) difficulties in industry engagement in HTA processes; and (iv) industry interest in HTA. The review of six agency websites provided information on industry involvement in strategic activities, early dialogues, provision of documentation, management of industry clarifications, review of the report/allegations and other forms of relationship.
Both the review of the literature and the contents of the web pages of international agencies with experience in relations with industry show that the interest is in the creation of collaborative frameworks between regulatory authorities that decide on authorization and price and reimbursement and HTA agencies, while both try to maintain an early, transparent and systematic interaction with the healthcare industry.
In December 2017, a patient involvement (PI) Interest Group was created in the Spanish Network of Agencies for Assessing National Health System Technologies and Performance (RedETS) Annual conference. It started as a voluntary group of health technology assessment (HTA) methodologists interested in PI. The objective of the Group is to promote and facilitate PI in HTA. With the support of the Spanish Ministry of Health and the RedETS Council the Interest Group grew to at least one member for each of the eight RedETS regional agencies and units. It currently has 22 members. The PI Interest Group works in periodic online meetings and an annual offline meeting to establish a space for experiences exchange and reach consensus on main issues regarding PI.
RedETS published a strategy to facilitate effective and efficient PI in HTA processes in 2017. The long-term objective is to mainstream PI in all RedETS products. This strategy was built on a literature review and a qualitative study with semi-structured interviews. The interviews detected capacity building needs for technicians and methodologist in the network to be able to actively engage patients in HTA reports.
Since the kick-off meeting the PI Interest Group has worked in a number of activities. The main lines of action since its creation were: (i) evaluation of PI process in RedETS HTA reports in 2017 and in current reports, (ii) discussion on main methodological and procedural aspects, and feasibility of different patient participation approaches, (iii) development of technical protocols and templates to facilitate PI, (iv) the creation/adaptation of educational materials for patients and (v) translation of the HTAi Glossary for patients to Spanish.
Peer-to-peer learning processes can foster technical capacity of HTA methodologist in the Spanish HTA Network and may favor the implementation of the PI strategy.
Gluten is only partially digested by intestinal enzymes and can generate peptides that can alter intestinal permeability, facilitating bacterial translocation, thus affecting the immune system. Few studies addressed the role of diet with gluten in the development of colitis. Therefore, we investigate the effects of wheat gluten-containing diet on the evolution of sodium dextran sulphate (DSS)-induced colitis. Mice were fed a standard diet without (colitis group) or with 4·5 % wheat gluten (colitis + gluten) for 15 d and received DSS solution (1·5 %, w/v) instead of water during the last 7 d. Compared with the colitis group, colitis + gluten mice presented a worse clinical score, a larger extension of colonic injury area, and increased mucosal inflammation. Both intestinal permeability and bacterial translocation were increased, propitiating bacteria migration for peripheral organs. The mechanism by which diet with gluten exacerbates colitis appears to be related to changes in protein production and organisation in adhesion junctions and desmosomes. The protein α-E-catenin was especially reduced in mice fed gluten, which compromised the localisation of E-cadherin and β-catenin proteins, weakening the structure of desmosomes. The epithelial damage caused by gluten included shortening of microvilli, a high number of digestive vacuoles, and changes in the endosome/lysosome system. In conclusion, our results show that wheat gluten-containing diet exacerbates the mucosal damage caused by colitis, reducing intestinal barrier function and increasing bacterial translocation. These effects are related to the induction of weakness and disorganisation of adhesion junctions and desmosomes as well as shortening of microvilli and modification of the endocytic vesicle route.
El objetivo de este trabajo es discutir la relevancia de la localidad arqueológica Laguna de los Pampas en el estudio de las ocupaciones humanas del Campo de Dunas del Centro Pampeano (subregión Pampa Húmeda) durante el Holoceno. Un hallazgo relevante lo constituyen tres huevos de ñandú enteros y semienterrados, con perforaciones que sugieren su utilización como contenedor de líquido. Si bien la laguna fue habitada a lo largo del todo el Holoceno, las dataciones radiocarbónicas del sector excavado ubican a las ocupaciones humanas en el Holoceno medio (entre ca. 7000 y 5800 aP). Para este lapso se determinó que la explotación faunística estuvo orientada al consumo del guanaco, pero con un fuerte complemento de otros taxones como ñandú, venado de las Pampas y especies de menor tamaño. Se registró una tecnología ósea estandarizada sobre huesos de guanaco. Las rocas proceden principalmente del sistema serrano de Tandilia, aunque se identifican materias primas de otras áreas como el oeste pampeano. Las similitudes en las estrategias de producción y usos de los instrumentos con otros sitios de la subregión Pampa Húmeda sugieren el empleo de una misma concepción tecnológica a escala regional durante el Holoceno medio y la interacción con grupos cazadores-recolectores que ocupaban los pastizales pampeanos.
The aim of the present study was to evaluate the association between depression and SSRI monotherapy and frailty both baseline and prospectively in older adults.
Prospective cohort study, 12-month follow-up.
Geriatric outpatient clinic in São Paulo, Brazil.
A total of 811 elderly adults aged 60 or older.
Depression was diagnosed as follows: (1) a diagnosis of major depression disorder (MDD) according to DSM-5; or (2) an incomplete diagnosis of MDD, referred to as minor or subsyndromic depression, plus Geriatric Depression Scale 15-itens ≥ 6 points, and social or functional impairment secondary to depressive symptoms and observed by relatives. Frailty evaluation was performed through the FRAIL questionnaire, which is a self-rated scale. Trained investigators blinded to the baseline assessment conducted telephone calls to evaluate frailty after 12-month follow-up. The association between depression and the use of SSRI with frailty was estimated through a generalized estimating equation adjusted for age, gender, total drugs, and number of comorbidities.
Depression with SSRI use was associated with frailty at baseline (OR 2.82, 95% CI = 1.69–4.69) and after 12 months (OR 2.75, 95% CI = 1.84–4.11). Additionally, depression with SSRI monotherapy was also associated with FRAIL subdomains Physical Performance (OR 1.99, 95% CI = 1.29–3.07) and Health Status (OR 4.64, 95% CI = 2.11–10.21). SSRI use, without significant depressive symptoms, was associated with subdomain Health Status (OR 1.52, 95% CI = 1.04–2.23).
It appears that depression with SSRI is associated to frailty, and this association cannot be explained only by antidepressant use.