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Major depressive disorder (MDD) is common in patients diagnosed with advanced cancer (AC), with a prevalence of 16.5%. It is associated with great disability and worsened quality of life, increased number and intensity of physical symptoms, and lower survival. It is the main factor for the presence of suicidal ideation. Antidepressants show modest efficacy, and response requires several weeks. Ketamine has demonstrated a fast and robust antidepressant effect in subanesthetic doses. This effect may prove useful in patients with AC, MDD, and suicidal risk.
We report a case of a patient with advanced cervical cancer who presented with uncontrollable pain, MDD, and a suicide attempt.
A 39-year-old woman diagnosed with cervical cancer stage IVB presented to the Emergency Department after a suicide attempt by hanging. Upon evaluation by the palliative care psychiatrist, she reported intense pain, unresponsive to analgesics, and had a history of persistent suicidal ideation. Antidepressant treatment was started (sertraline 50mg/d) after a single dose of ketamine hydrochloride IV (0.5 mg/kg) was administered. Treatment response was measured using the Brief Edinburgh Depression Scale before and after the intervention. The depressive symptoms decreased by 17% on day 1, 39% on day 3, and 72% on day 17.
Significance of results
This case report shows ketamine's efficacy as an augmentation agent alongside conventional antidepressant treatment in patients with AC. Moreover, it shows rapid response in suicidal ideation that has not been achieved with treatment as usual. More clinical trials are needed to support the potential benefit and safety of ketamine in patients with AC, MDD, and persisting suicidal ideation.
Understanding the critical time of weed removal (CTWR) is necessary for designing effective weed management programs in popcorn production that do not result in yield reduction. The objective of this study was to determine the CTWR in popcorn with and without a premix of atrazine and S-metolachlor applied PRE. Field experiments were conducted at the University of Nebraska–Lincoln, South Central Agricultural Laboratory near Clay Center, NE in 2017 and 2018. The experiment was laid out in a split-plot design with PRE herbicide as the main plot and weed removal timing as the subplot. Main plots included no herbicide or atrazine/S-metolachlor applied PRE. Subplot treatments included a weed-free control, a non-treated control, and weed removal timing at V3, V6, V9, V15, and R1 popcorn growth stages and then kept weed free throughout the season. A four-parameter log-logistic function was fitted to percentage popcorn yield loss and growing degree days separately to each main plot. The number of growing degree days, when 5% yield loss was achieved, was extracted from the model and compared between main plots. The CTWR was from the V4 to V5 popcorn growth stage in absence of PRE herbicide. With atrazine/S-metolachlor applied PRE, the CTWR was delayed until V10 to V15. It is concluded that, to avoid yield loss, weeds must be controlled before the V4 popcorn growth stage when no PRE herbicide is applied, and PRE herbicide, such as atrazine/S-metolachlor in this study, can delay the CTWR until the V10 growth stage.
Depression in palliative advanced cancer patients is common, but often goes unrecognized. One of the first steps toward improving detection is the development of tools that are valid in the specific language and setting in which they are to be used. The Brief Edinburgh Depression Scale (BEDS) is a sensitive case-finding tool for depression in advanced cancer patients that was developed in the United Kingdom. There are no validated instruments to identify depression in Mexican palliative patients. Our aim was to validate the Spanish-language version of the BEDS in Mexican population with advanced cancer.
We conducted a cross-sectional study with outpatients from the palliative care unit at the Instituto Nacional de Cancerología in Mexico City. The Mexican BEDS was validated against a semistructured psychiatric clinical interview according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, classification criteria for major depressive disorder. The interviewer was blind to the BEDS score at the time of the assessment.
Seventy subjects completed the scale and interview. Women represented 71.4% of the sample and median age of subjects was 56.5 years (range, 20–85 years). The prevalence of major depressive disorder according to the psychiatric interview was 20%. The most valid cutoff for defining a case of depression was a score ≥5 of 18 on the Mexican BEDS, which gave a sensitivity of 85.7% and specificity of 62.5%. The scale's Cronbach's alpha was 0.71.
Significance of results
Major depressive disorder is frequent in Mexican palliative patients. The Spanish-language Mexican version of the BEDS is the first valid case-finding tool in advanced cancer patients in this setting.
In this paper, we connect ideas of the astrobiological and ecological schools to quantify habitability. We show how habitability indexes, devised using the astrobiologically inspired Quantitative Habitability Theory (QHT), can be embedded into ecological models of trophic levels. In particular, we address the problem of spatial-temporal scales. It turns out that the versatility of QHT allows to treat spatial and temporal scales typical of ecological studies. As a habitability index, we propose a new version of our Aquatic Primary Habitability, devised by some of us and formerly applied to saltwater ecosystems (both ocean and coastal) and now applied to freshwater. Although the aim of the paper is to outline the methodology rather than realism, initial steps for parameterization are considered for lakes of South-Central Chile.
This article outlines the development of an appropriate research approach, including methods from diverse disciplines, for researching the Colombian state-funded social music programme Music for Reconciliation (Música para la Reconciliación). After outlining the Colombian context and the literature, a pilot with ten participants is discussed. Findings show the contributions of sound postcards as part of life histories for capturing the experiences of displaced people in a country recovering from war. Their evocative capacity enriched the interviewees’ narrative, illustrating diverse sonorous landscapes throughout their lives that evidenced the changes generated by both the violence and programme participation. The conclusions offer suggestions for readers based in the arts, health, social sciences and beyond, interested in the uses of music and music education for other-than-musical purposes.
To determine the effects of lipid-based nutrient supplements (LNS) on children’s Hb, linear growth and development, compared with supplementation with micronutrient powder (MNP).
The study was a two-arm parallel-group randomized controlled trial, where participants received either LNS or MNP for daily consumption during 6 months. Supplements were delivered by staff at government-run health centres. Hb, anthropometric, motor development, language development and problem-solving indicators were measured by trained research assistants when children were 12 months of age.
The study was conducted in five rural districts in the Province of Ambo in the Department of Huánuco, Peru.
We enrolled 6-month-old children (n 422) at nineteen health centres.
Children who received LNS had a higher mean Hb concentration and lower odds of anaemia than those who received MNP. No significant differences in height-for-age, weight-for-height or weight-for-age Z-score, or stunting and underweight prevalence, were observed. Provision of LNS was associated with a higher pre-verbal language (gestures) score, but such effect lost significance after adjustment for covariates. Children in the LNS group had higher problem-solving task scores and increased odds of achieving this cognitive task than children in the MNP group. No significant differences were observed on receptive language or gross motor development.
LNS between 6 and 12 months of age increased Hb concentration, reduced anaemia and improved cognitive development in children, but showed no effects on anthropometric indicators, motor or language development.
Water-stable CdSTe quantum dots were synthesized under microwave irradiation heating conditions. An aqueous telluride solution (produced by reducing metallic Te with NaBH4), cadmium sulphate and thioglycolic acid were mixed together in an oxygen-free atmosphere to prevent oxidation of the telluride species. The reaction temperature varied from 60° C to 180° C and was controlled by using a microwave reactor (1,000 W) to control nucleation rate and tune the size of the quantum dots. Photoluminescence analyses of resulting quantum dots evidenced a red shift (from 490 nm to 640 nm, using an excitation wavelength of 380 nm) when the reaction temperature was increased, which suggested crystal growth. The variation in size was also evidenced by the color of the quantum dot suspensions that changed from blue to red, when excited with a 405 nm, 5mW diode laser. The highest quantum yield was observed for quantum dots synthesized from 120° to 150° C. X-ray diffraction analyses suggested the formation of a solid solution of CdSTe with average crystallite size ranging from 1.4 nm to 3.2 nm. FT-IR spectroscopy evidenced the presence of residual thioglycolic functional groups onto the crystals surface, whereas HRTEM confirmed the nanometric size of the quantum dots.
The United States' support for the Franco dictatorship, along with British dominion over Gibraltar, caused an increasing sense of frustration towards the United States and United Kingdom amongst broad sectors of the Spanish public during the 1960s and 1970s. Growing resentment towards the Anglo-American presence in Spain threatened to jeopardise the geopolitical objectives of these two governments given the strategic importance of the Iberian Peninsula in the Cold War. Both the Americans and the British identified the promotion of the English language as a cultural tool to develop empathy amongst those Spaniards who would drive forward the eventual transition to a post-Franco era. This ‘soft power’ strategy fit perfectly with the pro-modernisation efforts taking place in several parts of the world. English teaching did not serve as a magic potion, however. Cultural seduction was not a cure-all to right the wrongs inflicted by the Anglo-American geostrategic priorities. This article explores the benefits and limitations of English language promotion in Franco's Spain and reflects on the ability of ‘soft power’ to influence what was a rather hostile hard-power context.
The size-dependent optical properties of CdSe nanoparticles are desirable in bio-imaging and cell sorting applications because of their tunable photoluminescence in the visible range. Previous studies have already suggested that CdSe QDs could be utilized for pathogen detection by using suitable capping agents to make it biocompatible; however, systematic works on the effect of crystallite size and composition of the nanocrystals are scarce. The present research will be focused on the effect of CdSe crystal size and composition (pure and doped systems) to systematically evaluate its applicability in detecting pathogens, like Escherichia coli (E. coli). Highly luminescent water-soluble CdSe QDs were firstly synthesized in the aqueous phase, in the presence of thioglycolic acid (TGA) as a capping agent. CdSe/TGA molar ratios, reaction temperature, time, and pH were evaluated in order to optimizer the QDs optical properties. X-Ray diffraction (XRD) measurements confirmed the formation of CdSe exhibiting hexagonal structure with an estimated averaged crystallite size in the 4-6 nm range. Transmission electron microscopy (TEM) analyses evidenced the formation of CdSe nanocrystals with particle sizes between 3-5 nm. UV-Vis measurements showed a strong exciton peak between 390-400 nm with an estimated band gap of 2.64 eV (bulk: 1.74 eV); additionally, a strong fluorescence peak was observed between 500-550 nm using an excitation wavelength of 400 nm. Fourier Transform Infrared Spectroscopy (FT-IR) analyses suggested the actual functionalization of the CdSe surface with TGA functional groups. Preliminary results of the CdSe/TGA coupling with the selected bacteria, E. coli, are presented and discussed.
Medical research has demonstrated the importance of the utilization of stable, fluorescent nanoprobes. The present work addresses the applicability of biocompatible and fluorescent ZnO nanoparticles as probes for detection of pathogens with the aim of achieving extremely low detection limits. For this purpose, ZnO surface must be functionalized for its subsequent interaction with bacterial cellular membrane (coupling), which will allow the corresponding detection and quantification. Herein we will discuss the aqueous synthesis of stable, water soluble and biologically compatible ZnO nanoparticles (NPss) capped with L-glutathione (GSH). The understanding of the interactions between GSH molecules and surface atoms in ZnO QDs became critical to foster the applicability of this nanomaterial in the biomedical and bioengineering fields. In this regard, the GSH/ZnO molar ratios, reaction temperature (40°C and 60°C), time and pH (6-9) became crucial factors to attain suitable tuning of the QDs properties. ZnO/GSH synthesized QDs were characterized by Transmission Electron Microscopy, X-Ray Diffraction, FT-IR, UV-Vis and photoluminescence (PL) spectroscopy. The QDs shape was spherical with a particle size between 80-100nm. The synthesis of ZnO/GSH under different experimental conditions and the corresponding coupling with E. Coli species, are presented and discussed.
The Evolution of the Financial System: Quantitative and Qualitative Issues
In the previous chapters we have moved from a broad sketch of the developments of the 2008 global economic and financial crisis to the policymaking responses to that challenge. But we have done so through its theoretical scaffolding, starting with the anthropological structure of the competing economic schools of thought, passing through the common logical structure of economic theories, and the framework of modern contemporary mainstream macroeconomic modelling. Rather than making a case against both conventional and unconventional economic wisdom, we have been looking for solutions by broadening the scope of the regular praxis. Most of these reflections could have been made with no reference at all to the 2008 developments. Nevertheless, the social costs assumed by people almost everywhere in the world, forces a serious self-examination about the reliability of our present-day macroeconomic research. From the very beginning, our view has been critical but quite inclusive as well. Rather than eschewing all previous work as useless, we take it as a valuable starting point. As we saw in Chapter 3, the logical structure of economic theory, the meta-theory, can provide us with a general framework for improving our modelling as well as a benchmark to test the successes and failures of a specific research programme. The analysis of RBC theory carried out in Chapter 4 shows that its theoretical structure did not allow a proper understating of the financial processes that brought about the crisis.
What has been said in previous chapters about economic theory and modelling could have been just an idle mental exercise if the 2008 financial crisis had never happened. But it did, and it happened in such a way that we were shocked for months, uncertain about what was actually occurring. In this chapter we are going to review what the policymakers did during that time from the point of view of economic theory and modelling. In previous chapters we have looked at what we really know about economic processes. Now we are going to compare this with what policymakers did during that time, and examine which of these models and theories will survive the ‘stress test’ of the Great Recession. Of course this will not be a complete account of the entire sequence of events starting in 2007. Rather, it is simply a brief journey through a select number of policymaking decisions which marked a salient departure from the ‘rules of the game’. It will not be a thorough historical examination of what was done in that time.
Economic Policies during the Crisis
During the months before and after the fall of Lehman Brothers, policymakers worldwide had to face the political challenges of the most unexpected of all of the economic and financial crises up to that point. We have shown (see Chapter 1) that no economic theory or model was able to predict the Great Recession, with the exception of some insightful authors.
Modelling Agent's Economic Behaviour: The Choices that Theorists Face
In the previous chapter, we have seen that all economic theories or models rely upon a specific anthropology, that is, upon some more or less explicit ideas of human beings as economic agents. There we classified theories and models under three large headings, neoclassical, Keynesian and Austrian. Setting aside historical issues, this classification was made taking into account the kind of ‘statements’ about the economic agent and the environment they create. We saw that there are specific statements that made a model ‘Keynesian’ and not ‘neoclassical’, and vice versa. It is also true that ‘mixed’ or ‘hybrid’ models can be found, but ultimately they rely upon a critical statement or assumption which allows classifying them into one of these broad categories. This classification is useful in itself as we can arrange the literally thousands of models and theories according to their underlying assumption. But this will be of limited interest if it does not help to improve our understanding of economic processes.
The question here is whether a systematic research on the structure of models and theories is possible to make them more reliable and closer to reality. Or, more precisely, if it is possible to appreciate the differences and commonalities of economic theories from a point of view that includes all of them simultaneously.
Widening the Focus: Economic Theory and Philosophy
As with any other scientific branch, the content of economics is not only the corpus of actual economic theories. To a certain extent, economics also includes every single word written about economic issues in the past. All this knowledge is available to us now but it does not mean that it is competing today to explain the economic phenomena. Part of it is obsolete and we study it only for historical reasons. Today, when we talk about contending theories in economics it is necessary to first establish the ones that are more relevant and that deserve to be taken into account.
A suitable criterion of demarcation is provided by history. At the end of the classical period, the three major economic traditions of our times, the neoclassical, Austrian and Keynesian, developed over a sixty-year period. For this reason, we will not treat economic theories of the classical age (even if they are still active, as in the case of neo-Marxists theories).
There is another important reason. We are especially interested in focusing on cooperation among theories, more than in stressing their mutually exclusive characteristics. However, we face some difficulties which arise from two aspects. On the one hand, neoclassicals, Keynesians and Austrians are rooted in different philosophical and epistemological bases. As a consequence, they apply different methodologies in their model building.
Science is a self-correcting endeavour. Our hypotheses and results are tentative statements that have to be checked and revised as new evidence arises. Once we notice a sizeable gap between theory and reality, we must assume that some changes have to be made in the structure of the theory. In some cases the changes affect only auxiliary, non-critical assumptions, and we can still rely on that theory as a source of knowledge. Sometimes, core, critical assumptions have to be changed or even removed from the logical structure of the theory and, and such, the whole research programme has to be reshaped. Researchers can adopt a true progressive attitude toward change or can be reluctant until new, stronger evidence arises.
Nevertheless, this ideal picture of scientific progress has hardly anything to do with reality, at least in economics. Researchers support long established competing programmes which stand simply because there are ideological and/or political biases that sustain them. We have seen in Chapters 2 and 3 that neoclassicals, Keynesians and Austrians have long been struggling for the survival of their research programmes in spite of the growing empirical evidence that neglects some of their critical hypotheses as well as their main results. New and alternative research programmes have arisen in the last decades, although there is very little contact between these programmes, and also between them and the mainstream programmes. Thomas Kuhn was absolutely right when he spoke about the sociological, idiosyncratic character of the scientific enterprise.
One of the most salient features of the current crisis is that there were no warning signs. We had been living through a long period of growth in the majority of developed countries. During the last twenty years economic crises seemed to affect only developing countries. Those who lived in North America and Europe believed that they were immune to crisis. Only Japan had suffered a long period of stagnation and lost its position as a leader among developed countries. At the beginning of the 1990s Japan was the world's second biggest economy and it rivalled the US GDP, but ten years later this challenge had vanished.
The dotcom crisis was temporary because it mainly focused on some technological companies and it affected only these companies. The crisis drove the stock market to a peak followed by a sudden stop and fall. Many investors lost their money, but the overall economy did not suffer a downturn. Unemployment increases only affected workers in the tech companies.
The creation of the euro was a success even though some experts warned that the Eurozone was not an optimal currency area. For many years the euro was beneficial for all its members: some countries could borrow at a very low interest rate while others increased their exports considerably. This success attracted other European countries to join this promising project.
At the same time China was growing considerably and world trade was Increasing.