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 firstname.lastname@example.org
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 late Pleistocene glaciolacustrine record was studied at Fagnano Lake (54°35´S, 67°20´W), central Isla Grande de Tierra del Fuego, southernmost South America. Two profiles from the Río Valdéz outcrop were collected for isotopic, geochemical, sedimentological, and geophysical analyses. The sedimentological characteristics, such as rhythmites, presence of dropstones, absence of fossil record, and scarce presence of organic matter, suggest deposition in an ice-contact lake, possibly dammed by the Fagnano paleoglacier. Organic matter of C3 plant origin suggests certain cold and wet conditions. A chronology of the late Pleistocene outcrop was obtained from five 14C ages resulting in an age-depth model. The time span covered 49.01 cal ka BP to 32.14 cal ka BP. Based on the thickness of the deposit and the calculated average sedimentation rate, the glacial environment could have been present in the study area prior to the last glacial maximum, in agreement with the Inútil-San Sebastián paleoglacier. Both glaciers flowed from the same mountain ice sheet in the Darwin Cordillera, which makes it possible to infer a different behavior of this ice cap from those of the Patagonian Andes, perhaps forced by different atmospheric dynamics and proximity to the wet and cold subantarctic air masses.
To assess infectious and thrombotic complications of peripherally inserted central catheters (PICCs) in adults.
A 5-year prospective cohort study.
Tertiary-care teaching hospital in Seville, Spain.
Adult patients undergoing PICC insertion.
Catheter-associated bloodstream infection (CABSI) including catheter-related bloodstream infection (CRBSI), primary bacteremia (PB), and upper extremity deep vein thrombosis (UEDVT) were recorded. Independent predictors of complications were assessed by multivariate analysis.
In total, 1,142 PICCs were inserted, with 153,191 catheter days (median, 79). Complications included 66 cases of CABSI (5.78%; 0.43‰ catheter days), 38 cases of CRBSI (3.33%; 0.25‰ catheter days), 28 cases of PB (2.45%; 0.18‰ catheter days), and 23 cases of UEDVT (2.01%; 0.15‰ catheter days). The median times to infection were 24, 41, and 60 days for CRBSI, PB, and UEDVT, respectively. Parenteral nutrition (odds ratio [OR], 3.40; 95% confidence interval [CI], 1.77–6.52) and admission to the hematology ward (OR, 4.90; 95% CI, 2.25–10.71) were independently associated with CRBSI and PB, respectively. Admission to the hematology ward (OR, 12.46; 95% CI, 2.49–62.50) or to the oncology ward (OR, 7.89; 95% CI, 1.77–35.16) was independently associated with UEDVT. The crude mortality rate was 24.8%. Only 2 patients died of complications.
PICCs showed a low rate of thrombotic and infectious complications. Compared to PB, CRBSI showed significantly different risk factors, a higher incidence density per catheter days, and a shorter median time to infection. Separate analyses of CRBSI and PB are more specific and clinically useful when analyzing infectious complications.
Microwave radars can be used to monitor the internal structure of the snowpack, delivering real-time and non-destructive measurements. Recently, the working principle of an innovative radar architecture able to identify some of the most important snowpack parameters, without external aids, has been demonstrated. A key point of this new architecture is the use of two independent receiving antennas, and one transmitting antenna. This paper presents a comparison between two different implementations, either based on one physical antenna miming two receiving antennas, or based directly on two physical receiving antennas. The different advantages and disadvantages of both solutions are discussed, highlighting the superior accuracy achieved by the implementation based on two physical receiving antennas. Then, this paper also presents the field results achieved by this type of radar architecture, on the grounds of a 5-day experimental campaign that took place in winter 2019 in the Italian Alps on dry snow. The comparison between the radar measurements and the ground truth (manual snowpit analysis, in terms of snowpack depth, dielectric constant, bulk density, and snow water equivalent) is provided. Overall, a root mean square error of around 3.5 cm, 0.05, 27 kg/m3, and 2.5 cm is achieved, respectively.
The irrelevance of ideology is perhaps one of the most strongly held views shared by the historians of the Late Republic. As indicated by Matthias Gelzer in 1912, in those final years of the Roman Republic, ‘political struggles were fought out by the nobiles at the head of their dependents’. In his opinion, this was nothing more than a power struggle, in which slogans or ideas were merely propaganda, without any real value. In 1931, analysing the political proposals of Cicero, Gelzer's disciple Hermann Strasburger rejected the existence of political parties, as, in his opinion, terms such as optimates or populares were merely propagandistic mottos and pure wordplay. As a result, it became widely believed that the civil war between Caesar and Pompey was nothing more than a struggle between dignitates, that is, a confrontation for leadership between ambitious politicians who were not prepared to compromise. More recently, in 1994, Luigi Loreto considered the conflict between Caesar and Pompey to be aimed at seizing power, unlike ‘ideological’ wars, where the aim was to maintain or instate a specific type of social or political order.
Parkinson's disease and Alzheimer's disease are progressive nervous system disorders that affect physical and cognitive capacities of individuals, including memory loss, motion impairment, or problem-solving dysfunctions. Leisure activities are associated with reducing the risk of dementia and are preventive policies for delaying the cognitive impairment in later stages of those neurodegenerative diseases. Electronic games related to cognitive abilities are an easy and inexpensive alternative for stimulating brain activity in this kind of patients. The previous research demonstrated the acceptance of these activities in the environment of Connected TV when playing at home and in daily care centers. Interaction in Connected TV applications has its own particularities that influence the design of the interface, including the viewing distance, the type of interaction through a remote control or other techniques, the size of the screen, or the collectiveness of consumption. Iterative testing with patients of these groups revealed how the physical characteristics and cognitive impairment of these concrete end-users affect the human–computer interaction, offering guidelines and recommendations in good practices for the Smart TV interface design. On the other hand, data analytics extracted from the interaction and evolution of the game offer important information enabling the creation of estimation prediction models about the cognitive state of the patient.
Conventional tests with written information used for the evaluation of sign language (SL) comprehension introduce distortions due to the translation process. This fact affects the results and conclusions drawn and, for that reason, it is necessary to design and implement the same language interpreter-independent evaluation tools. Novel web technologies facilitate the design of web interfaces that support online, multiple-choice questionnaires, while exploiting the storage of tracking data as a source of information about user interaction. This paper proposes an online, multiple-choice sign language questionnaire based on an intuitive methodology. It helps users to complete tests and automatically generates accurate, statistical results using the information and data obtained in the process. The proposed system presents SL videos and enables user interaction, fulfilling the requirements that SL interpretation is not able to cover. The questionnaire feeds a remote database with the user answers and powers the automatic creation of data for analytics. Several metrics, including time elapsed, are used to assess the usability of the SL questionnaire, defining the goals of the predictive models. These predictions are based on machine learning models, with the demographic data of the user as features for estimating the usability of the system. This questionnaire reduces costs and time in terms of interpreter dedication, as well as widening the amount of data collected while employing user native language. The validity of this tool was demonstrated in two different use cases.
Universal access on equal terms to audiovisual content is a key point for the full inclusion of people with disabilities in activities of daily life. As a real challenge for the current Information Society, it has been detected but not achieved in an efficient way, due to the fact that current access solutions are mainly based in the traditional television standard and other not automated high-cost solutions. The arrival of new technologies within the hybrid television environment together with the application of different artificial intelligence techniques over the content will assure the deployment of innovative solutions for enhancing the user experience for all. In this paper, a set of different tools for image enhancement based on the combination between deep learning and computer vision algorithms will be presented. These tools will provide automatic descriptive information of the media content based on face detection for magnification and character identification. The fusion of this information will be finally used to provide a customizable description of the visual information with the aim of improving the accessibility level of the content, allowing an efficient and reduced cost solution for all.
Positive symptoms are a useful predictor of aggression in schizophrenia. Although a similar pattern of abnormal brain structures related to both positive symptoms and aggression has been reported, this observation has not yet been confirmed in a single sample.
To study the association between positive symptoms and aggression in schizophrenia on a neurobiological level, a prospective meta-analytic approach was employed to analyze harmonized structural neuroimaging data from 10 research centers worldwide. We analyzed brain MRI scans from 902 individuals with a primary diagnosis of schizophrenia and 952 healthy controls.
The result identified a widespread cortical thickness reduction in schizophrenia compared to their controls. Two separate meta-regression analyses revealed that a common pattern of reduced cortical gray matter thickness within the left lateral temporal lobe and right midcingulate cortex was significantly associated with both positive symptoms and aggression.
These findings suggested that positive symptoms such as formal thought disorder and auditory misperception, combined with cognitive impairments reflecting difficulties in deploying an adaptive control toward perceived threats, could escalate the likelihood of aggression in schizophrenia.
The Egyptian Vulture Neophron percnopterus was once an abundant species in the Cabo Verde Islands. Since the 1960s though, and especially during the 1980–1990s, it consistently declined to near extinction. Evidence collected indicates a remnant population of about a dozen pairs or less, scattered through the desert rangelands of only three islands. Extensive enquiry work revealed that this likely resulted from the concomitant effects of the rise in unnatural mortality due to the formerly widespread and long-lasting use of dangerous pesticides and the (still on-going) poisoning of stray dogs and other nuisance animals, and a decrease in food resources associated with factors linked with development, such as urbanisation, rural abandonment and better sanitation. Avoiding imminent extinction calls for emergency action against current threats to the remaining vultures, such as poisoning and electrocution, but also potential causes of impaired fecundity such as hazardous pesticides and shortage of food resources.
Healthcare professionals who work in palliative care units face stressful life events on a daily basis, most notably death. For this reason, these professionals must be equipped with the necessary protective resources to help them cope with professional and personal burnout. Despite the well-recognized importance of the construct “meaning of work,” the role of this construct and its relationship with other variables is not well-understood. Our objective is to develop and evaluate a model that examines the mediating role of the meaning of work in a multidisciplinary group of palliative care professionals. Using this model, we sought to assess the relationships between meaning of work, perceived stress, personal protective factors (optimism, self-esteem, life satisfaction, personal growth, subjective vitality), and sociodemographic variables.
Professionals (n = 189) from a wide range of disciplines (physicians, psychologists, nurses, social workers, nursing assistants, physical therapists, and chaplains) working in palliative care units at hospitals in Madrid and the Balearic Islands were recruited. Sociodemographic variables were collected and recorded. The following questionnaires were administered: Meaning of Work Questionnaire, Perceived Stress Questionnaire, Life Orientation Test-Revised, Satisfaction with Life Scale, Subjective Vitality Scale, Rosenberg Self-Esteem Scale, and the Personal Growth Scale.
The explanatory value of the model was high, explaining 49.5% of the variance of life satisfaction, 43% of subjective vitality, and 36% of personal growth. The main findings of this study were as follow: (1) meaning of work and perceived stress were negatively correlated; (2) optimism and self-esteem mediated the effect of stress on the meaning attached to work among palliative care professionals; (3) the meaning of work mediated the effect of stress on subjective vitality, personal growth, and life satisfaction; and (4) vitality and personal growth directly influenced life satisfaction.
Significance of results
The proposed model showed a high explanatory value for the meaning professionals give to their work and also for perceived stress, personal protective factors, and sociodemographic variables. Our findings could have highly relevant practical implications for designing programs to promote the psychological well-being of healthcare professionals.
Earlier activities on health technology assessment (HTA) started in Spain around 1984, with the creation of a National Advisory Board on HTA, and the development of national and regional HTA organizations in the early 1990s. In 2012, the Spanish Health Ministry established the Spanish Network for Health Technology Assessment of the National Health System (RedETS); funded at national level and including all public HTA organizations at national and regional levels. RedETSis focused on the assessment of nondrug health technologies to inform the revision (approval and funding or disinvestment) of the Benefit Portfolio of the Spanish NHS. In parallel with European Network for Health Technology Assessment (EUnetHTA), RedETS has been setting-up and sharing common procedures and methodological guidelines to ensure effective cooperation and mutual recognition of the scientific and technical production in HTA. The output of RedETS is fifty to sixty annual reports, including the production of full HTA reports, Clinical Practice Guidelines, methodological guidance reports, relative effectiveness assessments, tools to support shared decision making between patients and healthcare professionals, and monitoring studies. The HTA assessments requested by the Regional Health Authorities are the biggest component of the annual RedETS working plan. These assessment needs are identified according to a yearly process and prioritized by a Commission composed of representatives from all Spanish regions with the aid of the PRITEC tool. The objectives of this study are to report and update the normative and organizational state of HTA in Spain; describing noteworthy advances witnessed over the past 10 years, as well as discussing existing challenges.
To assess the daily intake of polychlorinated biphenyls not similar to dioxins (NDL-PCB) derived from fish consumption in Spain and compare it with tolerance limits in order to establish a safe threshold so that the nutritional benefits derived from fish consumption may be optimized.
Analysis of NDL-PCB in fish samples and ecological study of the estimated intake of NDL-PCB from fish consumption in different Spanish population groups.
National representative sample of the Spanish population.
The intake of NDL-PCB was estimated in two different scenarios: upper bound (UB) and lower bound (LB). Estimating intake using the average concentration of NDL-PCB found in the fish samples, the intake for ‘other children’ is estimated as: 1·80 (UB) and 5·33 (LB) ng/kg per d at the 50th percentile (P50); 7·39 (UB) and 21·94 (LB) ng/kg per d at the 95th percentile (P95) of fish consumption. Estimated NDL-PCB intake shoots up in the toddler group, reaching values of 30·43 (UB) and 90·37 (LB) ng/kg per d at P95. Estimated intake values are lower than those previously estimated in Europe, something expected since in previous studies intake was estimated through total diet. In adults, our estimated values are 1·59 (UB) and 4·72 (LB) ng/kg per d at P50; 4·95 (UB) and 14·72 (LB) ng/kg per d at P95.
NDL-PCB concentration in fish is under the tolerance limits in most samples. However, daily intake in consumers of large quantities of fish should be monitored and special attention should be given to the youngest age groups due to their special vulnerability and higher exposure.
Masked revelry, the quaffing of large amounts of wine and the sound of flutes … this cavalcade would pass through the streets of Rome every 13th June, even crossing the forum itself. As we will show later on, a connection can be established between this celebration (the Quinquatrus minusculae) and the statue of Marsyas, the acolyte of Dionysus, which stood in the forum and was associated with freedom, wine and charivari. In turn, this connection will open the way for a new interpretation of the multiple meanings of the feast and the satyr in the highly charged political atmosphere of Late Republican Rome. The main aim of this study will be to show, in the third part of this article, how populares politicians tried to exploit the opportunities presented to them by religious festivities and ludi to draw more of the public into their contiones or to obtain a favourable verdict in a political trial.
The rapid spread of glyphosate-resistant sourgrass populations generates concern in the agricultural production sector in Brazil. Nonetheless, there is not much information related to the frequency and dispersion of sourgrass throughout recent years. We investigated the frequency and dispersion of glyphosate-resistant sourgrass populations in Brazilian agricultural regions as part of a larger-scale weed resistance monitoring study. A discriminatory rate of 960 g ae ha−1 of glyphosate was used on plants at the 2- to 3-tiller stage, originating from 2,593 populations of sourgrass sampled in 329 counties in 14 Brazilian states between 2012 and 2015. The dispersion of sourgrass populations originated in western Paraná State, next to the Paraguay border, where the first resistance case was reported. Its dispersion to the central region of Brazil, mainly in soybean-producing areas, is most likely a consequence of agricultural equipment movement and wind-mediated dispersal. Glyphosate-resistant sourgrass populations were found in every geographical region across all Brazilian states tested. These data highlight the importance of an appropriate weed resistance monitoring program to track the evolution and dispersion of resistance to mitigate these issues by focusing efforts regionally and raising awareness among stakeholders in each region.
The Spanish National Network (REDETS) is a group of eight agencies, units and services, depending on National and Regional Governments that coordinate their work within a common methodological framework, guided by the principles of mutual recognition and cooperation. The necessity of considering a Quality Management System has been detected and, consequently, a common tool for all the members needs to be developed. We describe in this study the process to achieve that goal.
Based on both a review of previous literature and the proposal for a self-evaluating tool, a group of experts from each agency through consensus have developed a tool for self-evaluation in Health Technology Assessment (HTA) agencies. Through the structure described in the handbook of the Andalusian Agency for Healthcare Quality (ACSA), each standard should have a statement or proposal that needs to also include evidence or good practices, and the corresponding evaluation questions. In separate workgroups, the definition of these proposals, evidence and evaluation questions were developed. One face-to-face meeting and two meetings via teleconference were necessary to achieve a final document with all the quality standards.
From a proposed structure of sixty-six standards, the titles, definitions, statements and evidence as well as good practices and evaluation questions were established in workgroups with consensus among all of the members (1 - 3). The final version of the self-assessment tool was composed of sixty-eight standards, grouped in twelve quality criteria structured in four dimensions: I Responsibility, II Clients and Stakeholders, III Production Process, and IV Resources.
Quality management requires an evaluation tool and this version, based on a systematic review and consensus, is a useful and practical instrument for developing a handbook by each member of REDETS. An online version of the tool is in process of development.
This study examines the associations between subjective memory complaints (SMC) and health variables: multimorbidity, presence of certain diseases, health perceived state, difficulties seeing and hearing, pain, and use of medications and health services. Furthermore, we aim to identify risk groups based on multimorbidity and calculate the effect size for each of these relationships.
Cross-sectional epidemiological study using a face-to-face interview with a structured questionnaire. Sample size: 1,342 people aged 65 years and older taken from a random sample of the census tracts. SMC were studied using questions regarding memory complaints.
Multimorbidity and polypharmacy are associated with SMC, so are impaired vision and hearing. SMC are more frequently present in people who use health services more intensively and exhibit reduced functional activity as a result of diseases. With respect to specific diseases, only cerebrovascular accidents and chronic constipation were associated with SMC. In regression analysis, predictors of SMC were vision and hearing impairment, poor self-perceived health, pain, and general practitioner visits. However, the effect size of these factors is low. The variables that indicate risk groups are number of diseases, reduced functional activity, hearing impairment, and poor self-perceived health.
Memory complaints are a heterogeneous phenomenon. Our results confirm that multimorbidity, polypharmacy, greater use of health services, pain, and poor self-perceived health are associated with SMC. We identified two risk groups with a high percentage of complaints and a healthy group with a low percentage. Detecting these factors and these risk and healthy groups is useful in achieving proper patients management.
Chronic obstructive pulmonary disease (COPD) is one of the most important and prevalent diseases suffered by the elderly. Evidence exists that its onset and severity might be conditioned by antioxidant status. The aim of the present study was to investigate the relationship between antioxidant status and COPD in institutionalised elderly people. In all, 183 elderly people aged >65 years (twenty-one had COPD and 160 healthy controls) were studied. The subjects’ diets were investigated via the use of precise individual weighing for 7 d. Body weight, height, and biceps and triceps skinfold thickness were measured, and body fat (kg) and BMI (kg/m2) were calculated. Serum retinol, α-tocopherol, β-carotene and vitamin C levels were determined. Subjects with COPD ate less fruits than healthy controls (117 (sd 52) v. 192 (sd 161) g/d), their coverage of the recommended intake of vitamin C was smaller (150 (sd 45) v. 191 (sd 88) %; note that both exceeded 100 %) and their diets had a lower antioxidant capacity (6558 (sd 2381) v. 9328 (sd 5367) mmol trolox equivalent/d). Those with COPD had lower serum vitamin C and α-tocopherol concentrations than healthy controls (32·4 (sd 15·3) v. 41·5 (sd 14·8) µmol/l and 12·1 (sd 3·2) v. 13·9 (sd 2·8) µmol/l, respectively). In addition, subjects with α-tocopherol <14·1µmol/l (50th percentile) were at 6·43 times greater risk of having COPD than those subjects with ≥14·1µmol/l (OR 6·43; 95 % CI 1·17, 35·24; P<0·05), taking sex, age, use of tobacco, body fat and vitamin E intake as covariables. Subjects with COPD had diets of poorer antioxidant quality, especially with respect to vitamins C and E, compared with healthy controls.
In species that aggregate for reproduction, the social and fitness costs of movement between groups frequently lead to restricted exchange between breeding areas. We report on four individual humpback whales identified in both the Cape Verde Islands and Guadeloupe; locations separated by an ocean basin and >4000 km. This rate of exchange is rarely encountered between such geographically discrete breeding areas. Two individuals returned to the area where they were originally identified. In contrast, no individuals from the Cape Verde Islands were resighted to the much larger sample from the Dominican Republic, though the migratory distances from the feeding areas are comparable between these areas. The social factors driving the stark difference between groups that is observed here are not clear. Effective conservation requires an understanding of the extent and pattern of movement between population units. The findings presented here suggest that there may well be more than one behaviourally distinct group within the West Indies. More broadly, they argue that considerable caution is warranted in assumptions made regarding the number, boundaries and status of population units based solely on spatial separation or proximity.
Anthropometric reference data for older adults, particularly for the oldest old, are still limited, especially in developing countries. The aim of the present study was to describe sex- and age-specific distributions of anthropometric measurements and body composition in Mexican older adults. The methods included in the present study were assessment of height, weight, BMI, calf circumference (CC), waist circumference (WC) and hip circumference (HC) as well as knee height in a sample of 8883 Mexican adults aged 60 years and above and the estimation of sex- and age-specific differences in these measures. Results of the study (n 7865, 54 % women) showed that men are taller, have higher BMI, and larger WC than women, whereas women presented higher prevalence of obesity and adiposity. Overall prevalence of underweight was 2·3 % in men and 4·0 % in women, with increasing prevalence with advancing age. Significant differences were found by age group for weight, height, WC, HC, CC, BMI and knee height (P<0·001), but no significant differences in waist–hip circumference were observed. Significant differences between men and women were found in height, weight, circumferences, BMI and knee height (P<0·001). These results, which are consistent with studies of older adults in other countries, can be used for comparison with other Mexican samples including populations living in the USA and other countries with similar developmental and socio-economic conditions. This information can also be used as reference in clinical settings as a tool for detection of individuals at risk of either underweight or overweight and obesity.