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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.
Phytoliths can be an important source of information related to environmental and climatic change, as well as to ancient plant use by humans, particularly within the disciplines of paleoecology and archaeology. Currently, phytolith identification and categorization is performed manually by researchers, a time-consuming task liable to misclassifications. The automated classification of phytoliths would allow the standardization of identification processes, avoiding possible biases related to the classification capability of researchers. This paper presents a comparative analysis of six classification methods, using digitized microscopic images to examine the efficacy of different quantitative approaches for characterizing phytoliths. A comprehensive experiment performed on images of 429 phytoliths demonstrated that the automatic phytolith classification is a promising area of research that will help researchers to invest time more efficiently and improve their recognition accuracy rate.
To investigate if depression risk modifies the association between frailty and mortality in older adults.
Ongoing cohort study.
Albacete city, Spain
Eight hundred subjects, 58.8% women, over 70 years of age from the Frailty and Dependence in Albacete (FRADEA) study.
Frailty phenotype, Geriatric Depression Scale (GDS), comorbidity, disability, and drug use were collected at baseline. Six groups were categorized: (G1: non-frail/no depression risk; G2: non-frail/depression risk; G3: prefrail/no depression risk; G4: prefrail/depression risk; G5: frail/no depression risk; and G6: frail/depression risk). Mean follow-up was 2542 days (SD 1006). GDS was also analyzed as a continuous variable. The association between frailty and depression risk with 10-year mortality was analyzed.
Mean age was 78.5 years. Non-frail was 24.5%, prefrail 56.3%, frail 19.3%, and 33.5% at depression risk. Mean GDS score was 3.7 (SD 3.2), increasing with the number of frailty criteria (p < 0.001). Ten-year mortality rate was 44.9%. Mortality was 21.4% for the non-frail, 45.6% for the prefrail, and 72.7% for the frail participants, 56% for those with depression risk, and 39.3% for those without depression risk. Mean survival times for groups G1 to G6 were, respectively, 3390, 3437, 2897, 2554, 1887, and 1931 days. Adjusted mortality risk was higher for groups G3 (HR 2.1; 95% confidence interval (CI) 1.4–3.1), G4 (HR 2.5; 95% CI 1.7–3.8), G5 (HR 3.8; 95% CI 2.4–6.1), and G6 (HR 4.0; 95% CI 2.6–6.2), compared with G1 (p < 0.001). Interaction was found between frailty and depression risk, although they were independently associated with mortality.
Depression risk increases mortality risk in prefrail older adults but not in non-frail and frail ones. Depression should be monitored in these older adults to optimize health outcomes. Factors modulating the relationship between frailty and depression should be explored in future studies.
An oblique shock impinging on a shear layer that separates two uniform supersonic streams, of Mach numbers
, at an incident angle
can produce regular and irregular interactions with the interface. The region of existence of regular shock refractions with stable flow structures is delineated in the parametric space
considering oblique-shock impingement on a supersonic vortex sheet of infinitesimal thickness. It is found that under supercritical conditions, the oblique shock fails to deflect both streams consistently and to provide balanced flow properties downstream. In this circumstance, the flow renders irregular configurations which, in the absence of characteristic length scales, exhibit self-similar pseudosteady behaviours. These cases involve shocks moving upstream at constant speed and increasing their intensity to comply with equilibrium requirements. Differences in the variation of propagation speed among the flows yield pseudosteady configurations that grow linearly with time. Supercritical conditions are described theoretically and reproduced numerically using highly resolved inviscid simulation.
PA6 and PMMA polymers with different MWCNTs addition (5, 7 and 9 wt %) were synthetized through casting solution, resulting in improvement properties in contrast to pristine polymers. SEM images showed the MWCNTs embedded into polymeric matrices. D, G and G´ bands of MWCNTs were confirmed by Raman spectroscopy and functional groups observed in both nanocomposites by FTIR demonstrated a strong interaction. A significant increasing in electrical conductivity and microhardness was observed in all the nanocomposites. Major microhardness values were obtained in MWCNTs/PA6 (50 HV) however the MWCNTs/PMMA nanocomposites showed the highest electrical conductivity value (6.4×10-4 S/cm).
The diet and habitat of Leptomeryx sp. from the Late Uintan Yolomécatl Formation of NW Oaxaca, SE Mexico were inferred using dental enamel carbon and oxygen isotopic relationships, and compared with those of congeneric species from temperate North America. Results show that Leptomeryx sp. fed on C3 plants and lived in open forest or forest/savanna ecotone. The palynoflora and co-occurrence of perissodactyls and artiodactyls that live in an environment like that of Leptomeryx support this interpretation. Further, both records disclose that in NW Oaxaca (southern North America) tropical conditions prevailed at that time, unlike that of temperate North America.
Here we present a new site in the Sierra de Atapuerca (Burgos, Spain): Galería de las Estatuas (GE), which provides new information about Mousterian occupations in the Iberian Plateau. The GE was an ancient entrance to the cave system, which is currently closed and sealed by a stalagmitic crust, below which a detritic sedimentary sequence of more than 2 m is found. This has been divided into five litostratigraphic units with a rich assemblage of faunal and lithic remains of clear Mousterian affinity. Radiocarbon dates provide minimum ages and suggest occupations older than 45 14C ka BP. The palynological analysis detected a landscape change to increased tree coverage, which suggests that the sequence recorded a warming episode. The macromammal assemblage is composed of both ungulates (mainly red deer and equids) and carnivores. Taphonomic analysis reveals both anthropic, and to a lesser extent, carnivore activities. The GE was occupied by Neanderthals and also sporadically by carnivores. This new site broadens the information available regarding different human occupations at the Sierra de Atapuerca, which emphasizes the importance of this site-complex for understanding human evolution in Western Europe.
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.
It is likely that the Mediterranean diet (MedDiet) may mitigate the adverse effects of obesity on the incidence of type 2 diabetes mellitus (T2DM). We assessed this hypothesis in a cohort of 18 225 participants initially free of diabetes (mean age: 38 years, 61 % women). A validated semi-quantitative 136-item FFQ was used to assess dietary intake and to build a 0–9 score of adherence to MedDiet. After a median of 9·5-year follow-up, 136 incident cases of T2DM were confirmed during 173 591 person-years follow-up. When MedDiet adherence was low (≤4 points), the multivariable-adjusted hazard ratios (HR) were 4·07 (95 % CI 1·58, 10·50) for participants with BMI 25–29·99 kg/m2 and 17·70 (95 % CI 6·29, 49·78) kg/m2 for participants with BMI≥30 kg/m2, (v.<25 kg/m2). In the group with better adherence to the MedDiet (>4 points), these multivariable-adjusted HR were 3·13 (95 % CI 1·63, 6·01) and 10·70 (95 % CI 4·98, 22·99) for BMI 25–30 and ≥30 kg/m2, respectively. The P value for the interaction was statistically significant (P=0·002). When we assessed both variables (BMI and MedDiet) as continuous, the P value for their interaction product-term was marginally significant (P=0·051) in fully adjusted models. This effect modification was not explained by weight changes during follow-up. Our results suggest that the MedDiet may attenuate the adverse effects of obesity on the risk of T2DM.
Mental health research funding priorities in high-income countries must balance longer-term investment in identifying neurobiological mechanisms of disease with shorter-term funding of novel prevention and treatment strategies to alleviate the current burden of mental illness. Prioritising one area of science over others risks reduced returns on the entire scientific portfolio.
Afortunadamente, y no en el sentido de la ‘Fortuna’ de Mena, lejos del horizonte crítico actual quedan las añejas relaciones establecidas entre la dificultad del lenguaje poético del cantor de Juan II y Álvaro de luna y una presunta tradición poética cordobesa, a modo de vínculo, en una línea de continuidad, entre lucano y Pablo García Baena, por citar un nombre señero en el panorama reciente. Sin embargo, no se han formulado lecturas hermenéuticas fuertes en torno a esta incuestionable marca autorial, pese a tocar problemas mayores en un cronotopo sociocultural que bien pudiera identificarse con la considerada transición entre el medievo y la modernidad renacentista, con elementos de ambos paradigmas. En las páginas que siguen propongo un ensayo interpretativo en esta dirección, apoyándome en la noción de ‘campo literario’ de Bourdieu desde la conciencia del carácter apenas incipiente que éste tiene en el entorno, entre cortesano y burgués, de Juan de Mena. Sin pretender adelantar las fechas propuestas para el campo literario moderno, sí creo posible rastrear algunas marcas significativas de una emergente conciencia autorial, manifiesta en diversas estrategias en torno a la conformación y presentación de los textos propios, tanto en su contenido como en las formas pragmáticas que adoptan. En la Coronación del Marqués de Santillana alcanza una altura excepcional la manifestación de esta actitud, en la combinación de alabanza y autoafirmación, entre lo corporativo y la distinción individual, en un trabado discurso entre los versos y su comentario, conformando un apoyo privilegiado para el acercamiento a la posición de Juan de Mena en los límites de un campo apenas intuido, pero ya en sintonía con los que serán sus rasgos definitivos en la plena modernidad.
Los rasgos de un autocomentario
Datables hacia 1439, los versos de las 51 coplas de la Coronación se han transmitido en estrecha unión con su comentario en prosa, dispuesto en alternante disposición con las estrofas a modo de un poco refinado prosímetro, que puede encontrar un modelo remoto en el tratado de Boecio De consolatione Philosophiae.
Este libro reúne un número significativo de artículos suponen una aportación ciertamente notable a la bibliografía disponible hasta la fecha. Juan de Mena: de letrado a poeta recoge dieciséis trabajos en los que se estudia su figura y su obra desde perspectivas distintas pero complementarias que abren nuevas líneas de investigación o bien enriquecen otras ya existentes. El libro está estructurado en tres grandes bloques temáticos: El primero de ellos se dedica al contexto histórico de Juan de Mena. El segundo bloque gira en torno a la configuración del poeta, atendiendo a la conciencia autorial de Mena y a los recursos literarios que emplea. El tercer y último bloque está dedicado a la transformación del 'famosíssimo poeta Juan de Mena' en un clásico. Cristina Moya García es profesora en la Universidad de Córdoba. This book contains several studies reviewing the two facets of Juan de Mena's life as lawyer and poet. These contributions open up new lines of research on this important early-fifteenth-century Castilian writer and enrich some existing ones, studying Juan de Mena from different perspectives. The book is structured into three thematic blocks: The first is devoted to the historical context of Juan de Mena. The second section focuses on the configuration of the poet. The third and final part is dedicated to the transformation of "famosíssimo poeta Juan de Mena" into a classic author. Cristina Moya García is a profesor at the Universidad de Córdoba.Contributors: Federica Accorsi, Carlos Alvar, Linde M. Brocato, Daniel Capra, Juan Luis Carriazo Rubio, Antonio Cortijo, Sila Gómez Álvarez, Ángel Gómez Moreno, Daniel Hartnett, Julián Jiménez Heffernan, Maxim Kerkhof, Françoise Maurizi, Cristina Moya García, Francisco de Paula Cañas Gálvez, Pedro Ruiz Pérez.