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To describe the association between duration of antimicrobial prophylaxis (AMP) and 30-day surgical site infection (SSI), 7-day acute kidney injury (AKI), 90-day Clostridioides difficile infection (CDI), prolonged hospitalization, and 30-day reoperation after lumbar spine surgery for noninfectious indications, and to report adherence to current guidelines.
Participants and setting:
The study cohort comprised 6,198 patients who underwent lumbar spine surgery for noninfectious indications across 137 Veterans’ Health Administration surgery centers between 2016 and 2020.
Used univariate and multivariate logistic regression to determine the association between type and duration of AMP with 30-day SSI, 7-day AKI, 90-day CDI, prolonged hospitalization, and 30-day reoperation.
Only 1,160 participants (18.7%) received the recommended duration of AMP. On multivariate analysis, the use of multiple prophylactic antimicrobials was associated with increased odds of 90-day CDI (adjusted odds ratio [aOR], 5.5; 95% confidence interval [CI], 1.1–28.2) and 30-day reoperation (aOR, 2.3; 95% CI, 1.2–4.4). Courses of antimicrobials ≥3 days were associated with increased odds of prolonged hospitalization (aOR,1.8; 95% CI, 1.4–2.3) and 30-day reoperation (aOR, 3.5; 95% CI, 2.2–5.7). In univariate analysis, increasing days of AMP was associated with a trend toward increasing odds of 90-day CDI (cOR, 1.4; 95% CI, 1.0–1.8 per additional day; P = .056).
Longer courses of AMP after lumbar spine surgery were associated with higher odds of CDI, prolonged hospitalization, and reoperation, but not with lower odds of SSI. However, adherence to the recommended duration of AMP is very low, hinting at a wide evidence-to-practice gap that needs to be addressed by spine surgeons and antimicrobial stewardship programs.
Contrasting the well-described effects of early intervention (EI) services for youth-onset psychosis, the potential benefits of the intervention for adult-onset psychosis are uncertain. This paper aims to examine the effectiveness of EI on functioning and symptomatic improvement in adult-onset psychosis, and the optimal duration of the intervention.
360 psychosis patients aged 26–55 years were randomized to receive either standard care (SC, n = 120), or case management for two (2-year EI, n = 120) or 4 years (4-year EI, n = 120) in a 4-year rater-masked, parallel-group, superiority, randomized controlled trial of treatment effectiveness (Clinicaltrials.gov: NCT00919620). Primary (i.e. social and occupational functioning) and secondary outcomes (i.e. positive and negative symptoms, and quality of life) were assessed at baseline, 6-month, and yearly for 4 years.
Compared with SC, patients with 4-year EI had better Role Functioning Scale (RFS) immediate [interaction estimate = 0.008, 95% confidence interval (CI) = 0.001–0.014, p = 0.02] and extended social network (interaction estimate = 0.011, 95% CI = 0.004–0.018, p = 0.003) scores. Specifically, these improvements were observed in the first 2 years. Compared with the 2-year EI group, the 4-year EI group had better RFS total (p = 0.01), immediate (p = 0.01), and extended social network (p = 0.05) scores at the fourth year. Meanwhile, the 4-year (p = 0.02) and 2-year EI (p = 0.004) group had less severe symptoms than the SC group at the first year.
Specialized EI treatment for psychosis patients aged 26–55 should be provided for at least the initial 2 years of illness. Further treatment up to 4 years confers little benefits in this age range over the course of the study.
Perceived discrimination is associated with worse mental health. Few studies have assessed whether perceived discrimination (i) is associated with the risk of psychotic disorders and (ii) contributes to an increased risk among minority ethnic groups relative to the ethnic majority.
We used data from the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions Work Package 2, a population-based case−control study of incident psychotic disorders in 17 catchment sites across six countries. We calculated odds ratios (OR) and 95% confidence intervals (95% CI) for the associations between perceived discrimination and psychosis using mixed-effects logistic regression models. We used stratified and mediation analyses to explore differences for minority ethnic groups.
Reporting any perceived experience of major discrimination (e.g. unfair treatment by police, not getting hired) was higher in cases than controls (41.8% v. 34.2%). Pervasive experiences of discrimination (≥3 types) were also higher in cases than controls (11.3% v. 5.5%). In fully adjusted models, the odds of psychosis were 1.20 (95% CI 0.91–1.59) for any discrimination and 1.79 (95% CI 1.19–1.59) for pervasive discrimination compared with no discrimination. In stratified analyses, the magnitude of association for pervasive experiences of discrimination appeared stronger for minority ethnic groups (OR = 1.73, 95% CI 1.12–2.68) than the ethnic majority (OR = 1.42, 95% CI 0.65–3.10). In exploratory mediation analysis, pervasive discrimination minimally explained excess risk among minority ethnic groups (5.1%).
Pervasive experiences of discrimination are associated with slightly increased odds of psychotic disorders and may minimally help explain excess risk for minority ethnic groups.
Non-communicable chronic diseases (NCCDs) are the main cause of morbidity and mortality globally. Demographic aging has resulted in older populations with more complex healthcare needs. This necessitates a multilevel rethinking of healthcare policies, health education and community support systems with digitalization of technologies playing a central role. The European Innovation Partnership on Active and Healthy Aging (A3) working group focuses on well-being for older adults, with an emphasis on quality of life and healthy aging. A subgroup of A3, including multidisciplinary stakeholders in health care across Europe, focuses on the palliative care (PC) model as a paradigm to be modified to meet the needs of older persons with NCCDs. This development paper delineates the key parameters we identified as critical in creating a public health model of PC directed to the needs of persons with NCCDs. This paradigm shift should affect horizontal components of public health models. Furthermore, our model includes vertical components often neglected, such as nutrition, resilience, well-being and leisure activities. The main enablers identified are information and communication technologies, education and training programs, communities of compassion, twinning activities, promoting research and increasing awareness amongst policymakers. We also identified key ‘bottlenecks’: inequity of access, insufficient research, inadequate development of advance care planning and a lack of co-creation of relevant technologies and shared decision-making. Rethinking PC within a public health context must focus on developing policies, training and technologies to enhance person-centered quality life for those with NCCD, while ensuring that they and those important to them experience death with dignity.
Fewer than 200 radiocarbon (14C) dates with secure contextual information are available for Cuba, making it challenging to reconstruct Caribbean indigenous population dynamics, their identities and interactions. In this paper, we discussed 21 accelerator mass spectrometry (AMS) 14C dates from two mounds (M1 and M2) at the Playa del Mango site (Granma province, Cuba), traditionally associated with the Banwaroid stone tool tradition. The ΔR calculated for the site was –132.0 ± 176 and –164.0 ± 68. The chronology of burials from the peripheral area of M2 suggested that the cemetery was continuously used from at least cal BC 116–AD 241 (2 σ). The domestic area of M2 was used at minimum between cal BC 55–AD 435 (2 σ), which encompasses the use of the funerary areas. An isolated human tooth from M1 [cal AD 125–435 (2 σ)] suggested that this funerary area is later than the one at the periphery of M2, and possibly contemporaneous with the later formation of the M2 shell midden. The archaeological assemblage of the “Banwaroid tradition” is widely distributed in Cuba, and mixed with other archaeological traditions, supporting that a complex web of human interactions took place in the Caribbean in precolonial times.
Mental health problems can lead to costs and benefits in other sectors (e.g. in the education sector) in addition to the healthcare sector. These related costs and benefits are known as intersectoral costs and benefits (ICBs). Although some ICBs within the education sector have been identified previously, little is known about their extensiveness and transferability, which is crucial for their inclusion in health economics research.
The aim of this study was to identify ICBs in the education sector, to validate the list of ICBs in a broader European context, and to categorize the ICBs using mental health as a case study.
Previously identified ICBs in the education sector were used as a basis for this study. Additional ICBs were extracted from peer-reviewed literature in PubMed and grey literature from six European countries. A comprehensive list of unique items was developed based on the identified ICBs. The list was validated by surveying an international group of educational experts. The survey results were used to finalize the list, which was categorized according to the care atom.
Additional ICBs in the education sector were retrieved from ninety-six sources. Fourteen experts from six European countries assessed the list for completeness, clarity, and relevance. The final list contained twenty-four ICBs categorized into input, throughput, and output.
By providing a comprehensive list of ICBs in the education sector, this study laid further foundations for the inclusion of important societal costs in health economics research in the broader European context.
Bipartite networks represent pairwise relationships between nodes belonging to two distinct classes. While established methods exist for analyzing unipartite networks, those for bipartite network analysis are somewhat obscure and relatively less developed. Community detection in such instances is frequently approached by first projecting the network onto a unipartite network, a method where edges between node classes are encoded as edges within one class. Here we test seven different projection schemes by assessing the performance of community detection on both: (i) a real-world dataset from social media and (ii) an ensemble of artificial networks with prescribed community structure. A number of performance and accuracy issues become apparent from the experimental findings, especially in the case of long-tailed degree distributions. Of the methods tested, the “hyperbolic” projection scheme alleviates most of these difficulties and is thus the most robust scheme of those tested. We conclude that any interpretation of community detection algorithm performance on projected networks must be done with care as certain network configurations require strong community preference for the bipartite structure to be reflected in the unipartite communities. Our results have implications for the analysis of detected community structure in projected unipartite networks.
In this work, we study the optical properties of 58 CSS/GPS radio sources selected from the literature in order to determine the impact of the radio-jet in the circumnuclear environment of these objects. We obtained optical spectra for all sources from SDSS-DR12 and performed a stellar population synthesis using the Starlight code. Our results indicate that the sample is dominated by intermediate to old stellar populations and there is no strong correlation between optical and radio properties of these sources.
We analyzed the inner 320 × 535 pc2 of the elliptical galaxy NGC 1052 with integral field spectroscopy, both in the optical and in the near-infrared (NIR). The stellar population analysis revealed a dominance of old stellar populations from the optical data, and an intermediate-age ring from NIR data. When combining optical+NIR data, optical results were favoured. The emission-line analysis revealed five kinematic components, where two of them are unresolved and probably associated with the active galactic nucleus (AGN), one is associated with large-scale shocks, one with the radio jets, and the last could be explained by either a bipolar outflow, rotation in an eccentric disc or a combination of a disc and large-scale gas bubbles. Our results also indicate that the emission within the galaxy is caused by a combination of shocks and photoionization by the AGN.
Understanding the interplay between the phenomena of active galactic nuclei (AGN) and starbursts remains an open issue in studies of galaxy evolution. The galaxy NGC 34 is the remnant of the merger of two former gas-rich disc galaxies and it also hosts a strong nuclear starburst. In this work, we map the ionized and molecular gas present in the nuclear regions of the galaxy NGC 34 using adaptive optics (AO) assisted near infrared (NIR) integral field unity (IFU) observations. Our main goals are to better constrain the energy source of this object and to use NGC 34 as a laboratory to probe the AGN-starburst connection in the context of galaxy evolution and AGN feeding and feedback processes.
To investigate changes in socio-economic inequalities in growth in height, weight, BMI and grip strength in children born during 1955–1993 in Guatemala, a period of marked socio-economic-political change.
We modelled longitudinal data on height, weight, BMI and hand grip strength using Super-Imposition by Translation and Rotation (SITAR). Internal Z-scores summarising growth size, timing and intensity (peak growth velocity, e.g. cm/year) were created to investigate inequalities by socio-economic position (SEP; measured by school attended). Interactions of SEP with date of birth were investigated to capture secular changes in inequalities.
Urban and peri-urban schools in the region of Guatemala City, Guatemala.
Participants were 40 484 children and adolescents aged 3–19 years of Ladino and Maya ancestry (nobservations 157 067).
The difference in height (SITAR size) between lowest and highest SEP decreased from −2·0 (95 % CI −2·2, −1·9) sd to −1·4 (95 % CI −1·5, −1·3) sd in males, and from −2·0 (95 % CI −2·1, −1·9) sd to −1·2 (95 % CI −1·3, −1·2) sd in females over the study period. Inequalities also reduced for weight, BMI and grip strength, due to greater secular increases in lowest-SEP groups. The puberty period was earlier and shorter in higher-SEP individuals (earlier SITAR timing and higher SITAR intensity). All SEP groups showed increases in BMI intensity over time.
Inequality narrowed between the 1960s and 1990s. The lowest-SEP groups were still >1 sd shorter than the highest. Risks remain for reduced human capital and poorer population health for urban Guatemalans.
We present a numerical methodology for construction of reduced-order models (ROMs) of fluid flows through the combination of flow modal decomposition and regression analysis. Spectral proper orthogonal decomposition is applied to reduce the dimensionality of the model and, at the same time, filter the proper orthogonal decomposition temporal modes. The regression step is performed by a deep feedforward neural network (DNN), and the current framework is implemented in a context similar to the sparse identification of nonlinear dynamics algorithm. A discussion on the optimization of the DNN hyperparameters is provided for obtaining the best ROMs and an assessment of these models is presented for a canonical nonlinear oscillator and the compressible flow past a cylinder. Then the method is tested on the reconstruction of a turbulent flow computed by a large eddy simulation of a plunging airfoil under dynamic stall. The reduced-order model is able to capture the dynamics of the leading edge stall vortex and the subsequent trailing edge vortex. For the cases analysed, the numerical framework allows the prediction of the flow field beyond the training window using larger time increments than those employed by the full-order model. We also demonstrate the robustness of the current ROMs constructed via DNNs through a comparison with sparse regression. The DNN approach is able to learn transient features of the flow and presents more accurate and stable long-term predictions compared to sparse regression.
Although relapse in psychosis is common, a small proportion of patients will not relapse in the long term. We examined the proportion and predictors of patients who never relapsed in the 10 years following complete resolution of positive symptoms from their first psychotic episode.
Patients who previously enrolled in a 12-month randomized controlled trial on medication discontinuation and relapse following first-episode psychosis (FEP) were followed up after 10 years. Relapse of positive symptoms was operationalized as a change from a Clinical Global Impression scale positive score of <3 for at least 3 consecutive months to a score of ⩾3 (mild or more severe). Baseline predictors included basic demographics, premorbid functioning, symptoms, functioning, and neurocognitive functioning.
Out of 178 first-episode patients, 37 (21%) never relapsed during the 10-year period. Univariate predictors (p ⩽ 0.1) of patients who never relapsed included a duration of untreated psychosis (DUP) ⩽30 days, diagnosed with non-schizophrenia spectrum disorders, having less severe negative symptoms, and performing better in logical memory immediate recall and verbal fluency tests. A multivariate logistic regression analysis further suggested that the absence of any relapsing episodes was significantly related to better short-term verbal memory, shorter DUP, and non-schizophrenia spectrum disorders.
Treatment delay and neurocognitive function are potentially modifiable predictors of good long-term prognosis in FEP. These predictors are informative as they can be incorporated into an optimum risk prediction model in the future, which would help with clinical decision making regarding maintenance treatment in FEP.
There is a large literature linking current BMI to levels of cardiovascular risk biomarkers, but it is unknown whether measures of BMI earlier in the life course and maximum BMI are predictive of current levels of biomarkers. The objective of the current study was to determine how current, maximum and age-25 BMI among individuals over the age of 60 years are associated with their current levels of cardiovascular risk biomarkers.
Cross-sectional study with retrospective recall.
Costa Rica (n 821) and the USA (n 4110).
Nationally representative samples of adults aged 60 years or over.
We used regression models to examine the relationship between multiple meaures of BMI with four established cardiovascular risk biomarkers. The most consistent predictor of current levels of systolic blood pressure, TAG and HDL-cholesterol was current BMI. However, maximum BMI was the strongest predictor of glycosylated Hb (HbA1c) and was also related to HDL-cholesterol and TAG. HbA1c was independent of current BMI. We found that these relationships are consistent between Costa Rica and the USA for HbA1c and for HDL-cholesterol.
Current levels of cardiovascular risk biomarkers are not only the product of current levels of BMI, but also of maximum lifetime BMI, particularly for levels of HbA1c and for HDL-cholesterol. Managing maximum obtained BMI over the life course may be most critical for maintaining the healthiest levels of cardiovascular risk.
This essay considers the development of Cuban American literature, which can be traced to the first part of the nineteenth century, when Cubans fled the Spanish colony to live and write in the United States. The early works were written in Spanish about island concerns. This critic argues that a US perspective is also discernable in these works. In its most recent manifestation, Cuban American literature refers to works produced by exiles fleeing Castro’s rise to power, living mainly in Miami but also in other US cities. Written in Spanish and English, these works take issues with events unfolding at home and in the adopted country. They combine two perspective, two geographic spaces, two cultures, and two languages. In the United States, women, gay, and lesbian writers explore uncomfortable topics known to their parents’ culture. Cuban American literature is rich and varied, and speaks to the changing perspectives of the Cuban American experience.
Two female snapper-choking isopods Cymothoa excisa (body length 11 and 14 mm) were in the buccal cavity of two invasive lionfish Pterois volitans (total length 294 and 301 mm) collected in Alacranes Reef, southern Gulf of Mexico. This is the first record of C. excisa parasitizing invasive lionfish P. volitans in coral reefs of the Western Atlantic, where these isopods appear to have infected the host through adult prey-predator transfer.
Social wasps can face many challenges during their colony cycle, including the presence of parasites. The order Strepsiptera is among the main parasites of the wasp genus Polistes. The aim of this study was to evaluate the effect of an endoparasite species on the host Polistes ferreri, with the hypothesis that females of this social wasp would undergo morphophysiological alterations as well as changes in their cuticular chemical profile caused by the obligate endoparasite. On average, parasitism was found in 10% of the colonies studied. All the parasitized females showed filamentous ovarioles without developing oocytes, which indicates a physiological castration. Moreover, the endoparasites present in the gaster of females caused its volume to increase, and the presence of endoparasites changed the cuticular chemical profiles of females, confirming our hypothesis. It is likely that this parasitism effect could hamper the maintenance of wasp colonies.
The characteristics of silicon films deposited by plasma depend strongly on the reactor parameters. In our experiments, the two-level factorial design was implemented. Pressure, silane and hydrogen flows were set at high and low values for the synthesis of silicon films. Results showed that the flows of silane and hydrogen played a key role, being the influence of pressure low. In particular, the samples at high level of hydrogen exhibited the lowest deposition rate and photosensitivity. On the other hand, the samples at low level of hydrogen showed crystalline regions and high deposition rate. For the lowest dilution ratio, nano/meso-structured silicon films were obtained, showing high photosensitivity and high roughness that increases the scattering of light. These characteristics of our films make them suitable to be used in photovoltaics.
We present the observed “continuum” levels of polarization as a function of time for four well-observed Type II-Plateau supernovae (SNe II-P; Fig. 1), the class of SNe decisively determined to arise from red supergiant stars (Smartt 2009). All four objects show temporally increasing degrees of polarization through the end of the photospheric phase, with some exhibiting early-time polarization that challenge existing models (e.g., Dessart and Hillier 2011) to reproduce. A fundamental ejecta asymmetry is present in this photometrically diverse sample of type II SNe, and it probably takes different forms (e.g., 56Ni blobs/fingers, large scale deformation). We acknowledge support from NSF grants AST-1009571 and AST-1210311.