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This study investigates the impact of the Aztec Triple Alliance on trade and economic activity in the region of Puebla-Tlaxcala during the Late Postclassic period (AD 1200–1519). Ethnohistorical sources describe the Aztec Triple Alliance as constantly at war with settlements in the Tlaxcala region. To weaken their Tlaxcalteca rivals, the Aztecs imposed a trade blockade to reduce the flow of resources into Puebla-Tlaxcala. This article uses archaeological evidence to evaluate the effectiveness of this blockade. It compares the types of obsidian used to manufacture lithic tools from Aztec-controlled sources with those used within Puebla-Tlaxcala. Information from the large center of Tepeticpac and the small obsidian workshop site of Cinco Santos II, both in the Tlaxcala domain, are compared to other sites in Central Mexico prior to and during the height of Aztec influence. The results show little difference in regional trade patterns: obsidian from Sierra de las Navajas and Otumba was used in proportions in the Tlaxcala region in the Late Postclassic similar to those used during earlier periods. If an embargo was attempted, it was largely unsuccessful in isolating Tlaxcala from broader regional distribution networks.
Understanding the role of species traits in mediating ecological interactions and shaping community structure is a key question in ecology. In this sense, parasite population parameters allow us to estimate the functional importance of traits in shaping the strength of interactions among hosts and parasites in a network. The aim of this study was to survey and analyse the small mammal-helminth network in a forest reserve of the Brazilian Atlantic Forest in order to understand (i) how functional traits (type of parasite life cycle, site of infection in their host, host and parasite body length, host diet, host locomotor habit and host activity period) and abundance influence host–parasite interactions, (ii) whether these traits explain species roles, and (iii) if this relationship is consistent across different parasite population parameters (presence and absence, mean abundance and prevalence). Networks were modular and their structural patterns did not vary among the population parameters. Functional traits and abundance shaped the interactions observed between parasites and hosts. Host species abundance, host diet and locomotor habit affected their centrality and/or vulnerability to parasites. For helminths, infection niche was the main trait determining their central roles in the networks.
ABSTRACT IMPACT: This study highlights the importance of creatine in developmental myelination and remyelination to investigate whether creatine provides a therapeutic value during a central nervous system (CNS) demyelinating insult with a potential value in patients with Multiple Sclerosis. OBJECTIVES/GOALS: Creatine is vital for ATP buffering in the brain. Interestingly, the cells that generate myelin express the main enzyme for creatine synthesis, Gamt. Patients with Gamt mutations display intellectual delays and impaired myelination. Therefore, we hypothesize that creatine is essential for developmental myelination and improves remyelination. METHODS/STUDY POPULATION: To investigate these hypotheses, we developed a new transgenic mouse model with LoxP sites flanking exons 2-6 of the guanidinoacetate methyltransferase (Gamt) gene where excision leads to expression of a green fluorescent tag allowing us to track the cells normally expressing Gamt. We used immunohistochemistry techniques to look at the corpus callosum, the main white matter tract in the brain, and evaluate the number of oligodendrocytes (OL), glial cells responsible for generating myelin. We also used the cuprizone model of toxic demyelination to investigate whether dietary creatine and cyclocreatine, a planar analog of creatine that more efficiently crosses the blood-brain barrier, can enhance remyelination. RESULTS/ANTICIPATED RESULTS: In this mouse model, we show a 95% (+/-0.47%, n=3) co-localization of Gamt within mature OL during postnatal (P) day P14 with no co-localization in neurons or other glial cells. This suggests that mature OL are the main cells making creatine in the CNS. Next, we show that knocking out Gamt leads to a significant reduction in OL in the developing corpus callosum, at P14 and P21 (P14: 0.007, n=3; P21: 0.04, n=3). We also show that creatine supplementation causes a trending increase in mature OL density in the corpus callosum following cuprizone demyelination (2% creatine; p=0.052; n=4). Interestingly, cyclocreatine supplementation significantly increased mature OL density in the corpus callosum following cuprizone demyelination (0.1% cyclocreatine; p=0.034; n=4). DISCUSSION/SIGNIFICANCE OF FINDINGS: These studies highlight the important role creatine plays in developmental myelination and remyelination to investigate whether creatine and cyclocreatine provide a therapeutic value during a CNS demyelinating insult. This work investigates a potential therapeutic value of creatine to patients with Multiple Sclerosis.
Background: Using alternatives to indwelling urinary catheters plays a vital role in reducing catheter-associated urinary tract infections (CAUTIs). We assessed the impact of introducing female external catheters on urinary catheter utilization and CAUTIs. Methods: In a 500-bed academic medical center, female external catheters were implemented on October 1, 2017, with use encouraged for eligible females with urinary incontinence but not meeting other standard indications for urinary catheters. Nurses were educated and trained on female external catheter application and maintenance, and infection prevention staff performed surveillance case reviews with nursing and medical staff. We determined the number of catheter days for both devices based on nursing documentation of device insertion or application, maintenance, and removal. We used the CAUTI and DUR (device utilization ratio) definitions from the CDC NHSN. Our primary outcomes were changes in DUR for both devices 21 months before and 24 months after the intervention in both intensive care units (ICUs) and non-ICU wards. We used a generalized least-squares model to account for temporal autocorrelation and compare the trends before and after the intervention. Our secondary outcome was a reduction in CAUTIs, comparing females to males. Results: In total, there were 346,213 patient days in 35 months. The mean rate of patient days per month increased from 7,436.4 to 7,601.9 after the implementation of female external catheters, with higher catheter days for both urinary catheters (18,040 vs 19,625) and female external catheters (22 vs 12,675). After the intervention, the DUR for female external catheters increased (0 vs 0.07; P < .001) and for urinary catheters the DUR decreased (0.12 vs 0.10; P < .001) (Fig. 1). A reduction in urinary catheter DUR was observed in ICUs (0.29 vs 0.27; P < .001) but not wards (0.08 vs 0.08; P = NS) (Fig. 2). Of the 39 CAUTIs, there was no significant overall change in the rate per 1,000 catheter days (1.22 vs 0.87; P = .27). In females (n = 20 CAUTI), there was a 61% reduction in the CAUTI rate per 1,000 catheter days (0.78 vs 0.31; P = .02), but no significant change in the rate in males (0.44 vs 0.56; P = .64). The CAUTI rate per 1,000 catheter days among females decreased in the ICUs (1.14 vs 0.31; P = .04) but not in wards (0.6 vs 0.33; P = .96). Conclusions: In a setting with a baseline low UC DUR, successful implementation of female external catheters further modestly reduced UC DUR and was associated with a 61% decrease in CAUTI among females in the ICU but not in wards. Further interventions to better identify appropriate patients for female external catheters may improve patient safety and prevent patient harm.
Judicial review of EU soft law – Liberal-constitutionalism – Principle of effective judicial protection – The liberal-constitutional jurisprudence of the European Court of Justice – Action for annulment – Formalistic understanding of the concept of ‘legally binding effects’ – Preliminary ruling procedure – Limitations of the preliminary ruling procedure in granting effective judicial protection in relation to EU soft law – A plea for a liberal-constitutional reading of Articles 263 and 288 TFEU in relation to direct review of EU soft law
We derive linear instability and nonlinear stability thresholds for a problem of thermal convection in a bidispersive porous medium with a single temperature when Darcy theory is employed in the micropores whereas Brinkman theory is utilized in the macropores. It is important to note that we show that the linear instability threshold is the same as the nonlinear stability one. This means that the linear theory is capturing completely the physics of the onset of thermal convection. The coincidence of the linear and nonlinear stability boundaries is established under general thermal boundary conditions.
This presentation is focused to analyse the safety of SSRIs and mood stabilisers in pregnancy and breastfeeding in order to reduce the risks associated with pre- and postnatal exposure to both classes of psychotropic drugs.
Recent literature information seems to suggest that SSRIs as group, sertraline, and, especially, paroxetine, may be associated with an increased risk of fetal malformations (cardiovascular anomalies, prevalently).
Moreover, exposure to such agents late in pregnancy is associated with an increased risk of inducing neonatal complications.
Further, the repercussions of SSRI exposure through placenta on the infant's neuropsychological development remain substantially unknown.
On the other hand, only sporadic case-reports have described unwanted reactions (of low degree of severity, however) in infants breastfed by mothers who were treated with SSRIs during lactation.
(1) Classic and emergent mood stabilizers
Classic mood stabilizers have been associated with an increased risk of fetal major malformations.
As regards atypical antipsychotics, available data are still insufficient to confirm or exclude an intrinsic teratogenic potential.(2) Conversely, information on lamotrigine seems to be quite reassuring.
Placental exposure to valproate is also associated with impaired neurodevelopmental outcomes.
Finally, all mood stabilising agents show too limited data for suggesting their safe use in lactation.
As weight-gain and metabolic abnormalities during treatment with psychotropic drugs are of great concern, we evaluated effects of psycho-education and medical monitoring on metabolic changes among severely mentally ill patients.
Materials and methods
During repeated, systematic psycho-education about general health among 66 consecutive patients diagnosed with DSM-IV-TR schizophrenia (n = 33) or type-I bipolar disorder (n = 33), we evaluated (at intake 1, 2, 3, and 6 months) clinical psychiatric status, treatments and doses, recorded physiological parameters, and assessed attitudes about medication.
At intake, patients with schizophrenia vs bipolar disorder were receiving 3–7 times more psychotropic medication, with 14% higher initial body-mass index (BMI: 29.1 vs 25.6 kg/m2), 12 times more obesity, and significantly higher serum lipid concentrations. During 6-months follow-up, among bipolar disorder patients, polytherapy and serum lipid concentrations declined more than among schizophrenia patients (e.g., total cholesterol + triglycerides, by 3.21 vs 1.75%/month). BMI remained stable. Declining lipid levels were associated with older age, bipolar disorder, being unemployed, higher antipsychotic doses, and lower initial BPRS scores (all P ≤ 0.001).
Psychotropic treatments were more complex, and metabolic measures more abnormal among bipolar disorder than schizophrenia patients. Intensive psycho-education, clinical monitoring, and encouragement of weight-control for six months were associated with improvements in metabolic measures (but not to BMI), and more realistic attitudes about medication.
Some authors have found an association between affective temperaments and mood fluctuations, and a common comorbidity between somatization disorders and mood disorders. In addition, It’s known a significant association between abnormal affective temperaments and somatoform disorders.
The present study investigated associations between affective temperaments and somatization in a 55 healthy subjects sample.
The aim of the study was to describe associations between affective temperament and somatization scores in a sample of healthy subjects.
In this observational study we adopted the following rating scales: Mini International Neuropsychiatric Interview (MINI), 17-item Self Rating Depression Scale (SDS), Hypomania check list 32(HCL-32), Self Rating Anxiety Scale (SAS), DCPR diagnostic criteria for psychosomatic research, Brief TEMPS-A, Modified Somatic Perception Questionnaire (MSPQ), Somatosensory Amplification Scale- SSAS.
Logistic regression analysis showed that cyclothymic temperament scores at Brief TEMPS-A are associated with MSPQ scores for somatic perception (somatosensory amplification) and SASS scores (hypochondriacal aspects). Moreover, depressive temperaments scores at Brief TEMPS-A are significantly associated to MSPQ tools.
Our data suggest an association between an affective temperamental dysregulation and somatization aspects in a 55 healthy subjects sample.
As weight-gain and metabolic abnormalities during treatment with psychotropic drugs are of great concern, we evaluated effects of psychoeducation and medical monitoring on metabolic changes among severely mentally ill patients.
Materials and Methods
During repeated, systematized psychoeducation about physical health among 66 consecutive patients diagnosed with DSM-IV schizophrenia (SZ; n=33) or type-I bipolar disorder (BD; n=33), we evaluated (at intake, 1, 2, 3, and 6 months) clinical psychiatric status, treatments and doses, rated drugs- attitude of patients, and recorded physiological parameters.
At intake, BD vs. SZ patients were receiving 3–7-times more psychotropic medication, with correspondingly higher initial body-mass index (BMI: 29.1 vs. 25.6 kg/m2), 12-times more obesity, and significantly higher serum lipid concentrations. During 6-month follow-up, ratings of drugs- attitude of patients improved, polytherapy decreased in BD, and BMI decreased slightly, as serum lipid concentrations declined continuously (e.g., total cholesterol+triglycerides: BD by 3.21 > SZ by 1.75%/month). Declining lipid levels were associated with: [a] older age, [b] BD diagnosis, [c] being unemployed, [d] higher antipsychotic dose, [e] lower initial BPRS scores (all p≤0.001).
Literature describes important comorbidity rates between somatization and mood disorders. Furthermore, there are data suggesting an association between affective temperament and somatization traits in healthy subjects.
In the present observational study, we investigated affective temperaments and somatization aspects in clinical and healthy samples.
The study focused on differences between unipolar depressive inpatients (DEP) and controls (C).
We administered to 20 DEP and 20 C following questionnaires: Mini International Neuropsychiatric Interview (MINI), 17-item Self Rating Depression Scale (SDS), Hypomania check list 32(HCL-32), Self Rating Anxiety Scale (SAS), DCPR diagnostic criteria for psychosomatic research, Brief TEMPS-A, Modified Somatic Perception Questionnaire (MSPQ), Somatosensory Amplification Scale-SSAS. DEP and C were matched for age, sex and marital status.
About temperaments, ANOVA showed that DEP were more cyclothymic (p<0,0001), depressive (p<0,0002) and irritable (p<0,0425) (scores to Brief TEMPS-A) than C. In addition, in DEP, MSPQ scores (somatic perception scale) were higher than C (p<0,0001). Similar results were about SASS scores (somatosensory amplification scale). DEP present more frequently than C Type A Behavior Pattern (DCPR diagnosis) (CHI-SQUARE p <0,0601).
Our data suggest that DEP present an important affective temperamental dysregulation. Relative to somatization aspects, DEP show a greater vulnerability than C.
The clinical vignette aims to provide how PM could assist psychiatry treatment.
A 43-years-old woman with a 12-years history of Multiple Chemical Sensitivity (MCS), also affected by celiac disease and gastroesophageal reflux. In 2011, she was diagnosed with breast cancerin a surgically treatable stage. Due to previous severe drug adverse events, with undefined cause, no medical team accepted to take care her. Then she developed a depressive syndrome with hypochondriac features, based on DSM-IV-TR criteria.
Pharmacogenomic testing for the main enzymes involved in drugs metabolism (fig. 1) was performed and database interrogation was used to select the safer drug combination, based on the personal genomic profile. Illness progression was evaluated by Ham-A, Ham-d, BPRS, VGF and MMPI-2 scales (fig.2).
Genomic profile (fig. 1) was compatible with reported previous toxic effects following assumption of different drugs. The personal genome-based choice of pharmacological therapies allowed to avoid surgery-related adverse effects. Through genome-guided therapy selection, rapidly we set-up an efficacious psychotropic therapy. After a year the access to the PM Service, the patient showed an important improvement in both social impairment and quality of life, allowing her to get out, without a surgical mask.
Application of pharmacogenomic screening to patients undergoing composite therapies could be an effective tool to improve clinical outcomes and minimize side effects.
Given the poor compliance of schizofrenic patients to antipsychotic therapies, are been developed drugs in long-acting formulation that for their pharmacokinetic ensures prolonged therapeutic activities. Currently, we consider that their efficacy depends on hereditary tracts, influencing both pharmacodynamic and pharmacokinetic parameters.
Investigate relationships between clinical efficacy and genetic polymorphims of long-acting drugs’ pharmacodynamic targets.
Seventy-eight psychotic patients, treated with atypical long-acting antipsychotics (olanzapine pamoate, paliperidone palmitate, risperidon and aripiprazole), were examined. We carried out a blood sampling to evaluate dopaminergic DRD2 and glutamatergic GRM3 genetic receptors polymorphisms. PANSS and BPRS scales were used to assess clinical condition.
Regarding the GRM3 genes, the study of rs2228595 and rs6465084 polymorphisms showed a prevalence of wild type genotypic frequency of 81.2% and 56.2%, respectively. The prevalence of the patients with mutated heterozygote genotype (rs6465084 polymorphisms) resulted high (40.6%). Considering rs1989796 e rs274622 polymorphisms, the sample showed a prevalence of mutated heterozygote genotype in the 53.1% e 45.3%, respectively, with a percentage of 43.7% of patients with a mutation in homozygosis. Considering the rs146812 polymorphism, the 53.1% of patients resulted with a wild type genotype. Finally, findings showed a prevalence of 56.2% for the mutated heterozygote genotype in the DRD2 rs6277 polymorphism. The genotypic categorization analysis demonstrated a significative association between the GRM3 rs274622 polymorphism and higher BPRS scores.
The relationship between rs274622 polymorphism and worse clinical conditions could indicate a major resistance to long-acting antipsychotics in patients with genotypic frequency CT (mutated heterozygosis) for this polymorphism.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
A new species of Moniliformis Travassos, 1915 (Acanthocephala: Moniliformidae) is described from the hairy-tailed bolo mouse, Necromys lasiurus Lund, 1840 (Cricetidae: Sigmondontinae), captured in the Brazilian Cerrado, in Uberlândia, state of Minas Gerais, Brazil. The specimens were studied by light and scanning electron microscopy. Molecular phylogenies were inferred from partial nuclear large subunit ribosomal RNA gene sequences and partial mitochondrial cytochrome c oxidase subunit I gene. The new species is distinguished from other moniliformid species by the number of rows and number of hooks per row, size of the proboscis, size of the eggs, host species and geographical distribution. Molecular phylogenies and genetic distances analyses demonstrated that Moniliformis necromysi sp. n. forms a well-supported monophyletic group with sequences of other species of Moniliformis and is distinguished from them, which agrees with the morphological characteristics, allocating the new species to this genus and to the family Moniliformidae Van Cleave, 1924. This is the first moniliformid acanthocephalan described from a wild rodent in Brazil.
Article 52(1) of the EU Charter of Fundamental Rights lays down respect for the essence of right as one of the requirements that limitations on rights must respect. This provision is not innovative, as it formalizes into EU law the distinction between “core” and “periphery” of rights present in many national constitutions and in the ECJ and ECtHR case law. Nonetheless, the express reference to essence has given unprecedented resonance to that concept. Essence as the “limit of limits” has a Janus-like character. On the one hand, it pronounces that every fundamental right bears a minimum content which is ringfenced from interference by public and private actors. On the other hand, it stresses the malleability of rights and their social function. The core/periphery dichotomy reflects a balancing act moored in European legal tradition whose symbolism outperforms its utility as a judicial tool. This Article examines the essence clause of the Charter in light of the ECJ case law and the constitutional traditions of the Member States and assesses its role in the framework of fundamental rights protection in EU law. The Article first attempts a classification of rights limitations clauses in national constitutions, following which it discusses the interpretation of essence by the Spanish and the Italian Constitutional Courts. The Article then engages with a theoretical discussion of the concept of essence and examines the case law of the ECJ. Lastly, it looks at the limitations of the concept as a rights protection instrument in EU law.
Invertebrates living in underground environments often have unusual and sometimes unique adaptations and occupy narrow ranges, but there is a lack of knowledge about most micro-endemic cave-dwelling invertebrate species. An illustrative case is that of the flatworm Dendrocoelum italicum, the first survey of which was performed 79 years after its description. The survey revealed that the underground stream supplying water to the pool from which the species was first described had been diverted into a pipe for human use, thus severely reducing the available habitat for the species. Here we describe the results of what we believe is the first habitat restoration action performed in a cave habitat for the conservation of a flatworm. The water-diverting structure was removed, with the involvement of local protected area administrators, citizens and volunteers from local organizations. The intervention resulted in the restoration of a large, stable pool inside the cave, thus creating an optimal habitat for this threatened planarian, with increased availability of prey and a stable population. This report of habitat restoration for a neglected invertebrate offers insights for the protection of other micro-endemic species.
Examination gloves have been previously noted as a possible barrier to hand hygiene. We performed a prospective quantitative and qualitative study to investigate. Glove usage was found to be a potential barrier to hand hygiene; this was driven by desire for personal safety and potentially learned during professional training.