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.
The coronavirus disease 2019 (COVID-19) pandemic is putting health-care systems under unprecedented stress to accommodate unexpected numbers of patients forcing a quick re-organization. This article describes the staff management experience of a third level referral hospital in the city of Madrid, Spain, one of the cities and hospitals with the largest number of COVID-19 cases.
A newly created COVID-19-specific clinical management unit (CMU) coordinated all clinical departments and conducted real-time assessments of the availability and needs of medical staff, alongside the hospital’s general management board. The CMU was able to (i) redeploy up to 285 physicians every week to bolster medical care in COVID-19 wards and forecast medical staff requirements for the upcoming week so all departments could organize their work while coping with COVID-19 needs, (ii) overview all clinical activities conducted in a medicalized hotel, and (iii) recruit a team of roughly 90 volunteer medical students to accelerate data collection and evidence generation.
The main advantage of a CMU composed by a member of every job category—its ability to generate rapid, locally adapted responses to unexpected challenges—made it perfect for the unprecedented increase in health-care need generated by the COVID-19 pandemic.
This paper sets out to explore to what extent integrating employment effects, equity, and risk aversion within cost–benefit analysis (CBA) affect the economic appraisal of a climate change adaptation project designed to protect against flood risk in a region of Bilbao (Basque Country, Spain). Four CBAs are conducted: (i) a standard CBA; (ii) a standard CBA considering equity; (iii) a standard CBA considering equity and employment; and (iv) a standard CBA considering equity, employment and risk aversion. All CBAs are conducted using a time frame of 2014–2080 and considering a 100-year return period under a middle of the road emission scenario (RCP4.5). A sensitivity analysis is also undertaken. Results suggest that the economic efficiency of the adaptation investment is contingent on what types of considerations are included within CBA. Integrating elements of employment, equity and risk aversion can strengthen or weaken the case for action (leading to higher or lower net-present values) and (depending on the discount rate chosen) may even be the deciding factor for determining whether a particular action should be carried out or not (whether the net-present value is positive or negative).
Barnyardgrass [Echinochloa crus-galli (L.) P. Beauv] is the foremost weed in rice (Oryza sativa L.) systems, and its control is crucial to successful rice production. Quinclorac, a synthetic auxin herbicide, has been used effectively to manage E. crus-galli. However, occurrences of quinclorac-resistant genotypes are frequently reported, and its resistance evolution has led to questions about the continued utility of quinclorac for grass control. Identification of the resistance mechanism(s) of resistant genotypes will facilitate development of integrated weed management strategies that sustain quinclorac use for management of E. crus-galli. We evaluated the responses to quinclorac of two contrasting genotypes: E7 (resistant, R) and LM04 (susceptible, S). Quinclorac induced ethylene and cyanide biosynthesis in the S-genotype. Both genotypes responded similarly to an increasing application of exogenous 1-carboxylic acid aminocyclopropane (ACC) and potassium cyanide, and their growth was inhibited at higher doses. The key mechanism for cyanide (HCN) detoxification in plants, β-cyanoalanine synthase (β-CAS) activity, was evaluated in both genotypes, and no significant difference was observed in the basal activity. However, quinclorac significantly induced β-CAS–like activity in the S-genotype, which is consistent with the increased synthesis of ethylene and cyanide. This work suggests that the resistance to quinclorac of the E7 R-genotype is likely related to an alteration in the auxin signal transduction pathway, causing a lower stimulation of ACC synthase and, therefore, limited synthesis of ethylene and HCN after quinclorac treatment.
Antisocial behaviour is common among patients with severe mental illness (SMI) requiring hospitalisation.
To determine whether differential treatments and services are provided to patients with SMI who engage in antisocial behaviour.
A random sample of 161 inpatients with SMI were recruited from general adult wards and assessed at baseline and two years later. Information on symptoms, aggressive behaviour, substance misuse, and service use was obtained from patients and clinical files.
Past antisocial behaviours were not associated with type or intensity of treatments and services. Severity of positive symptoms, aggressive behaviour, and illicit drug use were positively associated with the frequency of CMHT contact, but not with the type of CMHT, type of medication, or other treatments and benefits.
While the frequency of meetings with CMHTs increased with the severity of antisocial behaviours, no specific treatments were provided to patients with SMI engaging in antisocial behaviours.
To document long-term prevalence trends and changes in Post-Traumatic Stress Disorder (PTSD), Current Major Depression (MD), Agoraphobia, Generalized Anxiety Disorder (GAD), and Panic Disorder, in two groups of people with different levels of exposure to a massive terrorist attack.
Cohort study. Two random samples of people exposed to a terrorist attack, the injured (n = 127) and community residents (n = 485) were followed and assessed, 2 and 18 months after the event.
Among the injured, 2 and 18 months after the attack, the prevalences were respectively, PTSD: 44.1% and 34%, MD: 31.5% and 23.7%, Agoraphobia: 23.8% and 20.7%, GAD: 13.4% and 12.4% and Panic Disorder: 9.4% and 11.3%. The corresponding figures among residents were PTSD: 12.3% and 3.5%, MD: 8.5% and 5.4%, Agoraphobia: 10.5% and 8.7%, GAD: 8.6%, and 8.2% and Panic Disorder 2.1% and 2.7%.
Two months after the event, the prevalence of mental disorders among both injured and residents was higher than expected levels at baseline conditions. Eighteen months after the event, psychopathological conditions did not change significantly among the injured but returned to the expected baseline rates among community residents.
To determine the change in prevalence of posttraumatic stress disorder (PTSD) symptoms in victims of the March 11 attacks and their relatives, 1 and 6 months after the attacks.
Subjects and methods
Evaluation of PTSD symptoms using the Davidson Trauma Scale (DTS) and General Health Questionnaire (GHQ) in a sample of 56 patients admitted to an emergency room of a general hospital, and assessment of PTSD symptoms in relatives of the patients.
At Month 1, 41.1% of patients (31.3% of males and 54.2% of females) presented with PTSD. At Month 6, this figure was 40.9% (30.4% of males and 52.4% of females). There was a significant improvement in perception of health among females between Month 1 and Month 6. Relatives presented similar DTS scores at baseline and at 6 months.
We verified that rates of PTSD did not vary substantively between the two evaluations. PTSD symptoms positively correlated with psychological health involvement. This correlation points out that both PTSD symptoms and subjective general health involvement are part of the psychological response to trauma.
The prevalence of PTSD symptoms was high and remained stable between Month 1 and Month 6, while subjective perception of health improved significantly.
Parasomnias are a category of sleep disorders in which abnormal events occur during sleep, due to inappropriately timed activation of physiological systems.
we report the case of a 41-year-old female who has no psychiatric history. The patient went to emergency department because when she was starting to sleep, in the first state of sleep, she felts a sensation of paralysis in all her body, with incapacity for breathing, chest oppression and tactile hallucinations like something or someone was touching her entire body. Due to that, the patient awoke frightened, with high levels of anxiety, with heart palpitations, shortness of breath, trembling, choking feeling, sweating, nausea and fear of dying. When the patient arrived to the emergency department, she was suffering a panic attack, thinking that she could have some kind of neurological disease or she was suffering a heart attack. after treating the panic attack with 1 mg of lorazepam, all the symptoms subsided gradually.
in this case report, we present a patient with a new-onset parasomnia, with hypnagogic hallucinations and a panic attack at the awakening. It is known that stress factors are closely associated with parasomnias, as we can see in this case because the patient was moving and she was sleeping in a new place.
Parasomnias are very frequently present in general population and they can trigger intense anxiety status that can lead to panic attacks.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Adaptation to climate change has traditionally been framed as a local problem. However, in recent years, adaptation has risen on the global policy agenda. This article contributes to the study of transnational climate adaptation through an investigation of international connectivity on climate adaptation between regional policy-makers. We examine the RegionsAdapt initiative, the first global commitment to promote and track the progress of regional adaptation. While adapting to climate change at the regional level is crucial, we suggest that transnational adaptation governance not only helps to promote adaptation measures, but also improves the process of tracking the progress of such action, its visibility and its aggregation.
The objective of this study was to evaluate the relationship between muscle mitochondrial function and residual feed intake (RFI) in growing beef cattle. A 56-day feeding trial was conducted with 81 Angus × Hereford steers (initial BW = 378 ± 43 kg) from the University of California Sierra Foothills Research Station (Browns Valley, CA, USA). All steers were individually fed the same finishing ration (metabolizable energy = 3.28 Mcal/kg DM). Average daily gain (ADG), DM intake (DMI) and RFI were 1.82 ± 0.27, 8.89 ± 1.06 and 0.00 ± 0.55 kg/day, respectively. After the feeding trial, the steers were categorized into high, medium and low RFI groups. Low RFI steers consumed 13.6% less DM (P < 0.05) and had a 14.1% higher G : F ratio (P < 0.05) than the high RFI group. No differences between RFI groups were found in age, ADG or BW (P > 0.10). The most extreme individuals from the low and high RFI groups were selected to assess mitochondrial function (n = 5 low RFI and n = 6 high RFI). Mitochondrial respiration was measured using an oxygraph (Hansatech Instruments Ltd., Norfolk, UK). State 3 and State 4 respiration rates were similar between both groups (P > 0.10). Respiratory control ratios (RCRs, i.e., State 3 : State 4 oxygen uptakes) declined with animal age and were greater in low RFI steers (4.90) as compared to high RFI steers (4.26) when adjusted for age by analysis of covariance (P = 0.003). Mitochondrial complex II activity levels per gram of muscle were 42% greater in low RFI steers than in high RFI steers (P = 0.004). These data suggest that skeletal muscle mitochondria have greater reserve respiratory capacity and show greater coupling between respiration and phosphorylation in low RFI than in high RFI steers.
The aim of this study was to test the hypotheses that differences in residual feed intake (RFI) of beef steers are related to diet sorting, diet nutrient composition, energy intake and apparent digestibility. To phenotype steers for RFI, 69 weaned Angus × Hereford steers were fed individually for 56 days. A finishing diet was fed twice daily on an ad libitum basis to maintain approximately 0.5 to 1.0 kg refusals. Diet offered and refused was measured daily, and DM intakes (DMI) were calculated by difference. Body weights were recorded at 14-day intervals following an 18-h solid feed withdrawal. The residual feed intake was determined as the residual of the regression of DMI versus mid-test metabolic BW (BW0.75) and average daily gain (ADG). Particle size distributions of diet and refusals were determined using the Penn State Particle Separator to quantify diet sorting. Sampling of diet, refusals and feces were repeated in four sampling periods which occurred during weeks 2, 4, 6 and 8 of the study. Particle size distributions of refusals and diet were analyzed in weeks 2, 4 and 6, and sampling for chemical analysis of refusals and feces occurred in all four periods. Indigestible neutral detergent fiber (288 h in situ) was used as an internal marker of apparent digestibility. We conclude that preference for the intakes of particles > 19 mm and 4 to 8 mm were negatively correlated to RFI and ADG, respectively. Although steers did sort to consume a different diet composition than offered, diet sorting did not impact intake energy, digestible energy or DM digestibility.
There is a long history of exploitation of the South American river turtle Podocnemis expansa. Conservation efforts for this species started in the 1960s but best practices were not established, and population trends and the number of nesting females protected remained unknown. In 2014 we formed a working group to discuss conservation strategies and to compile population data across the species’ range. We analysed the spatial pattern of its abundance in relation to human and natural factors using multiple regression analyses. We found that > 85 conservation programmes are protecting 147,000 nesting females, primarily in Brazil. The top six sites harbour > 100,000 females and should be prioritized for conservation action. Abundance declines with latitude and we found no evidence of human pressure on current turtle abundance patterns. It is presently not possible to estimate the global population trend because the species is not monitored continuously across the Amazon basin. The number of females is increasing at some localities and decreasing at others. However, the current size of the protected population is well below the historical population size estimated from past levels of human consumption, which demonstrates the need for concerted global conservation action. The data and management recommendations compiled here provide the basis for a regional monitoring programme among South American countries.
The application of clay minerals in therapeutics is becoming important due to their structural and surface physicochemical properties. 5-aminosalicylic acid (5-ASA) is a very common pharmaceutical drug and is used worldwide. The interactions between the 5-ASA molecule and both the aluminol and siloxane surfaces of kaolinite are studied by means of atomistic calculations using force fields based on empirical interatomic potentials and quantum mechanics calculations based on density functional theory. A conformational analysis of 5-ASA has been performed and the anion of 5-ASA was also studied. The calculated adsorption energy values indicate that 5-ASA is likely to be adsorbed on the kaolinite surfaces with greater affinity to the aluminol surface. Hence, kaolinite may be considered as a promising pharmaceutical carrier of 5-ASA.
There has been much recent excitement about the possibility that some cases of psychosis may be wholly due to brain-reactive antibodies, with antibodies to N-methyl-D-aspartate receptor (NMDAR) and the voltage-gated potassium channel (VGKC)-complex reported in a few patients with first-episode psychosis (FEP).
Participants were recruited from psychiatric services in South London, UK, from 2009 to 2011 as part of the Genetics and Psychosis study. We conducted a case–control study to examine NMDAR and VGKC-complex antibody levels and rates of antibody positivity in 96 patients presenting with FEP and 98 controls matched for age and sex. Leucine-rich glioma inactiviated-1 (LGI1) and contactin-associated protein (CASPR) antibodies were also measured. Notably, patients with suspicion of organic disease were excluded.
VGKC-complex antibodies were found in both cases (n = 3) and controls (n = 2). NMDAR antibody positivity was seen in one case and one control. Either LGI1-Abs or CASPR2-Abs were found in three cases and three controls. Neuronal antibody staining, consistent with the above results or indicating potential novel antigens, was overall positive in four patients but also in six controls. Overall, antibody positivity was at low levels only and not higher in cases than in controls.
This case–control study of the prevalence of antibodies in FEP does not provide evidence to support the hypothesis that FEP is associated with an immune-mediated process in a subgroup of patients. Nevertheless, as other bio-clinical factors may influence the effect of such antibodies in a given individual, and patients with organic neurological disease may be misdiagnosed as FEP, the field requires more research to put these findings in context.
Knowledge of tissue and cuts growth depending on the sex could be used to improve performance and efficiency. Computed tomography (CT) is a non-invasive technology that enables the study of the body composition of live animals during growth. The aims of the present study were (1) to evaluate variation in the body composition of four sex types (SEX) of pigs (castrated males (CM), immunocastrated males (IM), entire males (EM) and females (FE)) at the live weight of 30, 70, 100 and 120 kg, assessed using CT; (2) to model the growth of the main tissues and cuts; and (3) to predict the mature BW (MBW) of the four SEX and establish the relationships between the growth models and the MBW. There were significant phenotypic differences in the allometric growth of fat and lean among SEX. For the lean tissue, FE and EM showed higher values of the b coefficient than CM and IM (1.07 and 1.07 v. 1.00 and 1.02, respectively) all of them close to unity, indicating a proportional growth rate similar to live weight and that this tissue developed faster in FE and EM than in CM and IM. However, these differences were not related to differences in estimated MBW. There were significant differences in estimated MBW among SEX, being higher in IM and EM than in CM and FE (303 and 247 v. 219 and 216 kg), however, the MBW may have been overestimated, especially for the IM. The poorer accuracy of the MBW estimate for the IM could be due to a maximum live weight of 120 kg in the experiment, or to the fact that this particular SEX presented two clear behaviours, being more similar to EM from birth to the second injection of the vaccine (130 days) and comparable with CM from that point to the final BW.
Childhood overweight and obesity are worldwide public health problems and risk factors for chronic diseases. The presence of SNP in several genes has been associated with the presence of obesity. A total of 580 children (8–13 years old) from Queretaro, Mexico, participated in this cross-sectional study, which evaluated the associations of rs9939609 (fat mass obesity-associated (FTO)), rs17782313 (melanocortin 4 receptor (MC4R)) and rs6548238 (transmembrane protein 18 (TMEM18)) SNP with obesity and metabolic risk factors. Overweight and obesity prevalence was 19·8 and 19·1 %, respectively. FTO, MC4R and TMEM18 risk allele frequency was 17, 9·8 and 89·5 %, respectively. A significant association between FTO homozygous and MC4R heterozygous risk alleles and obesity was found (OR 3·9; 95 % CI 1·46, 10·22, and OR 2·1; 95 % CI 1·22, 3·71; respectively). The FTO heterozygous subjects showed higher systolic and diastolic blood pressures, compared with the homozygous for the ancestral allele subjects. These results remain significant after considering adiposity as a covariate. The FTO and MC4R genotypes were not significantly associated with total cholesterol, HDL-cholesterol and insulin concentration. No association was found between TMEM18 risk allele and obesity and/or metabolic alterations. Our results show that, in addition to a higher BMI, there is also an association of the risk genotype with blood pressure in the presence of the FTO risk genotype. The possible presence of a risk genotype in obese children must be considered to offer a more comprehensive therapeutic approach in order to delay and/or prevent the development of chronic diseases.
Several databases of written language exist in Spanish that manage important information on the lexical and sublexical characteristics of words. However, there is no database with information on the productivity and frequency of use of derivational suffixes: sublexical units with an essential role in the formation of orthographic representations and lexical access. This work examines these two measures, known as type and token frequencies, for a series of 50 derivational suffixes and their corresponding orthographic endings. Derivational suffixes are differentiated from orthographic endings by eliminating pseudoaffixed words from the list of orthographic endings (cerveza [beer] is a simple word despite its ending in -eza). We provide separate data for child and adult populations, using two databases commonly accessed by psycholinguists conducting research in Spanish. We describe the filtering process used to obtain descriptive data that will provide information for future research on token and type frequencies of morphemes. This database is an important development for researchers focusing on the role of morphology in lexical acquisition and access.
Traditional views of Neanderthal hunting strategies envisage them preying on herd species such as bison and deer, rather than the sophisticated tracking of solitary animals. Analysis of faunal remains from El Esquilleu Cave in northern Spain, however, demonstrates that during certain periods of the Middle Palaeolithic occupation, Neanderthals focused on the hunting of ibex and chamois, small solitary species that inhabited the mountainous terrain around the site. These results indicate that Neanderthal hunting practices may have had more similarity to those of their Upper Palaeolithic relatives than is usually assumed.