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While there are accepted triage and treatment guidelines for the entrapped and mangled extremity in civilian and military resource rich environments, there are none for resource-scarce environments.
A PRISMA systematic literature review was performed to elucidate the current triage and treatment of the entrapped and mangled extremity to understand the factors that contribute to the decision to amputate, or not amputate, and to extract data to develop clinical guidelines.
A lead researcher followed the PRISMA systematic literature review search strategy inclusion and exclusion criteria.
A first reviewer was randomly assigned sources. One of the two lead researchers was the second reviewer. Each determined the Level of Evidence (LOE) and Quality of Evidence (QE) from each source.
Five-hundred ninety-seven (597) records were screened. Fifty-eight (58) articles were entered into the final study. There was one study determined to be LOE-1, 29 LOE-2, and 28 LOE-3 with 15 determined to achieve QE-1, 37 QE-2, and six QE-3.
Data extracted included relevant information to develop clinical guidelines to include physiologic parameters, injury patterns or procedures, imaging, rehabilitation, ethics, and the informed consent process.
This systematic literature review showed that there is a lack of studies producing strong evidence to support the triage and treatment of an entrapped or mangled extremity in resource-scarce environments. A Delphi method study is suggested to adapt and modify available evidence extracted to create clinical guidelines in the resource-scarce environment.
Fifty years of deforestation in the Arc of Deforestation have put at risk species survival, ecosystem services and the stability of biogeochemical cycles in Amazonia, with global repercussions. In response, we need to understand the diversity, distribution and abundance of flagship species groups, such as primates, which can serve as umbrella species for broad biodiversity conservation strategies and help mitigate climate change. Here we identify the range, suitable habitat areas and population size of Vieira's titi monkey Plecturocebus vieirai and use it as an emblematic example to discuss biodiversity conservation and climate change mitigation in one of the largest deforestation frontiers. Our findings show that deforestation for agriculture and cattle-ranching expansion is the major threat to P. vieirai and is responsible for present (56%) and projected (14%) reductions in habitat area and population size. We also found that human-driven climate change affects the P. vieirai niche negatively, triggering habitat degradation and further population decline even inside protected areas. Primate watching can be a profitable alternative to forest exploitation on private, public or Indigenous lands in the Arc of Deforestation and is a way to shift the traditional, predatory extraction of natural resources from Amazonia towards sustainable land use based on biodiversity conservation at local, regional and global scales, local people's welfare and climate change mitigation. New models of land use and income generation are required to protect the unique natural and human heritages of the Arc of Deforestation and the life-supporting ecosystem services and products provided by Amazonia.
The discovery of new clear windows in the Galactic plane using the VVV near-IR extinction maps allows the study of the structure of the Milky Way (MW) disk. The ultimate goal of this work is to map the spiral arms in the far side of the MW, which is a relatively unexplored region of our Galaxy, using red clump (RC) giants as distance indicators. We search for near-IR clear windows located at low Galactic latitudes (
deg) in the MW disk using the VVV near-IR extinction maps. We have identified two new windows named VVV WIN 1607–5258 and VVV WIN 1475–5877, respectively, that complement the previously known window VVV WIN 1713–3939. We analyse the distribution of RC stars in these three clear near-IR windows and measure their number density along the line of sight. This allows us to find overdensities in the distribution and measure their distances along the line of sight. We then use the VVV proper motions in order to measure the kinematics of the RC stars at different distances. We find enhancements in the distance distribution of RC giants in all the studied windows, interpreting them as the presence of spiral arms in the MW disk. These structures are absent in the current models of synthetic population for the same MW lines of sight. We were able to trace the end of the Galactic bar, the Norma arm, as well as the Scutum–Centaurus arm in the far disk. Using the VVV proper motions, we measure the kinematics for these Galactic features, confirming that they share the bulk rotation of the Galactic disk.
The use of internet among children and adolescent has risen in the last decade. In addition, suicide is the second cause of death among adolescents. Previous research have indicated the relation between Problematic Internet Use (PIU) and different mental health problems. Nonetheless there is a lack of studies analyzing the relation between suicide behaviour and PIU
The main objective of the present work was to analyze the relation between Problematic Internet Use and suicide behaviour and depression in adolescents
A total of 1036 adolescents (450 males) were randomly selected. Mean age was 15,21 (SD = 1,23). The Adolescent Behavioural Suicide Scale SENTIA, The Reynolds Adolescent Depression Scale Short Form (RADS-SF), and The Compulsive Internet Use Scale (CIUS) were used. A Manova was performed with two groups (risk and non-risk to PIU) as independent variables and suicide and depression scores as dependent variables
The results revealed a statiscally signifficant association between PIU and both depression and suicide behaviour (λ = 0.245, F(2,81,000) = 15.549, P ≤ 0.001, η² = 0.116). In particular, adolescents at a higher risk for PIU obtained higher scores on suicide behaviours and depression.
Results found in the present study reveal that adolescents have moderate prevalence rates for PIU. Also adolescents at risk for PIU with a total of more than 3 hour sof internet use everyday were at a higher risk for suicide. Prevention strategies should be devote to intervene in internet use as it maybe a variable affecting suicide behaviour.
In porcine in vitro production (IVP) systems, the use of oocytes derived from prepubertal gilts, whilst being commercially attractive, remains challenging due to their poor developmental competence following in vitro maturation (IVM). Follicular fluid contains important growth factors and plays a key role during oocyte maturation; therefore, it is a common supplementation for porcine IVM medium. However, follicular fluid contains many poorly characterized components, is batch variable, and its use raises biosecurity concerns. In an effort to design a defined IVM system, growth factors such as cytokines have been previously tested. These include leukaemia inhibitory factor (LIF), fibroblast growth factor 2 (FGF2), and insulin-like growth factor 1 (IGF1), the combination of which is termed ‘FLI’. Here, using abattoir-derived oocytes in a well established porcine IVP system, we compared follicular fluid and FLI supplementation during both IVM and embryo culture to test the hypothesis that FLI can substitute for follicular fluid without compromising oocyte nuclear and cytoplasmic maturation. We demonstrate that in oocytes derived from prepubertal gilts, FLI supplementation enhances oocyte meiotic maturation and has a positive effect on the quality and developmental competence of embryos. Moreover, for the first time, we studied the effects of follicular fluid and FLI combined showing no synergistic effects.
Disasters may have major impacts to mental health and to the utilization of mental health services (MHS). Moreover, these effects may be worsened by the preclusion of access to basic services following the event. The aim of this study is to evaluate the utilization of public MHS by the population that suffered water supply interruption following the Mariana Dam Failure in Brazil, 2015.
We conducted an Interrupted Time Series analyzing secondary health data from the municipalities that faced water supply interruption, comparing it to data from the other municipalities of Minas Gerais state.
We found a higher immediate (RR: 1.78; 95% CI: 1.25–2.53) and gradual (RR: 1.05; 95% CI: 1.03–1.06) change in the rate of mental health visits (MHV) in the affected population following the event, whereas there was an immediate fall (RR: 0.41; 95% CI: 0.29–0.59) followed by a higher gradual increase (RR: 1.04; 95% CI: 1.02–1.06) in the rate of hospital admissions (HA) in the affected population.
The results suggest that there was an increase in the utilization of public MHS by the population that suffered water supply interruption following the disaster.
To investigate a cluster of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in employees working on 1 floor of a hospital administration building.
Contact tracing was performed to identify potential exposures and all employees were tested for SARS-CoV-2. Whole-genome sequencing was performed to determine the relatedness of SARS-CoV-2 samples from infected personnel and from control cases in the healthcare system with coronavirus disease 2019 (COVID-19) during the same period. Carbon dioxide levels were measured during a workday to assess adequacy of ventilation; readings >800 parts per million (ppm) were considered an indication of suboptimal ventilation. To assess the potential for airborne transmission, DNA-barcoded aerosols were released, and real-time polymerase chain reaction was used to quantify particles recovered from air samples in multiple locations.
Between December 22, 2020, and January 8, 2021, 17 coworkers tested positive for SARS-CoV-2, including 13 symptomatic and 4 asymptomatic individuals. Of the 5 cluster SARS-CoV-2 samples sequenced, 3 were genetically related, but these employees denied higher-risk contacts with one another. None of the sequences from the cluster were genetically related to the 17 control sequences of SARS-CoV-2. Carbon dioxide levels increased during a workday but never exceeded 800 ppm. DNA-barcoded aerosol particles were dispersed from the sites of release to locations throughout the floor; 20% of air samples had >1 log10 particles.
In a hospital administration building outbreak, sequencing of SARS-CoV-2 confirmed transmission among coworkers. Transmission occurred despite the absence of higher-risk exposures and in a setting with adequate ventilation based on monitoring of carbon dioxide levels.
Longitudinal data on the mental health impact of the coronavirus disease 2019 (Covid-19) pandemic in healthcare workers is limited. We estimated prevalence, incidence and persistence of probable mental disorders in a cohort of Spanish healthcare workers (Covid-19 waves 1 and 2) -and identified associated risk factors.
8996 healthcare workers evaluated on 5 May–7 September 2020 (baseline) were invited to a second web-based survey (October–December 2020). Major depressive disorder (PHQ-8 ≥ 10), generalised anxiety disorder (GAD-7 ≥ 10), panic attacks, post-traumatic stress disorder (PCL-5 ≥ 7), and alcohol use disorder (CAGE-AID ≥ 2) were assessed. Distal (pre-pandemic) and proximal (pandemic) risk factors were included. We estimated the incidence of probable mental disorders (among those without disorders at baseline) and persistence (among those with disorders at baseline). Logistic regression of individual-level [odds ratios (OR)] and population-level (population attributable risk proportions) associations were estimated, adjusting by all distal risk factors, health care centre and time of baseline interview.
4809 healthcare workers participated at four months follow-up (cooperation rate = 65.7%; mean = 120 days s.d. = 22 days from baseline assessment). Follow-up prevalence of any disorder was 41.5%, (v. 45.4% at baseline, p < 0.001); incidence, 19.7% (s.e. = 1.6) and persistence, 67.7% (s.e. = 2.3). Proximal factors showing significant bivariate-adjusted associations with incidence included: work-related factors [prioritising Covid-19 patients (OR = 1.62)], stress factors [personal health-related stress (OR = 1.61)], interpersonal stress (OR = 1.53) and financial factors [significant income loss (OR = 1.37)]. Risk factors associated with persistence were largely similar.
Our study indicates that the prevalence of probable mental disorders among Spanish healthcare workers during the second wave of the Covid-19 pandemic was similarly high to that after the first wave. This was in good part due to the persistence of mental disorders detected at the baseline, but with a relevant incidence of about 1 in 5 of HCWs without mental disorders during the first wave of the Covid-19 pandemic. Health-related factors, work-related factors and interpersonal stress are important risks of persistence of mental disorders and of incidence of mental disorders. Adequately addressing these factors might have prevented a considerable amount of mental health impact of the pandemic among this vulnerable population. Addressing health-related stress, work-related factors and interpersonal stress might reduce the prevalence of these disorders substantially. Study registration number: NCT04556565
Direct numerical simulations are carried out to study the effect of finite Weissenberg number up to $Wi=16$ on laminar and turbulent channel flows of an elastoviscoplastic (EVP) fluid, at a fixed bulk Reynolds number of $2800$. The incompressible flow equations are coupled with the evolution equation for the EVP stress tensor by a modified Saramito model that extends both the Bingham viscoplastic and the finite extensible nonlinear elastic-Peterlin (FENE-P) viscoelastic models. In turbulent flow, we find that drag decreases with both the Bingham and Weissenberg numbers, until the flow laminarises at high enough elastic and yield stresses. Hence, a higher drag reduction is achieved than in the viscoelastic flow at the same Weissenberg number. The drag reduction persists at Bingham numbers up to 20, in contrast to viscoplastic flow, where the drag increases in the laminar regime compared with a Newtonian flow. Moreover, elasticity affects the laminarisation of an EVP flow in a non-monotonic fashion, delaying it at lower and promoting it at higher Weissenberg numbers. A hibernation phenomenon is observed in the EVP flow, leading to large changes in the unyielded regions. Finally, plasticity is observed to affect both low- and high-speed streaks equally, attenuating the turbulent dissipation and the fragmentation of turbulent structures.
A chloroacetamide herbicide by application timing factorial experiment was conducted in 2017 and 2018 in Mississippi to investigate chloroacetamide use in a dicamba-based Palmer amaranth management program in cotton production. Herbicides used were S-metolachlor or acetochlor, and application timings were preemergence, preemergence followed by (fb) early postemergence, preemergence fb late postemergence, early postemergence alone, late postemergence alone, and early postemergence fb late postemergence. Dicamba was included in all preemergence applications, and dicamba plus glyphosate was included with all postemergence applications. Differences in cotton and weed response due to chloroacetamide type were minimal, and cotton injury at 14 d after late postemergence application was less than 10% for all application timings. Late-season weed control was reduced up to 30% and 53% if chloroacetamide application occurred preemergence or late postemergence only, respectively. Late-season weed densities were minimized if multiple applications were used instead of a single application. Cotton height was reduced by up to 23% if a single application was made late postemergence relative to other application timings. Chloroacetamide application at any timing except preemergence alone minimized late-season weed biomass. Yield was maximized by any treatment involving multiple applications or early postemergence alone, whereas applications preemergence or late postemergence alone resulted in up to 56% and 27% yield losses, respectively. While no yield loss was reported by delaying the first of sequential applications until early postemergence, forgoing a preemergence application is not advisable given the multiple factors that may delay timely postemergence applications such as inclement weather.
Brain research in Europe is a rapidly evolving field, and increasingly at the forefront of science. Although considerable amounts of knowledge and innovative approaches have been generated, the translation into new health interventions is hindered by excessive fragmentation. Effective and efficient collaboration and cooperation among the various initiatives are often identified as a key success factor to achieve brain research full impact. EBRA fully responds to these needs by bringing together the various stakeholders and major brain research initiatives, at European level and beyond. EBRA creates the conditions for real and effective cross fertilisation, dialogue, building consensus and exploiting research potential. On the operational level, EBRA facilitates the emergence of research projects in specific areas in active clusters. A cluster is understood as a research community that can be directed towards basic research, clinical research and/or methodological approaches under a common topic and disease area within brain research. EBRA support clusters to: 1. Consolidate or expand further the research community expand their community, 2. Engage with policy makers and other relevant stakeholders, 3. Build consensus on various issues (research priorities, research roadmap, data sharing, etc.), 4. Promote links with existing research infrastructures, 5. Increase the visibility of the research community through communication and dissemination activities, 6. Coordinate the development of position/consensus papers, white papers, guidelines, meeting reports and/or other cluster outcomes. EBRA currently has 6 existing clusters: EPICLUSTER, Prevention of Severe Mental Disorders (PSMD)-cluster, TRISOMY21-cluster, BRAINFOOD-cluster., PREMOS-cluster and ECIB-cluster.
Brain research in Europe is a rapidly evolving field, and increasingly at the forefront of science. Although considerable amounts of knowledge and innovative approaches have been generated, the translation into new health interventions is hindered by excessive fragmentation. Effective and efficient collaboration and cooperation among the various initiatives are often identified as a key success factor to achieve brain research full impact. EBRA fully responds to these needs by bringing together the various stakeholders and major brain research initiatives, at European level and beyond. EBRA creates the conditions for real and effective cross fertilisation, dialogue, building consensus and exploiting research potential. At the strategic level, EBRA acts by fostering alignment and better coordination of research strategies across European and global brain initiatives. Therefore, an overview of the scale and scope of brain research activities funded in the EU framework programme and the funding initiatives of JPND, NEURON and HBP has been created. The results of the mapping exercise then underpinned the development of a Shared European Brain Research Agenda (SEBRA). The SEBRA focuses on research opportunities and research gaps to be addressed in the field, and priorities for action in the short- and long-term. It integrates pre-existing documents as well as expert (i.e., researchers, neurologists/psychiatrists, patient representatives) input that has been collected through surveys and in a dedicated expert workshop. The SEBRA will be used to provide recommendations on future areas for excellent, innovative, and translational research comprising those for maximized cooperation, reduced overlap, and fragmentation.
The paper presents the results of one international study due by our team in the period of restrictions imposed by Covid-19, between March and June 2020.
To inform the population about the risks concerning the excessiv use of internet To prevent the effects of those behaviors which affects the global functioning of individuals
Questionnaire applied to a number of 549 subjects, 18 to 60 years old, 217 from Romania and 332 from other European and Asian countries
The results allowed us to verify the assumption that there is a change in communications needs of individuals, as well gender and age differences in terms of time spent on the internet during the covid period.
The issue of psycho-education regarding the awareness of dangers and the traps of the virtual era remain relevant.
An accurate estimate of the average number of hand hygiene opportunities per patient hour (HHO rate) is required to implement group electronic hand hygiene monitoring systems (GEHHMSs). We sought to identify predictors of HHOs to validate and implement a GEHHMS across a network of critical care units.
Multicenter, observational study (10 hospitals) followed by quality improvement intervention involving 24 critical care units across 12 hospitals in Ontario, Canada.
Critical care patient beds were randomized to receive 1 hour of continuous direct observation to determine the HHO rate. A Poisson regression model determined unit-level predictors of HHOs. Estimates of average HHO rates across different types of critical care units were derived and used to implement and evaluate use of GEHHMS.
During 2,812 hours of observation, we identified 25,417 HHOs. There was significant variability in HHO rate across critical care units. Time of day, day of the week, unit acuity, patient acuity, patient population and use of transmission-based precautions were significantly associated with HHO rate. Using unit-specific estimates of average HHO rate, aggregate HH adherence was 30.0% (1,084,329 of 3,614,908) at baseline with GEHHMS and improved to 38.5% (740,660 of 1,921,656) within 2 months of continuous feedback to units (P < .0001).
Unit-specific estimates based on known predictors of HHO rate enabled broad implementation of GEHHMS. Further longitudinal quality improvement efforts using this system are required to assess the impact of GEHHMS on both HH adherence and clinical outcomes within critically ill patient populations.
Several recent reports have raised concern that infected coworkers may be an important source of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) acquisition by healthcare personnel. In a suspected outbreak among emergency department personnel, sequencing of SARS-CoV-2 confirmed transmission among coworkers. The suspected 6-person outbreak included 2 distinct transmission clusters and 1 unrelated infection.