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The coronavirus disease 2019 (COVID-19) has rapidly spread worldwide, leading to increased concerns about long-term patients’ neuropsychiatric morbidity. Currently, there is still few data regarding mental health after hospital discharge of severe COVID-19 elderly patients. Considering this, the present study aims to characterize the neuropsychiatric morbidity in old severe COVID-19 patients.
In the context of an ongoing multidisciplinary research project, this study analyzed a subsample of patients aged ≥60 years, admitted due to COVID-19, during the first wave, in the Intensive Care Medicine Department (ICMD) of a University Hospital in Porto, Portugal. ICMD length of stay (LoS) ≤24h, terminal illness, major auditory loss or inability to communicate at the time of follow- up were used as exclusion criteria. Participants were evaluated by telephone in average 99 (±32) days after being discharged from the hospital, with Six-item Cognitive Impairment Test, PatientHealth Questionnaire and Generalized Anxiety Disorder Scale. Sociodemographic and relevant clinicaldata were obtained from hospital electronic records and clinical interview.
A sample of 39 survivors with a mean age of 70 (±6.3) years old were assessed. The majority were male (62%), married (64%), retired (77%), with low educational level (59%), and 15% lived alone. The average number of comorbidities and the daily medications per patient were 4.7 (±1.7) and 5.5 (±3.5), respectively.
During ICMD stay, 69% had nosocomial infections and 56% delirium. Deep sedation was used in 74% of the patients (mean=30 days) and 74% needed Invasive Mechanical Ventilation. ICMD mean LoS was33 (±28.3) days. Based on follow-up assessment, 18% of survivors had cognitive impairment, whereas23% and 15% had depressive and anxiety symptoms, respectively. A positive and high correlation between depression and anxiety was found (rs=0.792; p<0.001). No significant associations were observed with cognitive impairment.
The presence of this symptomatology may hinder a successful recovery once the patient is discharged back home. This is particularly relevant accruing the strong relationship between depressive and anxious symptoms found in this sample. Therefore, early screening and timely multidisciplinary support interventions to minimize these neuropsychiatric symptoms after discharge should be considered in order to achieve positive health outcomes.
Start-ups tend to form with a central idea that differentiates them from their competitors in the market. It is crucial for them to efficiently transform the idea into a marketable product. Prototyping helps to iteratively achieve a minimum viable product and plays a crucial role by enabling teams to test their ideas with limited resources early on. However, the prototyping process may have wrong focus leading to a suboptimal allocation of resources. Previously, we proposed role-based prototyping for fuzzy front-end development in small teams. It supports (1) resource allocation, (2) the definition of responsibilities, and (3) structuring the development process with milestones. In recent research this was a promising yet incomplete approach. We extend the previous work by refining the prototyping process by adding a prototyping matrix with two dimensions (purpose and lens), a prototyping cycle (plan, execute, test, reflect, assimilate), and a modified Kanban board (Protoban) for planning, managing, and reflecting cycles. This process, named PETRA was tested with a start-up developing an autonomous trash picking robot. The extended approach supported the team significantly in providing a clear idea of what to do at what time.
This is descriptive study of a cohort of patients referred to a liaison psychiatry service from the intensive care department of a major London teaching hospital and trauma centre. The objective was to characterise key patterns in reasons for referral, nature of input, and gain a general sense of the workload. The rationale for collating this information was the consideration to developing a specific intensive care liaison service given the increasing evidence about the cognitive and mental health impacts of post-intensive care syndrome and the need for a coordinated management approach between stakeholders.
A cohort of 80 patients referred to liaison psychiatry service over a 6-month period from May to October 2020 was used. Descriptive statistics were used to characterise the patient's age, referring ward, reason for admission and referral, nature of input, number of reviews, previous engagement with mental health services, whether substance abuse or self-harm were related to the admission, and the destination upon discharge.
The age range of patients at point of referral was 25-80 years. For 25% of patients, this admission marked their first engagement with secondary mental health services and for around 50%, not only was a new diagnosis given during the admission, but there was no recorded history of any psychiatric diagnoses. Around 10% of patients were referred for management of delirium. Anxiety disorder accounted for the greatest proportion of diagnoses upon discharge, at 22%. There was much variability in the number of intensive care ward reviews carried out, ranging from one to over 10.
In 24%, self-harm led to presentation and 18% had comorbid substance misuse. Medication review was the single most common reason for referral in 13%, whereas requests for talking therapy and capacity assessments were 5% and 2% respectively. The vast majority of patients required a level of ongoing psychiatric input warranting community involvement or admission.
This cohort often required detailed work-ups, new diagnoses and a high level of subsequent psychiatric management following discharge from hospital. The wide age range of patients meant that both working age and older adult liaison teams were involved in assessing referrals. Consideration could be given to a specific intensive-care liaison service due to the workload and complexity of needs, as well as the increasing awareness of the need for family support and early inclusion both for their benefit and that of the patient, particularly when the proportion of new diagnoses in this cohort is considered.
Attention-deficit/hyperactivity disorder (ADHD) is a common and highly heritable neurodevelopmental disorder (NDD). In this narrative review, we summarize recent advances in quantitative and molecular genetic research from the past 5–10 years. Combined with large-scale international collaboration, these advances have resulted in fast-paced progress in understanding the etiology of ADHD and how genetic risk factors map on to clinical heterogeneity. Studies are converging on a number of key insights. First, ADHD is a highly polygenic NDD with a complex genetic architecture encompassing risk variants across the spectrum of allelic frequencies, which are implicated in neurobiological processes. Second, genetic studies strongly suggest that ADHD diagnosis shares a large proportion of genetic risks with continuously distributed traits of ADHD in the population, with shared genetic risks also seen across development and sex. Third, ADHD genetic risks are shared with those implicated in many other neurodevelopmental, psychiatric and somatic phenotypes. As sample sizes and the diversity of genetic studies continue to increase through international collaborative efforts, we anticipate further success with gene discovery, characterization of how the ADHD phenotype relates to other human traits and growing potential to use genomic risk factors for understanding clinical trajectories and for precision medicine approaches.
Liquid foams are, amongst other applications, used to mitigate shock waves. This aspect has received considerable attention at the macroscopic scale. However, the interaction between foam films and shock waves is still poorly understood and may be an important missing local information to build mitigation models. In this paper, we experimentally identify a new process leading to the foam film rupture, which dominates when the film thickness is sufficiently heterogeneous. Using a two-thickness film with a sharp and localised thickness gradient, we record the deformation of the interface between the thick and the thin parts. We observe the growth of an excess liquid area in the thin part and establish an analytical model and scaling laws which account for this phenomenon. Our results in this ideal configuration are consistent with actual rupture processes at stake in heterogeneous foam films.
Transdiagnostic group cognitive-behavioral therapy (tCBT) is a delivery model that could help overcome barriers to large-scale implementation of evidence-based psychotherapy for anxiety disorders. The aim of this study was to assess the effectiveness of combining group tCBT with treatment-as-usual (TAU), compared to TAU, for the treatment of anxiety disorders in community-based mental health care.
In a multicenter single-blind, two-arm pragmatic superiority randomized trial, we recruited participants aged 18–65 who met DSM-5 criteria for principal diagnoses of generalized anxiety disorder, social anxiety disorder, panic disorder, or agoraphobia. Group tCBT consisted of 12 weekly 2 h sessions. There were no restrictions for TAU. The primary outcome measures were the Beck Anxiety Inventory (BAI) and clinician severity rating from the Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5) for the principal anxiety disorder at post-treatment, with intention-to-treat analysis.
A total of 231 participants were randomized to either tCBT + TAU (117) or TAU (114), with outcome data available for, respectively, 95 and 106. Results of the mixed-effects regression models showed superior improvement at post-treatment for participants in tCBT + TAU, compared to TAU, for BAI [p < 0.001; unadjusted post-treatment mean (s.d.): 13.20 (9.13) v. 20.85 (10.96), Cohen's d = 0.76] and ADIS-5 [p < 0.001; 3.27 (2.19) v. 4.93 (2.00), Cohen's d = 0.79].
Our findings suggest that the addition of group tCBT into usual care can reduce symptom severity in patients with anxiety disorders, and support tCBT dissemination in routine community-based care.
Premature mortality affects the economy directly due to the loss of productivity of individuals who die, thus ceasing to contribute economically to the country. The one-third reduction in premature mortality (30–69 years) from chronic noncommunicable diseases is goal 3.4 of the United Nations Sustainable Development Goals (UN SDG). Although cancer is a chronic disease, it comprises more than 100 different conditions, with different risk factors and prognosis. This study aimed to calculate current and predicted premature mortality by 2030 for Brazil and regions, compared with the SDG 3.4 target and identify regional progress and future needs.
Mortality data were extracted from the National Mortality Information System of Brazil (SIM) and subsequently corrected for ill-defined causes. Crude and age-standardized mortality rates per 100,000 inhabitants were calculated. NordPred package by software R was used to calculate predictions up to 2030 and compared with the goal of one-third reduction of premature deaths.
Comparison of observed (2011–2015) and predicted (2026–2030) mortality rates show a 12.0% reduction in the likelihood of death among men and 4.6 percent among women nationally. Although predicted rates for 2026–2030 are lower than those observed in 2011–2015, the predicted number of deaths increases by 75,341 for men and 90,513 for women. Lung cancer mortality rates are predicted to decrease more among men than women, while colorectal cancer mortality will increase for both sexes.
The profile of cancer premature mortality is diverse in Brazil. Nationally, only male lung cancer will be close to reaching the SDG 3.4 target, endorsing the government's long-term efforts to reduce tobacco consumption. Colorectal cancer mortality increases in most regions, reflecting the epidemiological transition. Despite progress in cervical cancer control, it will continue to be a major challenge, especially in the North and Northeast. Our results provide a baseline for public policies for both prevention and access to treatment to reduce premature mortality in Brazil. Differences in cancer patterns show the need to plan and to adapt regionally for each reality.
Early death from cancer is potentially preventable. In developing countries, it is not only a human tragedy but also an economic tragedy. In Latin America and the Caribbean, the estimated number of deaths for people 15–64 years in 2018 was 262,141, with Brazil being the country with the largest number of cases in the region (38.2%). The mortality rate for cancer in Brazil was 68.7/100,000. The analysis of causes impacting premature mortality is an essential function of public health surveillance. This study aims to estimate Potential Productive Life Years of Lost (YPPLL) due to cancer from 2000 to 2016, according to the region, sex and cancer site.
Official data from the Brazilian government were used for the period 2000–2016 for the 15–64 age group (economically active population). For each cancer death in working-age people, potential years of productive life lost (YPPLL) were calculated as the difference between pensionable age and age at death from cancer (based on the age group mid-point). The limit considered as pensionable age was 65 years for men and 60 years for women.
The total of cancer deaths among working-age people was 61,547 in 2000 and increased to 93,551 in 2016. The correspondent YPPLL was 717,883 and 944,565, respectively (increase of 31.6%), mostly coming from males (56.8%). Highest individual YPPLL were observed in the North and Northeast and Midwest, for both sexes. The most substantial changes observed from 2000 to 2016 in total YPPLL were for colorectal cancer, which moved from sixth to the second position nationally.
The YPPLL due to cancer is increasing in Brazil and present different patterns by sex and geographic regions. While in the South and Southeast lung cancer has the highest impact among males, in the North and Northeast most YPPLL come from stomach cancer. Among females, a clear pattern is observed with breast cancer being responsible for most YPPLL excepting in the North, where cervical cancer still having a major impact compared to other tumors.
Colonization by fouling organisms is a problem that has challenged operators of ships since humans first took to the seas. Reducing or preventing the fouling of a ship’s hull is important to allow the vessel to pass efficiently through the water. For centuries, fouling has been controlled through the application of a coating that discourages fouling organisms. As early as the third century there are reports of the Greeks using tar and wax to coat ships’ hulls, and as early as the sixteenth century there are reports of copper sheathing or mixtures containing arsenic being used as anti-fouling (AF) coatings on wooden ships. Many of these and the AF solutions that followed were based on the presence of a toxin in the paint to deter organisms from colonizing the painted surface. Cuprous oxide has been used as a biocide since the early nineteenth century and continues to be a common component of modern AF products. The twentieth century saw the introduction of contact leaching AF coatings designed to increase the efficacy and active lifetime of the coating. Typically, these paints contained copper and zinc as the biocidal additives and would be released through dissolution of the painted surface or leaching from an insoluble paint matrix. A major advancement in AF technology was the introduction of self-polishing paints where organotin (OT; typically tributyltin (TBT)) biocides that were incorporated into the paint polymer would allow for controlled release of the biocide as the polymer surface was hydrolyzed. Environmental concerns regarding the use of TBT as an AF biocide saw a ban on its use and the introduction of new, primarily organic biocides, often used alongside other biocides such as copper oxide. A common feature of these coatings has been the release of a biocide(s) into the environment. While modern coatings now aim to be biocide free, AF biocides continue to be developed and introduced onto the market. This chapter provides a comprehensive overview of our understanding of the potential harm caused by biocides released from AF paints applied to ships.
This study focuses on the dolphins populating the water between Gibraltar and Algeciras in the south Iberian Peninsula, an area subjected to pressure due to high human activity. The area is considered an important feeding and breeding ground for common dolphins (Delphinus delphis). Due to the degree of residence of some specimens, and the large gap in knowledge about the evolution of wounds in D. delphis specimens with lacerations, this work sought to perform the following analyses: identify lacerated individuals; characterize sequences of ‘before – during – after’ with respect to the occurrence of lacerations; and associate the type of injury with its severity. This work will inform future studies by expanding a database on injured individuals and contribute to periodical monitoring of specimens that frequent these geographic areas. Between 2013 and 2017, we were able to track the healing process of five injured individuals of common dolphins from a whale-watching platform thanks to photo identification. The animals exhibited fresh external wounds from different sources. In the majority of individuals, the wound-healing processes lasted 3–21 weeks. The frequency with which sightings are made and knowledge about the local population will help track injured animals, follow their wound evolution, and document their survival rates. The documented injuries inflicted by human interactions described in this paper may include fishing interactions and propeller strikes, probably as a consequence of the high intensity of recreational fishing and whale-watching activities in the area.
Increased adiposity, dyslipidemia and insulin resistance are associated with increased risk of developing cardiometabolic diseases (CM). Such deleterious phenotypes have been shown to be associated with a low gene-richness microbiota that can partly be restored by a short-term dietary intervention (energy-restricted high-protein diet, low glycemic index, enrichment with fibers) in parallel to an improvement of CM profile. In this study, we aimed at increasing fiber intake in quantity and diversity through a two-month consumption of bread enriched with a mix of selected fibers and evaluated the impact of this dietary intervention on gut microbiota gene richness and CM risk profile in subjects at risk of developing CM.
Materials and methods
In a randomized double blind cross-over design, thirty-nine subjects with CM risk profile (18–70 years old, BMI: 25–35 kg/m2, waist circumference > 80 cm for women and > 96 cm for men, fiber intake < 20g/day, low fiber diversity) consumed daily for 8 weeks 150 g of standard bread vs. 150 g of bread enriched with a 7-selected fibers mix (5.55 g vs. 16.35 g of fiber respectively; 4-week washout). Gut microbiota and CM risk factors’ analyzes were conducted before and after intervention. Stool samples were analyzed by shotgun metagenomics; microbial genes and metagenomics species (MSP) profiles were generated by mapping reads on a reference genes catalog (1529 MSP).
The included dyslipidemic subjects with CM risk profile presented a lower microbiota gene richness compared to reference healthy cohorts. The two-month consumption of fiber-rich bread did not alter microbiota gene richness but modified microbiota composition with a significant decrease of Bacteroides vulgatus (q = 1.7e-4) and a significant increase of Parabacteroides distasonis (q = 2.8e-6), Fusicatenibacter saccharivorans (q = 5e-5) and Clostridiales (q = 3.8e-2). We observed in parallel a significant decrease in total cholesterol (- 0.26 mmol/L; - 5%; p = 0.021), LDL-cholesterol (- 0.2 mmol/L; - 6%, p = 0.0061) and an improvement of insulin sensibility estimated by HOMA index (3.23–2.54 mUI/L; - 21%; p = 0.0079).These effects were even significantly more pronounced for subjects presenting the higher waist circumference. Anthropometric parameters were not altered.
The enrichment of the diet with a mix of selected fibers for 2 months altered microbiota composition by modifying the relative abundance of specific gut bacterial species, in parallel to a significant improvement of cholesterol and insulin sensitivity parameters. Increasing the quantity and diversity of dietary fiber intake could be used as an efficient tool to favorably impact CM profile.
Birch-bark tar, used continuously in the territory of modern Europe from the Middle Palaeolithic to the Iron Age, is conspicuous by its absence in the archaeological record of the Roman period, suggesting its replacement by conifer-based products. The results of chemical analyses of residues on Roman hinges, however, now challenge this interpretation. The presence of birch-bark tar in most of the samples demonstrates the persistence of a long-established practice into the Roman period. Examined in relation to textual and environmental evidence, these results illuminate the transmission of technical knowledge and the development of long-distance trade networks associated with birch-bark tar.
We present the highlights from our recent study of 22 local (z < 0.025) type-1 LINERs from the Palomar Survey, on the basis of optical long-slit spectroscopic observations taken with TWIN/CAHA, ALFOSC/NOT and HST/STIS. Our goals were threefold: (a) explore the AGN-nature of these LINERs by studying the broad (BLR-originated) Hαλ 6563 component; (b) derive a reliable interpretation for the multiple narrow components of emission lines by studying their kinematics and ionisation mechanism (via standard BPTs); (c) probe the neutral gas in the nuclei of these LINERs for the first time. Hence, kinematics and fluxes of a set of emission lines, from Hβ λ4861 to [SII]λλ 716,6731, and the NaDλλ5890,5896 doublet in absorption have been modelled and measured, after the subtraction of the underlying light from the stellar component.