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The intentional use of drugs before or during sexual intercourse (chemsex) is a phenomenon of special importance in the MSM (men who have sex with men) population due to its impact on mental, physical and sexual health. Sexual health issues related to chemsex practice have been described such as difficulties in achieving sober sex, erectile dysfunction or problems with sexual desire.
To describe the sexual health interventions (including sexual counselling and sexual therapy) for patients with chemsex practices in the NGO Apoyo Positivo in Madrid. We describe the main sexual problems.
The main sexual problems were dissatisfaction in sexual intercourse without substance and difficulties with sexual desire activation (70%); compulsive sexual behaviour (70%), difficulties with sexual orientation and non normative gender expression, difficulties in erection (34%), premature ejaculation (7%) and delayed ejaculation (10%).
Chemsex is a phenomenon that needs a multidisciplinary approach and mental and sexual health must be taken into account. “Sexo, Drogas y Tu” is a model of collaborative approach which is a pioneering intervention developed by an NGO in Spain.
As agricultural areas expand, interactions between wild animals and farmland are increasing. Understanding the nature of such interactions is vital to inform the management of human–wildlife coexistence. We investigated patterns of space use of two Critically Endangered Galapagos tortoise species, Chelonoidis porteri and Chelonoidis donfaustoi, on privately owned and agricultural land (hereafter farms) on Santa Cruz Island, where a human–wildlife conflict is emerging. We used GPS data from 45 tortoises tracked for up to 9 years, and data on farm characteristics, to identify factors that influence tortoise movement and habitat use in the agricultural zone. Sixty-nine per cent of tagged tortoises used the agricultural zone, where they remained for a mean of 150 days before returning to the national park. Large male tortoises were more likely to use farms for longer periods than female and smaller individuals. Tortoises were philopatric (mean overlap of farmland visits = 88.7 ± SE 2.9%), on average visiting four farms and occupying a mean seasonal range of 2.9 ± SE 0.3 ha. We discuss the characteristics of farm use by tortoises, and its implications for tortoise conservation and coexistence with people.
Functional impairment is a defining feature of psychotic disorders. A range of factors has been shown to influence functioning, including negative symptoms, cognitive performance and cognitive reserve (CR). However, it is not clear how these variables may affect functioning in first-episode psychosis (FEP) patients. This 2-year follow-up study aimed to explore the possible mediating effects of CR on the relationship between cognitive performance or specific clinical symptoms and functional outcome.
A prospective study of non-affective FEP patients was performed (211 at baseline and 139 at follow-up). CR was entered in a path analysis model as potential mediators between cognitive domains or clinical symptoms and functioning.
At baseline, the relationship between clinical variables or cognitive performance and functioning was not mediated by CR. At follow-up, the effect of attention (p = 0.003) and negative symptoms (p = 0.012) assessed at baseline on functioning was partially mediated by CR (p = 0.032 and 0.016), whereas the relationship between verbal memory (p = 0.057) and functioning was mediated by CR (p = 0.014). Verbal memory and positive and total subscales of PANSS assessed at follow-up were partially mediated by CR and the effect of working memory on functioning was totally mediated by CR.
Our results showed the influence of CR in mediating the relationship between cognitive domains or clinical symptoms and functioning in FEP. In particular, CR partially mediated the relationship between some cognitive domains or clinical symptoms and functioning at follow-up. Therefore, CR could improve our understanding of the long-term functioning of patients with a non-affective FEP.
San José 520 is a Classic period hamlet of single-family residences in the urban periphery of Teotihuacan, just beyond the southeast edge of the city. Three burial features were associated with one of the residences, AF2. One of the features contained the burial of a single adult, another the successive burials of eight adults and one neonate, and the third held a neonate. We analyzed 29 bone and enamel samples from the adults for bioapatite phosphate oxygen-isotope composition; we also considered isotopic data for another five bone samples analyzed in a separate project. The isotopic results suggest a pattern of birth in the Teotihuacan region and then movement in early childhood to a “relocation” region, the geographic location of which is unknown. Later, probably in adolescence, the individuals returned to live, and eventually die, in San José 520. Without knowing more about the occupation of the relocation region, it is difficult to say what concerns or beliefs underlay this unusual but long-established settlement system.
The giant gypsum crystals of Naica cave have fascinated scientists since their discovery in 2000. Human activity has changed the microclimate inside the cave, making scientists wonder about the potential environmental impact on the crystals. Over the last 9 years, we have studied approximately 70 samples. This paper reports on the detailed chemical–structural characterization of the impurities present at the surface of these crystals and the experimental simulations of their potential deterioration patterns. Selected samples were studied by petrography, optical and electronic microscopy, and laboratory X-ray diffraction. 2D grazing incidence X-ray diffraction, X-ray μ-fluorescence, and X-ray μ-absorption near-edge structure were used to identify the impurities and their associated phases. These impurities were deposited during the latest stage of the gypsum crystal formation and have afterward evolved with the natural high humidity. The simulations of the behavior of the crystals in microclimatic chambers produced crystal dissolution by 1–4% weight fraction under high CO2 concentration and permanent fog, and gypsum phase dehydration under air and CO2 gaseous environment. Our work suggests that most surface impurities are of natural origin; the most significant anthropogenic damage on the crystals is the extraction of water from the caves.
US Army Combat Medics and Navy Combat Corpsmen serve as a critical element of any fighting unit. Their professional responsibilities are for providing the emergency and preventive medical needs of their soldiers with whom they live and serve. These medical professionals are also expected to do any job that maintains the mission of their fighting unit. Because of their importance to sustaining the US fighting forces, Combat Medics may be an ideal group to study because of the high levels of adversity and stress endured while serving both roles. The Medic Mettle Study was established to develop a model of combat stress resilience and a prevention of PTSD. The first step was to identify the psychosocial and bio-behavioral characteristics of combat stress injury. A mixed methods model was utilized and over 700 recently deployed Combat Medics were enrolled. The presentation discusses both the early quantitative results and elaborates on the qualitative interviews conducted with the most resilient combat medics, as nominated by their peers. Preliminary findings of the 16 intensive, videotaped interviews with Combat Medics between war deployments using a Variable Generating Activity (VGA) protocol
(1) found 138 variables that appear to provide some missing pieces in our understanding of combat stress injury and its psychosocial markers;
(2) Identified five variable domains within a nomothetic network of medic resilience;
(3) utility of annual surveys to validate the qualitative findings.
For the first time in Spain, a large scale survey (5205 people) was carried out to establish the real needs of those directly affected by the illness. Patients and caregivers responded to a 9-question survey concerning dimensions: personal, social, medical treatment, psychotherapy and rehabilitation. For patients, the most important need (an average score of 3.5 on a scale of importance from 1 to 4) was to feel their emotional needs covered. The following average scores were also obtained: feel well physically (3.42), improve autonomy (3.41), have leisure activities (3.21) and work/study (3.1). A total of 42% of patients indicated having little or no freedom over their lives. Thirty-six percent indicated that medical treatment did not start soon enough, 35% that psychotherapy started too late and 13% saying they had received no psychotherapy at all. The help from professionals most valued was provide information about the illness (3.4), dedicating more time (3.4) investigating new treatments (3.3) paying attention to secondary effects (3.3) and incorporating the patient in decision making (3.3). Most patients reported a state of health “regular to good” but 10% indicated not being understood at all in their social environment since onset of illness and 25% being little understood. The anti-stigma initiative most valued was to increase investment in schizophrenia in health planning. Integral health planning should incorporate patient insights concerning basic needs and treatment preferences.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
In recent years there has been an increase in the field of research of advanced steels that have excellent mechanical properties combining high strength with excellent ductility. Within this range of advanced steels are the stable austenitic phase steels at room temperature of twinning induced plasticity known as TWIP. An important aspect to highlight about TWIP steels is their addition with different microalloying elements, generally less than 0.20 wt. %, which are forming precipitated phases such as carbides, nitrides and carbonitrides, and directly or indirectly control and/or modify microstructure and mechanical properties in these steels. Microalloying elements can cause a higher degree of hardening due to the formation of precipitates and grain refinement. The present research work studies the inclusions and second-phase particles formed in Fe–21Mn–1.3Si–1.6Al TWIP steels microalloyed with Ti, Nb, V, Mo and Ti/B in as-solution condition. TWIP steels melted in induction furnace were homogenized and hot-rolled at 1200 °C with reduction of 60 %. Subsequently, rolled plates were solubilized at 1100 °C followed by water quench. Thermodynamics-based predictions of inclusions and second-phases of different TWIP steels were carried out using JMatPro®V.9.1.2. Metallographic characterization was carried out by light optical and scanning electron microscopies (LOM, SEM), while second-phase particles characterization was performed using energy dispersion spectroscopy (SEM-EDS). Also, Vickers microhardness tests were carried out in accordance to ASTM E92 standard. In general, results showed the formation of inclusions of AlN and MnS at higher temperatures, which act as nuclei points for the precipitation particles of each type of microalloying element (TiN, TiC, Nb (C, N), VC and MoC) at lower temperatures. The studied TWIP steels exhibit similar microhardness values, since the microalloying elements are mostly dissolved in solid solution. The TWIP steels microalloyed with V and Ti exhibited the highest microhardness values.
We aimed to investigate the heterogeneity of seasonal suicide patterns among multiple geographically, demographically and socioeconomically diverse populations.
Weekly time-series data of suicide counts for 354 communities in 12 countries during 1986–2016 were analysed. Two-stage analysis was performed. In the first stage, a generalised linear model, including cyclic splines, was used to estimate seasonal patterns of suicide for each community. In the second stage, the community-specific seasonal patterns were combined for each country using meta-regression. In addition, the community-specific seasonal patterns were regressed onto community-level socioeconomic, demographic and environmental indicators using meta-regression.
We observed seasonal patterns in suicide, with the counts peaking in spring and declining to a trough in winter in most of the countries. However, the shape of seasonal patterns varied among countries from bimodal to unimodal seasonality. The amplitude of seasonal patterns (i.e. the peak/trough relative risk) also varied from 1.47 (95% confidence interval [CI]: 1.33–1.62) to 1.05 (95% CI: 1.01–1.1) among 12 countries. The subgroup difference in the seasonal pattern also varied over countries. In some countries, larger amplitude was shown for females and for the elderly population (≥65 years of age) than for males and for younger people, respectively. The subperiod difference also varied; some countries showed increasing seasonality while others showed a decrease or little change. Finally, the amplitude was larger for communities with colder climates, higher proportions of elderly people and lower unemployment rates (p-values < 0.05).
Despite the common features of a spring peak and a winter trough, seasonal suicide patterns were largely heterogeneous in shape, amplitude, subgroup differences and temporal changes among different populations, as influenced by climate, demographic and socioeconomic conditions. Our findings may help elucidate the underlying mechanisms of seasonal suicide patterns and aid in improving the design of population-specific suicide prevention programmes based on these patterns.
Triatomine bugs carry the parasitic protozoa Trypanosoma cruzi, the causal agent of Chagas disease. It is known that both the parasite and entomopathogenic fungi can decrease bug survival, but the combined effect of both pathogens is not known, which is relevant for biological control purposes. Herein, the survival of the triatomine Meccus pallidipennis (Stal, 1872) was compared when it was coinfected with the fungus Metarhizium anisopliae (Metschnikoff) and T. cruzi, and when both pathogens acted separately. The immune response of the insect was also studied, using phenoloxidase activity in the bug gut and hemolymph, to understand our survival results. Contrary to expectations, triatomine survival was higher in multiple than in single challenges, even though the immune response was lower in cases of multiple infection. We postulate that T. cruzi exerts a protective effect and/or that the insect reduced the resources allocated to defend itself against both pathogens. Based on the present results, the use of M. anisopliae as a control agent should be re-considered.
On September 20, 2017, Hurricane Maria made landfall on Puerto Rico as a category 4 storm, resulting in serious widespread impact across the island, including communication and power outages, water systems impairment, and damage to life-saving infrastructure. In collaboration with the Puerto Rico Department of Health, the Public Health Branch (PHB), operating under the Department of Health and Human Services Incident Response Coordination Team, was tasked with completing assessments of health-care facilities in Puerto Rico to determine infrastructure capabilities and post-hurricane capacity. Additionally, in response to significant data entry and presentation needs, the PHB leadership worked with the Puerto Rico Planning Board to develop and test a new app-based infrastructure capacity assessment tool. Assessments of hospitals were initiated September 28, 2017, and completed November 10, 2017 (n = 64 hospitals, 97%). Assessments of health-care centers were initiated on October 7, 2017, with 186 health-care centers (87%) assessed through November 18, 2017. All hospitals had working communications; however, 9% (n = 17) of health-care centers reported no communication capabilities. For the health-care centers, 114 (61%) reported they were operational but had sustainment needs. In conclusion, health-care facility assessments indicated structural damage issues and operational capacity decreases, while health-care centers reported loss of communication capabilities post-Hurricane Maria.
Social cognition has been associated with functional outcome in patients with first episode psychosis (FEP). Social cognition has also been associated with neurocognition and cognitive reserve. Although cognitive reserve, neurocognitive functioning, social cognition, and functional outcome are related, the direction of their associations is not clear. Therefore, the main aim of this study was to analyze the influence of social cognition as a mediator between cognitive reserve and cognitive domains on functioning in FEP both at baseline and at 2 years.
The sample of the study was composed of 282 FEP patients followed up for 2 years. To analyze whether social cognition mediates the influence of cognitive reserve and cognitive domains on functioning, a path analysis was performed. The statistical significance of any mediation effects was evaluated by bootstrap analysis.
At baseline, as neither cognitive reserve nor the cognitive domains studied were related to functioning, the conditions for mediation were not satisfied. Nevertheless, at 2 years of follow-up, social cognition acted as a mediator between cognitive reserve and functioning. Likewise, social cognition was a mediator between verbal memory and functional outcome. The results of the bootstrap analysis confirmed these significant mediations (95% bootstrapped CI (−10.215 to −0.337) and (−4.731 to −0.605) respectively).
Cognitive reserve and neurocognition are related to functioning, and social cognition mediates in this relationship.
First-degree relatives of patients with psychotic disorder have higher levels of polygenic risk (PRS) for schizophrenia and higher levels of intermediate phenotypes.
We conducted, using two different samples for discovery (n = 336 controls and 649 siblings of patients with psychotic disorder) and replication (n = 1208 controls and 1106 siblings), an analysis of association between PRS on the one hand and psychopathological and cognitive intermediate phenotypes of schizophrenia on the other in a sample at average genetic risk (healthy controls) and a sample at higher than average risk (healthy siblings of patients). Two subthreshold psychosis phenotypes, as well as a standardised measure of cognitive ability, based on a short version of the WAIS-III short form, were used. In addition, a measure of jumping to conclusion bias (replication sample only) was tested for association with PRS.
In both discovery and replication sample, evidence for an association between PRS and subthreshold psychosis phenotypes was observed in the relatives of patients, whereas in the controls no association was observed. Jumping to conclusion bias was similarly only associated with PRS in the sibling group. Cognitive ability was weakly negatively and non-significantly associated with PRS in both the sibling and the control group.
The degree of endophenotypic expression of schizophrenia polygenic risk depends on having a sibling with psychotic disorder, suggestive of underlying gene–environment interaction. Cognitive biases may better index genetic risk of disorder than traditional measures of neurocognition, which instead may reflect the population distribution of cognitive ability impacting the prognosis of psychotic disorder.
We describe the use of immobilized deoxyribonucleic acid (DNA) in a silica matrix as a biorecognition agent for the detection of albendazole sulfoxide (ASU), the primary metabolite of albendazole and a suspected teratogenic and embryotoxic agent. The biomaterial (DNA-containing gel) was synthesized by physical entrapment of salmon sperm in an inorganic silicate matrix by the sol-gel method. Functionality of the DNA-containing gel was evaluated by comparative offline frontal chromatography followed by HPLC analysis of ASU and caffeine (CAF, control) using DNA-containing gel and DNA-free gel. The DNA-containing gel showed relatively high specific retention for ASU, while CAF showed no retention using frontal analysis. We anticipate that the DNA-containing gel can be implemented to identify the interactions of DNA with other active pharmaceutical ingredients (APIs) and their metabolites in a readily available, sensitive and selective frontal chromatography experiment.
Cognitive deficits are a core feature of early stages in schizophrenia. However, the extent to which antipsychotic (AP) have a deleterious effect on cognitive performance remains under debate. We aim to investigate whether anticholinergic loadings and dose of AP drugs in first episode of psychosis (FEP) in advanced phase of remission are associated with cognitive impairment and the differences between premorbid intellectual quotient (IQ) subgroups.
Two hundred and sixty-six patients participated. The primary outcomes were cognitive dimensions, dopaminergic/anticholinergic load of AP [in chlorpromazine equivalents (Eq-CPZ) and the Anticholinergic Risk Scale (ARS), respectively].
Impairments in processing speed, verbal memory and global cognition were significantly associated with high Eq-CPZ and verbal impairment with high ARS score. Moreover, this effect was higher in the low IQ subgroup.
Clinicians should be aware of the potential cognitive impairment associated with AP in advanced remission FEP, particularly in lower premorbid IQ patients.
In order to fully participate in informed consent, patients must understand what it is that they are agreeing, or not agreeing, to. In most cases, patients look to their clinicians to help develop the appropriate understanding required to give informed consent. Often the quality of the information available as well as the delivery methods are not optimal.
Using a visual aid as an adjunct to risk communication in a stressful setting as the Emergency Department has a clear potential in facilitating the communication process. To support more accurate and consistent presentation of risk, we formed a team with implementation scientists, patient education specialists, nurses, physicians, and professional designers to transform the information available into a 6th grade reading level visual aid tool. We applied a DMAIC (Define, Measure, Analyze, Improve and Control) process to design the tool. We measured and analyzed its effectiveness through feedback from providers, patients, and caregivers. This cycle happened 3 times until we reached the final version of the visual aid.
We utilized a DMAIC methodology as well as modified Delphi method to create and refine a visual aid tool. Several rounds of end-user feedback along with DMAIC allowed us to create a tool that was consistently better with each round of development, analysis and feedback. After arriving at the final version of the tool, we surveyed physicians in our Emergency Department. We measured the difficulty to understand the information, whether doctors think the visual aid will help patients to understand the data, and the appropriateness of the tool’s length and the amount of information in it.
We believe that our experience can be replicated by other researchers and clinicians in the endeavor of translating the evidence into clinical practice. An effort should be made to fully translate research findings until the end of the research to practice continuum in order to better translate knowledge into a useful and useable form for informed consent decisions in busy clinical practice.
The University of Georgia (USA) is partnering with the University of Padova (Italy) for a dual Master’s degree program in sustainable agriculture, promoting collaboration on some of the biggest challenges facing agriculture today. This innovative program which was launched during 2016 provides students with outstanding training and a unique opportunity to learn about the challenges, opportunities, and leading edges of precision agriculture on another continent – an experience which will serve graduates well when they enter the job market in an increasingly global economy. This paper presents the goals of the program, the curriculum, and describes the opportunities available to prospective students. In addition it describes the process of developing the dual degree which can be used as guide by others wishing to develop similar programs.