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Worse sleep quality and increased inflammatory markers in women with schizophrenia (Sch) have been reported (Lee et al. 2019). However, the physiological mechanisms underlying the interplay between sleep and the inflammatory pathways are not yet well understood (Fang et al. 2016).
Analyze the relationship between Neutrophil/Lymphocyte (NLR), Monocyte/Lymphocyte (MLR) and Platelet/Lymphocyte (PLR) ratios, and insomnia in Sch stratified by sex.
Final sample included 176 Sch patients (ICD-10 criteria) [mean age: 38.9±13.39; males: 111(63.1%)]. Assessment: PANSS, Calgary Depression Scale (CDSS), and Oviedo Sleep Questionnaire (OSQ) to identify a comorbid diagnosis of insomnia based on ICD-10. Fasting counting blood cell were performed to calculate ratios. Statistics: U Mann-Whitney, logistic regression.
Insomnia as comorbid diagnosis was present in 22 Sch (12.5%) with no differences between sex [14 males (12.6%), 8 females (12.3%)], neither in their age. Female patients with insomnia showed increased NLR [2.44±0.69 vs. 1.88±0.80, U=122.00 (p=0.034)]. However, no differences in PLR and MLR were found, neither in any ratio in males. Regression models using insomnia as dependent variable and covariates (age, PANSS-positive, PANSS-negative, CDSS) were estimated. Females: presence of insomnia was associated with NLR [OR=3.564 (p=0.032)], PANSS-positive [OR=1.263 (p=0.013)] and CDSS [OR=1.198 (p=0.092)]. Males: only PANSS-positive [OR=1.123 (p=0.027)] and CDSS scores [OR=1.220 (p=0.005)] were associated with insomnia.
NLR represent an inflammatory marker of insomnia in Sch but only in female patients. Improving sleep quality in these patients could help to decrease their inflammatory response.
COVID-19 pandemic and lockdown have provoked a considerable psychological impact in Spain. Some studies have reported greater psychological impact in the younger population. To date, no previous study has focused on depressive disorder (DD) patients based on their age.
To describe the psychological impact on DD according to age.
Cross-sectional study of an online survey available from 19 to 26 March 2020. Out of a total of 21207 respondents, 608 (2.9%) reported suffering from DD (mean age ±SD = 41.2 years±14.07 [18-82], 80.6% women). The subsample (608) was divided according to age, “youngsters” <45 (57.4%)/ “elders” ≥45. DASS-21 and IES scales were employed. Statistical analyses: Chi-square, t-Student test.
Both groups did not differ (p>0.05) in sex, having COVID-19 symptoms, having family/friends infected, or income changes. While youngsters were single more frequently (68.8% vs 14.3%, χ² = 179.7, p<0.001), elders had somatic illness more frequently (64.8% vs 39.7% χ² =30.401, p<0.001). Youngsters obtained higher scores in depression (4.69 vs 4.1, T=5.413, p<0.001), anxiety (2.86 vs 1.97, T=5.249, p<0.001) and stress (4.48 vs 3.17, T=6.355, p<0.001) DASS-21 subscales, as in intrusive (3.42 vs 3.05, T=1.984, p=0.048) and avoidant (4.64 vs 4.11, T=3.056, p=0.002) IES scores.
Despite the group of elders with depression being more vulnerable to severe COVID-19 disease and presenting more frequently somatic comorbidities, younger depressive patients suffered more from depressive, anxiety, stress and avoidant symptoms and intrusive thoughts, in line with previous reports in the general population.
This paper proposes a differential sensor based on a pair of open split ring resonators (OSRR) operating in reflection. The output signal is thus the differential reflection coefficient of both resonators, intimately related to their dielectric loading. Thus, for identical loads in both sensing resonators, the individual reflection coefficients are equal, thereby providing an ideally null output signal. By contrast, when unequal dielectric loads truncate the symmetry, the reflection coefficients are different, resulting in a differential output signal related to the level of asymmetry. In order to ease the measurement of the output signal, a rat-race hybrid coupler is used. The OSRR sensing loads are connected to the coupled ports of the hybrid coupler, whereas the input signal is injected to the Δ-port, and the output signal is collected at the isolated port (Σ-port). By this means, the output signal, i.e. the differential reflection coefficient between both sensing loads, is obtained from the transmission coefficient of a simple two-port structure. For experimental validation purposes, the sensor is applied to the measurement of isopropanol content in aqueous solutions, and for that purpose, the sensitive regions are equipped with microfluidic channels.
In this paper, a differential microfluidic sensor and comparator based on a pair of microstrip lines loaded with dumbbell-shaped defected ground structure resonators is applied to the characterization of electrolyte concentration in samples of horse urine. Since variations in the total electrolyte content in urine may be indicative of certain pathologies, the interest is to use the device as a comparator, in order to determine changes in the electrolyte concentration as compared to a reference level. To validate the approach, we have made differential measurements of a set of urine samples with different electrolyte concentrations (which have been previously obtained by means of electrochemical methods). The obtained results correlate with the nominal electrolyte concentrations of the samples, thereby pointing out the potential of the approach as a low-cost pre-screening method (or complementary diagnosis system) to detect potential pathologies or diseases in horses and other animals.
Functional brain activity has been only studied marginally in schizoaffective disorder (SAD), a disorder whose nosological status is controversial. The present study investigated the prefrontal cortex (PFC) activity of schizomanic patients during performance of a working memory task.
13 schizoaffective patients, with current schizomanic episode (Young> 18); and 26 sex- and age-matched healthy controls underwent functional magnetic resonance imaging (fMRI) while performing baseline, 1-back and 2-back versions of the n-back task. Linear models were used to obtain maps of activations and deactivations in the groups.
During performance of the n-back task, controls showed activation in a cluster of frontal areas and de-activation in the medial orbitofrontal and anterior cingulate cortex. The SAD patients showed significantly less activation in prefrontal areas than the controls. They also showed a marked failure to de-activate in medial frontal cortex. The SAD patients’ impaired task performance was associated with both reduced activation of the dorsolateral PFC and reduced de-activation of the medial frontal areas.
Schizomanic patients show failure of activation in a network of cortical regions, and also a failure to de-activate the ventromedial PFC and anterior cingulate cortex. This latter area corresponds to the one of the components of the 'default mode network´. This pattern of abnormality is similar to that found by our group to characterise schizophrenia (failure to activate and failure to de-activate), but different from that which characterises manic patients (failure to de-activate only).
Given the capacity of the adult brain to generate new neurons (a process called neurogenesis), adult neuronal stem cells have been proposed as an endogenous source of healthy cells for the treatment of certain neurodegenerative diseases. However, it is not completely understood to what extent this process is altered in neurodegenerative conditions such as Huntington's Disease (HD). An increase in neurogenesis in the subventricular zone (SVZ) of HD patients has been previously reported. On the other hand, we and others found a dramatic decrease in neurogenesis in the dentate gyrus (DG) of the hippocampus of the most studied HD transgenic mouse models, the R6/2 and R6/1 lines. We are now examining neurogenesis in a transgenic model that expresses the full-length huntingtin gene with 128 CAG repeats, the YAC128 mice. We are analysing how disease progression in the YAC128 model affects each stage of the neurogenic process (i.e., proliferation, survival, migration, and differentiation) in the two neurogenic regions (SVZ and DG). Proliferation will be evaluated in end-stage, symptomatic, early-symptomatic and pre-symptomatic YAC128 mice by immunohistochemistry for a variety of exogenous and endogenous cell cycle markers. Cell survival, migration and differentiation will be assessed by immuno-labelling of immature and mature neurons. Since hippocampal neurogenesis is thought to be involved in cognitive processes, a reduction in it might contribute to the cognitive deficits and/or depression in HD. Furthermore, these results will ascertain how well the HD brain might sustain neuronal transplant therapies.
Paranoid Schizophrenia (PS), yet included within the same nosological category than Non-Paranoid Schizophrenia (NPS), may in fact constitute a different disorder. In this study, the above both schizophrenia subtypes are compared with Delusional Disorder (DD). We hypothesized that, phenomenologically PS could either be a half-way category between DD and NPS or part of a phenomenological continuum of psychotic and cognitive symptoms between these three psychotic categories.
102 patients fulfilling DSM-IV-TR criteria of schizophrenia (with 56 PS and 46 with NPS) and 80 DD patients were included in this study (n=182). We compared outcome groups (DD vs. PS vs. NPS) on clinical dimensions, global functioning and sociodemographics. Clinical dimensions were extracted from the PANSS and neuropsychological scales using Principal-Component-Analysis and, subsequently, cluster analysis to assign subjects to empirically emerging clinical groups. The associations between such groups and DSM-IV-TR groups were explored using polynomial regression.
We found lineal associations demonstrating empirically that, from the psychopathological, neuropsychological and functioning perspectives, it is reasonable to consider PS as an intermediate and independent category right in between DD and NPS. Thus, the distribution of subjects assigned to three empirically emerging clinical groups (Paranoid-Affective, Paranoid-Hostile and Negative) associated, significantly and preferentially, with DSM-IV categories along the following fashion: The proportion of paranoid-hostile and, particularly, paranoid-affective subjects decreased progressively along DD, PS and NPS categories; On the contrary, the proportion of negative subjects increased lineally along those categories (Mante-Haenszel-X2= 18.02;p=0.0001). Our results question, on the bases of an empirical study, the current categorical division of paranoid psychoses.
In Portugal, after the integration, in 1992, of the Mental Health Services in General Hospitals and, later, with the publication of the Mental Health Act in 1998, there was a clear choice, in terms of health policy, for the deinstitutionalization of the mentally ill and for promoting the integration into their communities. In 1977, at the time called Mental Health Center of Viseu, inspired by the avant-garde currents of French sector psychiatry, pioneered through the creation of their Community Service, immediately reducing its capacity from 120 inpatients to 44.
To conduct a descriptive analysis of the patient population monitored by the team of the Community Service of Centro Hospitalar Tondela-Viseu.
An observational, cross-sectional study.
Descriptive analysis. Data collected from the clinical files and the database built by this service team, analyzed in the program EXCEL ® 2010.
The Community Service currently integrates 562 patients, about half of which are aged between 30 and 49 years. Most patients are male and the main diagnosis is schizophrenic psychosis.
The Community Services have progressively assumed a more relevant importance in the monitoring of individuals with mental illness, allowing their deinstitutionalization to happen and contributing to a more harmonious reintegration of these patients in their community.
Alcohol use disorders (AUD) is a preventable cause of significant morbidity and mortality worldwide. AUD is a heterogeneous disorder stemming from a complex interaction of neurobiological, genetic, and environmental factors. To achieve treatment effectiveness this heterogenity should be considered, as well as safety.
Review mechanisms underlying alcohol addiction in order to work out new, more effective treatment strategies.
To update on treatment for alcoholism.
A literature search was performed on PubMed database.
Alcohol dependence is a chronic, relapsing condition in which there is evidence of significant change in the motivation and control systems in the brain. Increasingly drug therapy is focused not just on the treatment of the acute withdrawal syndrome, but on modifying these other dysregulated brain systems. Of the numerous neurotransmitter systems that have been identified for the development of new medicines, the most promising compounds appear to be those that modulate the function of opioids, glutamate with or without gamma-aminobutyric acid, and serotonin. Other putative therapeutic medications including direct modulators of dopamine function and enzyme inhibitors also shall be discussed. At present, only four medications are approved for the treatment of alcohol dependence in Europe, that is naltrexone, acamprosate, disulfiram and the most recent nalmefene. Among other promising strategies the following drugs are mentioned: baclofen, topiramate, ondansetron, aripiprazole, rimonabant and varenicline.
Pharmacological development remains a high priority in the alcoholism field. Drugs have different safety profiles that need to be balanced with the treatment objective, individual patient preferences and comorbid conditions.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The World Health Organization (WHO, 2006) defines sexual abuse as the involvement of a child in sexual activity that he or she does not fully comprehend, being unable to give informed consent to, or for which the child is not developmentally prepared, or else that violates the laws or social taboos of society. In Portugal, the law that regulates the sexual abuse of underage people (minors) is enclosed in crimes of sexual auto-determination, which are described as child sexual abuse (article 171°) and sexual acts with a teenager (article 172°), and those are applied to the person that has copulation, anal intercourse and oral intercourse with underage abusing from their inexperience. Our objective is to investigate the profile of sexual abusers of minors, namely, the socio-demographic features, clinical correlations, and the level of penal responsibility of sexual offenders who were referred by court to forensic psychiatric assessment in the Institute of Legal Medicine of the City of Coimbra. Moreover, verify if these individuals present mental disorders at the time of the offence. The present study is of descriptive nature, being based on the observation and consultation of 30 clinical processes of sexual abusers. All written reports were obtained from 2005 to 2015 by court-appointed psychiatric experts on individuals that have been charged of committing sexual crimes against minors and referred to the main forensic institute in the city of Coimbra. This study will contribute to the increase of more information on these offenders, promoting the development of more adequate contingency plans for this population.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The eastern North Atlantic (ENA) has many highly productive areas where several species of cetaceans have been recorded, with the common dolphin (Delphinus delphis) being one of the most frequently sighted species. However, its spatial and temporal distribution in high seas is poorly known. The study presents the results from 5 years of cetacean monitoring in the ENA (2012–2016) aboard cargo ships that follow the routes from Continental Portugal to the Macaronesian archipelagos and north-west Africa. Common dolphin was the most frequently sighted cetacean with 192 occurrences registered on effort and an overall encounter rate of 0.36 sightings/100 nmi. The species was distributed in coastal and offshore waters, but absent from the Canaries and Cape Verde islands. Statistical ‘habitat’ models were developed to describe and explain the occurrence of sightings of the species: variables affecting detection of dolphins had a small impact and there were clear spatiotemporal distribution patterns, influenced to some degree by environmental variables. Predicted probability of occurrence was highest in coastal waters of continental Portugal and around the Azores. The models, combined with maps of distribution, were useful to identify important areas for the species, which could be the focus of future conservation efforts. Common dolphin presence was related to depth, distance to coast and seamounts, seabed slope, chlorophyll concentration, sea-surface temperature and sea level anomalies; the possible ecological significance of these relationships is explored.
Major depressive disorder (MDD) is a multifactorial syndrome with significant interactions between genetic and environmental factors. This study specifically investigates the association between family history of alcohol problems (FHAP) and family history of depression (FHD), and how these relate to different clusters of depressive symptoms.
Correlations between FHAP and FHD and different clusters of the Beck Depression Inventory (BDI) were studied. We sampled 333 employees from a general hospital who had been receiving a psychiatric consultation between 2005 and 2012. Analysis of variance (ANOVA) and Analysis of covariance (ANCOVA) models were conducted to explore these correlations.
There was a significant positive correlation between FHAP and BDI affective score. This result remained significant even after the adjustment for other variables considered as important factors for MDD, such as gender, age, marital status, education, ethnic group and FHD. More specifically, FHAP was correlated with dissatisfaction and episodes of crying among the affective symptoms. FHAP showed no statistical difference in any of the other clusters score or in the BDI total score. Moreover, as expected, we found a correlation between FHD and BDI total score and Somatic and Cognitive clusters.
FHAP should be routinely investigated in individuals presenting with depressive symptoms. This is especially important in cases presenting with dissatisfaction and episodes of crying in patients who do not endorse criteria for MDD. Due to study limitations, the findings require replication by neurobiological, epidemiological and clinical studies.
Although mild to moderate major depressive disorder (MDD) is one of the main reasons for consulting a general practitioner (GP), there is still no international consensus on the most appropriate therapeutic approach.
The aim of this study is to evaluate the clinical effectiveness of watchful waiting (WW) compared with the use of antidepressants (ADs) for the treatment of mild to moderate depressive symptoms in 263 primary care (PC) usual-practice patients in a 12-month pragmatic non-randomised controlled trial. Both longitudinal and per-protocol analyses were performed, through a multilevel longitudinal analysis and a sensitivity analysis.
We observed a statistically significant time x treatment interaction in the severity of depression (Patient Health Questionnaire, PHQ-9) and disability (World Health Organization Disability Assessment Schedule, WHODAS) in favour of the AD group at 6 months but not at 12 months. The effect size of this difference was small. No statistically significant differences were observed between groups in severity of anxiety (Beck Anxiety Inventory, BAI) or health-related quality-of-life (EuroQol-5D, EQ-5D). Sensitivity analysis and per-protocol analysis showed no differences between the two groups in any of the evaluated scales.
Superiority of either treatment (WW and AD) was not demonstrated in patients treated for depression in PC after one year of follow-up.
In this work we have conducted a study on the radiative and spectroscopic properties of the radiative precursor and the post-shock region from experiments with radiative shocks in xenon performed at the Orion laser facility. The study is based on post-processing of radiation-hydrodynamics simulations of the experiment. In particular, we have analyzed the thermodynamic regime of the plasma, the charge state distributions, the monochromatic opacities and emissivities, and the specific intensities for plasma conditions of both regions. The study of the intensities is a useful tool to estimate ranges of electron temperatures present in the xenon plasma in these experiments and the analysis performed of the microscopic properties commented above helps to better understand the intensity spectra. Finally, a theoretical analysis of the possibility of the onset of isobaric thermal instabilities in the post-shock has been made, concluding that the instabilities obtained in the radiative-hydrodynamic simulations could be thermal ones due to strong radiative cooling.
Oral anti-diabetic drugs (OADs) have been associated with community-acquired pneumonia (CAP). We aimed to validate the recording of CAP in the Spanish Database for Pharmacoepidemiological Research in Primary Care (BIFAP) for the future evaluation of OAD–CAP association. The incidence rate (IR/1000 person-years) of CAP in type 2 diabetes mellitus (T2DM) was also determined. In total, 2966 pneumonia records (2040 listed as diagnosis and 926 as identified from comments added by physicians) were identified from 76 009 patients with T2DM after the first OAD in 2002–2013. Data around the CAP date were reviewed: 1803 (60·9%) were classified as ‘probable CAP’ (confirmed by X-ray/laboratory, referral letters or CAP lung site); 589 (19·8%) as ‘no-case’ (486 had other illness, 78 previous CAP, 25 cancer); and 574 (19·4%) as ‘possible CAP’ (441 without confirmatory information, 133 with uncertain diagnosis or uncertain diagnosis date). In total, 74·2% and 31·4% of pneumonia records in the diagnosis and comments, respectively, were ‘probable cases’ (IR: 6·04), which increased to 90·5% and 42·9%, respectively, when the 441 ‘possible cases’ without confirmatory information were included (IR: 7·52). In summary, diagnosis had a high positive predictive value, and adding cases automatically detected from comments decreased that value significantly.
Contact precautions are a traditional strategy to prevent transmission of methicillin-resistant Staphylococcus aureus (MRSA). Chlorhexidine bathing is increasingly used to decrease MRSA burden and transmission in intensive care units (ICUs). We sought to evaluate a hospital policy change from routine contact precautions for MRSA compared with universal chlorhexidine bathing, without contact precautions. We measured new MRSA acquisition in ICU patients and surveyed for MRSA environmental contamination in common areas and non-MRSA patient rooms before and after the policy change. During the baseline and chlorhexidine bathing periods, the number of patients (453 vs. 417), ICU days (1999 vs. 1703) and MRSA days/1000 ICU days (109 vs. 102) were similar. MRSA acquisition (2/453 vs. 2/457, P = 0·93) and environmental MRSA contamination (9/474 vs. 7/500, P = 0·53) were not significantly different between time periods. There were 58% fewer contact precaution days in the ICU during the chlorhexidine period (241/1993 vs. 102/1730, P < 0·01). We found no evidence that discontinuation of contact precautions for patients with MRSA in conjunction with adoption of daily chlorhexidine bathing in ICUs is associated with increased MRSA acquisition among ICU patients or increased MRSA contamination of ICU fomites. Although underpowered, our findings suggest this strategy, which has the potential to reduce costs and improve patient safety, should be assessed in similar but larger studies.
The improvement in porcine embryo preservation and non-surgical embryo transfer (ET) procedures achieved in recent years represents essential progress for the practical use of ET in the pig industry. This study aimed to evaluate the effects of parity, weaning-to-estrus interval (WEI) and season on reproductive and embryonic parameters at day 6 after insemination of donor sows superovulated after weaning. The selection of donor sows was based on their reproductive history, body condition and parity. The effects of parity at weaning (2 to 3, 4 to 5 or 6 to 7 litters), season (fall, winter and spring), and WEI (estrus within 3 to 4 days), and their interactions on the number of corpus luteum, cysts in sows with cysts, number and quality of viable and transferable embryos, embryo developmental stage and recovery and fertilization rates were evaluated using linear mixed effects models. The analyses showed a lack of significant effects of parity, season, WEI or their interactions on any of the reproductive and embryonic parameters examined. In conclusion, these results demonstrate that fertilization rates and numbers of viable and transferable embryos collected at day 6 of the cycle from superovulated donor sows are not affected by their parity, regardless of the time of the year (from fall to spring) and WEI (3 or 4 days).
This study aimed to examine the association between vitamin B6, folate and vitamin B12 biomarkers and plasma fatty acids in European adolescents. A subsample from the Healthy Lifestyle in Europe by Nutrition in Adolescence study with valid data on B-vitamins and fatty acid blood parameters, and all the other covariates used in the analyses such as BMI, Diet Quality Index, education of the mother and physical activity assessed by a questionnaire, was selected resulting in 674 cases (43 % males). B-vitamin biomarkers were measured by chromatography and immunoassay and fatty acids by enzymatic analyses. Linear mixed models elucidated the association between B-vitamins and fatty acid blood parameters (changes in fatty acid profiles according to change in 10 units of vitamin B biomarkers). DHA, EPA) and n-3 fatty acids showed positive associations with B-vitamin biomarkers, mainly with those corresponding to folate and vitamin B12. Contrarily, negative associations were found with n-6:n-3 ratio, trans-fatty acids and oleic:stearic ratio. With total homocysteine (tHcy), all the associations found with these parameters were opposite (for instance, an increase of 10 nmol/l in red blood cell folate or holotranscobalamin in females produces an increase of 15·85 µmol/l of EPA (P value <0·01), whereas an increase of 10 nmol/l of tHcy in males produces a decrease of 2·06 µmol/l of DHA (P value <0·05). Positive associations between B-vitamins and specific fatty acids might suggest underlying mechanisms between B-vitamins and CVD and it is worth the attention of public health policies.
The intensity of annual Spanish influenza activity is currently estimated from historical data of the Spanish Influenza Sentinel Surveillance System (SISSS) using qualitative indicators from the European Influenza Surveillance Network. However, these indicators are subjective, based on qualitative comparison with historical data of influenza-like illness rates. This pilot study assesses the implementation of Moving Epidemic Method (MEM) intensity levels during the 2014–2015 influenza season within the 17 sentinel networks covered by SISSS, comparing them to historically reported indicators. Intensity levels reported and those obtained with MEM at the epidemic peak of the influenza wave, and at national and regional levels did not show statistical difference (P = 0·74, Wilcoxon signed-rank test), suggesting that the implementation of MEM would have limited disrupting effects on the dynamic of notification within the surveillance system. MEM allows objective influenza surveillance monitoring and standardization of criteria for comparing the intensity of influenza epidemics in regions in Spain. Following this pilot study, MEM has been adopted to harmonize the reporting of intensity levels of influenza activity in Spain, starting in the 2015–2016 season.
The discrepancy between abundances computed using optical recombination lines (ORLs) and collisionally excited lines (CELs) is a major, unresolved problem with significant implications for the determination of chemical abundances throughout the Universe. In planetary nebulae (PNe), the most common explanation for the discrepancy is that two different gas phases coexist: a hot component with standard metallicity, and a much colder plasma enhanced in heavy elements. This dual nature is not predicted by mass loss theories, and direct observational support for it is still weak. In this work, we present our recent findings that demonstrate that the largest abundance discrepancies are associated with close binary central stars. OSIRIS-GTC tunable filter imaging of the faint O ii ORLs and MUSE-VLT deep 2D spectrophotometry confirm that O ii ORL emission is more centrally concentrated than that of [Oiii] CELs and, therefore, that the abundance discrepancy may be closely linked to binary evolution.