To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Despite the multitude of clinical manifestations of post-acute sequelae of SARS-CoV-2 infection (PASC), studies applying statistical methods to directly investigate patterns of symptom co-occurrence and their biological correlates are scarce.
We assessed 30 symptoms pertaining to different organ systems in 749 adults (age = 55 ± 14 years; 47% female) during in-person visits conducted at 6–11 months after hospitalization due to coronavirus disease 2019 (COVID-19), including six psychiatric and cognitive manifestations. Symptom co-occurrence was initially investigated using exploratory factor analysis (EFA), and latent variable modeling was then conducted using Item Response Theory (IRT). We investigated associations of latent variable severity with objective indices of persistent physical disability, pulmonary and kidney dysfunction, and C-reactive protein and D-dimer blood levels, measured at the same follow-up assessment.
The EFA extracted one factor, explaining 64.8% of variance; loadings were positive for all symptoms, and above 0.35 for 16 of them. The latent trait generated using IRT placed fatigue, psychiatric, and cognitive manifestations as the most discriminative symptoms (coefficients > 1.5, p < 0.001). Latent trait severity was associated with decreased body weight and poorer physical performance (coefficients > 0.240; p ⩽ 0.003), and elevated blood levels of C-reactive protein (coefficient = 0.378; 95% CI 0.215–0.541; p < 0.001) and D-dimer (coefficient = 0.412; 95% CI 0.123–0.702; p = 0.005). Results were similar after excluding subjects with pro-inflammatory comorbidities.
Different symptoms that persist for several months after moderate or severe COVID-19 may unite within one latent trait of PASC. This trait is dominated by fatigue and psychiatric symptoms, and is associated with objective signs of physical disability and persistent systemic inflammation.
The Dimensional Anhedonia Rating Scale (DARS) is a novel questionnaire to assess anhedonia of recent validation. In this work, we aim to study the equivalence between the traditional paper-and-pencil and the digital format of DARS. Sixty-nine patients filled the DARS in a paper-based and digital versions. We assessed differences between formats (Wilcoxon test), validity of the scales [Kappa and intraclass correlation coefficients (ICCs)], and reliability (Cronbach’s alpha and Guttman’s coefficient). We calculated the comparative fit index and the root mean squared error (RMSE) associated with the proposed one-factor structure. Total scores were higher for paper-based format. Significant differences between both formats were found for three items. The weighted Kappa coefficient was approximately 0.40 for most of the items. Internal consistency was greater than 0.94, and the ICC for the digital version was 0.95 and 0.94 for the paper-and-pencil version (F = 16.7, p < 0.001). Comparative Adjustment Index was 0.97 for the digital DARS and 0.97 for the paper-and-pencil DARS, and RMSE was 0.11 for the digital DARS and 0.10 for the paper-and-pencil DARS. We concluded that the digital DARS is consistent in many respects with the paper-and-pencil questionnaire, but equivalence with this format cannot be assumed without caution.
In 2017, a Patient Involvement Interest Group (PIIG) was created in the Spanish Network for Health Technology Assessment of the National Health System (RedETS) to facilitate and promote Patient Involvement (PI) in Health Technology Assessment (HTA). The PIIG proposed a decisional flowchart to guide researchers’ in decisions regarding PI methods in HTA. The flowchart proposed a combination of direct involvement and incorporation of patient-based evidence depending on the scope and the aims of the assessment.
This work aims to present the flowchart and the results of the evaluation of the latest experiences in PI in HTA in RedETS (2018–2020), including direct-involvement and patient-based evidence.
A survey was sent to the HTA researchers who implemented PI initiatives in RedETS assessments. The survey asked to describe their experiences, lessons learned, challenges and added value regarding the use of direct-involvement, systematic reviews (SR) and primary studies. A descriptive analysis was performed and the results were discussed in an online PIIG workshop.
Thirty-two assessments included direct PI, twenty-one SR synthesized qualitative and quantitative studies about patient experiences, values and preferences and eight included primary studies, mainly of qualitative design. Recruitment and the lack of methodological resources were the main barriers both for direct PI and primary studies. Relevance of the included studies was the main barrier for SR. Added value was found in all PI methods. Direct-involvement had an impact on the project plan and PICO definition, outcomes relevance, information about the health condition and treatments. SR contributed with relevant patient-based evidence, deeper assessment of patient experiences, values and preferences and implementation factors. Primary studies developed new or contextualized knowledge directly applicable to decision-making.
The PI flowchart has served to facilitate the incorporation of patient input in HTA reports. The different approaches implemented have allowed to provide relevant and well-grounded data in each report to inform decision-making in patient-centered healthcare provision, but it is necessary that specific training and resources are provided to enable adequate and timely implementation.
Hepatitis A (HA) is a liver disease with a low mortality rate, but it can cause debilitating symptoms and fulminant hepatitis in some cases. Its incidence is greater in geographical areas with poor sanitation and hygiene. Spain is considered a low-endemicity country, so universal childhood immunization against HA is currently not financed by the National Health System. The aim of this study was to synthesize the scientific evidence on the cost effectiveness of universal childhood vaccination against HA.
Full economic evaluations, published in the English or Spanish languages, were included if they reported outcome measures related to the prevention of HA, adverse effects, or incremental cost-effectiveness ratios (ICERs). The Medline, Embase and Cochrane Library databases were searched for articles published from the beginning of the databases to April 2018.
A total of 23 economic evaluations were included: one in a country of high endemicity, nine in countries of intermediate endemicity, and 13 in countries with low endemicity. Only one Spanish study, published in 1997, was found. Studies conducted in high- and intermediate- endemicity countries concluded that a universal childhood vaccination program against HA was a cost-effective option. However, in the case of countries with low endemicity the results were heterogeneous, although most agreed that a systematic vaccination strategy would not be a cost-effective option and that the adoption of such a strategy would not be justified given the limited benefits it would offer. The results of the economic evaluations depended on parameters such as the price and duration of the vaccine effect and the program coverage.
In countries with low endemicity the results were heterogeneous, although most studies concluded that the implementation of a universal vaccination strategy is not justified from the point of view of cost effectiveness.
The Roca San Miguel (RSM) archaeological site was occupied during Mousterian times. Here we present a geoarchaeological and paleoenvironmental reconstruction of the site. Five stratigraphic units (A to E) formed by different archaeological levels are identified. Three optically stimulated luminescence (OSL) ages show that Unit A dates to between 169.6 ± 9.1 and 151.9 ± 11.1 ka, during the penultimate glacial period (PGP), and contains numerous signs of recurring hearths. Unit B is unexcavated. Unit C dates to between 118.9 ± 11.5 and 103.4 ± 6.9 ka (late Eemian–marine isotope stage (MIS) 5d) and shows an abundance of lithic remains as well as some faunal elements. Unit C is covered by Unit D, which incorporates materials moved downslope, and is dated at 81.2 ± 4.7 ka. These OSL ages concur with U/Th ages (129.3 ± 1.5 and 123.6 ± 0.6 ka) derived from a flowstone covered by both -C and D- post-flowstone units. Finally, Unit E covers the archaeological site, which was partially eroded during MIS2. The robust and well-constrained chronology of the RSM site and surroundings enables the establishment of its evolutionary model from the PGP to the last glacial cycle. The RSM site is the oldest Neanderthal occupation accurately dated in the Pre-Pyrenean region.
Massive hemorrhage (MH) is a growing pathology in military settings and increasingly in civilian settings; it is now considered a public health problem in the United States with large-scale programs. Tourniquets are the fastest and most effective intervention in MH if direct pressure is not effective.
The Liaison Committee on Resuscitation (ILCOR) recognizes a knowledge gap in optimal education techniques for first aid providers. This review aims to describe training and evaluation methods for teaching tourniquet use to both health care and military professionals.
The MEDLINE, CINAHL, WEB of Science, and Scopus databases were reviewed (from 2010 through April 2020). The quality of the selected studies was assessed using the Consolidated Standards of Reporting Trials (CONSORT) scale. Studies that met at least 65% of the included items were included. Data were extracted independently by two reviewers.
Ten of the 172 articles found were selected, of which three were randomized clinical trials. Heterogeneity was observed in the design of the studies and in the training and evaluative methods that limit the comparison between studies.
The results suggest that the training strategies studied are effective in improving knowledge, attitudes, and practical skills. There is no universal method, learning is meaningful but research should be directed to find out which ones work best.
To examine whether the educational level moderates the relationship between baseline depressive symptoms and cognitive functioning at 5- and 10-year follow-ups in older adults, considering the association between cognitive functioning and difficulty with activities of daily living (ADL).
Using a prospective design, a path analysis was performed.
In-home, face-to-face interviews and self-administered questionnaires, within the National Social Life, Health, and Aging Project.
In total, 1,461 participants (mean age = 66.62) were followed up from Wave 1 (baseline) to Wave 2 (at 5 years) and Wave 3 (at 10 years).
Depressive symptoms were assessed at baseline. Cognitive functioning and difficulty with ADL were assessed at baseline and at 5 and 10 years.
Educational level moderates the relationship between depressive symptoms and cognitive functioning at 5 years (β = 0.07, SE = 0.03, p = 0.04, Cohen’s f2 = 0.02), being depressive symptoms related to poor cognitive functioning only at low educational levels. Cognitive functioning predicts difficulty with ADL at 5 and 10 years (β = −0.08, SE = 0.03, p = 0.008, Cohen’s f2 = 0.01; β = −0.09, SE = 0.03, p = 0.006, Cohen’s f2 = 0.02). The proposed model yielded excellent fit (CFI = 1.00, RMSEA = 0.0001, 90% CI 0.0001–0.03, SRMR = 0.004, and χ2(8) = 7.16, p = 0.52).
Cognitive reserve may act as a protective factor against the effect of depressive symptoms on cognition in older adults, which, in turn, is relevant to their functional independence.
Parliamentary youth quotas have been adopted by nine countries, mainly African autocracies. They have also attracted the attention of international organisations, which consider them indicators of democratic progress. Why were these quotas adopted? This article challenges the long-standing regime survival thesis by explaining quota adoption as the result of the convergent strategies of actors placed inside and outside the regime. It also provides new theoretical arguments that point to the transformation of representative linkages in hybrid regimes and shows how this is justified in the light of empirical evidence grounded on qualitative methodology and extensive fieldwork. By connecting the broader historical and socio-political context where youth quotas emerged – Africa – to the micro-level processes of quota adoption – based on the Moroccan case – this article provides a dynamic picture of how political representation is claimed and mobilised in contemporary Africa while shedding some light on the inclusive limits of quota policies.
Hydrogen cyanide (HCN) is considered a fundamental molecule in prebiotic chemistry experiments due to the fact that it could have an important role as raw material to form more complex molecules, as well as it could be an intermediate molecule in chemical reactions. However, the primitive scenarios in which this molecule might be available have been widely discussed. Hydrothermal systems have been considered as abiotic reactors and ideal niches for chemical evolution. Nevertheless, several experiments have shown that high temperatures and pressures could be adverse to the stability of organic molecules. Thus, it is necessary to carry out systematic experiments to study the synthesis, stability and fate of organic molecules in hydrothermal scenarios. In this work, we performed experiments focused on the stability and fate of HCN under a simple hydrothermal system scenario: the thermolysis of HCN at 100°C, at acidic and basic pH and in the presence of Mg-montmorillonite. Furthermore, we analysed the products from HCN thermolysis and highlighted the role of these chemical species as prebiotic molecules under a hydrothermal scenario.
Reliable population size estimates are imperative for effective conservation and management of globally threatened birds like the ‘Critically Endangered’ Blue-throated Macaw Ara glaucogularis. Endemic to one of South America’s largest grassland floodplains, the Llanos de Moxos in northern Bolivia, the species’ global population size is uncertain. The region’s inaccessibility renders the application of traditional methods for obtaining bird population estimates impracticable or cost prohibitive. We developed a simultaneous, multilocality, double-sampling approach combined with quantitative habitat availability analyses to obtain the first rigorous population size estimate for the Blue-throated Macaw. We established 11 survey areas across its three subpopulations that were visited twice by one team in each subpopulation over a 23-day period in the 2015 dry season and obtained additional count data from two roost sites. We classified suitable habitat (palm forest islands) using Landsat 8 images and CLASlite forest monitoring software. We extrapolated the number of macaws detected (conservative estimate of the total number of macaws [CETN], highest single count [HSC]) per 100 ha of suitable habitat in each survey area to the entire area of suitable habitat in all subpopulations combined, corrected for the species’ range occupancy of 34.3%. The total number of Blue-throated Macaws detected by survey (CETN) and roost site counts was 137. Across all survey areas, the number of macaws per 100 ha of suitable habitat was 4.7 for the first and 4.4 for the second period for CETN and 3.2 and 3.4, respectively, for HSC data. Corresponding global population estimates were 426–455 (CETN) and 312–329 (HSC) individuals. Other recent research and anecdotal data support these estimates. Although it would be premature to propose downlisting the species to ‘Endangered’, our findings indicate that it has a larger population and slightly larger range than previously thought, and that the positive effects of conservation actions are now becoming apparent.
The PA6G blue is a polymeric material for great versatility of engineering applications that required good mechanical and tribological properties such as gears. The focus of this study was to investigate the mechanical properties as well as the friction and wear resistance of a commercial PA6G blue under biodegradable external lubrication, to evaluate its potential use for gear applications. Firstly, the PA6G blue was characterized by FTIR analysis in order to identify the characteristic chemical groups of this polymer. The mechanical characterization was performed by tension and hardness tests according to the standards ASTM D638 and ASTM E10, respectively. Subsequently, friction tests were carried out on a tribometer with pin-on-disk configuration based on the ASTM G99 standard, in dry and lubricated conditions. Natural castor and canola oils were employed as bio-lubricants, as well as their mixture at 50% by volume. The results exhibited that the PA6G blue exhibit good mechanical performance as that required by gear fabrications. Besides, the friction performance showed a low friction coefficient of 0.11 in the dry condition that decreased about 50% in lubricated tests, obtaining a friction coefficient value of 0.054.
Women suffer different forms of violence, both explicit and covert, due to gender asymmetry. This study analyzes the relationship between the internalization of norms assigned to the female gender understood as a form of covert social violence and the presence of anxiety and depression. 286 women were evaluated with the Inventory of Concealed Social Violence (IVISEM) to measure the internalization of gender norms, the Inventory of Situations and Responses to Anxiety (ISRA), to measure anxiety, and the Three-Dimensional Depression Questionnaire (CTD) to measure depression. In addition, the possible influence of some variables such as maternity, age and marital status on the internalization of norms and on the presence of emotional alterations is discussed. The findings showed the relationship between IVISEM factors and the seven health indicators measured. Age appeared as a modulating variable in relation to cognitive anxiety and depression and marital status is related to all depression factors. The results show that women's internalization of gender norms can be understood as hidden social violence, since it was associated with high scores in anxiety and depression.
Neuroanatomical abnormalities in first-episode psychosis (FEP) tend to be subtle and widespread. The vast majority of previous studies have used small samples, and therefore may have been underpowered. In addition, most studies have examined participants at a single research site, and therefore the results may be specific to the local sample investigated. Consequently, the findings reported in the existing literature are highly heterogeneous. This study aimed to overcome these issues by testing for neuroanatomical abnormalities in individuals with FEP that are expressed consistently across several independent samples.
Structural Magnetic Resonance Imaging data were acquired from a total of 572 FEP and 502 age and gender comparable healthy controls at five sites. Voxel-based morphometry was used to investigate differences in grey matter volume (GMV) between the two groups. Statistical inferences were made at p < 0.05 after family-wise error correction for multiple comparisons.
FEP showed a widespread pattern of decreased GMV in fronto-temporal, insular and occipital regions bilaterally; these decreases were not dependent on anti-psychotic medication. The region with the most pronounced decrease – gyrus rectus – was negatively correlated with the severity of positive and negative symptoms.
This study identified a consistent pattern of fronto-temporal, insular and occipital abnormalities in five independent FEP samples; furthermore, the extent of these alterations is dependent on the severity of symptoms and duration of illness. This provides evidence for reliable neuroanatomical alternations in FEP, expressed above and beyond site-related differences in anti-psychotic medication, scanning parameters and recruitment criteria.
As the Inca Empire was predominantly agrarian, the integration of local farming communities into a corporate agricultural system constituted a great challenge for the imperial political economy. The authors thus analyse an unusual circular structure in the Altos de Arica region of northern Chile, which resembles an important building—called ‘sunturhuasi’—in the capital, Cusco. They explore this structure using three-dimensional modelling, identifying its probable use in astronomical observations and hence its clear connection with the Inca agricultural calendar, ultimately suggesting that it was central to an imperial built environment related to the political economy of maize production.
This paper examines how monuments with ‘local’ idiosyncrasies are key in processes of place-making and how, through persistence, such places can engage in supra-local and even ‘global’ dynamics. Departing from a detailed revision of its context, materiality and iconography, we show how a remarkable Iberian ‘warrior’ stela brings together the geo-strategic potential of a unique site, located literally between the Mediterranean and the Atlantic worlds, the century-long dialogue between shared and local identities and the power of connectivity of inexorable global processes. Previous approaches to Iberian late prehistoric stelae have had problems in developing bottom-up, theoretically informed and empirically sound approaches to their simultaneously local and supra-local character. The remarkable site of Almargen provides the opportunity to explore this issue. Located in Lands of Antequera (Málaga), a region with a strong tradition of landscape-making through monuments going back to the Late Neolithic, the Almargen ‘warrior’ stela serves us to explore the notion of ‘glocalization’, which embodies persistent local engagements with material culture, sites and landscapes on the one hand, and their connections with wider regional and even ‘global’ worlds on the other.
Trypanosoma cruzi is the causative agent of Chagas disease, a vector-borne disease. The parasite molecules involved in vector interaction have been little investigated. Metallopeptidases and gp63 molecules have been implicated in parasite adhesion of several trypanosomatids to the insect midgut. Although gp63 homologues are highly expanded in the T. cruzi genome, and are implicated in parasite–mammalian host interaction, its role in the insect vector has never been explored. Here, we showed that divalent metal chelators or anti-Tcgp63-I antibodies impaired T. cruzi adhesion to Rhodnius prolixus midgut. Parasites isolated after insect colonization presented a drastic enhancement in the expression of Tcgp63-I. These data highlight, for the first time, that Tcgp63-I and Zn-dependent enzymes contribute to the interaction of T. cruzi with the insect vector.
Gender archaeology approaches to Iberian late prehistory have experienced a significant growth in the last two decades. However, much of the work undertaken has focused on specific aspects of the archaeological record (rock art, burial practices), particularly from the Bronze Age and Iron Age periods for which the evidence is more readily available. In addition, it has tended to be regional or local in scope. Here, we attempt an empirically robust multi-proxy approach to the development of early gender inequalities in Neolithic Iberia. Inspired by Gerda Lerner's ideas on the origins of patriarchy and based on a systematic collection of data analysed by means of significance testing, we present the first comprehensive study of gender dissymmetries in Iberian prehistory. Our conclusions suggest that, first, the multi-proxy method used has potential for the systematic study of gender inequalities on the basis of archaeological data and, second, that the Neolithic witnessed emerging gender inequalities that set the basis for male domination in later periods.