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Major depressive disorder (MDD) is the leading cause of disability worldwide. Patients with MDD have high rates of comorbidity with mental and physical conditions, one of which is chronic pain. Chronic pain conditions themselves are also associated with significant disability, and the large number of patients with MDD who have chronic pain drives high levels of disability and compounds healthcare burden. The management of depression in patients who also have chronic pain can be particularly challenging due to underlying mechanisms that are common to both conditions, and because many patients with these conditions are already taking multiple medications. For these reasons, healthcare providers may be reluctant to treat such patients. The Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines provide evidence-based recommendations for the management of MDD and comorbid psychiatric and medical conditions such as anxiety, substance use disorder, and cardiovascular disease; however, comorbid chronic pain is not addressed. In this article, we provide an overview of the pathophysiological and clinical overlap between depression and chronic pain and review evidence-based pharmacological recommendations in current treatment guidelines for MDD and for chronic pain. Based on clinical experience with MDD patients with comorbid pain, we recommend rapidly and aggressively treating depression according to CANMAT treatment guidelines, using antidepressant medications with analgesic properties, while addressing pain with first-line pharmacotherapy as treatment for depression is optimized. We review options for treating pain symptoms that remain after response to antidepressant treatment is achieved.
The coronavirus disease (COVID-19) pandemic represented an unprecedented challenge for health care facilities, and innovative solutions were urgently required to overcome the high volume of critically ill infectious patients, limit in-hospital outbreaks, and limit the risk of occupational infection for health care workers (HCWs). Bergamo was the hardest-hit Italian province by COVID-19, and the local health care system had to undergo a profound and prompt reorganization. A COVID-19-only field hospital was rapidly set up meeting the standards for severe acute respiratory infection (SARI) treatment centers (https://apps.who.int/iris/handle/10665/331603). A zones partition, dedicated in-hospital pathways for HCWs, strict infection prevention and control (IPC) measures, and constant staff supervision were key components of our strategy to limit the risk of occupational infection for HCWs. Herein, we present the Bergamo field hospital layout enlightening fundamental IPC measures adopted as a valuable example of a SARI treatment center confronting COVID-19.
Values—the motivational goals that define what is important to us—guide our decisions and actions every day. Their importance is established in a long line of research investigating their universality across countries and their evolution from childhood to adulthood. In adolescence, value structures are subject to substantial change, as life becomes increasingly social. Value change has thus far been understood to operate independently within each person. However, being embedded in various social systems, adolescents are constantly subject to social influence from peers. Thus, we introduce a framework investigating the emergence and evolution of value priorities in the dynamic context of friendship networks. Drawing on stochastic actor-oriented network models, we analyze 73 friendship networks of adolescents. Regarding the evolution of values, we find that adolescents’ value systems evolve in a continuous cycle of internal validation through the selection and enactment of goals—thereby experiencing both congruence and conflicts—and external validation through social comparison among their friends. Regarding the evolution of friendship networks, we find that demographics are more salient for the initiation of new friendships, whereas values are more relevant for the maintenance of existing friendships.
Genetic variants associated with dietary intake may be important as factors underlying the development of obesity. We investigated the associations between the obesity candidate genes (fat mass and obesity-associated (FTO), melanocortin-4 receptor (MC4R), leptin (LEP) and leptin receptor) and total energy intake and percentage of energy from macronutrients and ultra-processed foods before and during pregnancy. A sample of 149 pregnant women was followed up in a prospective cohort in Rio de Janeiro, Brazil. A FFQ was administered at 5–13 and 30–36 weeks of gestation. Genotyping was performed using real-time PCR. Associations between polymorphisms and the outcomes were investigated through multiple linear regression and ANCOVA having pre-pregnancy dietary intake as a covariate. The A-allele of FTO-rs9939609 was associated with a −6·5 % (95 % CI −12·3, −0·4) decrease in the percentage of energy from protein and positively associated with the percentage of energy from carbohydrates before pregnancy (β=2·6; 95 % CI 0·5, 4·8) and with a 13·3 % (95 % CI 0·7, 27·5) increase in the total energy intake during pregnancy. The C-allele of MC4R-rs17782313 was associated with a −7·6 % (95 % CI −13·8, −1·0) decrease in the percentage of energy from protein, and positively associated with the percentage of energy from ultra-processed foods (β=5·4; 95 % CI 1·1, 9·8) during pregnancy. ANCOVA results revealed changes in dietary intake from pre-pregnancy to pregnancy for FTO-rs9939609 (percentage of energy from ultra-processed foods, P=0·03), MC4R-rs17782313 (total energy intake, P=0·02) and LEP-rs7799039 (total energy intake, P=0·04; percentage of energy from protein, P=0·04). These findings suggest significant associations between FTO-rs9939609, MC4R-rs17782313 and LEP-rs7799039 genes and the components of dietary intake in pregnant women.
Innovation platforms are fast becoming part of the mantra of agricultural research for development projects and programmes. Their basic tenet is that stakeholders depend on one another to achieve agricultural development outcomes, and hence need a space where they can learn, negotiate and coordinate to overcome challenges and capture opportunities through a facilitated innovation process. Although much has been written on how to implement and facilitate innovation platforms efficiently, few studies support ex-ante appraisal of when and for what purpose innovation platforms provide an appropriate mechanism for achieving development outcomes, and what kinds of human and financial resource investments and enabling environments are required. Without these insights, innovation platforms run the risk of being promoted as a panacea for all problems in the agricultural sector. This study makes clear that not all constraints will require innovation platforms and, if there is a simpler and cheaper alternative, that should be considered first. Based on the review of critical design principles and plausible outcomes of innovation platforms, this study provides a decision support tool for research, development and funding agencies that can enhance more critical thinking about the purposes and conditions under which innovation platforms can contribute to achieving agricultural development outcomes.
Cathelicidins are antimicrobial peptides produced by humans and animals in response to various pathogenic microbes. Crotalicidin (Ctn), a cathelicidin-related vipericidin from the South American Crotalus durissus terrificus rattlesnake's venom gland, and its fragments have demonstrated antimicrobial and antifungal activity, similarly to human cathelicidin LL-37. In order to provide templates for the development of modern trypanocidal agents, the present study evaluated the antichagasic effect of these four peptides (Ctn, Ctn[1-14], Ctn[15-34] and LL-37). Herein, Ctn and short derived peptides were tested against the epimastigote, trypomastigote and amastigote forms of Trypanosoma cruzi Y strain (benznidazole-resistant strain) and cytotoxicity in mammalian cells was evaluated against LLC-MK2 lineage cells. Ctn inhibited all T. cruzi developmental forms, including amastigotes, which is implicated in the burden of infection in the chronic phase of Chagas disease. Moreover, Ctn showed a high selective index against trypomastigote forms (>200). Ctn induced cell death in T. cruzi through necrosis, as determined by flow cytometry analyses with specific molecular probes and morphological alterations, such as loss of membrane integrity and cell shrinkage, as observed through scanning electron microscopy. Overall, Ctn seems to be a promising template for the development of antichagasic agents.
Initial results en route toward construction of complex magnetic core-shell silica and organosilica nanotheranostics are presented. Magnetite nanoparticles are synthesized by three different methods and embedded within mesoporous silica and organosilica frameworks by different surfactant-templated procedures to produce three types of core-shell nanoparticles. Magnetite nanoparticles (15 nm in diameter) are embedded within mesoporous silica nanoparticles to produce cell-like material with predominantly one magnetite nuclei-resembling core per nanoparticle, with final particle diameter of ca. 150 nm, specific surface area of 573 m2/g and hexagonally structured tubular pores (2.6 nm predominant diameter), extended throughout the volume of nanoparticles. Two forms of spherical core-shell nanoparticles composed of magnetite cores embedded within mesoporous organosilica shells are also obtained by employing ethylene and ethane bridged organobisalkoxysilane precursors. The obtained nanomaterials are characterized by high surface area (978 and 820 m2/g), tubular pore morphology (2 and 2.8 nm predominant pore diameters), different diameters (386 and 100-200 nm), in case of ethylene- and ethane-composed organosilica shells, respectively. Different degree of agglomeration of magnetite nanoparticles was also observed in the obtained materials, and in the case of utilization of surfactant-pre-stabilized magnetite nanoparticles for the syntheses, their uniform and non-agglomerated distribution within the shells was noted.
Objectives: The objective was to review the literature on diffusion tensor imaging as well as resting-state functional magnetic resonance imaging and electroencephalography (EEG) to unveil neuroanatomical and neurophysiological substrates of Alzheimer’s disease (AD) as a brain neural network pathology affecting structural and functional cortical connectivity underlying human cognition. Methods: We reviewed papers registered in PubMed and other scientific repositories on the use of these techniques in amnesic mild cognitive impairment (MCI) and clinically mild AD dementia patients compared to cognitively intact elderly individuals (Controls). Results: Hundreds of peer-reviewed (cross-sectional and longitudinal) papers have shown in patients with MCI and mild AD compared to Controls (1) impairment of callosal (splenium), thalamic, and anterior–posterior white matter bundles; (2) reduced correlation of resting state blood oxygen level-dependent activity across several intrinsic brain circuits including default mode and attention-related networks; and (3) abnormal power and functional coupling of resting state cortical EEG rhythms. Clinical applications of these measures are still limited. Conclusions: Structural and functional (in vivo) cortical connectivity measures represent a reliable marker of cerebral reserve capacity and should be used to predict and monitor the evolution of AD and its relative impact on cognitive domains in pre-clinical, prodromal, and dementia stages of AD. (JINS, 2016, 22, 138–163)
Locally abundant ungulates often come into conflict with human activities. After a population collapse that reached its nadir in the 1970s, the guanaco Lama guanicoe population in Tierra del Fuego, Chile, recovered and is now in conflict with sheep ranching and commercial logging. We studied the effects of livestock density and environmental factors on guanaco abundance and spatial ecology, using seasonal counts and radio-telemetry in a private protected area (Karukinka) and neighbouring ranches in a forest–grassland mosaic in Tierra del Fuego. Guanaco density was highest in low-elevation areas with more grassland cover and little snow accumulation in winter. In low-elevation areas, guanaco density decreased with increasing livestock density. Radio-tracked guanacos exhibited a partial migration pattern: two individuals migrated seasonally, selecting grasslands and avoiding forests mainly in summer, whereas six sedentary individuals used habitats according to their availability. Migratory guanacos spent the summer in Karukinka and winter on nearby ranches. High sheep densities and poor range condition on the ranches reduce key forage resources available to guanacos and may promote use of forests by guanacos, affecting forest regeneration and increasing conflict with logging. Current guanaco harvest by loggers may fail to reduce the impact of guanacos on logged-forest regeneration if guanaco spatial ecology and sheep management are not considered. Our results provide insight into the interactions among guanacos, forests and livestock ranching, and may be used to reduce conflicts and guide conservation in the Fuegian ecosystem.
Distributed energy-balance melt models have rarely been applied to glaciers with extensive supraglacial debris cover. This paper describes the development of a distributed melt model and its application to the debris-covered Miage glacier, western Italian Alps, over two summer seasons. Sub-debris melt rates are calculated using an existing debris energy-balance model (DEB-Model), and melt rates for clean ice, snow and partially debris-covered ice are calculated using standard energy-balance equations. Simulated sub-debris melt rates compare well to ablation stake observations. Melt rates are highest, and most sensitive to air temperature, on areas of dirty, crevassed ice on the middle glacier. Here melt rates are highly spatially variable because the debris thickness and surface type varies markedly. Melt rates are lowest, and least sensitive to air temperature, beneath the thickest debris on the lower glacier. Debris delays and attenuates the melt signal compared to clean ice, with peak melt occurring later in the day with increasing debris thickness. The continuously debris-covered zone consistently provides 30% of total melt throughout the ablation season, with the proportion increasing during cold weather. Sensitivity experiments show that an increase in debris thickness of 0.035 m would offset 18C of atmospheric warming.
In recent years, nuclear waste management has become a fundamental issue in the nuclear energy production cycle. Tomographic Gamma Scanner (TGS) is an essential tool for nuclear waste characterization. It is crucial to rely on local support and cost effective solutions; for this reasons, we are designing our TGS system based on local technology. In this work, we present a study of different geometries and instrumentation chain parameters to design a TGS.
A set of Monte Carlo simulations were performed to evaluate energy and spatial resolution limitations of scintillator, CZT (Cadmium Zinc Telluride), and HPGe (high purity germanium) detectors. Collimator and detector geometries were studied to maximize the characteristics of the system. In this study, a phantom of 137Cs and 60Co was utilized to evaluate the overall performance of the proposed TGS system. In addition, the impact of electronic instrumentation chain and image reconstruction algorithms was taken into account.
Non-reinforced retrieval induces memory extinction, a phenomenon characterized by a decrease in the intensity of the learned response. This attribute has been used to develop extinction-based therapies to treat anxiety and post-traumatic stress disorders. Histamine modulates memory and anxiety but its role on fear extinction has not yet been evaluated. Therefore, using male Wistar rats, we determined the effect of the intra-hippocampal administration of different histaminergic agents on the extinction of step-down inhibitory avoidance (IA), a form of aversive learning. We found that intra-CA1 infusion of histamine immediately after non-reinforced retrieval facilitated consolidation of IA extinction in a dose-dependent manner. This facilitation was mimicked by the histamine N-methyltransferase inhibitor SKF91488 and the H2 receptor agonist dimaprit, reversed by the H2 receptor antagonist ranitidine, and unaffected by the H1 antagonist pyrilamine, the H3 antagonist thioperamide and the antagonist at the NMDA receptor (NMDAR) polyamine-binding site ifenprodil. Neither the H1 agonist 2-2-pyridylethylamine nor the NMDAR polyamine-binding site agonist spermidine affected the consolidation of extinction while the H3 receptor agonist imetit hampered it. Extinction induced the phosphorylation of ERK1 in dorsal CA1 while intra-CA1 infusion of the MEK inhibitor U0126 blocked extinction of the avoidance response. The extinction-induced phosphorylation of ERK1 was enhanced by histamine and dimaprit and blocked by ranitidine administered to dorsal CA1 after non-reinforced retrieval. Taken together, our data indicate that the hippocampal histaminergic system modulates the consolidation of fear extinction through a mechanism involving the H2-dependent activation of ERK signalling.
Objectives: During the 2009 influenza A (H1N1) pandemic, Argentina's Hospital Nacional Profesor Alejandro Posadas, a referral center in the capital province of Buenos Aires, treated a large urban patient population. Beginning in April, after severe influenza had been reported in North America but before any suspected cases of H1N1 had been reported in Argentina, the authors formed a pandemic planning committee to direct our hospital's response. An important strategy of the management team was to create a single daily monitoring tool that could integrate multiple information sources. We describe our pandemic planning strategy so that it may serve as a template for other hospitals.
Methods: We describe our integrated data management system and the indicators it measured. We also describe the iterative process used to develop these tools and the current versions we use in surveillance for possible new waves of pandemic influenza.
Results: We present 3 examples of strategic decision making applied to data from our integrated information system. Daily pandemic surveillance data motivated the planning committee to reallocate hospital resources to care for patients during the peak pandemic period.
Conclusions: This report illustrates the importance of pandemic planning and advanced integrated information tools for management of a health care facility during a pandemic.
(Disaster Med Public Health Preparedness. 2010;4:207-212)
In Argentinean crop fields, weed control is mainly achieved by intense use of glyphosate as a nonselective and/or selective herbicide. Glyphosate use is very high as more than 95% of the 16 million ha soybean crop consists of glyphosate-resistant cultivars, always treated with this herbicide. From initial success, inconsistent glyphosate control of Johnsongrass, an invading C4 perennial grass of soybean crops, has become evident to producers from northern Argentina over the last 3 yr. Prior to this, glyphosate provided good control. This study evaluated the nature of these recurrent glyphosate failures in Johnsongrass. Experiments conducted with Johnsongrass plants obtained from seed and rhizome phytomers collected from fields with intense glyphosate use history showed that these populations showed differential survival and biomass productivity when glyphosate treated than Johnsongrass plants obtained from similar propagules collected from field sites with no history of glyphosate use. This empirical evidence establishes that the Johnsongrass survival in glyphosate-treated transgenic soybean fields from northern Argentina is due to evolved glyphosate resistance.
Data from several sources and original data are presented regarding sightings, strandings and incidental captures of leatherback sea turtles (Dermochelys coriacea) on the Brazilian coast in a 33 year period, from 1969 to 2001. Two of the turtles were small juveniles (curved carapace length=40 cm and approximately 85 cm) and the remaining animals with known carapace size were large juveniles or adults. The origin of leatherbacks observed in Brazil is unknown. Several colonies in South America, including a Brazilian one, in the Caribbean, in western Africa and even in eastern South Africa could be the source of these turtles. The data presented here suggest that more effort should be directed to the assessment of the impact of fishing gear and marine pollution on leatherbacks and that systematic surveys on beaches should be maintained in order to monitor long term fluctuations in stranding levels and spatial stranding patterns. Genetic studies and satellite telemetry would be helpful in clarifying the origin of leatherbacks stranded or incidentally captured on the Brazilian coast.
Bacillus species were recovered from the blood cultures of 39 oncology patients over 14 weeks. A matched case-control study showed a strong association of Bacillus species bacteremia with use of calcium gluconate solution (odds ratio=25.0) and of central venous lines (odds ratio=8.8). Stopping use of the implicated calcium gluconate vials controlled the outbreak.
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