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Astronauts will encounter isolated, confined and extreme (ICE) conditions during future missions, and will have to be able to adapt. Until recently, however, few places on Earth could serve as acceptable space analogues (i.e., submarine and polar regions). The coronavirus disease-2019 (COVID-19)-related lockdowns around the globe provided a good opportunity to obtain more comprehensive datasets on the impact of prolonged isolation on human functioning in a very large sample.
Seven hundred forty-eight individuals (Belgium 442, Spain 183, Germany 50, Italy 50, US 23; Mean age ± SD: 41 ± 14 years, with an age range of 18–83 years; 66% women) filled out an online survey assessing the impact of the COVID-lockdown on psychological, exercise and general health variables a first time near the beginning of the initial lockdown (hereafter ‘T1’; 24 ± 13 days after the start of the first lockdown; i.e., 3 weeks after the start of the first lockdown) and a second time a couple of weeks thereafter (hereafter ‘T2’; 17 ± 5 days after the first online survey; i.e., 6 weeks after the start of the first lockdown).
From T1 to T2 an improvement of subjective sleep quality was observed (P = 0.003), that was related to an increase in subjective sleep efficiency and a decrease in sleep latency and disturbance (P ≤ 0.013). Weekly sitting time decreased, and the weekly amount of moderate and vigorous physical activity increased from T1 to T2 (P ≤ 0.049). No differences from T1 to T2 were observed in terms of mood, loneliness and state anxiety. A lower amount of sitting time was significantly correlated with improved subjective sleep quality (r = 0.096, P = 0.035) and with an increased amount of moderate (r = −0.126, P = 0.005) and vigorous (r = −0.110, P = 0.015) physical activity.
Compared to 3 weeks into the first COVID-imposed lockdown, 6-weeks after the start of the first COVID-imposed lockdown, physical activity and subjective sleep scores were positively impacted. The present, large sample size study further confirms exercise as a worthwhile countermeasure to psycho-physiological deconditioning during confinement.
To determine the proportion of patients in symptomatic remission and recovery following a first-episode of psychosis (FEP).
A multistep literature search using the Web of Science database, Cochrane Central Register of Reviews, Ovid/PsychINFO, and trial registries from database inception to November 5, 2020, was performed. Cohort studies and randomized control trials (RCT) investigating the proportion of remission and recovery following a FEP were included. Two independent researchers searched, following PRISMA and MOOSE guidelines and using a PROSPERO protocol. We performed meta-analyses regarding the proportion of remission/recovery (symptomatic plus functional outcomes). Heterogeneity was measured employing Q statistics and I2 test. To identify potential predictors, meta-regression analyses were conducted, as well as qualitative reporting of studies included in a systematic review. Sensitivity analyses were performed regarding different times of follow-up and type of studies.
One hundred articles (82 cohorts and 18 RCTs) were included in the meta-analysis. The pooled proportion of symptomatic remission was 54% (95%CI [30, 49–58]) over a mean follow-up period of 43.57 months (SD = 51.82) in 76 studies. After excluding RCT from the sample, the proportion of remission remained similar (55%). The pooled proportion of recovery was 32% (95%CI [27–36]) over a mean follow-up period of 71.85 months (SD = 73.54) in 40 studies. After excluding RCT from the sample, the recovery proportion remained the same. No significant effect of any sociodemographic or clinical predictor was found.
Half of the patients are in symptomatic remission around 4 years after the FEP, while about a third show recovery after 5.5 years.
El Niño cave, located on the south-eastern border of the Spanish Meseta, hosts a discontinuous sequence including Middle Palaeolithic and Neolithic levels, along with Upper Palaeolithic and Levantine style paintings. It is a key site for understanding human occupations of inland Iberia during the Palaeolithic and early prehistory. This paper summarises the main results of a multidisciplinary project aimed at defining the prehistoric human occupations at the site.
It is unclear what the prevalence of metabolic syndrome (MetS) in drug-naïve first-episode of psychosis (FEP) is, as previous meta-analyses were conducted in minimally exposed or drug-naïve FEP patients with psychotic disorder at any stage of the disease; thus, a meta-analysis examining MetS in naïve FEP compared with the general population is needed.
Studies on individuals with FEP defined as drug-naïve (0 days exposure to antipsychotics) were included to conduct a systematic review. A meta-analysis of proportions for the prevalence of MetS in antipsychotic-naïve patients was performed. Prevalence estimates and 95% CI were calculated using a random-effect model. Subgroup analyses and meta-regressions to identify sources and the amount of heterogeneity were also conducted.
The search yielded 4143 articles. After the removal of duplicates, 2473 abstracts and titles were screened. At the full-text stage, 112 were screened, 18 articles were included in a systematic review and 13 articles in the main statistical analysis. The prevalence of MetS in naïve (0 days) FEP is 13.2% (95% CI 8.7–19.0). Ethnicity accounted for 3% of the heterogeneity between studies, and diagnostic criteria used for MetS accounted for 7%. When compared with controls matched by sex and age, the odds ratio is 2.52 (95% CI 1.29–5.07; p = 0.007).
Our findings of increased rates of MetS in naïve FEP patients suggest that we are underestimating cardiovascular risk in this population, especially in those of non-Caucasian origin. Our findings support that altered metabolic parameters in FEPs are not exclusively due to antipsychotic treatments.
Healthcare workers (HCWs) not fulfilling the coronavirus disease 2019 (COVID-19) case definition underwent severe acute respiratory coronavirus virus 2 (SARS-CoV-2) screening. Risk of exposure, adherence to personal protective equipment (PPE), and symptoms were assessed. In total, 2,000 HCWs were screened: 5.5% were positive for SARS-CoV-2 by polymerase chain reaction (PCR). There were no differences in PPE use between SARS-CoV-2–positive and –negative HCWs (adherence, >90%). Nursing and kitchen staff were independently associated with positive SARS-CoV-2 results.
Major depressive disorder (MDD) is characterised by a recurrent course and high comorbidity rates. A lifespan perspective may therefore provide important information regarding health outcomes. The aim of the present study is to examine mental disorders that preceded 12-month MDD diagnosis and the impact of these disorders on depression outcomes.
Data came from 29 cross-sectional community epidemiological surveys of adults in 27 countries (n = 80 190). The Composite International Diagnostic Interview (CIDI) was used to assess 12-month MDD and lifetime DSM-IV disorders with onset prior to the respondent's age at interview. Disorders were grouped into depressive distress disorders, non-depressive
distress disorders, fear disorders and externalising disorders. Depression outcomes included 12-month suicidality, days out of role and impairment in role functioning.
Among respondents with 12-month MDD, 94.9% (s.e. = 0.4) had at least one prior disorder (including previous MDD), and 64.6% (s.e. = 0.9) had at least one prior, non-MDD disorder. Previous non-depressive distress, fear and externalising disorders, but not depressive distress disorders, predicted higher impairment (OR = 1.4–1.6) and suicidality (OR = 1.5–2.5), after adjustment for sociodemographic variables. Further adjustment for MDD characteristics weakened, but did not eliminate, these associations. Associations were largely driven by current comorbidities, but both remitted and current externalising disorders predicted suicidality among respondents with 12-month MDD.
These results illustrate the importance of careful psychiatric history taking regarding current anxiety disorders and lifetime externalising disorders in individuals with MDD.
Depressive and anxiety disorders are highly comorbid, which has been theorized to be due to an underlying internalizing vulnerability. We aimed to identify groups of participants with differing vulnerabilities by examining the course of internalizing psychopathology up to age 45.
We used data from 24158 participants (aged 45+) in 23 population-based cross-sectional World Mental Health Surveys. Internalizing disorders were assessed with the Composite International Diagnostic Interview (CIDI). We applied latent class growth analysis (LCGA) and investigated the characteristics of identified classes using logistic or linear regression.
The best-fitting LCGA solution identified eight classes: a healthy class (81.9%), three childhood-onset classes with mild (3.7%), moderate (2.0%), or severe (1.1%) internalizing comorbidity, two puberty-onset classes with mild (4.0%) or moderate (1.4%) comorbidity, and two adult-onset classes with mild comorbidity (2.7% and 3.2%). The childhood-onset severe class had particularly unfavorable sociodemographic outcomes compared to the healthy class, with increased risks of being never or previously married (OR = 2.2 and 2.0, p < 0.001), not being employed (OR = 3.5, p < 0.001), and having a low/low-average income (OR = 2.2, p < 0.001). Moderate or severe (v. mild) comorbidity was associated with 12-month internalizing disorders (OR = 1.9 and 4.8, p < 0.001), disability (B = 1.1–2.3, p < 0.001), and suicidal ideation (OR = 4.2, p < 0.001 for severe comorbidity only). Adult (v. childhood) onset was associated with lower rates of 12-month internalizing disorders (OR = 0.2, p < 0.001).
We identified eight transdiagnostic trajectories of internalizing psychopathology. Unfavorable outcomes were concentrated in the 1% of participants with childhood onset and severe comorbidity. Early identification of this group may offer opportunities for preventive interventions.
We report on what appear to be increasing predation events on nesting Thick-billed Parrots Rhychopsitta pachyrhyncha. Thick-billed Parrots are classified as ‘Endangered’ and their seasonal breeding range is restricted to increasingly fragmented and degraded high elevation mixed conifer forest habitat within the Sierra Madre Occidental region of north-western Mexico. Predation of established breeding pairs has recently contributed to the ongoing decline of Thick-billed Parrot populations by removing mature birds with high reproductive value, which has associated consequences for future recruitment. We observed increasing predation events on nesting Thick-billed Parrots by bobcats Lynx rufus accompanied by kittens throughout the 2018–2019 breeding seasons, and we speculate that recent reductions in bobcat habitat have pushed them into new ranges where they are supplementing their diet with nontraditional prey items.
Less is known about the relationship between conduct disorder (CD), callous–unemotional (CU) traits, and positive and negative parenting in youth compared to early childhood. We combined traditional univariate analyses with a novel machine learning classifier (Angle-based Generalized Matrix Learning Vector Quantization) to classify youth (N = 756; 9–18 years) into typically developing (TD) or CD groups with or without elevated CU traits (CD/HCU, CD/LCU, respectively) using youth- and parent-reports of parenting behavior. At the group level, both CD/HCU and CD/LCU were associated with high negative and low positive parenting relative to TD. However, only positive parenting differed between the CD/HCU and CD/LCU groups. In classification analyses, performance was best when distinguishing CD/HCU from TD groups and poorest when distinguishing CD/HCU from CD/LCU groups. Positive and negative parenting were both relevant when distinguishing CD/HCU from TD, negative parenting was most relevant when distinguishing between CD/LCU and TD, and positive parenting was most relevant when distinguishing CD/HCU from CD/LCU groups. These findings suggest that while positive parenting distinguishes between CD/HCU and CD/LCU, negative parenting is associated with both CD subtypes. These results highlight the importance of considering multiple parenting behaviors in CD with varying levels of CU traits in late childhood/adolescence.
Previous literature supports antipsychotics’ (AP) efficacy in acute first-episode psychosis (FEP) in terms of symptomatology and functioning but also a cognitive detrimental effect. However, regarding functional recovery in stabilised patients, these effects are not clear. Therefore, the main aim of this study is to investigate dopaminergic/anticholinergic burden of (AP) on psychosocial functioning in FEP. We also examined whether cognitive impairment may mediate these effects on functioning.
A total of 157 FEP participants were assessed at study entry, and at 2 months and 2 years after remission of the acute episode. The primary outcomes were social functioning as measured by the functioning assessment short test (FAST). Cognitive domains were assessed as potential mediators. Dopaminergic and anticholinergic AP burden on 2-year psychosocial functioning [measured with chlorpromazine (CPZ) and drug burden index] were independent variables. Secondary outcomes were clinical and socio-demographic variables.
Mediation analysis found a statistical but not meaningful contribution of dopaminergic receptor blockade burden to worse functioning mediated by cognition (for every 600 CPZ equivalent points, 2-year FAST score increased 1.38 points). Regarding verbal memory and attention, there was an indirect effect of CPZ burden on FAST (b = 0.0045, 95% CI 0.0011–0.0091) and (b = 0.0026, 95% CI 0.0001–0.0006) respectively. However, only verbal memory post hoc analyses showed a significant indirect effect (b = 0.009, 95% CI 0.033–0.0151) adding premorbid IQ as covariate. We did not find significant results for anticholinergic burden.
CPZ dose effect over functioning is mediated by verbal memory but this association appears barely relevant.
Subclinical psychotic symptoms are present in the general population. Furthermore, they are quite common in diagnostic categories beyond psychosis, such as BPD patients.
We want to assess the differences between 3 groups: BPD (n = 68), FEP (n = 83) and controls (n = 203) in an experimental paradigm measuring the presence of speech illusions in white noise. The Positive and Negative Syndrome Scale was administered in the patient group, the Structured Interview for Schizotypy-Revised, and the Community Assessment of Psychic Experiences in the control and BPD group. The white noise task was also analysed within a signal detection theory (SDT) framework. Logistic regression analyses and the general linear models were used to analyse the adjusted differences between groups.
Differences were more prevalent in signals that were perceived as affectively salient in patients groups (9.6% in FEP vs 5.9% in BPD and 1% in controls; OR: 10.7; 95%CI: 2.2–51.6, p = 0.003 in FEP; OR: 6.3; 95%CI: 1.1–35.0, p = 0.036 in BPD). Besides, we found a worse general performance and more false alarms in the task for FEP group using SDT framework.
Experimental paradigms indexing the tendency to detect affectively salient signals in noise may be used to identify liability to psychosis in people with vulnerability. Its predictable value in other diagnostic categories and general population requires further research.
‘Hey boss, we have a real challenging case tomorrow. She is a 94-year-old lady with carcinoma of the stomach needing a laparoscopic resection for recurrent bleeding. She could move around the house ok six months ago but has lost a lot of weight over the past few months. On a load of medications for hypertension, diabetes and has atrial fibrillation. Family said she took ages waking up from her last GA. The family reckon the last anaesthetist overdosed her but the doctor said he gave her the usual dose at one MAC. I guess you want to use TIVA… what should I read up on tonight?’
In cases of mass-casualty incidents (MCIs), triage represents a fundamental tool for the management of and assistance to the wounded, which helps discriminate not only the priority of attention, but also the priority of referral to the most suitable center.
The objective of this study was to evaluate the capacity of different prehospital triage systems based on physiological parameters (Shock Index [SI], Glasgow-Age-Pressure Score [GAP], Revised Trauma Score [RTS], and National Early Warning Score 2 [NEWS2]) to predict early mortality (within 48 hours) from the index event for use in MCIs.
This was a longitudinal prospective observational multi-center study on patients who were attended by Advanced Life Support (ALS) units and transferred to the emergency department (ED) of their reference hospital. Collected were: demographic, physiological, and clinical variables; main diagnosis; and data on early mortality. The main outcome variable was mortality from any cause within 48 hours.
From April 1, 2018 through February 28, 2019, a total of 1,288 patients were included in this study. Of these, 262 (20.3%) participants required assistance for trauma and injuries by external agents. Early mortality within the first 48 hours due to any cause affected 69 patients (5.4%). The system with the best predictive capacity was the NEWS2 with an area under the curve (AUC) of 0.891 (95% CI, 0.84-0.94); a sensitivity of 79.7% (95% CI, 68.8-87.5); and a specificity of 84.5% (95% CI, 82.4-86.4) for a cut-off point of nine points, with a positive likelihood ratio of 5.14 (95% CI, 4.31-6.14) and a negative predictive value of 98.7% (95% CI, 97.8-99.2).
Prehospital scores of the NEWS2 are easy to obtain and represent a reliable test, which make it an ideal system to help in the initial assessment of high-risk patients, and to determine their level of triage effectively and efficiently. The Prehospital Emergency Medical System (PhEMS) should evaluate the inclusion of the NEWS2 as a triage system, which is especially useful for the second triage (evacuation priority).
The aim of this study is to investigate the impact of anatomical changes in prostate cancer patients on the target coverage when using 6 MV beams-VMAT therapy and to propose strategies that allow us to evaluate the dose or correct it by normalization without having to perform a new simulation.
Methods and materials:
Ten patients of high-risk prostate cancer were chosen for the study. All test plans were delivered using the same isocenter and monitor units as the original plan and compared against the original unedited plan. The expansion and contraction of body contours due to size changes was mimicked by increasing and decreasing the body contour with depths of −2, −1·5, …, 1·5, 2 cm, in the anterior, and both lateral directions of the patient. A total of 90 plans were evaluated, 9 for each patient. Dose-volume histogram statistics were extracted from each plan and normalized to prescription dose.
Weight changes resulted in considerable dose modifications to the target and critical structures. Plans were found to be varied with 2·9% ± 0·3% per cm SSD change for VMAT treatment with a correlation index close to one. Therefore, doses variations were linear to the changes of depth. Gamma index evaluation was performed for the 10 renormalized plans. All of them passed criteria of 3%/3 mm in at least 98.2% of points. Eight of them passed criteria in 99% points. Gamma index 4%/4 mm passed 100% points in all patients for the chosen region of interest.
The dosimetry estimation presented in this study shows important data for the radiation oncology staff to justify whether a CT rescan is necessary or not when a patient experiences weight changes during treatment. Based on the results of our study, discrepancies between real dose and planned dose were >5% for 1·7 cm of difference in external contour in the anterior and both lateral directions of the patient.
Hernia is defined as the protrusion of one or several internal organs through an opening in the cavity that contains them due to a tissue defect, abdominal wall surgery by means of synthetic meshes is the most common method used for hernia repair, however, postsurgical effects can range from some discomfort, to chronic pain and even the reappearance of the hernia due to a poor mechanical adaptability between the synthetic tissue and the host tissue. The knowledge of the mechanical properties of the materials involved in hernia repair is fundamental in the understanding and subsequent solution of this type of problems. In this work, experimental data were obtained by means of uniaxial tensile tests in two perpendicular directions of commercial meshes used in hernia repair. The tests were carried out on the UniVert® machine of the CellScale® brand. Anisotropic mechanical behavior is observed due to the structure of the mesh and the interaction between each of the yarns that make it up. The data found vary with respect to the direction of traction and also has non-linear hyperelastic behavior, so the adjustment of curves was made through a hyperelastic model in the COMSOL Multiphysics® software through the Levenberg-Marquardt Algorithm for the characterization of these materials.
Studies of abundance and distribution of organisms are fundamental to ecology. The identity of host species is known to be one of the major factors influencing ectoparasitic flea abundance, but explanations are still needed regarding how host taxa influence abundance parameters of different flea species. This study was carried out at La Malinche National Park (LMNP), Tlaxcala, Mexico, where previously 11 flea species had been recorded on 8 host species. Our aims were to list micromammal flea species, to determine flea infection parameters [flea prevalence (FP) and flea mean abundance (FMA)] and to analyse the influence of host species on these parameters. A total of 16 species of fleas were identified from 1178 fleas collected from 14 species of 1274 micromammals captured with Sherman® traps from March 2014 to December 2015 in 18 sites at LMNP. Some host species influence FP and FMA, in particular, Microtus mexicanus and Peromyscus melanotis showed particularly higher infection values than other host species. Plusaetis aztecus and Plusaetis sibynus were identified as the most abundant flea species.