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To characterize the clinical and microbiological features of carbapenem-resistant Enterobacterales (CRE) compared to carbapenem-susceptible Enterobacterales (CSE) in the Dominican Republic (DR), and to assess risk factors associated with CRE.
Design:
Retrospective case-control study.
Setting:
Hospital General Plaza de la Salud, a tertiary teaching hospital in Santo Domingo, DR, from January 2015 to June 2024.
Patients:
Patients with CRE infections were identified from microbiology records. For each year, a matched group of CSE cases was selected at a 2.5:1 ratio. A total of 101 CRE cases and 280 CSE cases were included.
Methods:
Data were collected on demographics, comorbidities, infection sources, hospital stay duration, antibiotic use, and microbiology results. Statistical analysis included univariate and multivariate logistic regression to identify independent risk factors for CRE.
Results:
CRE cases showed higher prevalence of Enterobacter (36.5%) and Klebsiella (38.5%), while Escherichia predominated in CSE (65.5%). CRE patients had longer hospital stays (mean 18.7 vs 4.6 days, P < 0.001), higher ICU admission rates (34.7% vs 3.6%, P < 0.001), and increased invasive procedure use (eg central venous catheters, 36.6% vs 5.4%, P < 0.001). Key risk factors included antibiotic use (OR 3.09, P < 0.001) and ICU stay (OR 3.60, P= 0.012). The peak CRE resistance rate was 3.47% in 2022, a 64% increase from pre-pandemic levels.
Conclusions:
CRE infections in the DR increased during the COVID-19 pandemic, associated with prolonged hospitalizations and critical care. Enhanced antimicrobial stewardship is essential to curb resistance.
This article analyses the collapse of the Mongol empire in the mid- to late fourteenth century (1330s to 1390s) across Eurasia, looking at three facets of the Crisis: environmental—focusing on climate change; epidemiological—exploring the Black Death's impact on the fall of the Chinggisids; and political—mainly the dilution of the Chinggisid charisma due to the halt of expansion. We argue that the main facet of the Crisis was political, and that it derived from the nomadic culture of the Mongols. This was the same political culture that enabled them to establish their huge empire. However, an integral part of this political culture was the need to secure the support of the nomadic elites who were also the backbone of the Mongol army. This proved to be much harder in a reality of excessive natural disasters on the one hand and the erosion of the Chinggisid charisma due to the renunciation of the ideal of world conquest on the other. The result was a growing number of elite groups who contested for power while nominally retaining the framework of the Chinggisid principle, among whom the imperial sons-in-law played a significant part, as well as the shrink and fragmentation of the Chinggisid polities that survived the Crisis.
In the mid-fourteenth century, the Jochid ulus went through a phase of extreme political turbulence. Following the death of the last Batuid khan Berdibek (r. 1357–1359), during the next two decades, circa 1360–1380, a high number of power contenders rose at both the central and the local levels of the ulus. This article aims to map and exemplify those attempts as part of the broader theoretical discussion concerning the scope and depth of the khanate's crisis. It does so by combining an overall, bird's-eye perspective on the political history of the ulus by zooming in on the regional history, as well as through the analysis of both written primary and numismatic sources. None of the multiple patterns of reaction to the dying-out of the Batuid lineage clearly contradicted the idea of the khanate's unity and the overarching ‘Chinggisid principle’. At this point in time, the ulus still followed the centrifugal logic of the Chinggisid rule. At the same time, the crisis of the Jochid ulus of the mid-fourteenth century indeed prepared the very ground for the power division between the still-existing branches of the Jochid family and the break-up of the Jochid power domain of the fifteenth century that followed the last unification attempt of the ulus under Toqtamïsh (r. 1380–1406).
The interaction of water with synthetically prepared goethite (α-FeOOH) and amorphous hyd-rated ferric oxide surfaces was studied using i.r. absorption and water vapor adsorption measurements. I.R. results show that the last traces of physically adsorbed water are removed from the amorphous material by outgassing at 25°C. In contrast, goethite retains approximately a monolayer of physically adsorbed water with similar outgassing. This monolayer of water on goethite, which is presumably hydrogen-bonded at least in part with structural hydroxyls, is readily exchangeable with D2O.
Integral entropies of adsorption were evaluated from water vapor adsorption isotherms at 15, 25 and 35°C and compared with values for mobile and immobile layers calculated through application of statistical mechanics (McCafferty and Zettlemoyer, 1970). Entropy values for both the first physically adsorbed monolayer of water on the amorphous material and the second monolayer on goethite were about the same as or greater than those calculated for an immobile layer, indicating strong hydrogen bonding of water by both surfaces. The larger deviation between the entropy values for goethite and those calculated for the immobile layer may be associated with changes in the structure of the first as well as the second physically adsorbed water layers. Surface areas, calculated using the BET method, were 320 and 32 m2 g-1 for the amorphous material and goethite respectively. Since the unit surface activity is probably about the same for the two materials, it follows that as the amorphous material crystallizes to form goethite, there would be a reduction in total surface activity in proportion to the reduction in surface area.
The nature of freshly-precipitated and aged hydrated ferric oxides prepared by the addition of ferric chloride to KOH was investigated by the use of scanning and transmission electron microscopy, X-ray diffraction, i.r. absorption, and pH 3·0 ammonium oxalate extraction. The results show the fresh material to be essentially non-crystalline hydrated ferric oxide, which when aged at 60°C C and high pH rapidly crystallizes as goethite, without any indication of coexisting hematite. The various methods were evaluated as indices of crystallinity for aging materials. The acid ammonium oxalate method was shown to extract selectively only the non-crystalline portion of such mixtures. The use of X-ray diffraction analysis for estimating aging stage requires elimination of the preferred orientation of the goethite crystals. While both the oxalate and X-ray methods can detect as little as 2 per cent crystallinity, the oxalate method is probably superior for quantitative determinations as it depends directly on an inherent difference in the solubility of the crystalline and non-crystalline materials, rather than on a technique dependent intensity measurement. The use of the intensity of the O-H bending vibrations of the infrared absorption spectra can also potentially detect as little as 2 per cent crystallinity, but the procedure is probably less useful for quantitative determinations than the oxalate or X-ray methods because of the problem of evaluating the area under the peaks.
This study examines the extent to which the Basque ergative -k marker is undergoing change in the Basque Autonomous Community. The inclusion of Standard Basque in the education system since 1982 has brought a significant generational change in the mode of language acquisition: older speakers had no formal education in Basque, whereas younger speakers were educated in the Basque immersion program. Contrary to popular belief, results provide no evidence of ergative loss in apparent time; rather, they are consistent with linguistic stabilization. We claim that the differences in social constraints of gender and language use among the younger group reflect social changes, in which mode of language acquisition is responsible for the social stabilization and further stratification of ergativity. We conclude by arguing that minoritized contexts undergoing language revitalization provide important implications for sociolinguistic change, whereby social changes are embraced in assessing linguistic change.
La navegación, la tecnología naval, la vida a bordo y las actividades llevadas a cabo en barcos de época moderna y contemporánea han sido temas ampliamente estudiados dentro de la arqueología marítima y náutica. Sin embargo, el devenir de los náufragos sobrevivientes de accidentes y las correspondientes evidencias materiales en la costa, no fueron abordados en grado semejante. Las investigaciones muestran un desarrollo dispar, destacando los trabajos realizados en el Pacífico occidental. En Latinoamérica, esta problemática se encuentra aún apenas esbozada. El estudio arqueológico de campamentos de náufragos puede aportar información novedosa para conocer las relaciones humanas, interpersonales e intergrupales, en situaciones de crisis. En este artículo, presentamos los primeros resultados del análisis arqueológico-histórico de la materialidad asociada al sitio Faro Segunda Barranca 4, localizado en el Partido de Patagones, Provincia de Buenos Aires, Argentina. A partir de una discusión de las diferentes líneas de evidencia, identificamos los restos como un campamento de náufragos en el marco de la Guerra del Brasil o Guerra de Cisplatina (1825-1828).
As an escape from the day-to-day drudgery of our “real” world, video games allow us to leave reality and explore new fictional worlds. These worlds are more enjoyable when they are developed from various digital materials and presented as an official story, which is called “lore.” Lore invites the player to submerge into background stories of fictional worlds, including but not limited to those in video games. Video-game lore often provides historical narratives of these worlds, sometimes even drawing on archaeological themes in the creation of characters and places. The video game League of Legends (LoL), developed by Riot Games, has its own detailed lore, often revolving around individual characters. Riot has developed this lore not only through the video game itself but through accompanying media. Although the lore is separate from the game and not necessarily needed, the advantage is that it can orient individuals to the world and the background stories of the characters and players. Additionally, it allows people who are not interested in playing the game to interact with the fictional world, given that the stories are captivating on their own. Here, we briefly discuss Riot's interactive lore website and focus on the background of two places within the LoL fictional world: Ionia and Targon. We examine the presentation of these places through an archaeological framework. Then, we evaluate how archaeology is portrayed throughout the lore, focusing specifically on archaeological field notes and the methods that we are told are employed by one of the characters. In our analysis of the portrayal of Targon, the discussion centers on how archaeological perspectives are an integral framework for the LoL lore. Lore creates a sense of place (a connection between a person and a spatial setting) for the fan community, players, and even developers. Consequently, it is useful to focus on this idea of storytelling through lore, taking a critical view of its power and how it can impact various audiences.
A paucity of data exists regarding the duration of post-traumatic amnesia (PTA) as a predictor of cognitive functioning among children after traumatic brain injury (TBI). The study aimed to assess the relationship between PTA duration and areas of neurocognitive function among the pediatric population in the sub-acute phase of recovery and rehabilitation.
Methods:
Data were collected from medical files on 103 children aged 5.5–16.5 hospitalized at a pediatric rehabilitation department with a diagnosis of moderate–severe TBI (msTBI) between the years 2004–2019. The Children Orientation and Amnesia Test was used to evaluate PTA duration. Measures of high-order cognitive abilities of attention and executive function were collected using the Test of Everyday Attention–Child version (TEA-Ch).
Results:
Three PTA duration groups were assembled out of a cluster analysis: “Long PTA” (M = 21 days), “Very Long PTA” (M = 47 days), and “Extremely Long PTA” (M = 94 days). Analyses revealed that the “Long PTA” group preformed significantly better than the “Very Long PTA” and “Extremely Long PTA” groups on all TEA-Ch measures, that is, Selective Attention, Attentional Control Switching, and Sustained Attention.
Conclusions:
This study is the first to demonstrate that PTA duration is a useful predictor of high-order cognitive functions among children with msTBI in the sub-acute phase of recovery and rehabilitation. The findings emphasize the importance of using a more sensitive classification of prolonged PTA durations to improve outcome prediction and allocation of resources to those who can benefit most after severe brain injuries.
Causal mechanisms' portability and their predictions in sometimes counterfactual settings point to the value of studies with details of interactions and/or convenience samples that depart from those in the proximate contexts of the phenomena of interest. The proper role of such contexts must be construed within an explanatory framework attentive to the nature and properties of relevant causal mechanisms.
Pericardial effusions in children have multiple causes and variable presentations. Cardiac tamponade occurs when the heart chambers become externally compressed and ultimately cardiac output is compromised. The classical signs of cardiac tamponade include jugular venous distention, muffled heart sounds, and systemic hypotension (“Beck’s triad”); however, these are rarely all present. As cardiac output is dependent on preload and heart rate, the anesthetic goal is to avoid cardiac depression, maintain sympathetic outflow, and avoid a decrease in preload. If the effusion is amenable to percutaneous drainage, ideal anesthetic management includes sedation and analgesia with local anesthetic, while keeping the patient spontaneously breathing. If an open procedure is required, it is advisable to perform a “staged” anesthetic and surgical approach in which sedation, analgesia, and local anesthetic are administered to drain the effusion percutaneously before inducing general anesthesia and starting positive-pressure ventilation. As in most emergency situations, the risks of pulmonary aspiration and the chosen anesthetic techniques must be weighed against the urgency of intervention.
Infant siblings of children with autism spectrum disorder (ASD) exhibit greater heterogeneity in behavioral presentation and outcomes relative to infants at low familial risk (LR), yet there is limited understanding of the diverse developmental profiles that characterize these infants. We applied a hierarchical agglomerative cluster analysis approach to parse developmental heterogeneity in 420 toddlers with heightened (HR) and low (LR) familial risk for ASD using measures of four dimensions of development: language, social, play, and restricted and repetitive behaviors (RRB). Results revealed a two-cluster solution. Comparisons of clusters revealed significantly lower language, social, and play performance, and higher levels of restricted and repetitive behaviors in Cluster 1 relative to Cluster 2. In Cluster 1, 25% of children were later diagnosed with ASD compared to 8% in Cluster 2. Comparisons within Cluster 1 between subgroups of toddlers having ASD+ versus ASD− 36-month outcomes revealed significantly lower functioning in the ASD+ subgroup across cognitive, motor, social, language, symbolic, and speech dimensions. Findings suggest profiles of early development associated with resiliency and vulnerability to later ASD diagnosis, with multidimensional developmental lags signaling vulnerability to ASD diagnosis.
Pharmacological and non-pharmacological antidepressant therapies increase the firing rate of lateral septal nucleus neurons (a brain structure involved in mood state regulation) and reduce immobility in the forced swim test (FST), whereas the neurosteroid allopregnanolone appears to produce antidepressant-like effects through actions at GABAA receptors.
Objective
To explore the participation of the lateral septal nucleus and GABAA receptors in the antidepressant-like effects of allopregnanolone in Wistar rats.
Methods
First, the minimally effective dose of allopregnanolone that produces antidepressant-like effects in the FST was determined. Second, the effect of this minimally effective dose in the FST was evaluated on the firing rate of lateral septal neurons. Third, the antidepressant-like effects of microinjection of allopregnanolone (1.0 μg/rat) into the lateral septal nucleus was evaluated in the FST. Fourth, we explored whether the effects of allopregnanolone on the lateral septal neuron firing rate and FST are blocked by picrotoxin or bicuculline, two GABAA receptor antagonists.
Results
The minimally effective dose of allopregnanolone with antidepressant-like effects in the FST was 1.0 mg/kg (i.p.) and significantly increased the firing rate of lateral septal neurons. Microinjection of allopregnanolone into the lateral septal nucleus produced antidepressant-like effects in the FST. Pretreatment with picrotoxin and bicuculline blocked the increase in lateral septal neuron firing rate and the antidepressant-like effects of allopregnanolone in the FST.
Conclusion
The lateral septal nucleus participates in the antidepressant-like effects of allopregnanolone through actions on GABAA receptors in Wistar rats.
The start of Child and Adolescent attention to gender dysphoria is very recent. In our Unit, it has objectified a growing increase in such demand over recent years.
As a typical example would be a patient of 13 years following gender dysphoria begins to present school failure and behavior problems at home with emotional instability.
According to the recommendations of the Group Identity and Sexual Differentiation (GIDSEEN) after early detection is to guide parents towards a comprehensive treatment at a specialized interdisciplinary teams and a psychosocial approach to improve the quality of life, decrease mental comorbidity and gender dysphoria own. Having no such care in our community has been necessary to make a referral to another community to attend this demand.
Currently it is giving adequate attention to these cases, but except for referral to another community. However, as we are seeing progression care in our area in the future could be feasible. Therefore, we consider as a first step dysphoria quantify each case in our area.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Epistocratic arrangements are widely rejected because there will be reasonable disagreement about which citizens count as epistemically superior and an epistemically superior subset of citizens may be biased in ways that undermine their ability to generate superior political outcomes. The upshot is supposed to be that systems of democratic government are preferable because they refuse to allow some citizens to rule over others. We show that this approach is doubly unsatisfactory: although representative democracy cannot be defended as a form of government that prevents some citizens from ruling over others, it can be defended as a special form of epistocracy. We demonstrate that well-designed representative democracies can, through treatment and selection mechanisms, bring forth an especially competent set of individuals to make public policy, even while circumventing the standard objections to epistocratic rule. This has implications for the justification of representative democracy and questions of institutional design.
To determine the prevalence of low scores for two neuropsychological tests with five total scores that evaluate learning and memory functions.
Method:
N = 5402 healthy adults from 11 countries in Latin America and the commonwealth of Puerto Rico were administered the Rey–Osterrieth Complex Figure (ROCF) and the Hopkins Verbal Learning Test (HVLT-R). Two-thirds of the participants were women, and the average age was 53.5 ± 20.0 years. Z-scores were calculated for ROCF Copy and Memory scores and HVLT-R Total Recall, Delayed Recall, and Recognition scores, adjusting for age, age2, sex, education, and interaction variables if significant for the given country. Each Z-score was converted to a percentile for each of the five subtest scores. Each participant was categorized based on his/her number of low scoring tests in specific percentile cutoff groups (25th, 16th, 10th, 5th, and 2nd).
Results:
Between 57.3% (El Salvador) and 64.6% (Bolivia) of the sample scored below the 25th percentile on at least one of the five scores. Between 27.1% (El Salvador) and 33.9% (Puerto Rico) scored below the 10th percentile on at least one of the five subtests. Between 5.9% (Chile, El Salvador, Peru) and 10.3% (Argentina) scored below the 2nd percentile on at least one of the five scores.
Conclusions:
Results are consistent with other studies that found that low scores are common when multiple neuropsychological outcomes are evaluated in healthy individuals. Clinicians should consider the higher probability of low scores when evaluating learning and memory using various sets of scores to reduce false-positive diagnoses of cognitive deficits.
In recent years, modified graphene has been used in various biomedical applications due to its excellent properties that allow the development of devices capable of detecting macromolecules within the human organism, also for biomolecular analysis, discovery of biomarkers, bioimaging and target delivery. These applications involve interactions between enzymes, proteins, peptides, DNA, RNA, etc. and modified graphene, therefore the study and the theoretical and experimental investigation of these interactions is essential for the development of nanobio-technology. For example, many applications based on using modified graphene to detect macromolecules require studying the changes in the properties of doped graphene when interacting with macromolecules. In this work, DFT and molecular dynamics methods were used to obtain results of the changes in energy density of states of graphene doped with iron when it is made to interact with coenzyme A. Besides, we presented a study of molecular dynamics in order to determine the quantum factors that guide the interaction graphene-coenzyme A. The system was studied in aqueous medium which it was simulated by the dielectric constant of water. The results confirm that the methodology presented in this work can be used to theoretically detect various macromolecules.