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Background: Amyotrophic Lateral Sclerosis (ALS) leads to progressive functional decline and reduced survival. Identifying clinical predictors like ALSFRS-R and FVC is essential for prognosis and disease management. Understanding progression profiles based on diagnostic characteristics supports clinical trial design and assessment of treatment response. This study evaluates disease progression and survival predictors in ALS patients from the CNDR. Methods: 1565 ALS patients in the CNDR were analyzed to assess baseline ALSFRS-R, FVC, time from symptom onset to diagnosis, and their association with disease progression and survival. Results: At diagnosis, ALSFRS-R was 44.7 (SD = 5.46), with 72.3% scoring ≥44. Mean FVC was 84.2% (SD = 23.3), with 78.3% of patients having FVC ≥65%. ALSFRS-R declined at 1.06 points/month (SD = 1.33), with faster progression in patients diagnosed within 24 months (1.61 points/month). Patients with ALSFRS-R ≥44 had a median survival of 41.8 months, compared to 30.9 months for those <44 (p < 0.001). Similarly, FVC ≥65% was associated with longer survival (35.4 vs. 29.5 months, p = 0.002). Conclusions: ALSFRS-R and FVC at diagnosis predict survival and inform clinical decision-making. These findings highlight the importance of early diagnosis and targeted interventions to slow disease progression and improve patient outcomes.
Energy drinks can cause cardiovascular, gastrointestinal, and other health disorders. These effects are particularly pronounced in youth. The aim of this study was to systematically review the literature on the consumption of energy drinks in European countries.
Design
A systematic bibliographic search was performed in November 2024 in EMBASE, MEDLINE (Ovid), Scopus and Cochrane databases with no restrictions on country, study period, study design and language.
Setting
Energy drinks are beverages high in caffeine, sugar, and other stimulants.
Participants
A total of 2008 studies were identified and reviewed by four researchers. Ninety-four met the inclusion criteria and were extracted in a table designed ad hoc.
Results
The included studies showed differences regarding their design, definition of consumption, and time frame under study. The most studied frequency of energy drink consumption was weekly consumption, and the most studied population was school students. An increase in prevalence of consumption was observed when tracking energy drink consumption over time. Variables most related to consumption were low socioeconomic status, alcohol and tobacco consumption, physical activity, age, and sex.
Conclusions
It is difficult to have a clear picture of the extent of energy drink consumption in Europe, mainly due to differences in the design of the studies and the lack of periodicity of the estimates in different countries. However, given the health problems that have been associated with energy drink consumption, regulation of these beverages is essential, especially in youth.
Many factors can impact survey completion rates, including survey length, sensitivity of the topics addressed, and clarity of wording. This study used cognitive interviews (CIs), a methodological tool that can aid in developing and refining elements for multi-faceted assessments, and previous survey response patterns to refine, streamline, and increase response rates of RADx-UP Common Data Elements (CDEs) for survey/questionnaire use.
Methods:
Ten previously enrolled CO-CREATE study participants were interviewed between May–June 2023. Interviewees identified CDEs that were “confusing, uncomfortable, and/or not applicable,” along with their reasoning. Interview data were analyzed using a rapid qualitative analytic approach, resulting in a summary matrix categorized by language. For further contextualization, CDE response rates were calculated for the 9147 surveys administered during the CO-CREATE study (May 2021–March 2023) and compared against their survey position.
Results:
Of the 94 CDEs evaluated in the CIs, 20 (21.3%) were flagged by one or more interviewees. Nine (9.6%) English while fourteen (14.9%) Spanish CDEs were flagged by interviewees, with some overlap. Also, CDE response rates differed according to position in the survey, with lower response rates for questions positioned later in the survey. Following review by the research team and the RADx-UP program, 10 English and 15 Spanish were revised, and seven were removed in both languages in the final survey.
Conclusion:
Our findings underscore the importance of integrating community member perspectives to enhance the relevance and clarity of assessment instruments, optimizing the impact of public health research among underrepresented populations.
The description and delineation of trematode species is a major ongoing task. Across the field there has been, and currently still is, great variation in the standard of this work and in the sophistication of the proposal of taxonomic hypotheses. Although most species are relatively unambiguously distinct from their congeners, many are either morphologically very similar, including the major and rapidly growing component of cryptic species, or are highly variable morphologically despite little to no molecular variation for standard DNA markers. Here we review challenges in species delineation in the context provided to us by the historical literature, and the use of morphological, geographical, host, and molecular data. We observe that there are potential challenges associated with all these information sources. As a result, we encourage careful proposal of taxonomic hypotheses with consideration for underlying species concepts and frank acknowledgement of weaknesses or conflict in the data. It seems clear that there is no single source of data that provides a wholly reliable answer to our taxonomic challenges but that nuanced consideration of information from multiple sources (the ‘integrated approach’) provides the best possibility of developing hypotheses that will stand the test of time.
We present a novel scheme for rapid quantitative analysis of debris generated during experiments with solid targets following relativistic laser–plasma interaction at high-power laser facilities. Results are supported by standard analysis techniques. Experimental data indicate that predictions by available modelling for non-mass-limited targets are reasonable, with debris of the order of hundreds of μg per shot. We detect for the first time two clearly distinct types of debris emitted from the same interaction. A fraction of the debris is ejected directionally, following the target normal (rear and interaction side). The directional debris ejection towards the interaction side is larger than on the side of the target rear. The second type of debris is characterized by a more spherically uniform ejection, albeit with a small asymmetry that favours ejection towards the target rear side.
The excavation of a stratified sequence of deposits spanning the Initial Late Formative period (250 BC–AD 120) at Iruhito, in the upper Desaguadero Valley of Bolivia, provides insight into this previously unrecognized, four-century period separating the well-documented Middle Formative (800–250 BC) from the Late Formative (~AD 120–590) period. By tracking subtle shifts in ceramic, architectural, lithic, and faunal data, we can explore tempos of change in social life during this dynamic time. These data lead us to suggest that, rather than being a “transitional” period or a “hiatus” in regional occupation, the Initial Late Formative period was a distinct mode of sociality characterized by the realignment and expansion of interaction networks, on the one hand, and rejection of the decorative aesthetics, monumentality, and public-oriented performances of earlier periods, on the other. We argue that the Late Formative period centers emerging after ~AD 120 intentionally cited architecture and aesthetics that were distant in time and space, constituting a sophisticated political strategy. Finally, these data suggest that the chronological schemata we use to build regional histories often obscure social variability.
We used the PW high-repetition laser facility VEGA-3 at Centro de Láseres Pulsados in Salamanca, with the goal of studying the generation of radioisotopes using laser-driven proton beams. Various types of targets have been irradiated, including in particular several targets containing boron to generate α-particles through the hydrogen–boron fusion reaction. We have successfully identified γ-ray lines from several radioisotopes created by irradiation using laser-generated α-particles or protons including 43Sc, 44Sc, 48Sc, 7Be, 11C and 18F. We show that radioisotope generation can be used as a diagnostic tool to evaluate α-particle generation in laser-driven proton–boron fusion experiments. We also show the production of 11C radioisotopes, $\approx 6 \times 10^{6}$, and of 44Sc radioisotopes, $\approx 5 \times 10^{4}$ per laser shot. This result can open the way to develop laser-driven radiation sources of radioisotopes for medical applications.
A paleomagnetic study of basaltic lava flows exposed in the northern Neuquén Cordillera, southernmost Central Andes, along the Antiñir-Copahue fault zone (ACFZ), involved 25 sites of the Cola de Zorro Formation (Pliocene–Early Pleistocene) along two different sections. The sites show exclusive normal polarity, corresponding to the Late Pliocene Gauss chron (3.6–2.6 Ma). The angular standard deviation of virtual geomagnetic poles (VGPs; ASD = 14.8°) is consistent with the expected values from recent geomagnetic models, in opposition to anomalously low dispersion found in previous studies in Pleistocene VGPs of reverse polarity from neighboring areas to our study zone. Mean paleomagnetic directions for Bella Vista (Dec = 0.0°, Inc = −50.0°, α₉₅ = 7.6°, K = 36.7, N = 11) and Río Huaraco sections (Dec = 354.9°, Inc = −57.0°, α₉₅ = 7.5°, K = 55.7, N = 8) do not show tectonic rotation around vertical axes. Combining and regrouping our and previous data by area confirmed the absence of tectonic rotations in the Huaraco-Trohunco block and a statistically significant clockwise rotation of 14.4° ± 10.3° of three adjacent tectonic blocks located south of our study locality in Pleistocene times. These results suggest that strike-slip deformation along some sections of the ACFZ was significant in the Pleistocene structural evolution of this region.
To summarize insights generated during the preceding four conventions of the European Access Academy (EAA) regarding the interface of patient organizations and medical societies with the evolving European Union (EU) health technology assessment (HTA) process.
Methods
In 2022 and 2023 four EAA conventions were held on the EU HTA regulation, focusing on: (i) its relevance for beating cancer; (ii) stakeholder involvement; (iii) recommended preparatory steps to ensure its successful implementation; and (iv) the role of hematology and oncology as a pacemaker for the EU HTA process. Here we summarize insights generated at the four EAA conventions about the integration of patient and clinician insights in the evolving EU HTA process, including joint scientific consultations (JSC) and joint clinical assessments (JCA).
Results
Throughout the conventions it became clear that the interface of patient associations and clinical societies with the EU HTA process is key for successful implementation of the regulation. All involved stakeholders rely on the principles of evidence-based medicine (EBM), including best internal and external evidence, patient values and expectations, and clinical experience. It was agreed that patient and clinician perspectives on the assessments are needed to balance the technical analysis of best external evidence. While patient input is rather well defined, when and how input from clinical societies is best incorporated during the process remains unclear.
Conclusions
As stipulated by the EBM triad, systematic involvement of patients and clinicians throughout both JSC and JCA is key to ensuring best outcomes for patients and society as a whole, in line with the objectives of the EU HTA regulation.
The innermost region of the Milky Way harbors the central molecular zone (CMZ). This region contains a large amount of molecular gas but a poor star formation rate considering the densities achieved by the gas in this region. We used the arepo code to perform a hydrodynamic and star formation simulation of the galaxy, where a Ferrers bar was adiabatically introduced. During the stage of bar imposition, the bar strength excites density waves close to the inner Lindblad resonance guiding material towards the inner galaxy, driving the formation of a ring that we qualitatively associate with the CMZ. During the simulation, we identified that the ring passes three main phases, namely: formation, instability, and quasi-stationary stages. During the whole evolution, and particularly in the quasi-stationary stage, we observe that the ring is associated with the x2 family of periodic orbits. Additionally, we found that most of the star formation occurs during the ring formation stage, while it drastically decreases in the instability stage. Finally, we found that when the gas has settled in a stable x2 orbit, the star formation takes place mostly after the dense gas passes the apocentre, triggering the conveyor-belt mechanism described in previous studies.
This article uses tensions over the construction of a flow-regulation infrastructure built to control outflow from Lake Titicaca into the Desaguadero River, on the border between Peru and Bolivia, as a case study to explore the ways that relationships to water emerge and are contested. We argue that a nuanced understanding of tensions arising from this infrastructure requires us to recognize the long-term history of how the river accumulated practices, meanings and materials. Adapting the work of Arturo Escobar, we use the concept of ‘water regime’ to think about how engagements with the river are based in different spatiotemporal frameworks that have developed transhistorically and come into tension around the materiality and dynamism of the river itself.
According to International Union for the Conservation of Nature (IUCN) guidelines, all species must be assessed against all criteria during the Red Listing process. For organismal groups that are diverse and understudied, assessors face considerable challenges in assembling evidence due to difficulty in applying definitions of key terms used in the guidelines. Challenges also arise because of uncertainty in population sizes (Criteria A, C, D) and distributions (Criteria A2/3/4c, B). Lichens, which are often small, difficult to identify, or overlooked during biodiversity inventories, are one such group for which specific difficulties arise in applying Red List criteria. Here, we offer approaches and examples that address challenges in completing Red List assessments for lichens in a rapidly changing arena of data availability and analysis strategies. While assessors still contend with far from perfect information about individual species, we propose practical solutions for completing robust assessments given the currently available knowledge of individual lichen life-histories.
The field of healthcare epidemiology is increasingly focused on identifying, characterizing, and addressing social determinants of health (SDOH) to address inequities in healthcare quality. To identify evidence gaps, we examined recent systematic reviews examining the association of race, ethnicity, and SDOH with inpatient quality measures.
Methods:
We searched Medline via OVID for English language systematic reviews from 2010 to 2022 addressing race, ethnicity, or SDOH domains and inpatient quality measures in adults using specific topic questions. We imported all citations to Covidence (www.covidence.org, Veritas Health Innovation) and removed duplicates. Two blinded reviewers assessed all articles for inclusion in 2 phases: title/abstract, then full-text review. Discrepancies were resolved by a third reviewer.
Results:
Of 472 systematic reviews identified, 39 were included. Of these, 23 examined all-cause mortality; 6 examined 30-day readmission rates; 4 examined length of stay, 4 examined falls, 2 examined surgical site infections (SSIs) and one review examined risk of venous thromboembolism. The most evaluated SDOH measures were sex (n = 9), income and/or employment status (n = 9), age (n = 6), race and ethnicity (n = 6), and education (n = 5). No systematic reviews assessed medication use errors or healthcare-associated infections. We found very limited assessment of other SDOH measures such as economic stability, neighborhood, and health system access.
Conclusion:
A limited number of systematic reviews have examined the association of race, ethnicity and SDOH measures with inpatient quality measures, and existing reviews highlight wide variability in reporting. Future systematic evaluations of SDOH measures are needed to better understand the relationships with inpatient quality measures.
Community health workers and promotoras (CHW/Ps) increasingly support research conducted in communities but receive variable or no training. We developed a culturally and linguistically tailored research best practices course for CHW/Ps that can be taken independently or in facilitated groups. The purpose of this study was to evaluate the facilitated training.
Methods:
CHW/Ps were recruited from communities and partners affiliated with study sites in Michigan, Florida, and California. They participated in virtual or in-person training facilitated by a peer in English or Spanish and then completed a survey about their abilities (i.e., knowledge and skills for participating in research-related work) and perceptions of the training. Linear regression analyses were used to examine differences in training experience across several factors.
Results:
A total of 394 CHW/Ps, mean age 41.6 ± 13.8 years, completed the training and survey (n = 275 English; 119 Spanish). Most CHW/Ps were female (80%), and 50% identified as Hispanic, Latino, or Spanish. Over 95% of CHW/Ps rated their abilities as improved after training; 98% agreed the course was relevant to their work and felt the training was useful. Small differences were observed between training sites.
Discussion:
Most CHW/Ps rated the training positively and noted improved knowledge and skills for engaging in research-related work. Despite slight site differences, the training was well received, and CHW/Ps appreciated having a facilitator with experience working in community-based settings. This course offers a standard and scalable approach to training the CHW/P workforce. Future studies can examine its uptake and effect on research quality.
The increase in cortisol can be exogenous or endogenous. As etiologies of endogenous increase we find: Cushing’s disease, 68% of cases, generally due to an ACTH-producing pituitary tumor; Adrenal Cushing syndrome (17%); Ectopic Cushing syndrome (15%) due to lung tumor most frequently. It is relevant since among its symptoms one of the most notable are the psychiatric alterations it produces, among them mood disorders, depression being the most common, as well as psychotic symptoms, delirium and anxiety disorder.
Objectives
To carry out a correct differential diagnosis of the pathologies that could present with symptoms of a manic episode.
Methods
Clinical case description of a 52-year-old woman, who presented with manic symptoms in 2020, requiring hospitalization. Upon discharge from the acute care unit, she consulted with the endocrinologist due to weight gain, revealing an increase in abdominal diameter, hyperpigmentation, a moon-like face, and a hump. Free cortisol was measured in 24-hour urine, with a high result, followed by brain MRI, and pituitary microadenoma was confirmed.
Results
The patient underwent surgical resection of the microadenoma, which was partially effective, so she maintained high cortisol levels, even despite oral retreatment. In 2023 she had a new manic episode, with a cortisol value of approximately 300 nmol/day.
Conclusions
The importance lies in the correct diagnosis to provide appropriate treatment and avoid the chronicity of the disease and the patient psychiatrization. In this case and as in many other diseases, which present with psychiatric symptoms, it is important to differentiate whether it is a primary psychiatric disorder or are component symptoms of another disease that, upon receiving treatment, would resolve the psychiatric symptoms.
Ekbom syndrome also known as Morgellons syndrome or delirium of parasitosis is a psychiatric condition where the patient has the absolute conviction of being infested in spite of medical evidence. Patients may even mutilate themselves or apply toxic substances in order to get rid of these hypothetical organisms. Sometimes they bring samples of these hypothetical parasites to the office to prove their existence, which is known as the “matchbox sign”, a pathognomonic finding.
Objectives
The aim of this clinical case is to make visible the impact that this psychiatric condition can have on the patient’s quality of life
Methods
We present the case of a 40-year-old woman from Peru who was admitted to the otorhinolaryngology unit for injuries compatible with necrosis of the right pinna. When the patient was examined, scars were found on the lower limbs and back. The patient justifies the scratching lesions with the presence of pathogenic organisms, with no trace of them by the physician.
Results
The patient was evaluated by psychiatry service during her admission in otorhinolaryngology, being diagnosed with Ekbom’s delirium and starting treatment with 3 mL of Aripiprazole. Subsequently she was referred to the mental health unit where she left the follow-up until today.
Conclusions
Different effective treatments have been described, among them pimozide, atypical antipsychotics and some SSRIs. However, the complexity of treatment arises when dealing with the irreducible idea that the patient has of being infested, refusing in most cases to receive psychiatric treatment. This can degenerate into major organic and psychological problems that turn the patient’s life into a real hell, which often end up losing much of their daily functionality. The fact of empathizing with the patient and trying to elaborate a plan adjusted to the reality and needs of the moment, can help us to establish a good therapeutic bond that facilitates an early start of treatment and greater therapeutic adherence, enabling a significant improvement in their quality of life.
Children who have undergone an oncological process and have received treatment with chemotherapy or radiotherapy on the central nervous system may have significant neurocognitive sequelae. Some video games have shown neurocognitive benefits in people with impairments in different areas, such as attention or memory.
Objectives
This work aims to demonstrate the benefit of a video game-based training program to improve the neurocognitive profile in a child survivor of cancer.
Methods
The patient is a 9-year-old female who was diagnosed with acute lymphoblastic leukemia at the age of 4 years. She received routine treatment of this disease by chemotherapy, including high-dose chemotherapy (with blood-brain barrier crossing) and intrathecal chemotherapy. She is currently 3 years after the end of treatment.
The Continuous Performance Test 3 (CPT-3) (sustained attention/vigilance) was administered before and after a multifaceted training program consisting of playing 3 video games for 12 weeks, as follows: a brain-training game (4 days per week, 7-12 minutes per day), a skill-training game (2 days per week, 10 minutes per day) and an exergaming game (2 days per week, 10 minutes per day).
Results
Prior to intervention, the patient had 3 atypical z-scores on the CPT-3 (z scores: mean = 0, S.D. = 1), with a pattern compatible with ADHD (omissions z = 1.2; hit reaction time z = 3.4; hit reaction time block change z = 1.2). After intervention, she had only an atypical z-score (hit reaction time z = 3.6), with a pattern compatible with slowing, without ADHD.
Conclusions
The neuropsychological evaluation of this patient showed an improvement in his attentional pattern on the CPT-3 after the video game-based training.
Childhood cancer survivors have neurocognitive sequelae that in most survivor follow-up programs are underdiagnosed and for which there is usually no treatment plan.
Video games have demonstrated various psychological and neurocognitive benefits in different subpopulations, such as patients with organic neurological deficits or children with ADHD. However, few studies have been carried out using video games-based interventions in the paediatric oncology population.
Objectives
The aim of this work is to present the WINNERS study protocol, the objectives of which are to diagnose the neurological and cognitive sequelae in child cancer survivors, and to demonstrate the benefit in these areas of a training program based on video games.
Methods
A randomized controlled and unblinded trial is presented. Fifty-six patients aged 8 to 17 years stratified into two age groups (8-12 and 13-17) who had received any of the following treatments 1 to 6 years before the enrolment will be selected: high-dose chemotherapy with blood-brain barrier crossing, intrathecal or intraventricular chemotherapy, CNS radiotherapy or hematopoietic stem cell transplantation.
A neuropsychological evaluation will be performed consisting of a battery of neuropsychological tests to assess parameters such as attention, memory, visuospatial ability or speed of response, as well as a neuroimaging evaluation by structural and functional magnetic resonance imaging. The evaluation will be repeated 3 months and 6 months after the enrolment. Patients will be randomized to a treatment group or to a recycled waiting group. Intervention will consist on a 12-week training at home using 3 video games: a brain training game, an exergaming game and a skill training game.
Results
According to the hypotheses of this study, it is expected that the proposed program of videogame-based interventions will improve neurocognitive and other wellbeing parameters in the intervention group.
Conclusions
This study aims to improve the quality of care for patients who have survived a cancer disease by detecting sequelae that have so far been poorly attended, and by proposing a gamification-based intervention program that is effective and attractive for this population.