We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
This study aims to outline Clostridioides difficile infection (CDI) trends and outcomes in Mexican healthcare facilities during the COVID-19 pandemic.
Design:
Observational study of case series.
Setting:
Sixteen public hospitals and private academic healthcare institutions across eight states in Mexico from January 2016 to December 2022.
Patients:
CDI patients.
Methods:
Demographic, clinical, and laboratory data of CDI patients were obtained from clinical records. Cases were classified as community or healthcare-associated infections, with incidence rates calculated as cases per 10,000 patient days. Risk factors for 30-day all-cause mortality were analyzed by multivariate logistic regression.
Results:
We identified 2,356 CDI cases: 2,118 (90%) were healthcare-associated, and 232 (10%) were community-associated. Common comorbidities included hypertension, diabetes, and cancer. Previous high use of proton-pump inhibitors, steroids, and antibiotics was observed. Recurrent infection occurred in 112 (5%) patients, and 30-day mortality in 371 (16%). Risk factors associated with death were a high Charlson score, prior use of steroids, concomitant use of antibiotics, leukopenia, leukocytosis, elevated serum creatine, hypoalbuminemia, septic shock or abdominal sepsis, and SARS-CoV-2 coinfection. The healthcare-associated CDI incidence remained stable at 4.78 cases per 10,000 patient days during the pre-and pandemic periods. However, the incidence was higher in public hospitals.
Conclusions:
Our study underscores the need for routine epidemiology surveillance and standardized CDI classification protocols in Mexican institutions. Though CDI rates in our country align with those in some European countries, disparities between public and private healthcare sectors emphasize the importance of targeted interventions.
Paquimé (also known as Casas Grandes), situated in northern Chihuahua between Mesoamerican and Ancestral Puebloan groups, was a vibrant multicultural centre during the thirteenth and fourteenth centuries AD. Substantial debate surrounds the social organisation of Paquimé's inhabitants. Here, the authors report on the analysis of ancient DNA from a unique child burial beneath a central support post of a room in the House of the Well. They argue that the close genetic relationship of the child's parents, revealed through this analysis, and the special depositional context of the burial reflect one family's attempts to consolidate and legitimise their social standing in this ancient community.
The coronavirus disease 2019 (COVID-19) has serious physiological and psychological consequences. The long-term (>12 weeks post-infection) impact of COVID-19 on mental health, specifically in older adults, is unclear. We longitudinally assessed the association of COVID-19 with depression symptomatology in community-dwelling older adults with metabolic syndrome within the framework of the PREDIMED-Plus cohort.
Methods
Participants (n = 5486) aged 55–75 years were included in this longitudinal cohort. COVID-19 status (positive/negative) determined by tests (e.g. polymerase chain reaction severe acute respiratory syndrome coronavirus 2, IgG) was confirmed via event adjudication (410 cases). Pre- and post-COVID-19 depressive symptomatology was ascertained from annual assessments conducted using a validated 21-item Spanish Beck Depression Inventory-II (BDI-II). Multivariable linear and logistic regression models assessed the association between COVID-19 and depression symptomatology.
Results
COVID-19 in older adults was associated with higher post-COVID-19 BDI-II scores measured at a median (interquartile range) of 29 (15–40) weeks post-infection [fully adjusted β = 0.65 points, 95% confidence interval (CI) 0.15–1.15; p = 0.011]. This association was particularly prominent in women (β = 1.38 points, 95% CI 0.44–2.33, p = 0.004). COVID-19 was associated with 62% increased odds of elevated depression risk (BDI-II ≥ 14) post-COVID-19 when adjusted for confounders (odds ratio; 95% CI 1.13–2.30, p = 0.008).
Conclusions
COVID-19 was associated with long-term depression risk in older adults with overweight/obesity and metabolic syndrome, particularly in women. Thus, long-term evaluations of the impact of COVID-19 on mental health and preventive public health initiatives are warranted in older adults.
The early clinical predictors of respiratory failure in Latin Americans with Guillain–Barré syndrome (GBS) have scarcely been studied. This is of particular importance since Latin America has a high frequency of axonal GBS variants that may imply a worse prognosis.
Methods:
We studied 86 Mexican patients with GBS admitted to the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, a referral center of Mexico City, to describe predictors of invasive mechanical ventilation (IMV).
Results:
The median age was 40 years (interquartile range: 26–53.5), with 60.5% men (male-to-female ratio: 1.53). Most patients (65%) had an infectious antecedent (40.6% gastrointestinal). At admission, 38% of patients had a Medical Research Council (MRC) sum score <30. Axonal subtypes predominated (60.5%), with acute motor axonal neuropathy being the most prevalent (34.9%), followed by acute inflammatory demyelinating polyneuropathy (32.6%), acute motor sensory axonal neuropathy (AMSAN) (25.6%), and Fisher syndrome (7%). Notably, 15.1% had onset in upper limbs, 75.6% dysautonomia, and 73.3% pain. In all, 86% received either IVIg (9.3%) or plasma exchange (74.4%). IMV was required in 39.5% patients (72.7% in AMSAN). A multivariate model without including published prognostic scores yielded the time since onset to admission <15 days, axonal variants, MRC sum score <30, and bulbar weakness as independent predictors of IMV. The model including grading scales yielded lower limbs onset, Erasmus GBS respiratory insufficiency score (EGRIS) >4, and dysautonomia as predictors.
Conclusion:
These results suggest that EGRIS is a good prognosticator of IMV in GBS patients with a predominance of axonal electrophysiological subtypes, but other early clinical data should also be considered.
In the present study, the influence of three sex ratios (1:1, 1:2, and 1:3; female:male) of the mirid Engytatus varians (Distant) (Hemiptera) on different biological parameters and on its offspring was evaluated. The prey preference of different developmental stages of this predator for different nymphal instars (N) of Bactericera cockerelli (Sulcer) (Hemiptera: Triozidae) was also evaluated. The fertility was significantly higher (24 nymphs/female) in the 1:3 sex ratio than in the 1:1 and 1:2 sex ratios (14 and 16 nymphs/female, respectively). The females in the 1:1 and 1:2 sex ratios lived 1.14 and 1.43 days more (27 and 28 days, respectively) than those in the 1:3 sex ratio (26 days). The nymphs derived from the females of the three sex ratios (first filial generation, F1) had five instars and a duration of 17 or 18 days. The ratio of the F1 generation females was not affected by the sex ratio of their parents. In choice tests, independent of whether the preys were placed on a single or multiple tomato (Solanum lycopersicum L.) leaflets, the consumption of females and males and N3, N4, and N5 nymphs of E. varians on B. cockerelli, generally showed the order of N2>N3>N4>N5. In conclusion, the findings revealed in this study can help to improve the rearing methodology for increasing populations of E. varians. In addition, they can serve as a guideline for releasing this predator in times when there is an abundance of early instar nymphs of B. cockerelli.
Conclusions and recommendations of health technology assessment (HTA) reports have an impact on all relevant actors involved in the health system (health authorities, administrators, health professionals, patients, citizens and industry). The involvement of all those relevant stakeholders in the HTA process facilitates making valid and informed decisions and an efficient allocation of resources. Improving communication, participation and transparency among all agents will lead to more efficient evaluation and decision-making processes.
Methods
To review key aspects of the relations between HTA agencies and health industries, two process were carried out: a narrative review of literature searched in Medline, PubMed, Embase, CINAHL and WOS (2007-2017) and a review of websites of international HTA agencies. References and webs with information on the framework, objectives, methodologies, impact or results of the relationships were included.
Results
A total of 1961 references were located and forty-five were selected. From the synthesis of the selected references the following key aspects of the relationships between HTA and industry were identified: (i) the importance of early dialogues with industry to align HTA objectives with the generation of evidence; (ii) challenges of the bias in the evidence produced by industry; (iii) difficulties in industry engagement in HTA processes; and (iv) industry interest in HTA. The review of six agency websites provided information on industry involvement in strategic activities, early dialogues, provision of documentation, management of industry clarifications, review of the report/allegations and other forms of relationship.
Conclusions
Both the review of the literature and the contents of the web pages of international agencies with experience in relations with industry show that the interest is in the creation of collaborative frameworks between regulatory authorities that decide on authorization and price and reimbursement and HTA agencies, while both try to maintain an early, transparent and systematic interaction with the healthcare industry.
The aim of this study was to develop and to assess a specific Multi-Criteria Decision Analysis (MCDA) framework to evaluate new drugs in an hospital pharmacy and therapeutics committee (P&TC) setting.
Methods:
A pilot criteria framework was developed based on the EVIDEM (Evidence and Value: Impact on DEcisionMaking) framework, together with other relevant criteria, and assessed by a group of P&TC's members. The weighting of included criteria was done using a 5-point weighting technique. Two drugs were chosen by evaluation: an orphan-drug for Gaucher disease, and a nonorphan drug for the treatment of inflammatory bowel disease. Evidence matrices were developed, and value contribution of each drug was evaluated by P&TC's members. An agreed final framework was obtained through a discussion between the P&TC's members.
Results:
After criteria assessment, the pilot framework included eight quantitative criteria: “disease severity,” “unmet needs,” “comparative efficacy/effectiveness,” “comparative safety/tolerability,” “comparative patient-reported outcomes,” “comparative cost consequences-cost of treatment,” “comparative cost consequences-other medical costs,” and “quality of evidence”; and one contextual criterion: “opportunity costs and affordability.” The most valued criteria were: “comparative safety/tolerability,” “disease severity,” and “comparative efficacy/effectiveness.” When assessing the drugs most valued characteristics of the MCDA were the possibility that all team may contribute to drug assessment by means of scoring the matrices and the discussion to reach a consensus in drug positioning and value decision making.
Conclusions:
The reflective MCDA would integrate quantitative and qualitative criteria relevant for a P&TC setting, allowing reflective discussions based on the criteria weighting score.
The island of Gran Canaria is regularly affected by dust falls due to its proximity to the Saharan desert. Climatic oscillations may affect the Saharan dust input to the island. Geochemical, mineralogical, and textural analysis was performed on a well-developed and representative early Pleistocene paleosol to examine Saharan dust contribution to Gran Canaria. Significant and variable Saharan dust content was identified in addition to weathering products such as iron oxides and clay minerals. Variations in quartz and iron oxide concentrations in the paleosol likely reflect different Saharan dust input in more/less-contrasted rhexistasic/biostatic climatic conditions. Linking the quartz content in Canarian soils, the Ingenio paleosol, and two Canarian loess-like deposits to different ages from the Quaternary, we hypothesized that the dust input should be lower (about 33–38%) throughout the early to middle Pleistocene than during the late Quaternary. The Saharan dust input to the Gran Canaria profile in the Pleistocene persisted in spite of climatic variations.
Two scientists and sailors from the Spanish Navy, Jorge Juan and Antonio de Ulloa, the Italian sailor and explorer Alessandro Malaspina,and the German sage Alexander von Humboldt were the main actors in three great voyages to Spanish America between the second-third of the 18th century and the beginning of the 19th century. This enabled them to provide three first hand «photographs» of the state of the Spanish empire in America at three different moments in time: approximately before, during and after the implementation of colonial reforms designed in the reigns of Ferdinand VI and Charles III. This work aims, in the first place, to compare the socio-economic views of Spanish America deriving from the three expeditions, highlighting similarities and differences. Second, this work aims to connect the analysis of the weaknesses of the politico-institutional organisation of Spanish colonies, which the four travellers did at first hand, with the present debate on the role of colonial institutions in long-term economic development.
The trace-fossil name Tubotomaculum has been extensively used to refer to spindle-shaped pellet-filled tubes present in Upper Cretaceous to Miocene deep-marine deposits of the western Mediterranean region. However, it has never been formally diagnosed, and accordingly it was regarded as a nomen nudum. In this paper, we formally introduce the ichnogenus Tubotomaculum, including the new ichnospecies Tubotomaculum mediterranensis. Bioglyphs, represented by scratch traces that may be present on the basal and lateral surfaces of the structure, suggesting production by crustaceans. The functional meaning of these structures challenges the simple model of a mining strategy. Instead, the storing of pellets to use them as a bacteria-enriched resource during times when organic detritus was scarce is suggested. The association with chemoautothrophic bacteria in modern analogs of Tubotomaculum provides a crucial piece of evidence to support the cache model. Integration of information from modern environments and the fossil record points to a connection between Tubotomaculum, mud volcanism, fluid venting, and hydrocarbon seeps. The presence of bioglyphs suggests firmgrounds that may have resulted from bottom current scouring of the sea sediment, leading to erosional exhumation of previously buried compacted sediment, which was therefore available for colonization by the infauna. However, an alternative scenario involves enriched fluids related to mud-volcanism resulting in reducing conditions that favored carbonate precipitation and nodule formation just a few centimeters below the sediment-water interface.
As a preliminary study aiming to possible applications, novel polythiophenes (PTs) derivatives of 3-hexylthiophene and a thiophene functionalized with pyrene chromophore were synthesized. Homopolymer and copolymers of these monomers were obtained in different stoichiometric ratios which allow obtaining structure-property relation of each of the polymers. PTs were characterized by FT-IR, 1H NMR, UV-vis, DSC-TGA, GPC and fluorescence experiments. Polymers have λmax between 345 to 450 nm and an emission band at 485 and 542 nm. Low molecular weights distribution (Mn = 875 to 1600 g/mol) and thermostable products (Td = 336 to 474°C) were obtained. These PTs functionalized with aromatic molecules and π-conjugated systems could offer interesting applications such as optical sensors, nonlinear optics and photovoltaic cells.
Water fountains are evolved stars showing water masers with velocity spanning more than ~100 km/s. They usually appear at the end of the Asymptotic Giant Branch (AGB) phase or at the beginning of the post-AGB phase, and their masers trace the first manifestation of axisymmetric collimated mass-loss. For the first time, masers with water fountain characteristics have been detected towards a PN (IRAS 15103–5754), which might require a revision of the current theories about jet formation and survival times. IRAS 15103-5754 was observed using the ATCA interferometer at 22 GHz (both continuum and water maser). The main results of these observations are summarized here. The evolutionary classification of this object is also discussed.
This article fills a gap in the literature by examining the only leading classical economist whose influence on Spain has yet to be studied. In particular, it analyzes the influence John Stuart Mill had on nineteenth-century Spain by showing the impact of his multifaceted work both in scientific philosophy and utilitarian philosophy, and in political and economic theory, as well as in the world of feminism.
Among the British travellers who travelled across Spain in the eighteenth century, Alexander Jardine and Joseph Townsend were those whose itineraries were the most complete and who paid more attention to socioeconomic analysis. Their identification of the specific economic problems coincides broadly with those of Spanish economists, and particularly with those of Campomanes, whose work is considered by them as a basic point of reference. However, there are discrepancies between the travellers and Spanish economists in respect to the general economic situation, the political system and certain government attitudes still based on a mercantilist approach. The reformist gradualism of Spanish economists clashed then with the proposals of the more profound socioeconomic reforms recommended by our travellers. Moreover, the optimism of Spanish economists about growth possibilities of the Spanish economy faced up to the negative overall view of British travellers.
In the Central Amazon we investigated whether seedling performance (survival, and relative growth rates in height and leaf numbers) was affected by initial seedling size (height and leaf numbers) in habitats that varied in their degree of human disturbance: cattle pasture, young secondary forest, 1-ha forest fragment and old-growth forest. Additionally, effects of photosynthetically active radiation (PAR), litter standing crop (LSC) and insect herbivory were evaluated 12 mo after transplantation in seedlings from the native canopy trees Chrysophyllum pomiferum, Micropholis venulosa and Pouteria caimito. Seedling performance changed rank across the understorey environment depending on species. Seedlings of Chrysophyllum thrived in all conditions but under high PAR, Micropholis thrived only in intermediate light conditions, whereas Pouteria thrived under high PAR. Effects of initial seedling size, PAR and herbivory after 1 y were specific to species, whereas LSC had no effect on performance. Initially larger seedlings resulted in lower survival for Chrysophyllum and Pouteria. Herbivory affected seedling performance in all species. Negative effects of herbivory were intensified under low PAR. Overall, our results showed that, as seedlings, species of the same family and characteristic of old-growth forests respond differently to the environmental constraints present in contrasting human-disturbed conditions. Larger seedlings may not always present greater tolerance to physical and biotic mortality risks.