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.
The premorbid phase of treatment-resistant schizophrenia (TRS) may reveal underlying mechanisms and inform early interventions. According to the neurodevelopmental hypothesis, treatment resistance may be linked to pronounced developmental impairments. We examined school grades and attendance trajectories in children who later developed TRS.
Methods
This case-control study analyzed school grade point average and attendance among all individuals born after 1990 and started on clozapine in Chile’s public health system as a proxy for TRS. Control groups included children later diagnosed with treatment-responsive schizophrenia, bipolar disorder, and unaffected classmates. Linear mixed models accounted for individual and school-level confounders.
Results
We included 1072 children (9929 observations, 29.3% female) subsequently diagnosed with TRS, 323 (2802 observations, 25.7% female) with schizophrenia, 175 (1784 observations, 53.8% female) bipolar disorder, and 273,260 (533,335 observations, 47% female) unaffected classmates. Children who later developed TRS had worse grades across levels than their classmates (−0.26 SD [−0.2, −0.4]), but not treatment-responsive schizophrenia. All severe mental illness groups showed grade declines in later school levels, with TRS showing steeper linear decline than treatment-responsive schizophrenia (group×age of −0.03; 95%CI −0.04, −0.01) and steeper quadratic decline than bipolar disorder (group×age2 of −0.005; −0.01, −0.001). Attendance declined over time in the two groups developing schizophrenia compared to their classmates. Those developing TRS experienced the sharpest drop (group×age compared to schizophrenia −0.03; −0.05, −0.01 and bipolar disorder −0.027; −0.049, −0.006).
Conclusions
TRS may stem from a more aggressive pathological process or pronounced late-maturation abnormality, rather than an early premorbid impairment, suggesting an intervention target.
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.
There is a lack of standardised psychometric data in electronic health record (EHR)-based research. Proxy measures of symptom severity based on patients' clinical records may be useful surrogates in mental health EHR research.
Aims
This study aimed to validate proxy tools for the short versions of the Positive and Negative Syndrome Scale (PANSS-6), Young Mania Rating Scale (YMRS-6) and Montgomery–Åsberg Depression Rating Scale (MADRS-6).
Method
A cross-sectional, multicentre study was conducted in a sample of 116 patients with first-episode psychosis from 12 public hospitals in Spain. Concordance between PANSS-6, YMRS-6 and MADRS-6 scores and their respective proxies was evaluated based on information from EHR clinical notes, using a variety of statistical procedures, including multivariate tests to adjust for potential confounders. Bootstrapping techniques were used for internal validation, and an independent cohort from the Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne, Switzerland) for external validation.
Results
The proxy versions correlated strongly with their respective standardised scales (partial correlations ranged from 0.75 to 0.84) and had good accuracy and discriminatory power in distinguishing between patients in and not in remission (percentage of patients correctly classified ranged from 83.9 to 91.4% and bootstrapped optimism-corrected area under the receiver operating characteristic curve ranged from 0.76 to 0.89), with high interrater reliability (intraclass correlation coefficient of 0.81). The findings remained robust in the external validation data-set.
Conclusions
The proxy instruments proposed for assessing psychotic and affective symptoms by reviewing EHR provide a feasible and reliable alternative to traditional structured psychometric procedures, and a promising methodology for real-world practice settings.
The COVID-19 pandemic is a global challenge for humanity, in which a large number of resources are invested to develop effective vaccines and treatments. At the same time, governments try to manage the spread of the disease while alleviating the strong impact derived from the slowdown in economic activity. Governments were forced to impose strict lockdown measures to tackle the pandemic. This significantly changed people’s mobility and habits, subsequently impacting the economy. In this context, the availability of tools to effectively monitor and quantify mobility was key for public institutions to decide which policies to implement and for how long. Telefonica has promoted different initiatives to offer governments mobility insights throughout many of the countries where it operates in Europe and Latin America. Mobility indicators with high spatial granularity and frequency of updates were successfully deployed in different formats. However, Telefonica faced many challenges (not only technical) to put these tools into service in a short timing: from reducing latency in insights to ensuring the security and privacy of information. In this article, we provide details on how Telefonica engaged with governments and other stakeholders in different countries as a response to the pandemic. We also cover the challenges faced and the shared learnings from Telefonica’s experience in those countries.
To analyse the information on health claims present in the labelling of creatine monohydrate (CM) products.
Design:
A descriptive study of a selection of products marketed as CM, with health claims, and that met the inclusion/exclusion criteria, was conducted using the Amazon and Google Shopping websites. The adequacy and compliance of the health claims were evaluated with the European legislative requirements (European Food Safety Authority and European Commission). The results were discussed with scientific evidence criteria from the Academy of Nutrition and Dietetics, International Olympic Committee, and International Society of Sports Nutrition, as well as the systematic review carried out by Mielgo-Ayuso in 2019.
Setting:
Health claims in the commercial communications of a sample of CM supplements, in relation to current legislation and scientific knowledge.
Participant:
A total of 554 CM products were obtained.
Results:
Of the total sample, only 167 met the inclusion/exclusion criteria. Of these, 30·5 % recommended a CM dose of 5·0–5·9 g/d, while 29·9 % recommended 3·0 to 3·9 g/d. As for the health claims, ‘Enhances physical performance’ appeared in 73·1 % of the supplements, in most cases referring to a dosage of 3·0 to 3·9 g/d for these products. The rest of the declarations were not adequate or needed to be modified.
Conclusion:
Only 25 % of the health claims complied with the criteria established by the scientific reference documents. Most of the declarations must be modified or eliminated, as they could be considered fraudulent and/or misleading for the consumer.
Interactions between smooth muscle cells (SMCs) and biomaterials must not result in phenotype changes as this may generate uncontrolled multiplication processes and occlusions in vascular grafts. The aim of this study was to relate the hydrolytic stability and biocompatibility of polyurethanes (PUs) on SMCs. A higher polycaprolactone (PCL) concentration was found to improve the hydrolytic stability of the material and the adhesion of SMCs. A material with 5% polyethylene glycol, 90% PCL, and 5% pentaerythritol presented high cell viability and adhesion, suggesting a contractile phenotype in SMCs depending on the morphology. Nevertheless, all PUs retained their elastic modulus over 120 days, similar to the collagen of native arteries (~10 MPa). Furthermore, aortic SMCs did not present toxicity (viability over 80%) and demonstrated adherence without any abnormal cell multiplication processes, which is ideal for the function to be fulfiled in situ in the vascular grafts.
Darwin's frogs Rhinoderma darwinii and Rhinoderma rufum are the only known species of amphibians in which males brood their offspring in their vocal sacs. We propose these frogs as flagship species for the conservation of the Austral temperate forests of Chile and Argentina. This recommendation forms part of the vision of the Binational Conservation Strategy for Darwin's Frogs, which was launched in 2018. The strategy is a conservation initiative led by the IUCN SSC Amphibian Specialist Group, which in 2017 convened 30 governmental, non-profit and private organizations from Chile, Argentina and elsewhere. Darwin's frogs are iconic examples of the global amphibian conservation crisis: R. rufum is categorized as Critically Endangered (Possibly Extinct) on the IUCN Red List, and R. darwinii as Endangered. Here we articulate the conservation planning process that led to the development of the conservation strategy for these species and present its main findings and recommendations. Using an evidence-based approach, the Binational Conservation Strategy for Darwin's Frogs contains a comprehensive status review of Rhinoderma spp., including critical threat analyses, and proposes 39 prioritized conservation actions. Its goal is that by 2028, key information gaps on Rhinoderma spp. will be filled, the main threats to these species will be reduced, and financial, legal and societal support will have been achieved. The strategy is a multi-disciplinary, transnational endeavour aimed at ensuring the long-term viability of these unique frogs and their particular habitat.
Species distribution models (SDMs) are statistical tools used to develop continuous predictions of species occurrence. ‘Integrated SDMs’ (ISDMs) are an elaboration of this approach with potential advantages that allow for the dual use of opportunistically collected presence-only data and site-occupancy data from planned surveys. These models also account for survey bias and imperfect detection through the use of a hierarchical modelling framework that separately estimates the species–environment response and detection process. This is particularly helpful for conservation applications and predictions for rare species, where data are often limited and prediction errors may have significant management consequences. Despite this potential importance, ISDMs remain largely untested under a variety of scenarios. We performed an exploration of key modelling decisions and assumptions on an ISDM using the endangered Baird’s tapir (Tapirus bairdii) as a test species. We found that site area had the strongest effect on the magnitude of population estimates and underlying intensity surface and was driven by estimates of model intercepts. Selecting a site area that accounted for the individual movements of the species within an average home range led to population estimates that coincided with expert estimates. ISDMs that do not account for the individual movements of species will likely lead to less accurate estimates of species intensity (number of individuals per unit area) and thus overall population estimates. This bias could be severe and highly detrimental to conservation actions if uninformed ISDMs are used to estimate global populations of threatened and data-deficient species, particularly those that lack natural history and movement information. However, the ISDM was consistently the most accurate model compared to other approaches, which demonstrates the importance of this new modelling framework and the ability to combine opportunistic data with systematic survey data. Thus, we recommend researchers use ISDMs with conservative movement information when estimating population sizes of rare and data-deficient species. ISDMs could be improved by using a similar parameterization to spatial capture–recapture models that explicitly incorporate animal movement as a model parameter, which would further remove the need for spatial subsampling prior to implementation.
Healthy lifestyle habits are the cornerstone in the management of familial hypercholesterolaemia (FH). Nevertheless, dietary studies on FH-affected populations are scarce. The present study analyses dietary habits, adherence to a Mediterranean diet pattern and physical activity in an adult population with FH and compares them with their non-affected relatives.
Design
Cross-sectional study.
Setting
Data came from SAFEHEART, a nationwide study in Spain.
Participants
Individuals (n 3714) aged ≥18 years with a genetic diagnosis of FH (n2736) and their non-affected relatives (n 978). Food consumption was evaluated using a validated FFQ.
Results
Total energy intake was lower in FH patients v. non-affected relatives (P<0·005). Percentage of energy from fats was also lower in the FH population (35 % in men, 36 % in women) v. those non-affected (38 % in both sexes, P<0·005), due to the lower consumption of saturated fats (12·1 % in FH patients, 13·2 % in non-affected, P<0·005). Consumption of sugars was lower in FH patients v. non-affected relatives (P<0·05). Consumption of vegetables, fish and skimmed milk was higher in the FH population (P<0·005). Patients with FH showed greater adherence to a Mediterranean diet pattern v. non-affected relatives (P<0·005). Active smoking was lower and moderate physical activity was higher in people with FH, especially women (P<0·005).
Conclusions
Adult patients with FH report healthier lifestyles than their non-affected family members. They eat a healthier diet, perform more physical activity and smoke less. However, this patient group’s consumption of saturated fats and sugars still exceeds guidelines.
A orillas de los ríos Guadalquivir (Baetis) y Genil (Singilis), en el triángulo formado por las capitales de tres conventus de la Bética, Hispalis, Corduba y Astigi, se extienden los restos arqueológicos de casi un centenar de alfarerías productoras de ánforas del tipo Dressel 20 (fig. 1). Durante los tres primeros siglos d.C., el aceite de oliva producido en el interior de la Bética se comercializaba con estas ánforas globulares que fueron exportadas masivamente a todo el Imperio romano, siendo particularmente abundantes en Roma y en el limes germano/británico.
In this work, the synthesis of starch-clay nanocomposites was carried out. For this purpose, natural starch was extracted from rice grains and it was characterized by structural and spectrophotometric techniques. Afterwards, it was used as the polymer matrix for the synthesis of nanocomposites crosslinked with different agents: glycerol, citric acid (CA) and sodium trimetaphosphate (STMP). As a reinforcement phase, a natural Mexican clay from the Montmorillonite-type (Mt), was employed, which was modified with a cationic surfactant, hexadecyltrimethylammonium bromide (HDTMA-Br), in order to exchange cations, present in the interlaminar spaces of the raw clay mineral with those of the cationic surfactant; thus, changing its nature from hydrophilic to hydrophobic. Characterization, of both natural and organo-modified clays, was carried out by means of scanning electron microscopy (SEM), to determine the change in morphology between these two minerals; X-ray diffraction analysis (XRD), to obtain the crystalline structure of the organo-modified clay and that of the raw clay mineral (Mt). Also, the Fourier transform infrared spectroscopy (FTIR) was employed to determine materials spectra, and their thermal stability was evaluated by means of the thermogravimetric analysis (TGA). On the other hand, the synthesis of these nanocomposites was performed using different crosslinking agents, glycerol, CA or STMP, in order to identify the effect of them into the final properties of these materials.
In the present investigation, biocomposites were synthesized from a polymeric alginate matrix in which the carrot residue and a natural bentonite (ANat / Bio) or an iron-modified clinoptilolite-type zeolite (ZFe / Bio) were supported. Their properties were evaluated adsorbents in contact with aqueous solutions of methylene blue (MB). In the first hour of contact, 46% removal was obtained for the ZFe / Bio biocomposite and 60% for the ANat / Bio biocomposite; reaching 100% removal for the ZFe / Bio biocomposite and 98% for the ANat / Bio biocomposite after 24 hours. The biocomposites were characterized by Scanning Electron Microscopy (SEM) and Fourier Transformed Infrared Spectroscopy (FTIR).
We assessed inter-seasonal dynamics of seed banks, dormancy and seed germination in three endemic Chihuahuan Desert succulent species, under simulated soil warming conditions. Hexagonal open top-chambers (OTCs) were used to increase soil temperature. Seeds of Echinocactus platyacanthus (Cactaceae), Yucca filifera and Agave striata (Asparagaceae) were collected and buried within and outside OTCs. During the course of one year, at the end of each season, seed batches were exhumed to test viability and germination. Soil temperature in OTCs was higher than in control plots. Yucca filifera seeds always had high germination independently of warming treatment and season. Agave striata seeds from OTCs had higher germination than those from control plots. Agave striata exhibited low germination in fresh seeds, but high germination in spring. Seeds from this species lost viability throughout the experimental timeframe, and had no viable seeds remaining in the soil. Echinocactus platyacanthus showed high germination in fresh seeds and displayed dormancy cycling, leading to high germination in spring, low germination in summer and autumn, and high germination in winter. Germination of this species was also higher in seeds from OTCs than those from control plots. Echinocactus platyacanthus formed soil seed banks and its cycle of inter-seasonal dormancy/germination could be an efficient physiological mechanism in a climate change scenario. Under global warming projections, our results suggest that future temperatures may still fall within the three studied species’ thermal germination range. However, higher germination for A. striata and E. platyacanthus at warmer temperatures may reduce the number of seeds retained in the seed bank, and this could be interpreted as limiting their ability to spread risk over time. This is the first experimental study projecting an increase in soil temperature to assess population traits of succulent plants under a climate change scenario for American deserts.
A remarkable stela from Montoro, southern Spain, is unique in its morphology, epigraphic traits and landscape context. A programme of chemical characterisation, digital imaging, and geo-lithological and epigraphic analyses were conducted to determine its age and significance, and the results were integrated with data from archaeological investigations of the surrounding area. This multi-faceted approach allowed the stela to be interpreted within the context of early interactions between literate Mediterranean societies of the Late Bronze Age and Iron Age and non-literate Iberian societies. A key outcome of this research is a wider understanding of the complex patterns in the use and perception of early scripts.
Ambroperuvin is a new pseudoguaianolide isolated from Ambrosia peruviana Willd., a plant used in traditional medicine in Venezuela. The analysis of the X-ray powder pattern being reported led to an orthorhombic unit cell with space group P212121 and cell parameters a = 15.999(6) Å, b = 11.263(2) Å, c = 9.112(2) Å. No detectable impurities were observed.
In this article we evaluate ∼48km2 of airborne lidar data collected at a target density of 15 laser shots/m in central Yucatán, Mexico. This area covers parts of the sites of Chichén Itzá and Yaxuná, a kilometer-wide transect between these two sites, and a transect along the first few kilometers of Sacbé 1 from Yaxuná to Cobá. The results of our ground validation and mapping demonstrate that not all sizable archaeological features can be detected in the lidar images due to: (1) the slightly rolling topography interspersed with 1-6 m-high bedrock hummocks, which morphologically mimic house mounds, further complicated by the presence of low foundations; (2) the complex forest structure in central Yucatán, which has particularly dense near-ground understory resulting in a high number of mixed-signal ground and low vegetation returns which reduces the fidelity and accuracy of the bare-earth digital elevation models; and (3) the predominance of low archaeological features difficult to discern from the textural noise of the near-ground vegetation. In this article we explore different visualization techniques to increase the identification of cultural features, but we conclude that, in this portion of the Maya region, lidar should be used as a complement to traditional on-the-ground survey techniques.
The Endangered Cuvier's gazelle Gazella cuvieri is an endemic ungulate of north-western Africa. Information on the species has been based primarily on non-systematic surveys, and the corresponding status estimates are of unknown quality. We evaluate the effectiveness and efficiency of two field methods for systematic surveys of populations of Cuvier's gazelle in arid environments: distance sampling (based on sightings) and sampling indirect sign (tracks and scats). The work was carried out in the north-western Sahara Desert, in Morocco, where what is possibly the largest population of Cuvier's gazelle persists. A logistically viable survey was conducted over a total area of c. 20.000 km2 in 10 expeditions during 2011–2014. A total of 67 sites were surveyed, with 194 walking surveys (2,169 km in total). Gazelle signs were detected at 50 sites, and gazelles were sighted at 21 sites (61 individuals). We found a relationship between sightings and abundance indices based on indirect sign, which could be useful for population monitoring or ecological studies. Additionally, the data could be used in occupancy modelling. Density estimates based on distance sampling required considerable effort; however, it is possible to survey large areas during relatively short campaigns, and this proved to be the most useful approach to obtain data on the demographic structure of the population.
In the coast of Galicia an average of 200 stranded cetaceans are reported annually. From 1990 to 2013, 21 individuals of four species of the family Ziphiidae were found: 15 Cuvier's beaked whales (Ziphius cavirostris), two Sowerby's beaked whales (Mesoplodon bidens), one True's beaked whale (Mesoplodon mirus) and one Blainville's beaked whale (Mesoplodon densirostris), as well as two unidentified ones. These were the first records in Galicia for True's beaked whale and Blainville's beaked whale. The study of the distribution of oceanic species considering only stranded animals has limitations, but is a good approach to this not well-known cetacean family. Due to the small number of individuals of the different species, statistical analyses for geographic or seasonal patterns were only carried out for the Cuvier's beaked whales. Between the periods of 1990–2002 and 2003–2013 significant differences were found for geographic and seasonal occurrence patterns. Over the last decade strandings were located only in the north area of the region, mainly during the spring season, while in the previous decade they were located along the three considered areas and only in autumn and winter.
In this study, we attempt to demonstrate an association between low platelet monoamine oxidase (MAO) activity, as assessed by isotopic methods, and the stable behavioral pattern of sensation- and risk-seeking of professional bull-fighters. Sixteen professional bullfighters were studied and compared with a control group of 46 healthy control subjects who did not engage in risky jobs or activities. The group of bullfighters had significantly reduced platelet MAO activity compared with the control group (P<0.05). Bullfighters were shown to be significantly more extroverted and sensation-seeking than controls on various temperament scales. A predisposition to engage in risky activities (eg, bullfighting) and sensation-seeking could be partly conditioned by the presence of biological components of personality manifested by a significantly decreased platelet MAO activity.