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Hospital at home for psychiatric patients is a new emerging resource of delivering acute mental health care in the community. The main objective of this program is to provide intense care to patients with severe mental disorders at home as an alternative to acute admission.
Although home hospitalisation has begun to develop widely in recent years there is a notable lack of studies
The CAEM Psychiatric Home Hospitalization Unit (HAD-CAEM) has been operating since 2018 and takes place in Santa Coloma de Gramenet; and from March 2022 also in a part of Badalona. Both are sociodemographically depressed areas near Barcelona.
Objectives
The aim of this study is to describe the characteristics of patients attended at the Psychiatric Home Hospitalization Unit of our hospital and to study differences according to area and place of referral.
Methods
Socio-demographic and clinical data were collected retrospectively at admission and discharge of all patients treated at HAD-CAEM between March 2022 to february 2023.
Statistical analysis was performed by using SPSS program.
Results
85 patients were included in the study. 45.9% were women. The mean age was 45.5 years (SD 15.58 years). The main diagnoses of the sample were psychosis and schizophrenia (38.8%), Bipolar disorder (23.53%), Depressive disorder (21.18%), schizoaffective disorder (8.24%) and others (8,24%).
54 (63.53%) patients were from Santa Coloma area and 35 (41.18%) from Badalona area.
The total mean duration of admission was 40.22 days (SD 26.18 days), with a mean follow-up of 10.09 visits (SD 5.39 visits) and 2.41 teleassistence (SD 2.62).
The mean duration of admission for Santa Coloma patients was 43.98 days (SD 28.59), and for Badalona patients 33.68 days (SD 20.13). Trend without significance is observed (t= 1.77, p=0.08)
We found differences in the mean duration of admission according to referral location. Acute psychiatric unit 33.25 days (SD 18.06), Mental health Center 51.93 days (SD 33.45), Emergencies 34.28 days (SD 19.69) (F=5.1, p=0.008).
Conclusions
Sociodemografic and clinical característics obtained in our study are consistent with those reported in previous studies. The duration of admission of patients referred from the mental health center is longer than those referred from the acute psychiatric or emergency unit. Home hospitalization teams have been increasing in recent years, being an alternative to traditional hospitalization.
Background: We evaluated vorasidenib (VOR), a dual inhibitor of mIDH1/2, in patients with mIDH1/2 glioma (Phase 3; NCT04164901). Methods: Patients with residual/recurrent grade 2 mIDH1/2 oligodendroglioma or astrocytoma were enrolled (age ≥12; Karnofsky Performance Score ≥80; measurable non-enhancing disease; surgery as only prior treatment; not in immediate need of chemoradiotherapy). Patients were stratified by 1p19q status and baseline tumor size and randomized 1:1 to VOR 40 mg or placebo (PBO) daily in 28-day cycles. Endpoints included imaging-based progression-free survival (PFS), time to next intervention (TTNI), tumor growth rate (TGR), health-related quality of life (HRQoL), neurocognition and seizure activity. Results: 331 patients were randomized (VOR, 168; PBO, 163). The median age was 40.0 years. 172 and 159 patients had histologically confirmed oligodendroglioma and astrocytoma, respectively. Treatment with VOR significantly improved PFS and TTNI. Median PFS: VOR, 27.7 mos; PBO, 11.1 mos (P=0.000000067). Median TTNI: VOR, not reached; PBO, 17.8 mos (P=0.000000019). Treatment with VOR resulted in shrinkage of tumor volume. Post-treatment TGR: VOR, -2.5% (95% CI: -4.7, -0.2); PBO, 13.9% (95% CI: 11.1, 16.8). HRQoL and neurocognition were preserved and seizure control was maintained. VOR had a manageable safety profile. Conclusions: VOR was effective in mIDH1/2 diffuse glioma not in immediate need of chemoradiotherapy.
Demonstratives are cross-linguistically widespread deictic expressions. Demonstrative systems exhibit variation in number of terms, and parameters affecting their usage. The present paper assesses the relationship between spatial deixis and bilingualism: how language dominance affects speakers of two languages with different demonstrative systems. Here, we compare the use of demonstratives by 72 European Spanish-Catalan simultaneous bilinguals in Mallorca to 30 European Spanish monolinguals. Our results confirmed a significant effect of physical distance between speaker and referent on demonstrative choice in both languages, and differences between languages in the use of the middle term. We did not find the expected effect of language dominance in simultaneous bilinguals. Moreover, we found no influence of the hearer's position on demonstrative choice in monolinguals or bilinguals in European Spanish or Majorcan Catalan. In view of our results, the present study contributes to the debate on how bilingual speakers employ different deictic expressions.
We investigated parasitic zoonoses caused by protozoans and helminths in urban and peri-urban rat populations (Rattus norvegicus and R. rattus) in Spanish cities. Rats were trapped and then dissected to remove adult helminths, and the contents of the large intestine were retrieved for the study of parasitic forms. The Midi Parasep® solvent free (SF) technique was used to concentrate the parasites in the intestinal contents. Some of the rats studied (n = 8) were infected by the rat lungworm, Angiostongylus cantonensis, whose first stage larvae (L1) are shed in rat faeces. After the concentration technique, L1 larvae were found in the sediment of 6 of the 8 positive rats. The two negative sediment samples were due to the presence of either only adult females or, in addition to males, only young females in the lungs of the rats. In view of our results, Midi Parasep® SF turned out to be a simple, rapid, inexpensive, and sensitive method to detect nematode larvae, such as the L1 larvae of A. cantonensis (or A. costaricensis), in natural and experimentally infected rats.
Sea anemones have developed various strategies for interspecific interaction with other organisms and their own ability to obtain food, due to their coevolutionary history, ranging from mutualistic (e.g. clownfish, crustaceans, etc.) and symbiotic associations (zooxanthellae or zoochlorellae) to depredation (e.g. sea slug). This study aims to record some observations on feeding habits and interspecific interactions of Actinostella flosculifera (Le Sueur, 1817) in the locality of Pedra da Sereia in Vila Velha, Espírito Santo, Brazil, and to describe the hunting strategy of the sea slug Spurilla braziliana MacFarland, 1909 and the escape strategy of A. flosculifera. We found that the habitat of A. flosculifera is characterized by shallow pools ~10 cm deep at low tides, and this functions as a trap for many organisms and some biowaste (e.g. bones or fish drifting in from nearby populations) that fall into the oral disc. This is the first report of S. braziliana predating on A. flosculifera. We also report interspecific relationships between A. flosculifera with four species of crustaceans: Omalacantha bicornuta (Latreille, 1825), Menippe cf. nodifrons Stimpson, 1859, Alpheus cf. angulosus McClure, 2002, and Alpheus cf. carlae Anker, 2012.
Fasting is commonly used in aquaculture to empty the gut before slaughter, but little is known about how feeding frequency before fasting affects the stress response of trout. To find out more, 240 rainbow trout (Oncorhynchus mykiss) were separated into three groups with different feeding schedules during the final month of fattening, from 26 September to 28 October 2013 (daily, every two days or every four days) and two durations of pre-slaughter fasting (two days of fasting; 24.3 degree days, to nine days of fasting; 102 degree days). After slaughter, a number of stress-related parameters were measured, such as liver glycogen, skin/gill colour and haematological parameters (cortisol, glucose, lactate, triglycerides, lactate dehydrogenase and creatine phosphokinase). Trout given food every two days on the farm had lower levels of cortisol and higher levels of triglycerides and liver glycogen than the other treatments after two days of fasting; indicating that habituating trout to feed once every two days in the final month of fattening lowered their stress response to two days of fasting before slaughter.
Outcomes Based Agreements (OBAs) are financial arrangements that offer the opportunity to align payment to health outcomes in the real-world, and share the financial risk by providing long-term solutions that grant access to medicines, with reimbursement only when performance is achieved. OBAs are most likely to be useful when there is high uncertainty in the clinical data, but they are difficult to design and implement, and other financial options are usually preferred by payers. As a result, OBAs have been more the exception than the norm, and there is not a clear pattern that indicates if an OBA is likely to succeed in practice.
Methods
Through a retrospective OBA exercise with NHS Wales (Project IDEATE: Innovation in Data to Evolve Agreements That Enhance patient health outcomes), we have explored the circumstances under which an OBA might be most appealing to payers, and assessed implementation challenges and solutions, to propose a framework to evaluate the feasibility of a medicine for an OBA.
Results
Along with mitigating some of the clinical uncertainties associated with a lack of mature data at the time of launch, an OBA must also consider other factors: the commercial viability of the agreement, the associated administrative burden, and its cost of implementation. Also, the Health System commitment to a Value-Based Healthcare agenda and, most importantly, its willingness to offer long-term sustainable solutions to optimise treatment, are key to support this approach.
Practical considerations include: how the relevant outcomes are going to be selected and tracked in the real-world, how the whole model is going to fit within the current procurement and finance infrastructures, and how industry works in collaboration with the Health System.
Conclusions
Insights from Project IDEATE will be used to explore how our OBA feasibility framework might be applied in the future.
Demonstrative words are one of the most important ways of establishing reference in conversation. This work describes Spanish-speaking children’s demonstrative production between ages 2 to 10 using data from the CHILDES corpora. Results indicate that children feature all demonstratives in their lexicon – however, the distal term is scarce throughout development. Moreover, patterns of demonstrative use are not adult-like at age 10. We compare adult and child data to conclude that children’s development of demonstrative production is largely protracted. Adult use of the distal demonstrative is higher than in young children, although both older children and adults use the medial term ese more than any other demonstratives. In contrast, younger children use proximals relatively more frequently than older children and adults. Suggestions for future research and theoretical implications for the Spanish demonstrative system are discussed.
Ageing is interrelated with the development of immunosenescence. This article focuses on one of the cell sets of the adaptive immune system, T cells, and provides a review of the known changes in T cells associated with ageing. Such fundamental changes affect both cell molecular content and internal ordering. However, acquiring a complete description of the changes at these levels would require extensive measurements of parameters and, furthermore, important fine details of the internal ordering that may be difficult to detect. Therefore, an alternative approach for the characterisation of cells consists of the performance of physical measurements of the whole cell, such as deformability measurements or migration measurements: the physical parameters, complementing the commonly used chemical biomarkers, may contribute to a better understanding of the evolution of T-cell states during ageing. Mechanical measurements, among other biophysical measurements, have the advantage of their relative simplicity: one single parameter agglutinates the complex effects of the variety of changes that gradually appear in cells during ageing.
The consequences for the COVID-19 pandemic in the newborns of affected mothers remains unknown. Previous clinical experiences with other infections during pregnancy lead to considered pregnant women and their offspring especially vulnerable for SARS-COV-2. That is, the underlying physiopathological changes caused by the infection (e.g. storm of cytokines, micro-coagulation in placenta or vertical transmission) could clearly compromise fetal neurodevelopment.
Objectives
To analyze the impact of maternal SARS-COV-2 infection during pregnancy in early neurodevelopment of infants gestated during the COVID-19 pandemic period compared to those gestated immediately prior (2017-2021).
Methods
212 pregnant women (14% infected) were followed throughout their pregnancy and postpartum, including newborn development. SARS-COV-2 infection was serologically confirmed during pregnancy. The Brazelton Neonatal Assessment Scale (NBAS) was administered at 6 weeks old by a trained neonatologist to evaluate neurological, social and behavioral aspects of newborn’s functioning. Differences in NBAS scores between cases and controls were tested by ANOVAs. All the analysis were adjusted for maternal age, sociodemographic status, anxious-depressive symptomatology, infant’s sex and gestational age at birth and NBAS, and for the period of gestation (previous or during COVID-19 pandemic).
Results
NBAS social interactive dimension was significantly decreased in those infants exposed to prenatal SARS-COV-2 (F=4.248, p=.043), particularly when the infection occurred before the week 20 of gestation. Gestation during COVID-19 pandemic did not alter NBAS subscales.
Conclusions
SARS-COV-2 infection during pregnancy seems to be associated with lower NBAS scores on social dimension in 6 weeks old exposed newborns.
Livestock welfare assessment helps monitor animal health status to maintain productivity, identify injuries and stress, and avoid deterioration. It has also become an important marketing strategy since it increases consumer pressure for a more humane transformation in animal treatment. Common visual welfare practices by professionals and veterinarians may be subjective and cost-prohibitive, requiring trained personnel. Recent advances in remote sensing, computer vision, and artificial intelligence (AI) have helped developing new and emerging technologies for livestock biometrics to extract key physiological parameters associated with animal welfare. This review discusses the livestock farming digital transformation by describing (i) biometric techniques for health and welfare assessment, (ii) livestock identification for traceability and (iii) machine and deep learning application in livestock to address complex problems. This review also includes a critical assessment of these topics and research done so far, proposing future steps for the deployment of AI models in commercial farms. Most studies focused on model development without applications or deployment for the industry. Furthermore, reported biometric methods, accuracy, and machine learning approaches presented some inconsistencies that hinder validation. Therefore, it is required to develop more efficient, non-contact and reliable methods based on AI to assess livestock health, welfare, and productivity.
The Alicante Survey of MAssive Stars in Hii Regions (A-SMASHeR) is aimed at finding the ratio of massive stars that are born in isolation. We present LIRIS/WHT images and EMIR/GTC spectra of the massive stellar content in A-SMASHeR regions. Our preliminary analysis yields ∼20% of regions hosting relatively (or truly) isolated massive stars.
The aim of this survey is the homogeneous characterization of a large sample of H ii regions with active star formation in order to detect observational trends supporting the two main models of massive star formation.
We present results from our ongoing infrared spectroscopic studies of the massive stellar content at the Center of the Milky Way (GC) and across the obscured Galactic disk. Together with the full characterization of these clusters, we seek to obtain a present day metallicity 2-D map of the inner Galaxy and characterize the influence on the bar in the chemical evolution. We will also constrain the clusters IMFs, infer the presence of possible top-heavy recent star formation histories and test massive star formation channels: clusters vs isolation.
Cognition heavily relies on social determinants and genetic background. Latin America comprises approximately 8% of the global population and faces unique challenges, many derived from specific demographic and socioeconomic variables, such as violence and inequality. While such factors have been described to influence mental health outcomes, no large-scale studies with Latin American population have been carried out. Therefore, we aim to describe the cognitive performance of a representative sample of Latin American individuals with schizophrenia and its relationship to clinical factors. Additionally, we aim to investigate how socioeconomic status (SES) relates to cognitive performance in patients and controls.
Methods
We included 1175 participants from five Latin American countries (Argentina, Brazil, Chile, Colombia, and Mexico): 864 individuals with schizophrenia and 311 unaffected subjects. All participants were part of projects that included cognitive evaluation with MATRICS Consensus Cognitive Battery and clinical assessments.
Results
Patients showed worse cognitive performance than controls across all domains. Age and diagnosis were independent predictors, indicating similar trajectories of cognitive aging for both patients and controls. The SES factors of education, parental education, and income were more related to cognition in patients than in controls. Cognition was also influenced by symptomatology.
Conclusions
Patients did not show evidence of accelerated cognitive aging; however, they were most impacted by a lower SES suggestive of deprived environment than controls. These findings highlight the vulnerability of cognitive capacity in individuals with psychosis in face of demographic and socioeconomic factors in low- and middle-income countries.
Contrasting perspectives on racism and racial inequality collide in contemporary Cuba. On the one hand, government officials argue that Cuba is a racially egalitarian country; though vestiges of historical racism subsist, systematic discrimination does not. On the other hand, social movement actors and organizations denounce that racism and discrimination are systemic and affect large sectors of the Afro-Cuban population. To draw these visions into scholarly dialogue, our analytic strategy consists in the comparative examination of both narratives as well as the empirical bases that sustain them. Using data from the 1981, 2002, and 2012 Cuban Censuses for the first time, as well as various non-census evidentiary sources, both quantitative and qualitative, we examine how racial inequality has evolved in Cuba during the last decades. Our analyses of census data suggest that racial stratification has a limited impact on areas such as education, health care, occupation, and positions of leadership. We find, nonetheless, that an expanding and strikingly racialized private sector is fueling dramatic income inequality by skin color beyond the reach of official census data. Our analysis sheds light on how different data can convey profoundly different pictures of racial inequality in a given context. Moreover, we highlight that significant contradictions can coexist in the lived experiences of racism and racial inequality within a single country context.
The giant gypsum crystals of Naica cave have fascinated scientists since their discovery in 2000. Human activity has changed the microclimate inside the cave, making scientists wonder about the potential environmental impact on the crystals. Over the last 9 years, we have studied approximately 70 samples. This paper reports on the detailed chemical–structural characterization of the impurities present at the surface of these crystals and the experimental simulations of their potential deterioration patterns. Selected samples were studied by petrography, optical and electronic microscopy, and laboratory X-ray diffraction. 2D grazing incidence X-ray diffraction, X-ray μ-fluorescence, and X-ray μ-absorption near-edge structure were used to identify the impurities and their associated phases. These impurities were deposited during the latest stage of the gypsum crystal formation and have afterward evolved with the natural high humidity. The simulations of the behavior of the crystals in microclimatic chambers produced crystal dissolution by 1–4% weight fraction under high CO2 concentration and permanent fog, and gypsum phase dehydration under air and CO2 gaseous environment. Our work suggests that most surface impurities are of natural origin; the most significant anthropogenic damage on the crystals is the extraction of water from the caves.
One hypothesis proposed to underlie formal thought disorder (FTD), the incoherent speech is seen in some patients with schizophrenia, is that it reflects impairment in frontal/executive function. While this proposal has received support in neuropsychological studies, it has been relatively little tested using functional imaging. This study aimed to examine brain activations associated with FTD, and its two main factor-analytically derived subsyndromes, during the performance of a working memory task.
Methods
Seventy patients with schizophrenia showing a full range of FTD scores and 70 matched healthy controls underwent fMRI during the performance of the 2-back version of the n-back task. Whole-brain corrected, voxel-based correlations with FTD scores were examined in the patient group.
Results
During 2-back performance the patients showed clusters of significant inverse correlation with FTD scores in the inferior frontal cortex and dorsolateral prefrontal cortex bilaterally, the left temporal cortex and subcortically in the basal ganglia and thalamus. Further analysis revealed that these correlations reflected an association only with ‘alogia’ (poverty of speech, poverty of content of speech and perseveration) and not with the ‘fluent disorganization’ component of FTD.
Conclusions
This study provides functional imaging support for the view that FTD in schizophrenia may involve impaired executive/frontal function. However, the relationship appears to be exclusively with alogia and not with the variables contributing to fluent disorganization.
The use of psychiatric services has been associated with a wide range of clinical variables. However, information about the impact of adolescent personality pathology related to hospital admissions is limited.
Objective
To analyze the different combination of personality pathology associated to variables of psychiatric hospital admissions (number of admissions, total of days spent as psychiatric inpatient, average of days for admission, and number of admissions in a day care hospital).
Method
The ICD-10 and DSM-IV modules of the semi-structured interview IPDE (International Personality Disorders Examination) were administered, in a sample of 107 adolescent psychiatric patients (M=15.8, SD=0.8 years old; age rank 15-17; 79% female).
Results
Personality pathology group identified by the IPDE showed significantly higher number (p< .001) of psychiatric admissions (M=1.48) than no personality pathology group (M=0.57), but not significant higher number of admissions in a day care hospital. Psychotic patients showed the highest rate of admissions (M=2.88). In present sample, between 30% and 38% of all hospital admitted patients showed a Cluster B personality disorder (PD).The users of psychiatric inpatient services with a complex PD (two o more PD from different clusters) presents in average: 2-2.5 admissions, 34-53 total days spent as psychiatric inpatient, and 11-16 days on each admission.
Conclusion
Patients with psychotic disorders or complex PD were the highest users of inpatients services, but not of day care hospital admissions.