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Studies conducted during the COVID-19 pandemic found high occurrence of suicidal thoughts and behaviours (STBs) among healthcare workers (HCWs). The current study aimed to (1) develop a machine learning-based prediction model for future STBs using data from a large prospective cohort of Spanish HCWs and (2) identify the most important variables in terms of contribution to the model’s predictive accuracy.
Methods
This is a prospective, multicentre cohort study of Spanish HCWs active during the COVID-19 pandemic. A total of 8,996 HCWs participated in the web-based baseline survey (May–July 2020) and 4,809 in the 4-month follow-up survey. A total of 219 predictor variables were derived from the baseline survey. The outcome variable was any STB at the 4-month follow-up. Variable selection was done using an L1 regularized linear Support Vector Classifier (SVC). A random forest model with 5-fold cross-validation was developed, in which the Synthetic Minority Oversampling Technique (SMOTE) and undersampling of the majority class balancing techniques were tested. The model was evaluated by the area under the Receiver Operating Characteristic (AUROC) curve and the area under the precision–recall curve. Shapley’s additive explanatory values (SHAP values) were used to evaluate the overall contribution of each variable to the prediction of future STBs. Results were obtained separately by gender.
Results
The prevalence of STBs in HCWs at the 4-month follow-up was 7.9% (women = 7.8%, men = 8.2%). Thirty-four variables were selected by the L1 regularized linear SVC. The best results were obtained without data balancing techniques: AUROC = 0.87 (0.86 for women and 0.87 for men) and area under the precision–recall curve = 0.50 (0.55 for women and 0.45 for men). Based on SHAP values, the most important baseline predictors for any STB at the 4-month follow-up were the presence of passive suicidal ideation, the number of days in the past 30 days with passive or active suicidal ideation, the number of days in the past 30 days with binge eating episodes, the number of panic attacks (women only) and the frequency of intrusive thoughts (men only).
Conclusions
Machine learning-based prediction models for STBs in HCWs during the COVID-19 pandemic trained on web-based survey data present high discrimination and classification capacity. Future clinical implementations of this model could enable the early detection of HCWs at the highest risk for developing adverse mental health outcomes.
Anecdotal evidence suggests that intermediaries are ubiquitous in corrupt activities; however, empirical evidence on their role as facilitators of corrupt transactions is scarce. This paper asks whether intermediaries facilitate corruption by reducing the moral or psychological costs of possible bribers and bribees. We designed bribery lab experiment that simulates petty corruption transactions between private citizens and public officials. The experimental data confirm that intermediaries lower the moral costs of citizens and officials and, thus, increase corruption. Our results have implications with respect to possible anti-corruption policies targeting the legitimacy of the use of intermediaries for the provision of government services.
We examine experimentally how complexity affects decision-making, when individuals choose among different products with varying benefits and costs. We find that complexity in costs leads to choosing a high-benefit product, with high costs and overall lower payoffs. In contrast, when complexity is in the benefits of the product, we cannot reject the hypothesis of random mistakes. We also examine the role of heterogeneous complexity. We find that individuals still (mistakenly) choose the high-benefit but costly product, even if cheaper and simple products are available. Our results suggest that salience is a main driver of choices under different forms of complexity.
Using a simple one-shot bribery game simulating petty corruption exchanges, we find evidence of a negative externality effect and a framing effect. When the losses suffered by third parties due to a bribe being offered and accepted are high and the game is presented as a petty corruption scenario instead of in abstract terms bribes are less likely to be offered. Higher negative externalities are also associated with less bribe acceptance. However, framing has no effect on bribe acceptance, indicating that the issue of artificiality may be of particular importance in bribery experiments.
We examine the effectiveness of accountability systems that rely on patient reporting in Kenyan health clinics. Patients and health care providers from public and private health clinics participate in a lab-in-the field experiment focusing on the relationship of trust between patient and provider. Patients decide whether to trust providers, providers have discretion over their reciprocity, and patients can complain. We compare the effectiveness of: (1) a client reporting system where patients’ complaints are disclosed to the providers’ professional peers, possibly leading to non-monetary penalties, (2) a system where complaints lead to monetary penalties, and (3) a system that, like a standard complaint box, attaches no tangible consequences to complaints. Overall, our findings suggest that citizen reporting systems that leverage peer pressure and reputational concerns can improve service delivery.
Impairment in both psychosocial functioning and neurocognition (NC) performance is present in bipolar disorder (BD) yet the role of sex differences in these deficits remains unclear. The present systematic review and meta-analysis examined whether males and females with BD demonstrate differences in psychosocial functioning and NC performance.
Methods
The Cochrane Library, EMBASE, PsycINFO, PubMed, Scopus, and Web of Science databases were systematically searched from inception until November 20, 2023.
Results
Twenty studies published between 2005 and 2023 with a total sample size of 2286 patients with BD were included. A random effects meta-analysis revealed a statistically significant result with a small effect (SMD = 0.313) for sex differences in verbal learning and memory as well as visual learning and memory (SMD = 0.263). Females outperformed males in both domains. No significant sex differences were observed for any other NC outcome or psychosocial functioning. High heterogeneity and differences in assessment scales used should be considered when interpreting these findings, given their potential impact on results.
Conclusions
Future research should adopt a more homogenous, standardized approach using longitudinal designs to gain a clearer insight into sex differences in this population. This approach so may increase the use of preventative therapeutic options to address the difficult clinical challenge of reaching cognitive and functional recovery.
The family Dendrophylliidae comprises a genus of azooxanthellate corals, Tubastraea (also known as ‘sun corals’ or ‘cup corals’), native from the Indo-Pacific and introduced into the Atlantic Ocean in the early 1940s. In Brazil, Tubastraea colonies were first registered on oil platforms on the northern coast of Rio de Janeiro state (22°S) in the late 1980s. Two decades later, these corals were for the first time identified in the Todos-os-Santos Bay (Bahia state, 13°S), a warmer environment with diverse marine ecosystems including estuaries, mangroves, and coral reefs. Intending to describe the biological cycle of exotic dendrophylliids from the Brazilian northeastern coast, histological analyses revealed three new reproductive structures for Scleractinia: (1) a mucin layer composed of acid glycoproteins surrounding immature sun coral oocytes, (2) trophonema or specialized cells connecting the oocyte to the adjacent gastrodermis, and (3) nucleolini, small condensations in nucleoli.
Action mechanisms of therapeutic alliance in stepped and digital interventions remain unclear.
Aims
(a) To compare the development of therapeutic alliance between psychosocial treatment as usual (PTAU) and a stepped digital intervention designed to prevent distress in cancer patients; (b) to analyse the level of agreement between patients’ and therapists’ therapeutic alliance ratings; and (c) to explore variables associated with therapeutic alliance in the digital intervention.
Method
A multicentre randomised controlled trial with 184 newly diagnosed breast cancer women was conducted. Patients were assigned to digital intervention or PTAU. Therapeutic alliance was assessed at 3, 6 and 12 months after inclusion using the working alliance inventory for patients and therapists. Age, usability (system usability scale), satisfaction (visual analogue scale), type and amount of patient–therapist communication were analysed as associated variables.
Results
Patients and therapists established high therapeutic alliance in the digital intervention, although significantly lower compared with PTAU. The development of patients’ therapeutic alliance did not differ between interventions, unlike that of the therapists. No agreement was found between patients’ and therapists’ therapeutic alliance ratings. Patients’ therapeutic alliance was associated with usability and satisfaction with app, whereas therapists’ therapeutic alliance was associated with satisfaction with monitoring platform.
Conclusions
A stepped digital intervention for cancer patients could develop and maintain strong therapeutic alliance. Neither the type nor amount of communication affected patients’ therapeutic alliance, suggesting that flexible and available digital communication fosters a sense of care and connection. The association between usability and satisfaction with digital tools highlights their importance as key therapeutic alliance components in digital settings.
Clinostomids are a group of digeneans in which substantial diversity has been recently discovered, with some metacercariae specific to their fish hosts. Genetic analysis has been instrumental in elucidating species diversity within this genus. Recently, seven COI lineages were reported in Argentina, along with three metacercarial morphotypes lacking molecular data. Two of these were found parasitising Rivulidae fishes. The discovery of Clinostomum metacercariae in Trigonectes aplocheiloides and Titanolebias monstrosus from temporary ponds in the western Chacoan region allowed us to redescribe the metacercariae previously identified by other authors and provide the first sequences of this lineage. The morphology of the metacercariae in both hosts matched previously reported descriptions. Genetic analysis clustered the new lineage with Clinostomum detruncatum, Clinostomum sp. 7, Clinostomum L1, and Clinostomum CRA. This discovery leaves only two morphological records of metacercariae to be characterised using DNA sequencing: one in another Rivulidae (Neofundulus paraguayensis) and one in a Loricaridae (Hypostomus sp.). The present results represent the eighth clinostomid lineage sequenced from Argentina, highlighting the extensive diversity in South America and the many lineages yet to be described or identified, considering that only one of these lineages is formally described based on adult specimens found in the heron Ardea cocoi.
This study explores the relationship between maternal working hours and a child's emotional well-being using data from the UK Millennium Cohort Study. Child well-being is assessed through self-reported happiness and a well-being index that includes concerns, temperament, bullying, and behaviour. Results show a positive association between maternal employment and child well-being, supported by factor analysis combining child, mother, and teacher reports. The association remains consistent across income levels and is unaffected by commuting time or cohabitation status. These findings highlight the importance of maternal employment and contextual factors in shaping child well-being.
There has been limited focus placed on exploring food insecurity within the UK-ex-Armed Forces population. The present study aims to build on initial work by investigating the prevalence and associated factors of food insecurity within UK veterans and their families and their current health status. 881 veterans (or a family member) who previously served in the Royal Navy and Royal Marines, Army and the Royal Air Force completed an online survey to explore health status, food insecurity and receipt of benefits. In total, 16.9% of survey respondents were part of food-insecure households, with 12% of these also experiencing some element of hunger. Working age, non-officer rank at the time of service discharge, not being married, living in rented accommodation, having at least one medical condition and in receipt of other benefits were significant risk factors associated with food insecurity. Understanding the specific risk factors associated with food insecurity is vital to develop personalised interventions and policies, such as income support programmes and affordable housing initiatives. However, more work is needed to further explore the factors associated with food insecurity, particularly in the long term.
In recent years, air sac parasitic helminths have been reported to cause severe disease in birds. In addition, various species appear to be expanding and infecting new avian hosts in various regions worldwide. In this context, an air sac nematode was initially detected in 2014 infecting the Eurasian scops owl, hospitalized in the local wildlife hospital in Mallorca (Balearic Islands, Spain). Years later, the parasite was detected in 2 other owl species. Air sac nematodes had never been reported in the Mallorcan Strigiformes before. A comprehensive molecular and morphological characterization analysis, including scanning electron microscopy, was required for species confirmation. The species was identified as Lissonema sicki, a parasite infrequently reported in South American owls. Since its first introduction to Mallorca, it has dramatically increased in prevalence in hospitalized birds, being highly prevalent in the Eurasian scops owl (41%), in the long-eared owl (11%) and in the barn owl (4%). The introduction pathway of this parasite to Europe remains unknown. This discovery underscores the expanding range and impact of L. sicki, emphasizing the importance of ongoing surveillance and research to comprehend and manage the implications of its emergence in new territories.
Extending over warmer environments in the Brazilian waters, the exotic vermetid Eualetes tulipa was first recorded from Ceará State (3°S) in 2005. In 2009, it was reported in cold-water environments in Rio de Janeiro State (22°S). Seven years later, E. tulipa was recorded from Rio Grande do Norte State (6°S) on rocky pools in sandstone reefs. In the present study, E. tulipa is for the first time recorded from Bahia State (12°S), associated with a biofouling community in the Todos-os-Santos Bay, co-occurring with exotic dendrophylliid corals (Tubastraea). The vermetid community recorded from Bahia State shows a great diversity of epibionts, mostly bivalves, cirripeds and sponges. The co-occurrence of Eualetes and Tubastraea corals must be monitored, once these exotic species are co-occurring in a protected environmental area, bringing concern on possible impacts on native benthic fauna.
Haematological alterations, especially in the red blood cell series, are a rare adverse effect of olanzapine treatment. A 64-year-old female patient with a diagnosis of long-standing schizophrenia was admitted to the psychiatric room for psychotic decompensation and leukopenia in control laboratory tests. She had a history of mild psoriasis, allergy to sulphonamides and infectious bursitis nine years earlier secondary to neutropenia due to clozapine. On previous admission, episodes of anaemia and neutropenia related to increased doses of olanzapine were observed. On current admission, a new episode of anaemia and neutropenia occurred with doses of up to 20 mg/day of olanzapine, hemoglobin levels of 63g/L ann neutrophil count of 0,8*10^9 neutrophils/l were detected.
Objectives
Report a very rare but serious adverse effect in patients treated with olanzapine.
Methods
Haematological analysis were periodically carried out from 2009 to 2023.
A complete study was carried out with parameters of haemolysis, autoimmunity, a pharmacogenetic study and a myelogram.
Results
The autoimmunity and haemolysis study excluded an autoimmune or haematological illness that could justify the haematological alterations.
The myelogram showed normal cellularity.
The pharmacogenetic study showed no relevant alterations.
Image:
Image 2:
Conclusions
The case was classified as a non-immune haemolytic anaemia secondary to olanzapine and improved with withdrawal of the drug.
This article analyzes trends in drug shortages in the US and Germany, the largest pharmaceutical market in Europe, between 2016 and 2023. It assesses the commonalities and differences between the countries in terms of active substances in shortage, time duration in shortage, and cyclic trends.
A 24-kDa collagenase was localized in the Gymnorhynchus gigas plerocercoid immunohistochemically by peroxidase complex staining using polyclonal antibodies from NMRI mouse sera immunized with purified enzyme. Immunoreactivity was determined at different parts of the body (scolex, vesicle and caudal region) and mainly localized in microtriches and parenchymal tissues of the scolex and vesicle. These results, along with the absence of the enzyme in the plerocercoid excretion–secretion products, suggest that the 24-kDa collagenase is produced by parenchymal cells in the anterior region and transported to the outer regions of the worm It is possible that the enzyme plays an important role in degrading parasite tissues during the moulting process.
A preliminary purification has been carried out by continuous elution electrophoresis of a 49.5 kDa protease of crude extracts from Dicrocoelium dendriticum eggs. The enzyme showed a high capacity to degrade the collagen derivative azocoll at acidic pH. Although it is necessary to carry out further experiments to confirm any physiological role, this protease could be implicated in penetration mechanisms.
Proteolytic activities of soluble and insoluble fractions of the free-living soil nematode Caenorhabditis elegans were measured across a range of substrates, temperatures and pH conditions. Several protease inhibitors were also tested under these conditions. Results of these studies indicate that proteolytic activity is present in cytosolic (CF) and non-cytosolic (NCF) fractions of C. elegans extracts at every condition of pH, temperature and buffer assayed. On the other hand, the use of different protease inhibitors demonstrated the existence of exo and endoproteases types in CF as well as NCF. Moreover our results show that the use of two protease inhibitor mixed types proposed by several authors are not enough to avoid this lytic activity when homogenates of this nematode are employed in biochemical assays.
Covering Mexican literary history from pre-Columbian literature to the twenty-first-century, including works from Greater Mexico, this book is the most comprehensive study on Mexican poetry available in English. It examines key authors, such as Bernando de Balbuena, Juana de Asbaje, Ramón López Velarde, José Gorostiza, and Octavio Paz, and considers how they should be read today. Individual chapters focus on important movements, poetic forms, and topics, such as epics, lyric poetry, romanticism, modernism, poetry and performance, poetry in indigenous languages, Mexican American and Chicanx poetry, and the relationship between Mexican literature and gender. This book provides a global understanding of Mexican poetry, its institutions and its main authors for students and scholars in any discipline connected to the subject.