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.
Objectives/Goals: Adults from minority groups report more severe and pervasive pain than those in majority groups, resulting in a disproportionate burden of pain. Whether race disparities in pain outcomes exist in persons with multiple sclerosis (MS) is unknown. We examined the association of race with pain intensity, pain interference, and pain phenotypes in MS. Methods/Study Population: Ambulatory adults with medically documented MS completed a comprehensive survey battery including demographics and clinical data. Pain outcomes were assessed with four measures: Patient Reported Outcome Measurement Information System (PROMIS) pain intensity and pain interference short forms, the American College of Rheumatology Fibromyalgia Survey Criteria (a surrogate of degree of nociplastic pain), and the PainDETECT (a surrogate of neuropathic pain). Participants were categorized as either Black/African American or White based on their self-reported race. Four sets of unadjusted and adjusted (including sex, age, years since diagnosis, MS subtype and Patient Determined Disease Steps—PDDS score) linear regression models were built to examine the associations between race and pain outcomes. Results/Anticipated Results: A total of 258 participants (200 White and 58 Black), with a mean age of 51 ± 12 years, mostly female (77%), an average of 15 ± 10 years since diagnosis, a PDDS score ranging from 0 to 6, and mostly diagnosed with RRMS (79%), were included in the analyses. Unadjusted regression models indicated that pain intensity (β = 5.20; 95% CI 2.73 – 7.66, p < 0.001), pain interference (β = 5.17; 95% CI 2.29 – 8.06, p < 0.001), and nociplastic pain (β = 2.41; 95% CI 0.40 – 4.42, p = 0.019) were all higher for Black/African American participants compared to White participants. The differences remained statistically significant in adjusted models. No differences in neuropathic pain were observed between Black/African American and White participants in both unadjusted and adjusted models. Discussion/Significance of Impact: We highlight an increased burden of pain in Black/African American with MS compared with their White counterparts. The findings illuminate potential future targets of interventions to reduce disparities in the experience and impact of pain. A comprehensive examination of the role of social determinants in pain outcomes in MS is further warranted.
The polyserial and point polyserial correlations are discussed as generalizations of the biserial and point biserial correlations. The relationship between the polyserial and point polyserial correlation is derived. The maximum likelihood estimator of the polyserial correlation is compared with a two-step estimator and with a computationally convenient ad hoc estimator. All three estimators perform reasonably well in a Monte Carlo simulation. Some practical applications of the polyserial correlation are described.
Clays can act as osmotic membranes and thus give rise to osmotically induced hydrostatic pressures. The magnitude of generated osmotic pressures in geologic systems is governed by the theoretical osmotic pressure calculated solely from solution properties and by value of the membrane's three phe-nomenological coefficients: the hydraulic permeability coefficient, Lp; the reflection coefficient, σ; and the solute permeability coefficient, ω. Generally, low values of Lp correspond to highly compacted membranes in which σ is near unity and ω approaches zero. Such membrane systems should give rise to initially high osmotic fluxes and gradual dissipation of their osmotic potentials.
The high fluid pressures in the Dunbarton Triassic basin, South Carolina, are a good example of osmotically induced potentials. A unique osmotic cell is created by the juxtaposition of fresh water in the overlying Cretaceous sediments against the saline pore water housed within the membrane-functioning sediments of the Triassic basin. Because wells penetrating the saline core of the basin show anomalously high heads relative to wells penetrating the basin margins, the longevity of this osmotic cell is probably dictated by the rate at which salt diffuses out into the overlying fresh water aquifer.
Alteration experiments have been performed using RTT7 and synthetic basaltic glasses in MgCl2−CaCl2 salt solution at 190°C. The duration of experiments ranged from 0.25 to 463 days. The alteration products were studied by Scanning Electron Microscope (SEM), Scanning Transmission Electron Microscope (STEM), X-ray diffraction (XRD) and Electron Spectrometry for Chemical Analysis (ESCA). For both glasses, the early alteration product is a hydrotalcite-like compound [Mg6Al2CO3(OH)16·4H2O] in which HPO42−, SO42− and Cl− substitutes for CO32−. The measured basal spacing is 7.68 Å for the hydrotalcite formed from R7T7 glass and 7.62 Å for the hydrotalcite formed from basaltic glass which reflect the high Al/Al + Mg ratios x (0.34 ≤ x ≤ 0.46). The chemical microanalyses show that the hydrotalcite is subsequently covered by a silica-rich gel which evolves into saponite after a few months. These results support the use of basaltic glasses alteration patterns in Mg-rich solution, to understand the long-term behavior of R7T7 nuclear waste glass.
Transgression by the Western Interior Sea during the Late Cretaceous in southwestern Minnesota caused swampy conditions to be imposed upon a laterite consisting of gibbsite, goethite and kaolinite. Reducing conditions overprinted upon the laterite reduced ferric Fe in goethite for incorporation of ferrous Fe into Fe-berthierine. Attendant oxidation of organic matter provided CO2 for siderite's formation. Thermodynamic calculations indicate that berthierine, gibbsite, goethite, kaolinite and siderite were in equilibrium with a solution whose pH was 5.2 and whose pCO2 was on the order of 0.3 atm. Formation of Fe-berthierine is favored by solutions having: 1) low silica concentration; 2) low [Mg2+]/[Fe2+] ratio; 3) high pCO2; 4) extremely low sulfate content before reduction takes place; and 5) moderate reducing conditions (Eh around −0.05 V).
An Fe-berthierine occurs in a buried laterite from the Late Cretaceous (Cenomanian) in southwestern Minnesota. It formed beneath a lignitic horizon in which reducing solutions percolated through a laterite comprising gibbsite, kaolinite and goethite. Morphologic differences suggest 2 separate conditions of Fe-berthierine formation. Early forms of Fe-berthierine include radial bladed or radial blocky crystallites coating pisoids, along with alteration of kaolinite at crystal boundaries. These morphologies formed in the vadose zone. Later forms precipitated under subaqueous conditions as macroscopic, pore-filling cement. The large size of the later-formed Fe-berthierines enabled microprobe characterization. This 1st reported occurrence of Mg-free berthierine has a structural formula close to an idealized Fe-berthierine: Fe2Al2SiO5(OH)4. Apart from their chemistry, the unique feature of the Minnesota Fe-berthierines is their formation in an exclusive nonmarine depositional environment. They formed in situ as part of a lateritic weathering profile developed on a broad, low relief peneplain. Physical evidence of formation under nonmarine conditions includes the presence of 1) scattered lignitic fragments; 2) concretions forming casts and molds of woody material; and 3) a nonmarine fossil (Unio sp. undet). Chemical evidence includes siderites collected from the berthierine-bearing horizon having stable isotope values indicating freshwater formation.
Childhood cancer survivors are at increased risk of developing cardiovascular diseases, presenting as the main causes of morbidity and mortality within this group. Besides the usual primary and secondary prevention in combination with screening during follow-up, the modifiable lifestyle factors of physical activity, nutrition, and body weight have not yet gained enough attention regarding potential cardiovascular risk reduction.
Objective:
These practical recommendations aim to provide summarised information and practical implications to paediatricians and health professionals treating childhood cancer survivors to reduce the risk of cardiovascular late effects.
Methods:
The content derives from either published guidelines or expert opinions from Association of European Paediatric and Congenital Cardiology working groups and is in accordance with current state-of-the-art.
Results:
All usual methods of prevention and screening regarding the risk, monitoring, and treatment of occurring cardiovascular diseases are summarised. Additionally, modifiable lifestyle factors are explained, and clear practical implications are named.
Conclusion:
Modifiable lifestyle factors should definitely be considered as a cost-effective and complementary approach to already implemented follow-up care programs in cardio-oncology, which can be actively addressed by the survivors themselves. However, treating physicians are strongly encouraged to support survivors to develop and maintain a healthy lifestyle, including physical activity as one of the major influencing factors. This article summarises relevant background information and provides specific practical recommendations on how to advise survivors to increase their level of physical activity.
To reduce Coronavirus Disease 2019 (COVID-19)-related mortality and morbidity, widely available oral COVID-19 treatments are urgently needed. Certain antidepressants, such as fluvoxamine or fluoxetine, may be beneficial against COVID-19.
Objectives
The main objective was two-fold: (i) to test the hypothesis that the prevalence of antidepressant use in patients hospitalized with COVID-19 would be lower than in patients with similar characteristics hospitalized without COVID-19, and (ii) to examine, among patients hospitalized with COVID-19, whether antidepressant use is associated with reduced 28-day mortality. Our secondary aim was to examine whether this potential association could only concern specific antidepressant classes or molecules, is dose-dependent, and/or only observed beyond a certain dose threshold.
Methods
We included 388,945 adult inpatients who tested positive for SARS-CoV-2 at 36 AP–HP (Assistance Publique–Hôpitaux de Paris) hospitals from 2 May 2020 to 2 November 2021. We compared the prevalence of antidepressant use at admission in a 1:1 ratio matched analytic sample with and without COVID-19 (N = 82,586), and assessed its association with 28-day all-cause mortality in a 1:1 ratio matched analytic sample of COVID-19 inpatients with and without antidepressant use at admission (N = 1482) (Figure 1).
Results
Antidepressant use was significantly less prevalent in inpatients with COVID-19 than in a matched control group of inpatients without COVID-19 (1.9% versus 4.8%; Odds Ratio (OR) = 0.38; 95%CI = 0.35–0.41, p < 0.001) (Figure 2). Antidepressant use was significantly associated with reduced 28-day mortality among COVID-19 inpatients (12.8% versus 21.2%; OR = 0.55; 95%CI = 0.41–0.72, p < 0.001), particularly at daily doses of at least 40 mg fluoxetine equivalents (Figure 3). Antidepressants with high FIASMA (Functional Inhibitors of Acid Sphingomyelinase) activity seem to drive both associations.
Image:
Image 2:
Image 3:
Conclusions
Antidepressant use is associated with a reduced likelihood of hospitalization in patients infected with SARS-CoV-2 and with a reduced risk of death in patients hospitalized with COVID-19. These associations were stronger for molecules with high FIASMA activity. These findings posit that prospective interventional studies of antidepressants with the highest FIASMA activity may be appropriate to help identify variant-agnostic, affordable, and scalable interventions for outpatient and inpatient therapy of COVID-19.
To understand healthcare worker (HCW) perceptions surrounding Staphylococcus aureus transmission and prevention in the neonatal intensive care unit (NICU).
Design:
Qualitative case study with focus groups.
Setting:
A level IV, 150-bed NICU at a Midwestern academic medical center that conducts active surveillance and decolonization of S. aureus–positive patients.
Participants:
NICU HCWs, including bedside nurses, nurse managers, therapy services personnel, pediatric nurse practitioners, clinical fellows, and attending neonatologists.
Methods:
Semistructured focus group interviews, assembled by occupation, were conducted by 2 study team members. Interviews were video recorded and transcribed. Deductive coding and thematic analyses were performed using NVivo software.
Results:
In total, 38 HCWs participated in 10 focus groups (1–12 participants each), lasting 40–90 minutes. Four main themes emerged: (1) Methicillin-resistant S. aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) are inconsistently described as high risk. (2) Infection prevention interventions are burdensome. (3) Multiple sources of transmission are recognized. (4) opportunities exist to advance infection prevention. HCWs perceived MSSA to be less clinically relevant than MRSA. Participants expressed a desire to see published data supporting infection prevention interventions, including contact precautions, environmental cleaning, and patient decolonization. These practices were identified to be considerable burdens. HCWs perceived families to be the main source of S. aureus in the NICU, and they suggested opportunities for families to play a larger role in infection prevention.
Conclusions:
These data highlight opportunities for HCW and parental education, research, and reevaluating interventions aimed at improving infection prevention efforts to reduce the burden of S. aureus in NICU settings.
Commercial activity and regulatory oversight of the digital economy are growing apace. This essay argues that regulatory heterogeneity can deter digital trade without discrimination. Domestic policies that are not discriminatory can still result in fragmentation of the global digital economy, if sufficiently heterogeneous. We find that rules at the World Trade Organization (WTO) and in digital trade agreements offer important directions but insufficiently mitigate heterogeneity. We suggest that heterogeneity should be addressed through the progressive expansion of international trade law. We emphasize the importance of encouraging regulatory coherence and pre-empting the formation of digital blocks.
Predictions of species-level extinction risk from climate change are mostly based on species distribution models (SDMs). Reviewing the literature, we summarise why the translation of SDM results to extinction risk is conceptually and methodologically challenged and why critical SDM assumptions are unlikely to be met under climate change. Published SDM-derived extinction estimates are based on a positive relationship between range size decline and extinction risk, which empirically is not well understood. Importantly, the classification criteria used by the IUCN Red List of Threatened Species were not meant for this purpose and are often misused. Future predictive studies would profit considerably from a better understanding of the extinction risk–range decline relationship, particularly regarding the persistence and non-random distribution of the few last individuals in dwindling populations. Nevertheless, in the face of the ongoing climate and biodiversity crises, there is a high demand for predictions of future extinction risks. Despite prevailing challenges, we agree that SDMs currently provide the most accessible method to assess climate-related extinction risk across multiple species. We summarise current good practice in how SDMs can serve to classify species into IUCN extinction risk categories and predict whether a species is likely to become threatened under future climate. However, the uncertainties associated with translating predicted range declines into quantitative extinction risk need to be adequately communicated and extinction predictions should only be attempted with carefully conducted SDMs that openly communicate the limitations and uncertainty.
Captive chimpanzees fed at regular, predictable intervals are known to exhibit higher rates of aggression immediately prior to, and during feeding. Presumably, anticipation of food creates tensions leading to increased agonistic interactions prior to feeding. This study was conducted to determine if seasonal variabilities might contribute to pre-feeding agonism. A quantitative examination was made looking at events affected by seasonal (summer versus autumn) changes. Seasonal fruit diversity and the amount of available space during feeding bouts in socially housed, captive chimpanzees were tested for an effect on pre-feeding agonism. Groups were observed for a five-week period during both seasons. Each social group was observed five times per season for 30 minutes, beginning 30 minutes prior to the morning feeding. All occurrences of agonistic behaviours were recorded. Average frequencies of agonistic behaviours were calculated for each group and compared across season using a Wilcoxon matched-pairs test to determine the effect of seasonal fluctuations in fruit diversity. There were no significant differences in the number of agonistic behaviours exhibited during summer versus autumn seasons. A strong negative correlation was found for agonistic behaviours in both seasons: as space decreased, agonism increased in both summer and autumn. In addition, males scored significantly higher in the summer versus the autumn for submissive behaviours when space decreased. The provision of a variety of seasonal fruits did not result in increased pre-feeding agonism in captive chimpanzees. In fact, cage size had a greater effect on levels of agonism than did the provision of seasonal fruits.
The northern bald ibis Geronticus eremita was once widespread throughout the Middle East, northern Africa, and southern and central Europe. Habitat destruction, persecution and the impacts of pesticides have led to its disappearance from most of its former range. It disappeared from central Europe > 400 years ago, but has persisted as a relict and slowly growing breeding population in Morocco, where c. 700 wild birds of all ages remain. In Algeria, the last confirmed breeding was in 1984; in Turkey the fully wild population disappeared in 1989, but a population remains in semi-wild conditions. In Syria a small population was rediscovered in 2002, only to subsequently decline to functional extinction. Restoration programmes have been initiated independently in several locations, with over 300 free-flying birds resulting from reintroduction projects in Austria, Germany, Spain and Turkey, to restore both sedentary and fully migratory populations. Maintaining current efforts in Morocco remains a high conservation priority.
In 1990, Latin American countries committed to psychiatric reforms including psychiatric bed removals. Aim of the study was to quantify changes in psychiatric bed numbers and prison population rates after the initiation of psychiatric reforms in Latin America.
Methods
We searched primary sources to collect numbers of psychiatric beds and prison population rates across Latin America between the years 1991 and 2017. Changes of psychiatric bed numbers were compared against trends of incarceration rates and tested for associations using fixed-effects regression of panel data. Economic variables were used as covariates. Reliable data were obtained from 17 Latin American countries: Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, Honduras, Guatemala, Mexico, Nicaragua, Panama, Paraguay, Peru, El Salvador, Uruguay and Venezuela.
Results
The number of psychiatric beds decreased in 15 out of 17 Latin American countries (median −35%) since 1991. Our findings indicate the total removal of 69 415 psychiatric beds. The prison population increased in all countries (median +181%). Panel data regression analyses showed a significant inverse relationship −2.70 (95% CI −4.28 to −1.11; p = 0.002) indicating that prison populations increased more when and where more psychiatric beds were removed. This relationship held up when introducing per capita income and income inequality as covariates −2.37 (95% CI −3.95 to −0.8; p = 0.006).
Conclusions
Important numbers of psychiatric beds have been removed in Latin America. Removals of psychiatric beds were related to increasing incarceration rates. Minimum numbers of psychiatric beds need to be defined and addressed in national policies.
Different types of biogenic remains, ranging from siliceous algae to carbonate precipitates, accumulate in the sediments of lakes and other aquatic ecosystems. Unicellular algae called diatoms, which form a siliceous test or frustule, are an ecologically and biogeochemically important group of organisms in aquatic environments and are often preserved in lake or marine sediments. When diatoms accumulate in large numbers in sediments, the fossilized remains can form diatomite. In sedimentological literature, “diatomite” is defined as a friable, light-coloured, sedimentary rock with a diatom content of at least 50%, however, in the Quaternary science literature diatomite is commonly used as a description of a sediment type that contains a “large” quantity of diatom frustules without a precise description of diatom abundance. Here we pose the question: What is diatomite? What quantity of diatoms define a sediment as diatomite? Is it an uncompacted sediment or a compacted sediment? We provide a short overview of prior practices and suggest that sediment with more than 50% of sediment weight comprised of diatom SiO2 and having high (>70%) porosity is diatomaceous ooze if unconsolidated and diatomite if consolidated. Greater burial depth and higher temperatures result in porosity loss and recrystallization into porcelanite, chert, and pure quartz.
Response patterns derived from dichotomized (0/1) weekly CGI ratings conducted in antidepressant drug trials (Quitkin et al, 1984) were compared with those found in the pooled data from several randomized double-blind trials comparing the relative efficacy and tolerability low-dose flupenthixol im with that of three trieyclics (amitriptyline sr, imipramine, doxepine). Using the configurational frequency analysis (Krauth and Lienert, 1973), the postulated patterns could be rediscovered in our data apart from “early onset persistent patterns” which were less frequent in Quitkin et al's (1984) drug data. However, apart from this finding no “typical” patterns in terms of drug- or placebo-dependent response patterns could be detected in either the flupenthixol or Quitkin et al's (1984) data. It is concluded that there is little empirical evidence for the assumption of placebo- or drug related change- or response patterns. Moreover, theoretical aspects do not support the usefulness of such concepts.
Negative computer attitude has been shown to be a possible co-variable in computerized examinations of psychiatric patients, affecting patient-computer interaction as well as reliability and validity of assessment (Weber et al. 2002, Acta Psychiatr.Scand., 105, 126-130).
It remains still uncertain if the psychological construct of computer attitude can be dependably measured in acute psychiatric inpatients or whether it is impeded by the effects of mental illness. For that reason a German translation of the Groningen Computer Attitude Scale (GCAS) was evaluated in 160 acute psychiatric inpatients under naturalistic conditions.
General test criteria (internal structure, item analysis, internal consistency, split half reliability) to a large extent corresponded to those formerly found in healthy subjects and psychiatric outpatients. The mean GCAS score was calculated as 56.2 ± 10.8 points and a significantly better computer attitude was found in male, better educated and younger patients. Some diverging correlation patterns were found in diagnostic subgroups, indicating a possible minor impact of mental disorder on computer attitude.
Overall, the GCAS was found to be a suitable instrument for measuring computer attitude in acute psychiatric inpatients. It should be used in identifying patients with a negative attitude to computers in order to ensure reliability and validity of computerized assessment.