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.
Online ordering will be unavailable from 17:00 GMT on Friday, April 25 until 17:00 GMT on Sunday, April 27 due to maintenance. We apologise for the inconvenience.
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.
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.
Two new sites, identified during a survey of the Tajuña River Valley, central Iberia, show evidence of both flint extraction and working, specifically for the production of long blades. These are an important addition to the limited number of such sites known in Eurasia.
Stereotype construction is a complex process, with multiple relations to language processing, that combines collective sociocultural factors with individual cognitive elements. Regarding gendered languages, there is a debate about the effect of grammatical gender on the representation of inanimate entities. To evaluate the potential interaction between gender stereotypes and gender morphology on words that refer to inanimate entities in three different communities of Spanish speakers, we developed a task of conscious judgments on the level of association to men or women of words that refer to objects. In a 3 × 2 × 3 × 2 design, we manipulated Semantic Bias (gender stereotypicality), with three levels (male, e.g., martillo, hammer-M; female, e.g., vestido, dress-M; neutral, e.g., lápiz, pencil-M); Morphology, with two levels (masculine, e.g., vestido, dress-M; feminine, e.g., pulsera, bracelet-F); Linguistic variety, with three levels (Argentine, Chilean and Peninsular) and Questionnaire, with two levels (related to men vs. related to women). The results showed that grammatical gender has an effect on words that refer to inanimate entities when those words do not carry a strong stereotypical association (neutral items), semantic bias related to gender stereotypes overshadows any potential effect of grammatical gender in biased items, and there are differences depending on the community (Argentine, Chilean and Peninsular).
The Nasrid emirate of southern Iberia emanated power through architecture; this project aims to better understand how this was made possible, via an interdisciplinary exploration of the Alhambra monument and other Al-Andalus constructions. Initial results of archaeological campaigns, structure chronologies and communication plans undertaken in 2021 and 2022 are presented.
We present spectroscopic properties of 22 Ly$\alpha$ emitters (LAEs) at $z = 5.5 - 6.6$ with Ly$\alpha$ luminosity $\mathrm{log}( L_{\mathrm{Ly}\alpha} \, [\mathrm{erg} \, \mathrm{s}^{-1}]) = 42.4 - 43.5 $, obtained using VLT/MUSE as part of the Middle Ages Galaxy Properties with Integral Field Spectroscopy (MAGPI) survey. Additionally, we incorporate broad-band photometric data from the Subaru Hyper Suprime-Cam (HSC) Wide layer for 17 LAEs in our sample. The HSC-y band magnitudes show that our LAEs are UV-bright, with rest-frame absolute UV magnitudes $ -19.74 \leq \mathrm{M}_{\mathrm{UV}} \leq -23.27$. We find that the Ly$\alpha$ line width increases with Ly$\alpha$ luminosity, and this trend becomes more prominent at $z \gt 6$ where Ly$\alpha$ lines become significantly broadened ($\gtrsim+260 \, \mathrm{km}\, \mathrm{s}^{-1}$) at luminosities $\mathrm{log}( L_{\mathrm{Ly}\alpha} \, [\mathrm{erg} \, \mathrm{s}^{-1}]) \gt 43 $. This broadening is consistent with previous studies, suggesting that these sources are located inside larger ionised bubbles. We observe a slightly elevated ionising photon production efficiency estimated for LAEs at $z \gt 6$, which indicates that younger galaxies could be producing more ionising photons per UV luminosity. A tentative anti-correlation between ionising photon production efficiency and Ly$\alpha$ rest-frame equivalent width is noticed, which could indicate a time delay between production and escape of ionising photon primarily due to supernovae activity. Furthermore, we find a positive correlation between radius of ionised regions and Ly$\alpha$ line width, which again suggests that large ionised bubbles are created around these LAEs, which are allowing them to self-shield from the scattering effects of the intergalactic medium (IGM). We also detect two very closely separated LAEs at $z = 6.046$ (projected spatial distance between the cores is 15.92 kpc). This is the LAE pair with the smallest separation ever discovered in the reionisation epoch. The size of their respective bubbles suggests that they likely sit inside a common large ionised region. Such a closely separated LAE pair increases the size of ionised bubble, potentially allowing a boosted transmission of Ly$\alpha$ through neutral IGM and also supports an accelerated reionisation scenario.
Mass Casualty Incidents (MCIs) pose significant challenges to health care systems, especially regarding emergency preparedness and response. This study aims to analyze the epidemiological characteristics and burden of MCIs in Spain from 2014 to 2022, focusing on the type, frequency, and impact of these incidents on public health and emergency services.
Methods
A population-based retrospective observational study examined MCIs in Spain between January 2014 and December 2022. Data were collected from various emergency services. Incidents involving 4 or more victims requiring medical assistance and ambulance mobilization were included. The study categorized MCIs into 5 types: road traffic accidents, fires and explosions, chemical poisonings, maritime accidents, and others.
Results
A total of 1618 MCIs resulting in 8556 victims were identified, averaging 15 (95% CI, 11-19) incidents per month, with 79% due to road traffic accidents and 13% to fires and explosions, which also had the highest average of 7.6 victims per incident. Despite maritime accidents comprising only 1.9% of incidents, they had the highest fatality rate. MCIs were more frequent on weekends, in January and July, and between 3:00 PM and 9:00 PM. The average response time was 38 minutes, with 35% of victims sustaining severe injuries.
Conclusions
Despite a slight decrease in annual MCIs from 2014 to 2022 in Spain, the trend is not statistically significant. The study highlights the need for a national registry and standardized data collection to enhance emergency preparedness and response planning and facilitate the reduction of the MCI burden.
Species’ declines are caused by a combination of factors that affect survival and/or breeding success. We studied the effects of a set of environmental and anthropogenic variables on the disappearance of Canarian Houbara Bustards Chlamydotis undulata fuertaventurae on Fuerteventura (Canary Islands), once the main stronghold of this endangered bird. Of 83 male display sites detected in 1997–1998, only 29 remained occupied in 2020–2021 (a 65% decrease in only 23 years). We compared habitat quality, density of conspecifics, other steppe birds and crows, presence of human infrastructure, and degree of environmental protection between these 29 extant sites and the 54 extinct sites using univariate analyses and generalised linear models (GLMs). The most influential variable in the abandonment of display sites was the Normalised Difference Vegetation Index (NDVI), an indicator of green vegetation productivity, which suggests a strong effect of habitat aridification due to climate change on the population’s extinction process. Powerline density was the second most important factor. This suggests that houbaras have survived where a greater abundance of food resources has enabled a higher breeding success, and where powerline fatalities have caused lower mortality over the years. Higher densities of houbaras, and other steppe birds and crows at extant display sites confirmed the better habitat quality in these areas. Extant display sites, located generally in protected areas, also had lower densities of human infrastructure (e.g. buildings, roads). We discuss the conservation implications of these results and provide management recommendations for this endangered subspecies.
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 increasing recognition of the crucial need for robust community engagement in health research and clinical trials. Despite this awareness, challenges persist in bridging the gap between researchers and communities. Much of the current discourse focuses on addressing issues such as cultural humility and equitable partnerships. To expand this conversation, we conducted community engagement studios, following the model by Joosten et al. We wanted to gather perspectives on research involvement across New Mexico. This process and resultant findings offer valuable insights into effective community engagement practices and advance clinical and translational science by amplifying community voices and needs.
The aim of this study was to compare the levels of reactive oxygen species (ROS) in Bos taurus and Bos indicus in vitro embryos cryopreserved using either slow freezing or vitrification. Embryos were divided into four groups based on subspecies and freezing method: Bos indicus slow freezing (BiSF; n = 8), Bos indicus vitrification (BiVT; n = 10), Bos taurus slow freezing (BtSF; n = 9), and Bos taurus vitrification (BtVT; n = 6). After thawing, the embryos were incubated with CellRox Green and images were obtained using a confocal microscope. The fluorescence intensity of each cell was measured and expressed as arbitrary units of fluorescence (auf) and compared using a multiple regression and unpaired t-test with α = 0.05. Results showed that subspecies and the freezing method significantly affected auf (P < 0.001; R2 = 0.1213). Bos indicus embryos had higher auf than Bos taurus embryos, whether frozen by slow freezing (67.05 ± 23.18 vs 51.30 ± 16.84, P < 0.001) or vitrification (64.44 ± 23.32 vs 47.86 ± 17.53, P < 0.001). Slow freezing induced higher auf than vitrification in both Bos taurus (51.30 ± 16.84 vs 47.86 ± 17.53, P < 0.001) and Bos indicus (67.05 ± 23.18 vs 64.44 ± 23.32, P < 0.014). In conclusion, Bos taurus embryos had lower ROS levels when frozen using vitrification, while Bos indicus embryos had consistent ROS patterns regardless of the freezing method. However, Bos indicus embryos frozen by slow freezing tended to have a higher number of cells with elevated ROS levels.
This paper examines a Greek Middle Geometric II pottery assemblage recovered during the Tunisian-Spanish excavations in the ancient city of Utica, Tunisia. The ceramics come from the deposit that sealed Well 200017, which further contained animal bones representing the remains of a ritual collective banquet. The ceramics are mainly of Phoenician, Libyan and Sardinian as well as Greek, Italic and Iberian origin. Most of the sherds come from bowls for consumption of food and drinks; there are also a few vessels for serving food and amphoras, while cooking vessels are very scarce. Based on our radiocarbon evidence, the context dates between 965–903 cal BCE, with a lower interval at 832 cal BCE. Neutron Activation Analysis (NAA) was carried out on forty-five samples mainly of Geometric pottery in two campaigns. This paper presents the NAA results of the pottery from Utica’s well that were sampled during the first campaign in 2015.
Ermeloite is a new aluminium phosphate mineral from Galicia, Spain, in the northwest of the Iberian Peninsula. It is the third formally recognised mineral discovered in Galicia since morenosite and cervantite in the 19th Century. The name and symbol (Erm) were approved by the Commission on New Minerals, Nomenclature and Classification of the International Mineralogical Association (IMA2021–017a) in recognition of the geographical location where it was found. The mineral occurs as a light blue to white fine aggregate over quartz and microcline associated with wardite. Crystals of ~0.04 mm are transparent and have a waxy lustre. The simplified empirical formula determined using electron microprobe analysis is Al1.02P0.95F0.06O3.88⋅1.06 H2O, which is near to the ideal formula Al(PO4)⋅H2O. The mineral is an alteration product within a phosphate pegmatite. Ermeloite is the second phosphate isostructural with the sulfates of the kieserite group. Single-crystal X-ray diffraction showed that ermeloite crystallises in the monoclinic C2/c space group with cell parameters a = 6.5371(4) Å, b = 7.5670(5) Å, c = 7.1146(5) Å, β = 115.335(2)°, V = 318.08(4) Å3 and Z = 4 at room temperature. Comparative analysis of the crystallographic data, with isostructural phosphates, revealed an interesting behaviour for these compounds.
High-risk pregnancies elevate maternal stress, impacting offspring neurodevelopment and behavior. This study, involving 112 participants, aimed to compare perceived stress, neurodevelopment, and behavior in high-risk and low-risk pregnancies. Two groups, high-risk and low-risk, were assessed during pregnancy for stress using hair cortisol and psychological analysis. At 24 months post-birth, their children’s neurodevelopment and behavior were evaluated. Results revealed higher perceived stress and pregnancy-related concerns in high-risk pregnancies, contrasting with low-risk pregnancies. Offspring from high-risk pregnancies displayed elevated internalizing behavior scores, while low-risk pregnancies showed higher externalizing behavior scores. Additionally, women in low-risk pregnancies exhibited increased cortisol concentrations 24 months post-delivery. These findings underscore the necessity for early stress detection and prevention programs during pregnancy, particularly in high-risk cases, to enhance maternal and infant health.
This study aims to develop a framework for establishing priorities in the regional health service of Murcia, Spain, to facilitate the creation of a comprehensive multiple criteria decision analysis (MCDA) framework. This framework will aid in decision-making processes related to the assessment, reimbursement, and utilization of high-impact health technologies.
Method
Based on the results of a review of existing frameworks for MCDA of health technologies, a set of criteria was proposed to be used in the context of evaluating high-impact health technologies. Key stakeholders within regional healthcare services, including clinical leaders and management personnel, participated in a focus group (n = 11) to discuss the proposed criteria and select the final fifteen. To elicit the weights of the criteria, two surveys were administered, one to a small sample of healthcare professionals (n = 35) and another to a larger representative sample of the general population (n = 494).
Results
The responses obtained from health professionals in the weighting procedure exhibited greater consistency compared to those provided by the general public. The criteria more highly weighted were “Need for intervention” and “Intervention outcomes.” The weights finally assigned to each item in the multicriteria framework were derived as the equal-weighted sum of the mean weights from the two samples.
Conclusions
A multi-attribute function capable of generating a composite measure (multicriteria) to assess the value of high-impact health interventions has been developed. Furthermore, it is recommended to pilot this procedure in a specific decision context to evaluate the efficacy, feasibility, usefulness, and reliability of the proposed tool.
The objective of this work was to study mortality increase in Spain during the first and second academic semesters of 2020, coinciding with the first 2 waves of the Covid-19 pandemic; by sex, age, and education.
Methods:
An observational study was carried out, using linked populations and deaths’ data from 2017 to 2020. The mortality rates from all causes and leading causes other than Covid-19 during each semester of 2020, compared to the 2017–2019 averages for the same semester, was also estimated. Mortality rate ratios (MRR) and differences were used for comparison.
Results:
All-cause mortality rates increased in 2020 compared to pre-covid, except among working-age, (25–64 years) highly-educated women. Such increases were larger in lower-educated people between the working age range, in both 2020 semesters, but not at other ages. In the elderly, the MMR in the first semester in women and men were respectively, 1.14, and 1.25 among lower-educated people, and 1.28 and 1.23 among highly-educated people. In the second semester, the MMR were 1.12 in both sexes among lower-educated people and 1.13 in women and 1.16 in men among highly-educated people.
Conclusion:
Lower-educated people within working age and highly-educated people at older ages showed the greatest increase in all-cause mortality in 2020, compared to the pre-pandemic period.
Previous research has suggested that negative self-perceptions of aging and lower sense of control were significantly associated with worse physical and mental health, including physical limitations and feelings of guilt for perceiving oneself as a burden. However, no study has analyzed the associations of these variables when jointly considered and assessed the potential differences in the associations between people aged 40 to 59 years and people aged 60 years and older. The objective of this study was to assess the potential differences in the associations mentioned above between people aged 40 to 59 years and people aged 60 years and older.
Methods:
Participants were 377 people over 40 years (206 aged 40 to 59 years and 171 participants aged 60 years and older) who answered an online survey. The association between negative self-perceptions of aging, perceived control, physical limitations, and guilt for perceiving oneself as a burden was tested through path-analyses, with differences between age groups tested through multigroup analysis.
Results:
Significant differences between age groups were obtained. The results suggest that the influence of negative self-perceptions of aging on guilt for perceiving oneself as a burden is indirect through lower sense of control in participants aged 40 to 59 years; in participants aged 60 and over, negative self-perceptions of aging had a direct and indirect effect on guilt through greater physical limitations.
Conclusion:
Negative self-perceptions of aging seem to be a relevant variable to understand feelings of guilt for perceiving oneself as a burden in both middle-aged adults and older adults. However, this study documents potential differences in the correlates of guilt for perceiving oneself as a burden between participants aged 40 to 59 years and individuals aged 60 years and older. Specifically, the results suggest that the associations between negative self-perceptions of aging and guilt for perceiving oneself as a burden are modulated by lower sense of control in middle-aged and by greater physical limitations in older adults. These results support the relevance of social and cognitive processes related with aging for understanding feelings of guilt for perceiving oneself as a burden.
Control of massive hemorrhage (MH) is a life-saving intervention. The use of tourniquets has been studied in prehospital and battlefield settings but not in aquatic environments.
Objective:
The aim of this research is to assess the control of MH in an aquatic environment by analyzing the usability of two tourniquet models with different adjustment mechanisms: windlass rod versus ratchet.
Methodology:
A pilot simulation study was conducted using a randomized crossover design to assess the control of MH resulting from an upper extremity arterial perforation in an aquatic setting. A sample of 24 trained lifeguards performed two randomized tests: one using a windlass-based Combat Application Tourniquet 7 Gen (T-CAT) and the other using a ratchet-based OMNA Marine Tourniquet (T-OMNA) specifically designed for aquatic use on a training arm for hemorrhage control. The tests were conducted after swimming an approximate distance of 100 meters and the tourniquets were applied while in the water. The following parameters were recorded: time of rescue (rescue phases and tourniquet application), perceived fatigue, and technical actions related to tourniquet skills.
Results:
With the T-OMNA, 46% of the lifeguards successfully stopped the MH compared to 21% with the T-CAT (P = .015). The approach swim time was 135 seconds with the T-OMNA and 131 seconds with the T-CAT (P = .42). The total time (swim time plus tourniquet placement) was 174 seconds with the T-OMNA and 177 seconds with the T-CAT (P = .55). The adjustment time (from securing the Velcro to completing the manipulation of the windlass or ratchet) for the T-OMNA was faster than with the T-CAT (six seconds versus 19 seconds; P < .001; effect size [ES] = 0.83). The perceived fatigue was high, with a score of seven out of ten in both tests (P = .46).
Conclusions:
Lifeguards in this study demonstrated the ability to use both tourniquets during aquatic rescues under conditions of fatigue. The tourniquet with the ratcheting-fixation system controlled hemorrhage in less time than the windlass rod-based tourniquet, although achieving complete bleeding control had a low success rate.
PEPAdb (Prehistoric Europe's Personal Adornment Database) is a long-term, open-ended project that aims to improve access to archaeological data online. Its website (https://pepadb.us.es) publishes and analyses datasets about prehistoric personal adornment, drawing on the results of various research projects and bibliographic references.
Breast-feeding is associated with fewer comorbidities in very-low-birth-weight (VLBW) preterm infants. Bronchopulmonary dysplasia (BPD) of VLBW infants is a multifactorial pathology in which nutritional aspects may be of special importance. The aim of this study is to determine, in a cohort of VLBW infants, whether breast milk nutrition is associated with a reduced prevalence and severity of BPD. A retrospective study was conducted to record the intake of mother’s own milk (MOM), pasteurised donor human milk or preterm formula milk in the first 2 weeks of postnatal life of 566 VLBW newborns at our hospital during the period January 2008–December 2021. After applying the relevant exclusion criteria, data for 489 VLBW infants were analysed; 195 developed some degree of BPD. Moderate or severe BPD is associated with less weight gain. Moreover, the preferential ingestion of breast milk in the first and second postnatal weeks had effects associated with lower OR for BPD, which were statistically demonstrable for mild (OR 0·16; 95 % CI 0·03, 0·71) and severe (OR 0·08; 95 % CI 0·009, 0·91) BPD. Breast-feeding during the first weeks of postnatal life is associated with a reduced prevalence of BPD, which is frequently associated with less weight gain as a result of greater respiratory effort with greater energy expenditure.
Kaolin waste dumps contain a huge volume of material that cannot be commercialized due to the presence of variable amounts of iron minerals, which impart a yellowish color to the kaolin. Elimination of iron from kaolin using either a chemical or a biological method was the aim of this study. The chemical leaching of iron from kaolin was carried out using response surface methodology to optimize the reaction conditions. Time was found to be the most influential variable, although oxalic acid must be present to leach 32% of the iron. Biological leaching was also assayed for 14 days using a Bacillus strain. The results of bacterial leaching of iron from kaolin showed <1% iron elimination.