Summary Non-communicable diseases, including cancer, are overtaking infectious disease as the leading health-care threat in middle-income and low-income countries. Latin American and Caribbean ...countries are struggling to respond to increasing morbidity and death from advanced disease. Health ministries and health-care systems in these countries face many challenges caring for patients with advanced cancer: inadequate funding; inequitable distribution of resources and services; inadequate numbers, training, and distribution of health-care personnel and equipment; lack of adequate care for many populations based on socioeconomic, geographic, ethnic, and other factors; and current systems geared toward the needs of wealthy, urban minorities at a cost to the entire population. This burgeoning cancer problem threatens to cause widespread suffering and economic peril to the countries of Latin America. Prompt and deliberate actions must be taken to avoid this scenario. Increasing efforts towards prevention of cancer and avoidance of advanced, stage IV disease will reduce suffering and mortality and will make overall cancer care more affordable. We hope the findings of our Commission and our recommendations will inspire Latin American stakeholders to redouble their efforts to address this increasing cancer burden and to prevent it from worsening and threatening their societies.
The clinician-administered version of the Liebowitz Social Anxiety Scale (LSAS-CA) is a commonly used assessment device for the evaluation of social anxiety disorder and has been shown to have strong ...psychometric characteristics. Because of its apparently straightforward rating format and potential savings in time and effort, interest in the use of the LSAS as a self-report (LSAS-SR) measure has increased, and the LSAS-SR has been used in a number of studies. However, the psychometric properties of the LSAS-SR have not been well established.
This study examined the psychometric properties of the LSAS-SR in comparison to the LSAS-CA in a sample of 99 individuals with a primary diagnosis of social anxiety disorder and 53 individuals with no current psychiatric disorder.
There was little difference between the two versions of the LSAS on any scale or subscale score. Both forms were internally consistent and the subscale intercorrelations for the two forms were essentially identical. Correlations of each LSAS-SR index with its LSAS-CA counterpart were all highly significant. Finally, the convergent and discriminant validity of the two forms of the LSAS was shown to be strong.
Results of this study suggest that the self-report version of the LSAS compares well to the clinician-administered version and may be validly employed in the assessment of social anxiety disorder.
Abstract
Proton radioactivity was discovered exactly 50 years ago. First, this nuclear decay mode sets the limit of existence on the nuclear landscape on the neutron-deficient side. Second, it ...comprises fundamental aspects of both quantum tunnelling as well as the coupling of (quasi)bound quantum states with the continuum in mesoscopic systems such as the atomic nucleus. Theoretical approaches can start either from bound-state nuclear shell-model theory or from resonance scattering. Thus, proton-radioactivity guides merging these types of theoretical approaches, which is of broader relevance for any few-body quantum system. Here, we report experimental measurements of proton-emission branches from an isomeric state in
54m
Ni, which were visualized in four dimensions in a newly developed detector. We show that these decays, which carry an unusually high angular momentum, ℓ = 5 and ℓ = 7, respectively, can be approximated theoretically with a potential model for the proton barrier penetration and a shell-model calculation for the overlap of the initial and final wave functions.
OBJECTIVES: It is unclear whether IV milrinone relaxes spasmed cerebral arteries and therefore reduces cerebral blood mean velocity (V mean ). In patients treated for cerebral vasospasm, we aimed to ...assess and delineate the respective impacts of induced hypertension and its combination with IV milrinone on cerebral hemodynamics as assessed with transcranial Doppler. DESIGN: Observational proof-of-concept prospective study. SETTING: ICU in a French tertiary care center. PATIENTS: Patients with aneurysmal subarachnoid hemorrhage who received induced hypertension (mean arterial blood pressure MBP of 100–120 mm Hg) and IV milrinone (0.5 µg/kg/min) for moderate-to-severe cerebral vasospasm. We excluded patients who underwent invasive angioplasty or milrinone discontinuation within 12 hours after the diagnosis of vasospasm. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: V mean was measured at vasospasm diagnosis (T DIAGNOSIS ), after the induction of hypertension (T HTN ), and 1 (T HTN+MILRINONE_H1 ) and 12 hours after the adjunction of IV milrinone (T HTN+MILRINONE_H12 ). Thirteen patients were included. Median V mean was significantly lower ( p < 0.01) at T HTN+MILRINONE_H1 (99 interquartile range (IQR) 89; 134 cm.s −1 ) and T HTN+MILRINONE_H12 (85 IQR 73–127 cm/s) than at T DIAGNOSIS (136 IQR 115–164 cm/s) and T HTN (148 IQR 115–183 cm/s), whereas T DIAGNOSIS and T HTN did not significantly differ. In all patients but one, V mean at T HTN+MILRINONE_H1 was lower than its value at T DIAGNOSIS ( p = 0.0005). V mean -to-MBP and V mean -to-cardiac output (CO) ratios (an assessment of V mean regardless of the level of MBP n = 13 or CO n = 7, respectively) were, respectively, similar at T DIAGNOSIS and T HTN but were significantly lower after the adjunction of milrinone ( p < 0.01). CONCLUSIONS: The induction of arterial hypertension was not associated with a significant decrease in V mean , whereas the adjunction of IV milrinone was, regardless of the level of MBP or CO. This suggests that IV milrinone may succeed in relaxing spasmed arteries.
The aim was to describe the effectiveness of suppressive antibiotic treatment (SAT) in routine clinical practice when used in situations in which removal of a prosthetic implant is considered ...essential for the eradication of an infection, and it cannot be performed.
This was a descriptive retrospective and multicentre cohort study of prosthetic joint infection (PJI) cases managed with SAT. SAT was considered to have failed if a fistula appeared or persisted, if debridement was necessary, if the prosthesis was removed due to persistence of the infection or if uncontrolled symptoms were present.
In total, 302 patients were analysed. Two hundred and three of these patients (67.2%) received monotherapy. The most commonly used drugs were tetracyclines (39.7% of patients) (120/302) and cotrimoxazole (35.4% of patients) (107/302). SAT was considered successful in 58.6% (177/302) of the patients (median time administered, 36.5 months; IQR 20.75–59.25). Infection was controlled in 50% of patients at 5 years according to Kaplan–Meier analysis. Resistance development was documented in 15 of 65 (23.1%) of the microbiologically documented cases. SAT failure was associated with age <70 years (sub-hazard ratio (SHR) 1.61, 95% CI 1.1–2.33), aetiology other than Gram-positive cocci (SHR 1.56, 95% CI 1.09–2.27) and location of the prosthesis in the upper limb (SHR 2.4, 95% CI 1.5–3.84). SAT suspension was necessary due to adverse effects in 17 of 302 patients (5.6%).
SAT offers acceptable results for patients with PJI when surgical treatment is not performed or when it fails to eradicate the infection.
The clinical Global Impression Scale (CGI) is commonly used as a primary outcome measure in studies evaluating the efficacy of treatments for anxiety disorders. The current study evaluated the ...psychometric properties and predictors of clinicians' ratings on an adapted version of the CGI among individuals with social anxiety disorders.
An independent assessor administered the CGI Severity of Illness and Improvement ratings to 123 patients at baseline and the subset of treated patients again mid- and post-treatment.
Improvement ratings were strongly related to both concurrent Severity of Illness and changes in Severity of Illness ratings from baseline. Additionally, both CGI ratings were positively correlated with both self-report and clinician-administered measures of social anxiety, depression, impairment and quality of life. Measures of social anxiety symptoms accounted for a large portion of the variance in Severity of Illness ratings, with significant additional variance accounted for by measures of impairment and depression. Changes in social anxiety symptoms from baseline accounted for significant variance in Improvement ratings, but no significant additional variance was accounted for by changes in impairment and depressive symptoms.
Our findings support the utility of the CGI as an index of global severity and symptom-specific improvement among individuals with social anxiety disorder.
Abstract Given the substantial comorbidity between generalized anxiety disorder (GAD) and unipolar depressive disorders (UDDs), some have suggested that these disorders be combined in future editions ...of the DSM. However, decisions regarding nosology should not only account for current manifestations of symptom profiles, but also the potential diagnostic utility of associated characteristics, which, given past research, may suggest greater distinctiveness between these disorder classes. In the present investigation, we examined the role of one-item indices of physical, emotional/motivational, and cognitive symptoms in differentiating GAD from UDDs. We assessed these symptoms with one-item measures in order to provide an initial examination of the viability of these constructs as diagnostic criteria. In Study 1, in an unselected college sample, muscle pains and aches, gastrointestinal symptoms, emotion intensity, and intolerance of uncertainty were associated with GAD symptoms; conversely, low positive affect was associated with UDDs symptoms. In Study 2, we extended these findings to a clinical population and found that muscle pains and aches, positive affect, goal motivation, emotion intensity, and intolerance of uncertainty were higher in GAD than in UDDs.
The combination of advances in knowledge, technology, changes in consumer preference and low cost of manufacturing is accelerating the next technology revolution in crop, livestock and fish ...production systems. This will have major implications for how, where and by whom food will be produced in the future. This next technology revolution could benefit the producer through substantial improvements in resource use and profitability, but also the environment through reduced externalities. The consumer will ultimately benefit through more nutritious, safe and affordable food diversity, which in turn will also contribute to the acceleration of the next technology. It will create new opportunities in achieving progress towards many of the Sustainable Development Goals, but it will require early recognition of trends and impact, public research and policy guidance to avoid negative trade-offs. Unfortunately, the quantitative predictability of future impacts will remain low and uncertain, while new chocks with unexpected consequences will continue to interrupt current and future outcomes. However, there is a continuing need for improving the predictability of shocks to future food systems especially for ex-ante assessment for policy and planning.
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