1,840 research outputs found

    Longitudinal association between different levels of alcohol consumption and a new onset of depression and generalized anxiety disorder: Results from an international study in primary care

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    BACKGROUND: Several studies that have examined the full range of alcohol consumption have pointed to a possible non-linear association between alcohol use and the common mental disorders. Most of these studies are cross sectional and assessed psychiatric morbidity using non-specific instruments. Our aim was to investigate the longitudinal association between varying levels of alcohol consumption at baseline and the new-onset of depression and generalized anxiety disorder (GAD), in a large international primary care sample. METHODS: The sample consisted of 3201 primary care attenders from 14 countries in the context of WHO Collaborative Study of Psychological Problems in General Health Care. Alcohol use at baseline was assessed using AUDIT and the mental disorders were assessed with the Composite International Diagnostic Interview. RESULTS: Light to moderate alcohol consumption at baseline was associated with a lower incidence of depression and GAD compared to abstinence while excessive alcohol consumption was associated with a higher incidence of depression but not GAD. This non-linear association was not substantially affected after adjustment for a range of possible confounding variables. CONCLUSION: Any causal interpretation of this association is difficult in the context of an observational study and further combined and consistent evidence from different sources is needed

    Sampling‐based methods for uncertainty propagation in flood modeling under multiple uncertain inputs: finding out the most efficient choice

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    In probabilistic flood modeling, uncertainty manifests in frequency of occurrence, or histograms, for quantities of interest, including the Flood Extent and hazard rating (HR). Such modeling at the field-scale requires the identification of a more efficient alternative to the Standard Monte Carlo (SMC) method that can reproduce comparable output probability distributions with a relatively reduced sample size, including detailed histograms of quantities of interest. Latin hypercube sampling (LHS) is the most evaluated alternative for fluvial floods but yields no considerable sample size reduction. Potentially better alternatives include adaptive stratified sampling (ASS), Quasi Monte Carlo (QMC) and Haar-wavelet expansion (HWE), which are yet unevaluated for probabilistic flood modeling. To fulfill this gap, LHS, ASS, QMC, and HWE are compared to quantify sample size reduction to reproduce output detailed histograms—for Flood Extent, and average and maximum HR—while keeping the difference below 10% to the reference SMC prediction. The comparison is done for two test cases with two (i.e., inflow discharge and Manning's coefficient) and three (i.e., further including the ground elevation) input random variables, and a real case with five input random variables. With two input random variables, all four alternatives yield sample size reductions, with QMC and HWE considerably outperforming the others; with three and more input random variables, HWE becomes inflexible and LHS underperforms. Still, QMC is a better choice than ASS to boost sample size reduction for the real case and shall be preferred in probabilistic flood modeling. Accompanying research codes are openly available online

    Lung Microbiome in Asthma : Current Perspectives

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    A growing body of evidence implicates the human microbiome as a potentially influential player actively engaged in shaping the pathogenetic processes underlying the endotypes and phenotypes of chronic respiratory diseases, particularly of the airways. In this article, we specifically review current evidence on the characteristics of lung microbiome, and specifically the bacteriome, the modes of interaction between lung microbiota and host immune system, the role of the "lung-gut axis", and the functional effects thereof on asthma pathogenesis. We also attempt to explore the possibilities of therapeutic manipulation of the microbiome, aiming at the establishment of asthma prevention strategies and the optimization of asthma treatment

    Carotid shunt provides cerebral protection during emergency coronary artery bypass grafting in a patient with bilateral high grade carotid stenosis: a case report

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    <p>Abstract</p> <p>Background</p> <p>Management of patients with co-existent coronary and carotid disease is a controversial and challenging issue. The risk for stroke after coronary artery bypass grafting (CABG) in patients with hemodynamically significant carotid stenosis is up to 30%. In these patients a common practice is to proceed first with the restoration of cerebral perfusion and then perform the coronary revascularization. The rationale is that this strategy will reduce perioperative neurological morbidity and mortality. However, what happens when the carotid procedure is acutely complicated by cardiac instability which necessitates the interruption of the carotid procedure?</p> <p>Case report</p> <p>We describe a case of a patient with unstable angina and high grade asymptomatic bilateral carotid stenosis who underwent emergency combined CABG and carotid endarterectomy (CEA). Due to hemodynamic instability, ST-T changes, hypotension and bradycardia, upon completion of endarterectomy we placed a carotid shunt and the patient was put on cardiopulmonary bypass through median sternotomy. After triple CABG (duration of 90 minutes) we concluded the interrupted CEA procedure with primary closure of the carotid arteriotomy with the shunt in place. The postoperative course was uneventful and the patient was discharged after a week. In extreme cases with bilateral severe carotid stenosis and coronary artery disease where the carotid procedure should be interrupted, we suggest the use of carotid shunt which can provide adequate cerebral perfusion giving time to cardiac surgeon to perform the life saving cardiac procedure first.</p

    Agri-Food Globalisation and Rural Transformation in Chile: Smallholder Livelihoods in the Global Value Chain for Raspberries

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    As transnational capital continues to penetrate the agricultural sectors of developing countries, agri-food production-consumption is increasingly organised at the global scale. This has profound implications for small-scale farmers in the global South, who are being integrated into a globalising agri-food system geared towards the provision of agricultural commodities to meet the demands of wealthy consumers in Northern markets. Chile is one country that has purposefully inserted itself into the world trading system as an agri-exporter - a strategy that has fundamentally transformed Chilean agriculture. Framed within an examination of agrarian transformations in Chile and a world-historical account of agri-food globalisation, this thesis critically examines local-global linkages engendered by agri-food globalisation through a case study of export-oriented Chilean smallholder raspberry growers. The study aims to understand the structure and dynamics of the global value chain for raspberries, and to determine the livelihood implications of smallholder growers' participation in it. A detailed, locality case study was conducted in Yerbas Buenas - an important site of raspberry production within Chile - combining analysis of the raspberry value chain, and an in-depth survey of grower livelihoods. The value chain component focuses on key chain actors and functions within Chile, examining the role of public and private sector organisations governing and coordinating activities along the chain. The livelihoods component examines the significance of raspberry production within diversified household livelihood strategies, considering key assets, capabilities and mediating factors shaping smallholders' access to the value chain. Additionally, the research seeks to explore synergies and tensions between global value chain and sustainable rural livelihoods approaches, and to consider their integrative potential. The thesis finds that increasing competitive pressures, particularly arising from the evolving quality requirements of key overseas buyers, are seriously undermining the capacity of smallholder growers to participate in the chain. While existing private and public sector support is necessary for the participation of the smallest growers, it is not sufficient to secure their survival. It is argued that the neoliberal macroeconomic model represents a major barrier to smallholder participation, as the modernising agri-export-led growth strategy that it underpins can not accommodate the degree of intervention or the redistribution of resources required to address socio-economic inequality in the Chilean countryside
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