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AbstractBackgroundThe prevalence of medical illnesses is high among patients with psychiatric disorders. The current study aimed to investigate multi-comorbidity in patients with psychiatric disorders in comparison to the general population. Secondary aims were to investigate factors associated with metabolic syndrome and treatment appropriateness of mental disorders.MethodsThe sample included 54,826 subjects (64.73% females; 34.15% males; 1.11% nonbinary gender) from 40 countries (COMET-G study). The analysis was based on the registration of previous history that could serve as a fair approximation for the lifetime prevalence of various medical conditions.ResultsAbout 24.5% reported a history of somatic and 26.14% of mental disorders. Mental disorders were by far the most prevalent group of medical conditions. Comorbidity of any somatic with any mental disorder was reported by 8.21%. One-third to almost two-thirds of somatic patients were also suffering from a mental disorder depending on the severity and multicomorbidity. Bipolar and psychotic patients and to a lesser extent depressives, manifested an earlier (15–20 years) manifestation of somatic multicomorbidity, severe disability, and probably earlier death. The overwhelming majority of patients with mental disorders were not receiving treatment or were being treated in a way that was not recommended. Antipsychotics and antidepressants were not related to the development of metabolic syndrome.ConclusionsThe finding that one-third to almost two-thirds of somatic patients also suffered from a mental disorder strongly suggests that psychiatry is the field with the most trans-specialty and interdisciplinary value and application points to the importance of teaching psychiatry and mental health in medical schools and also to the need for more technocratically oriented training of psychiatric residents.

Detecting anomalies in patterns of sensor data is important in many practical applications, including domestic activity monitoring for Active Assisted Living (AAL). How to represent and analyse these patterns, however, remains a challenging task, especially when data is relatively scarce and an explicit model is required to be fine-tuned for specific scenarios. This paper, therefore, presents a new approach for temporal modelling of long-term human activities with smart-home sensors, which is used to detect anomalous situations in a robot-assisted environment. The model is based on wavelet transforms and used to forecast smart sensor data, providing a temporal prior to detect unexpected events in human environments. To this end, a new extension of Hybrid Markov Logic Networks has been developed that merges different anomaly indicators, including activities detected by binary sensors, expert logic rules, and wavelet-based temporal models. The latter in particular allows the inference system to discover deviations from long-term activity patterns, which cannot be detected by simpler frequency-based models. Two new publicly available datasets were collected using several smart-sensors to evaluate the approach in office and domestic scenarios. The experimental results demonstrate the effectiveness of the proposed solutions and their successful deployment in complex human environments, showing their potential for future smart-home and robot integrated services.

Background: Pathologic characterization of pulmonary complications following hematopoietic stem cell transplantation (HSCT) is limited. We describe lung findings in pediatric patients who died following HSCT and attempt to identify potential clinical associations.Methods: Pathology databases at Texas Children’s Hospital and the Children’s Hospital of Philadelphia were queried (2013-2018 CHOP and 2017-2018 TCH). Electronic medical records and slides were reviewed.Results: Among 29 patients, 19 received HSCT for hematologic malignancy, 8 for non-malignant hematologic disorders, and 2 for metastatic solid tumors. Twenty-five patients (86%) showed 1 or more patterns of acute and organizing lung injury. Sixty-two percent had microvascular sclerosis, with venous involvement noted in most cases and not correlating with clinical history of pulmonary hypertension, clinical transplant-associated thrombotic microangiopathy, irradiation, or graft-versus-host disease. Features suggestive of graft-versus-host-disease were uncommon: 6 patients had lymphocytic bronchiolitis, and only 2 patients had evidence of bronchiolitis obliterans (both clinically unexpected), both with a mismatched unrelated donor transplant.Conclusions: Acute and subacute alveolar injury (diffuse alveolar damage or organizing pneumonia) is common in pediatric patients who died following HSCT and is difficult to assign to a specific etiology. Microvascular sclerosis was frequent and did not correlate with a single distinct clinical feature.

Pulmonary complications, pulmonary chronic graft vs host disease (cGVHD) and bronchiolitis obliterans, are a major cause of morbidity and mortality following hematopoietic stem cell transplant (HSCT). Pulmonary function testing is insensitive for detecting changes in small airways (SA). Multiple breath nitrogen washout (MBW) is a technique to detect ventilation heterogeneity; a measure of peripheral SA disease often seen in early manifestations of pulmonary cGVHD. Primary outcome of MBW testing is lung clearance index (LCI), the number of lung turnovers required to clear an inert gas (N2). MBW has several advantages, allowing it to be used in younger age groups. Utilization of LCI as a marker for early disease may allow for prompt diagnosis at a time in which intervention is the most meaningful.

Hematopoietic stem cell transplantation (HSCT) is an effective treatment for malignant and non-malignant diseases in pediatric patients but comes with significant risk of toxicity. Pulmonary morbidity affects as many as 25% of children receiving transplant. Better diagnostic and treatment modalities for pulmonary complications are greatly needed as survival after HSCT improves.

To compare previous hemophagocytic lymphohistiocytosis criteria with adult coronavirus disease 2019 (COVID-19)-associated hyperinflammatory syndrome (cHIS) criteria for the diagnosis of hyperinflammation in pediatric patients with COVID-19. The secondary objective was to assess treatment response to intravenous (IV) anakinra in these patients.This case series included children admitted to the PICU for COVID-19 pneumonia with hyperinflammation and treated with IV anakinra between July 2020 to April 2021. Hyperinflammatory criteria were determined for each patient. Clinical course, chest imaging, and inflammatory marker trends were assessed pre- and post-anakinra treatment.All patients had a cHIS criteria score of ≥5. Two patients met 2004-hemophagocytic lymphohistiocytosis criteria. Only the patient that required extracorporeal membrane oxygenation met the H-Score cut-off value. All but one patient had a decrease in their inflammatory markers and improvement in clinical status with early initiation of adjunctive IV anakinra.In this case series, adult cHIS criteria were successfully used to identify pediatric COVID-19 patients with hyperinflammation. Ferritin levels decreased after the early initiation of IV anakinra.

Purpose: In this article, the authors analyse a complex social process affecting historic public paths in rural areas in southern Spain. Despite the fact that urban populations are demanding the enhancement of this type of natural heritage for tourism, sports and recreational use, some parts of the network have been abandoned or usurped. Design/methodology/approach: The study is multidisciplinary, comprising three interlinked studies. The cartographic study comprises an inventory of public paths in rural areas based on administrative sources. The legal study analyses local, regional and national regulations governing agricultural, environmental, heritage, sports and tourism uses of the infrastructure. The sociological study analyses social discourses on the uses of public paths, and identifies conflicts between farmers, landowners, environmentalists, sportspeople and tourists. Findings: The preliminary results identified an important public paths network in Andalusia, approximately 160,000 km. The legal study found that there are laws regulating use, although local authorities do not monitor compliance or provide solutions to enhance management. The sociological study determined the attribution of environmental, cultural and economic value to public paths, but also the existence of conflicts between rural and urban populations. Research limitations/implications: Given that this is ongoing research, only state of the art and some preliminary albeit sufficiently consistent results are presented. Practical implications: The results could help to guide public policy and governance of public paths. Social implications: Public paths promote rural development and a green/sustainable economy. Originality/value: The research results and conclusions are original.

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides with pulmonary involvement include granulomatosis with polyangiitis, microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis, and can present with life-threatening pulmonary hemorrhage in up to 40% of patients. Mortality in those patients who require intubation and mechanical ventilation can reach 77%. Extracorporeal membrane oxygenation (ECMO) can be used to support these patients through definitive diagnosis and treatment, although minimizing the risk of ventilator-induced lung injury. We aimed to determine factors associated with favorable outcomes in patients with (ANCA)-associated vasculitides supported on ECMO. We performed a retrospective observational study using the Extracorporeal Life Support Organization registry of pediatric and adult patients with ANCA-associated vasculitis supported on ECMO from 2010 to 2020. One hundred thirty-five patients were included for analysis. Many patients had renal involvement (39%) in addition to pulmonary involvement (93%). Survival was 73% in AAV patients supported on ECMO. The presence of pulmonary hemorrhage was not associated with worse outcomes in our cohort. Older age, the use of venoarterial ECMO, ECMO-cardiopulmonary resuscitation, or sustaining a cardiac arrest before ECMO was associated with decreased survival. In conclusion, venovenous ECMO should be considered as a supportive bridge to definitive diagnosis and treatment in (ANCA)-associated vasculitides, regardless if pulmonary hemorrhage is present.

The effects of microencapsulated phase-change materials (MPCM) on the rheological properties of a geopolymer paste (GPP) were investigated. In order to quantify the time-dependent viscosity increase of the geopolymer paste containing MPCM (GPP-MPCM), a new rheological model was successfully developed. Three different MPCMs were compared in order to examine the effect of the hygroscopic nature of the microcapsule shells and the size distribution of the microcapsules. In addition, the effect of microcapsule concentration was investigated. It was found that microcapsules with polar functional groups on the shells affect the viscosity and the geopolymerization reaction of the geopolymer paste much more than microcapsules with hydrophobic shells. In addition, aggregated microcapsules influence the viscosities less than unaggregated microcapsules.

The present work addresses the lack of reported information about the mechanical properties of solid-solid PCMs, and how these are affected by their processing, considering that they usually incorporate fillers to increase their thermal conductivity. To this end, this work analyzes pentaglycerine (PG) based composites, which are of great interest in TES intended for 80 °C. These composites are also doped with various contents of expanded graphite (EG) with two different particle sizes. With these combinations, the effect of two typical processing methods, pressing and casting, on the microstructure of the composites is evaluated. Furthermore, the mechanical behavior of these composites in both crystal and plastic phases, as well as their thermal expansion during the transition process, is also reported in the current study. Besides demonstrating the important role that processing plays in these properties in PG/EG-based composites, it has been found that the use of EG is also beneficial for mitigating the permanent deformations experienced by these composites during thermal cycling. Finally, the exposed results give the first evidence of the interesting effect these processing methods have on the thermal properties of the composites.

The development of novel thermal fluids having large thermal energy storage (TES) capacity represents a research field of growing interest nowadays. One of the most explored alternatives is the employment of slurries containing encapsulated Phase Change Materials (PCM) at nano-scale range to avoid pumping problems. Slurries constituted by capsules from melamine-formaldehyde (MF) polymer containing n-octadecane (C18) have been synthesized by varying the paraffin/polymer (C18/MF) mass ratio within 1.50–4.00, in one single reaction step process, without waste generation and non-requiring additional purification treatments. All synthesized products presented high fluidity (viscosity around 4 mPa·s); Zeta-potential (ζ) values lower than −45 mV and pH values comprised between 5.5 and 6.0. Nevertheless, the thermal and physical properties of the slurries were function of the 18/MF mass ratio. While above a C18/MF mass ratio of 3.00 the slurry presented an undesirable large amount of non-encapsulated PCM, those ones produced with a C18/MF mass ratio bellow 3 exhibited high encapsulation yield and monodisperse particle size distribution (PSD). The slurries produced with C18/MF mass ratios larger than 2.33 satisfied the European Commission and ISO/TS 80004–1 classification as nanomaterials. Therefore, the highest encapsulation yield (98.7%), the dn0.5of 63.7 ± 10.2 nm and the spherical shape and smooth morphology of nanocapsules allowed to select the slurry synthesized with C18/MF mass ratio of 2.33 as the optimal nano encapsulated PCM slurry (NPCS). This nanoslurry exhibited a latent heat of ~23 J/g, being constituted by 14.44 wt% of nanocapsules having a latent heat of 125.85 J/g. Finally, the properties of this NPCS are better than the reported in literature for this type of slurries, being suitable to be applied as thermal fluid in thermal energy storage active systems.

Mercury emissions from soil samples with different mercury contents have been estimated using a closed circuit array. The samples were collected from the Almadén mercury mining district. The emissions confirmed that temperature and light radiation favour mercury desorption due to the increase in the mercury vapour pressure. An additional positive factor could be the photocatalytic reduction of soluble Hg2+to volatile Hg0at the soil surface. A physicochemical model based on mass transfer and equilibrium was developed and was used to reproduce the mercury emissions at the laboratory scale. The use of this model allowed us to obtain the unknown mass transfer coefficient (KL) and adsorption parameters required to quantify the possible gaseous mercury fluxes from these contaminated soils. Experimental results indicate that an equilibrium between the solid and gas phases was established. The proposed kinetic model reproduced perfectly the experimental data, with KLfound to be proportional to the inverse of temperature and independent of the radiation. The concentration of mercury in the gas phase was mainly dependent on the soluble mercury content (HgS). Equilibrium data were fitted by Langmuir and Freundlich models and the best fit was obtained using the multi-layer model attending to the convex shape of the curves, which is characteristic of non-porous or possibly macroporous materials having a low adsorption energy. The Freundlich constant (KF) was also fitted as a polynomial function with temperature and this gave a straight line for the light radiation and a second grade equation for dark conditions. Once the parameters had been obtained, the Hg emission fluxes from contaminated soils were estimated and the values were between two and three orders of magnitude higher than those published in the literature for non-contaminated soils.

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Summary:Microcapsules with large amount of PRS® paraffin wax encapsulated and narrow size distribution were prepared by shirasu porous glass (SPG) emulsification technique and a subsequent suspension like polymerization process and then examined by DSC, laser diffraction and SEM analyses. An experimental design approach, based on a central composite design, was used to determine quantitatively the effect of PRS® paraffin wax/styrene mass ratio (PRS/St), percentage of polyvinylpyrrolidone/styrene mass ratio (%PVP/St) and water/styrene mass ratio (H2O/St) on the microparticles properties. The results were fitted using two black‐box models. The empirical equations allow the prediction of the amount of the paraffin wax encapsulated and the mean particle size in number as a function of aforementioned synthesis variables.

A microbiological study of saffron spice was undertaken in the context of a European research project (Methodologies for Implementing International Standards for Saffron Purity and Quality, the acronym for which is SAFFIC), analyzing 79 samples obtained from the main producer countries, namely Greece, Iran, Italy, Morocco, and Spain. Current microbiological quality criteria are the same as for other spices, but saffron is added in minute quantities during the cooking process, so the health risk associated with microbial contamination might be lower. We did not detect Salmonellaeither by culture or by PCR methods in any sample, and Escherichia coliwas only found in five samples. Enterobacteriaceaewere frequently found (70.9% of the samples), but most of them belonged to species of probable environmental origin. Aerobic sporulated bacteria were also common, but only three samples contained Bacillus cereusat low levels (<200 CFU g−1). Clostridium perfringenscounts were also very low, with only one sample reaching >100 CFU g−1, an acceptable value. Overall, microbial contamination in saffron was markedly lower than it was in other spices.

Saffron spice is valuable for its colour, taste and aroma. All these properties depend on the different postharvesting treatments that Crocus sativusL. stigmas received to convert it into a spice. No previous scientific data relate the volatile content with its postharvesting process or origin. In this paper, two different analytical methods are used, CG-MS to determine volatile markers and an electronic nose based on metal oxides to determine the volatile profile of the samples from different geographic origins. It is demonstrated by means of CG-MS that 3,5,5-trimethyl-2-cyclohexenone, 2,6,6-trimethylcyclohexane-1,4-dione and acetic acid are capable to differentiate saffron from its origin. The content of acetic acid is very high in samples from Iran or Morocco, while low or undetectable content was observed in Greek and Spanish samples. In turn, using an e-nose (specifically optimised for this particular application), samples from different countries could be discriminated using Principal Component Analysis with a 90% of confidence.Saffron spice is valuable for its colour, taste and aroma. All these properties depend on the different postharvesting treatments that Crocus sativusL. stigmas received to convert it into a spice. No previous scientific data relate the volatile content with its postharvesting process or origin. In this paper, two different analytical methods are used, CG-MS to determine volatile markers and an electronic nose based on metal oxides to determine the volatile profile of the samples from different geographic origins. It is demonstrated by means of CG-MS that 3,5,5-trimethyl-2-cyclohexenone, 2,6,6-trimethylcyclohexane-1,4-dione and acetic acid are capable to differentiate saffron from its origin. The content of acetic acid is very high in samples from Iran or Morocco, while low or undetectable content was observed in Greek and Spanish samples. In turn, using an e-nose (specifically optimised for this particular application), samples from different countries could be discriminated using Principal Component Analysis with a 90% of confidence.

The activity of the ς54-promoter Puof Pseudomonas putidawas examined in vitrowith a DNA template lacking upstream activating sequences, such that RNA polymerase can be activated by the enhancer-binding protein XylR only from solution. Although the transcription activation pathway in this system lacked the step of integration host factor (IHF)-mediated looping of the XylR·DNA complex toward the prebound RNA polymerase, IHF still stimulated promoter activity. The positive effect of IHF became evident not only with XylR from solution, but also with other ς54-dependent activators such as NtrC and NifA. Furthermore, an equivalent outcome was shown for the nonspecific DNA-binding protein HU. This stimulation of transcription in the absence of the enhancer was traced to the recruitment of RNA polymerase (i.e.increased efficiency of formation of closed complexes) brought about by IHF or HU binding. Thus, under limiting concentrations of the polymerase, the factor-mediated binding of the enzyme to Puseems to enter a kinetic checkpoint in the system that prevents the XylR-mediated formation of an open complex.

The initiation of transcription (open complex formation) on supercoiled DNA templates carrying the σ⁵⁴-dependent promotersglnAp2orglnHp2can be readily activated by NR_I-phosphate bound to sites located 100 bp upstream from the transcriptional start site. In the case ofglnAp2, open complex formation can also be activated by NR_I-phosphate on a linear template, but in the case ofglnHp2activation on a linear template requires in addition to NR_I-phosphate, a DNA-bending protein such as the histone- like protein HU or integration host factor (IHF). Moving the binding sites for NR_I200 bp further away fromglnHp2allows transcription to be activated equally well in the absence or presence of HU, and in this case IHF inhibits the open complex formation. Furthermore, replacement of the DNA segment separating the binding sites for NR_IfromglnAp2by a random sequence of bases of equal length, does not reduce open complex formation on supercoiled DNA but prevents open complex formation on linear DNA unless HU is provided. These observations indicate that with binding sites for NR_Ilocated in their usual position, 100 bp from the transcriptional start site, the DNA segment separating these sites from the promoter must be either intrinsically bent or bent by HU or, in the case ofglnHp2, by IHF to allow contact between activator and the σ⁵⁴-RNA polymerase–promoter complex. Computer simulation of the shape of the DNA suggests that in the case ofglnAp2, but not ofglnHp2or the alteredglnAp2, this segment has an intrinsic curvature of 70°.

A stopped-flow method for the determination of paracetamol and oxyphenbutazone individually and in mixtures with no prior separation is proposed. The method is based on the oxidation of these drugs by the tris(2,2'-bipyridine)-iron(III) complex in an acid medium. The reactions are monitored by measuring the rate of appearance of the absorbance of the ferroin complex (?max=490 nm). The calibration graphs for the individual determination of the two drugs are both linear in the range 5–40 µg ml-1, and the precision (R.S.D.) is about 2%. A linear graphical differential reaction rate method is used for the resolution of mixtures of these drugs at the µg ml-1 level at paracetamol/ oxyphenbutazone ratios from 6:1 to 1:2. The proposed method is practically free from interferences.

A kinetic method for the determination of nitrazepam by the continuous addition of reagent (CAR) technique is reported. The method involves the formation of an azo dye between 1-naphthol and a diazonium salt that is in turn obtained by reaction between 2-amino-7-nitrobenzophenone (the hydrolysis product of the drug) and sodium nitrite. The reaction is monitored by measuring the rate of change of the absorbance of the azo dye formed at 600 nm which is proportional to the nitrazepam concentration. The linear range of the determination is 0.58–2.90 gml-1 and the relative standard deviation is 0.47%. The method is quite simple and was applied to the analysis of pharmaceutical samples, the results obtained being highly consistent with the certified contents.

A stopped-flow method for the determination of paracetamol and oxyphenbutazone individually and in mixtures with no prior separation is proposed. The method is based on the oxidation of these drugs by the tris(2,2′-bipyridine)-iron(III) complex in an acid medium. The reactions are monitored by measuring the rate of appearance of the absorbance of the ferroin complex (λmax=490 nm). The calibration graphs for the individual determination of the two drugs are both linear in the range 5–40 μg ml−1, and the precision (R.S.D.) is about 2%. A linear graphical differential reaction rate method is used for the resolution of mixtures of these drugs at the μg ml−1level at paracetamol/ oxyphenbutazone ratios from 6∶1 to 1∶2. The proposed method is practically free from interferences.

Febrile seizures are commonly seen in emergency departments that treat children. Risk factors for initial and recurrent febrile seizures and epilepsy have been identified. Controversy still exists over the need for performing a lumbar puncture as part of the initial evaluation. Most children with a febrile seizure and meningitis present with an abnormal level of consciousness or have obvious meningeal signs. Emphasis should be placed on looking for a source of fever and reassuring and educating the caretakers.

The epiploic appendages are rarely the cause of intra-abdominal disease necessitating surgical intervention. Even less common is the occurrence of mechanical intestinal obstruction on the basis of disease involving them. In a recent study, Lynn et al.1 found 156 reported cases, of which 13 presented with intestinal obstruction. They further reviewed the records of the Mayo Clinic for a 13-year period (1940-1953) and found 17 cases of symptoms resulting from disease involving these appendages. Of these 17 cases, only 2 presented with intestinal obstruction. In the past two years, two cases of mechanical bowel obstruction on the basis of epiploic appendagitis have been diagnosed and surgically corrected in the Memorial Hospital, Hollywood, Fla. The following case histories will reveal that both these patients presented with classical signs and symptoms of mechanical bowel obstruction. Each presented x-ray evidence of an obstructive lesion of the large bowel. Both these cases were

Introduction and Aim Multiorgan autoimmunity and interstitial lung disease (ILD) are reported in patients with STAT3 GOF syndrome.Results We present lung histopathology findings in 3 such children, two of whom underwent wedge biopsies with adequate diagnostic material. Wedge biopsies showed interstitial cellular expansion with linear and nodular aggregates of CD8 positive T lymphocytes, plasma cells, and histiocytes; consistent with lymphocytic interstitial pneumonia pattern (LIP). CD4+ T cells and CD20+ B cells were present but infrequent in the interstitium. FOXP3 cells ranged from 0-5%. Focal interstitial and intraalveolar histiocytes were also seen. Neutrophils and eosinophils were rare/absent. Non-occlusive peribronchial lymphoid aggregates showed equal T and B cells; likely reactive in nature. Pulmonary vessels appeared normal without vasculitis or hypertensive change. There was no interstitial or subepithelial fibrosis or organizing pneumonia. Interlobular septa and visceral pleura were unremarkable.Conclusion Children with multi-system autoimmune disorders with ILD should be investigated for STAT3 GOF syndrome. Lung wedge biopsies are more informative than transbronchial biopsies, if a tissue sampling is indicated. CD8 dominant T cell inflammation seems to be a key driver of ILD. Although interstitial fibrosis was not seen in our small sample, longer follow up is needed to understand the natural history.