Stable isotopes, PCBs and pesticide concentrations in zooplankton, seawater and POM from Kongsfjorden and Liefdefjorden, Svalbard

Differences in bioaccumulation of persistent organic pollutants (POPs) between fjords characterized by different water masses were investigated by comparing POP concentrations, patterns and bioaccumulation factors (BAFs) in seven species of zooplankton from Liefdefjorden (Arctic water mass) and Kongsfjorden (Atlantic water mass), Svalbard, Norway. No difference in concentrations and patterns of POPs was observed in seawater and POM; however higher concentrations and BAFs for certain POPs were found in species of zooplankton from Kongsfjorden. The same species were sampled in both fjords and the differences in concentrations of POPs and BAFs were most likely due to fjord specific characteristics, such as ice cover and timing of snow/glacier melt. These confounding factors make it difficult to conclude on water mass (Arctic vs. Atlantic) specific differences and further to extrapolate these results to possible climate change effects on accumulation of POPs in zooplankton. The present study suggests that zooplankton do biomagnify POPs, which is important for understanding contaminant uptake and flux in zooplankton, though consciousness regarding the method of evaluation is important.

Size, blood organochlorine pesticide concentrations and biochemical indicators measured in hawksbill sea turtles (Eretmochelys imbricata) nesting at Punta Xen (Campeche, Mexico) in August 2010

The impact of environmental pollution on the homeostasis of sea turtles remains scarce, particularly in the southern Gulf of Mexico. As many municipalities do not rely on a waste treatment plant along the coastline of the Yucatan Peninsula, the vulnerability of these specimens could results enhanced. We searched for relationships between presence of organochlorine pesticides (OCP) and the level of several oxidative and pollutant stress indicators of the hawksbill sea turtle (Eretmochelys imbricata) during the egg-laying period 2010 at Punta Xen (Campeche, Mexico). Endosulfans, aldrin related (aldrin, endrin, dieldrin, endrin ketone, endrin aldehyde) and dichlorodiphenyldichloroethylene (DDT) families were detected in 17, 21 and 26 of the 30 sampled sea turtles, respectively. Significant correlation existed between the size of sea turtles with the concentration of methoxychlor, cholinesterase activity in plasma and heptachlors family, and catalase activity and hexachlorohexane family. Cholinesterase activity in washed erythrocytes and lipid peroxidation were positively correlated with glutathione reductase activity. Antioxidant enzyme actions seem adequate as no lipids damages were correlated with any OCPs. Future studies are necessary to evaluate the effect of OCPs on males of the area because of the significant detection of methoxychlor that target endocrine functioning and increase its concentration with size of the sea turtles.

STOPPFrail (Screening Tool of Older Persons Prescriptions in Frail Adults with Limited Life Expectancy): Consensus Validation

Background: To validate STOPPFrail, a list of explicit criteria for potentially inappropriate medications (PIMs) in frailer older adults with limited life expectancy. A Delphi consensus survey of an expert panel (n = 17) comprising specialists in geriatric medicine, clinical pharmacology, palliative care, psychiatry of old age, clinical pharmacy and general practice.
Methods: STOPPFrail criteria was initially created by the authors based on clinical
experience and appraisal of the available literature. Criteria were organised according to physiological system. Each criterion was accompanied by an explanation. Panellists ranked their agreement with each criterion on a 5-point Likert scale and invited to provide written feedback. Criteria with a median Likert response of 4/5 (agree/strongly agree) and a 25th centile of ≥4 were included in the final criteria.
Results: Three Delphi rounds were required. All panellists completed all rounds. Thirty criteria were proposed for inclusion; 26 were accepted. No new criteria were added. The first two criteria suggest deprescribing medications with no indication or where compliance is poor. The remaining 24 criteria include lipid-lowering therapies, alpha-blockers for hypertension, anti-platelets, neuroleptics, proton pump inhibitors, H-2 receptor antagonists, anti-spasmodics, theophylline, leukotriene antagonists, calcium supplements, bone anti-resorptive therapy, selective oestrogen receptor modulators, non-steroidal antiinflammatories, corticosteroids, 5-alpha reductase inhibitors, alpha-1 selective blockers, muscarinic antagonists, oral diabetic agents, ACE-inhibitors, angiotensin receptor blockers, systemic oestrogens, multivitamins, nutritional supplements and prophylactic antibiotics. Anticoagulants and anti-depressants were excluded. Despite incorporation of panellists’ suggestions, memantine and acetyl-cholinesterase inhibitors remained inconclusive.
Conclusion: STOPPFrail comprises 26 criteria, which have been judged by broad consensus, to be potentially inappropriate in frailer older patients with limited life expectancy. STOPPFrail may assist in deprescribing medications in these patients.

Complex organochlorine pesticide mixtures as determinant factor for breast cancer risk: a population-based case–control study in the Canary Islands (Spain)

[EN]All the relevant risk factors contributing to breast cancer etiology are not fully known. Exposure to organochlorine pesticides has been linked to an increased incidence of the disease, although not all data have been consistent. Most published studies evaluated the exposure to organochlorines individually, ignoring the potential effects exerted by the mixtures of chemicals.

Persons : their identity and individuation

This study is about the nature of persons and personal identity. It belongs to a tradition that maintains that in order to understand what it is to be a person we must clarify what personal identity consists in. In this pursuit, I differentiate between the problems (i) How do persons persist? and (ii) What facts, if any, does personal identity consist in? Concerning the first question, I argue that persons persist three-dimensionally (the endurance view), and not four-dimensionally (the perdurarne view), on the ground that objects must always fall under some substance sortal concept S (the sortal dependency of individuation), and that the concept person entails that objects falling under it are three-dimensional. Concerning the second question, I differentiate between Criterianists, who maintain that it is possible to specify a non-circular and informative criterion for personal identity, and Non-Criterianists, who deny that such a specification is possible. I argue against Criterianist accounts of personal identity on the ground that they are either (i) circular, (ii) violate the intrinsicality of identity or (iii) do not adequately represent what we are essentially. I further criticise three Psychological Non-Criterianist accounts of personal identity on the ground that they wrongly assume that 'person' refers to mental entities. Instead I formulate the Revised Animal Attribute View where person is understood as a basic sortal concept which picks out a biological sort of enduring animals. In this, I claim that the real essence of a person is determined by the real essence of the kind of animal he is, without thereby denying that persons have a real essence as persons.

Should I stay or should I go – Factors associated with hospitalization risk among older persons in Sweden

An increasingly older population will most likely lead to greater demands on the health care system, as older age is associated with an increased risk of having acute and chronic conditions. The number of diseases or disabilities is not the only marker of the amount of health care utilized, as persons may seek hospitalization without a disease and/or illness that requires hospital healthcare. Hospitalization may pose a severe risk to older persons, as exposure to the hospital environment may lead to increased risks of iatrogenic disorders, confusion, falls and nosocomial infections, i.e., disorders that may involve unnecessary suffering and lead to serious consequences. Aims: The overall aim of this thesis was to describe and explore individual trajectories of cognitive development in relation to hospitalization and risk factors for hospitalization among older persons living in different accommodations in Sweden and to explore older persons' reasons for being transferred to a hospital. Methods: The study designs were longitudinal, prospective and descriptive, and both quantitative and qualitative methods were used. Specifically, latent growth curve modelling was used to assess the association of cognitive development with hospitalization. The Cox proportional hazards regression model was used to analyse factors associated with hospitalization risk overtime. In addition, an explorative descriptive design was used to explore how home health care patients experienced and perceived their decision to seek hospital care. Results: The most common reasons for hospitalization were cardiovascular diseases, which caused more than one-quarter of first hospitalizations among the persons living in ordinary housing and nursing home residents (NHRs). The persons who had been hospitalized had a lower mean level of cognitive performance in general cognition, verbal, spatial/fluid, memory and processing speed abilities compared to those who had not been hospitalized. Significantly steeper declines in general cognition, spatial/fluid and processing speed abilities were observed among the persons who had been hospitalized. Cox proportional hazards regression analysis showed that the number of diseases, number of drugs used, having experienced a fall and being assessed as malnourished according to the Mini Nutritional Assessment scale were related to an increased hospitalization risk among the NHRs. Among the older persons living in ordinary housing, the risk factors for hospitalization were related to marital status, i.e., unmarried persons and widows/widowers had a decreased hospitalization risk. In addition, among social factors, receipt of support from relatives was related to an increased hospitalization risk, while receipt of support from friends was related to a decreased risk. The number of illnesses was not associated with the hospitalization risk for older persons in any age group or for those of either sex, when controlling for other variables. The older persons who received home health care described different reasons for their decisions to seek hospital care. The underlying theme of the home health care patients’ perceptions of their transfer to a hospital involved trust in hospitals. This trust was shared by the home health care patients, their relatives and the home health care staff, according to the patients. Conclusions: This thesis revealed that middle-aged and older persons who had been hospitalized exhibited a steeper decline in cognition. Specifically, spatial/fluid, processing speed, and general cognitive abilities were affected. The steeper decline in cognition among those who had been hospitalized remained even after controlling for comorbidities. The most common causes of hospitalization among the older persons living in ordinary housing and in nursing homes were cardiovascular diseases, tumours and falls. Not only health-related factors, such as the number of diseases, number of drugs used, and being assessed as malnourished, but also social factors and marital status were related to the hospitalization risk among the older persons living in ordinary housing and in nursing homes. Some risk factors associated with hospitalization differed not only between the men and women but also among the different age groups. The information provided in this thesis could be applied in care settings by professionals who interact with older persons before they decide to seek hospital care. To meet the needs of an older population, health care systems need to offer the proper health care at the most appropriate level, and they need to increase integration and coordination among health care delivered by different care services.

Evaluating the credibility of statements given by persons with intellectual disability

El objetivo del presente trabajo consistió en analizar las características diferenciales de los relatos emitidos por víctimas reales y simuladas con discapacidad intelectual ligera y moderada mediante el procedimiento de análisis de credibilidad de Control de la Realidad (RM). Dos evaluadores entrenados en los procedimientos de análisis de credibilidad mediante criterios de contenido evaluaron 13 relatos verdaderos y 16 relatos falsos. Los resultados encontrados muestran que existen pocas diferencias entre los dos tipos de relatos. Los únicos criterios que resultan significativos para discriminar entre los dos tipos de relatos son la cantidad de detalles y la longitud de las declaraciones espontáneas obtenidas mediante recuerdo libre. Ninguna de las características fenomenológicas examinadas resultó significativa para discriminar entre víctimas reales y simuladas. La representación gráfica mediante visualización hiperdimensional (HDV) considerando conjuntamente todos los criterios muestra una gran heterogeneidad entre relatos. Un análisis de conglomerados permitió clasificar los dos tipos de relatos con una probabilidad de acierto del 68.75 por ciento.

Adult missing persons: can an investigative framework be generated using behavioral themes?

There is a limited amount of research in the area of missing persons, especially adults. The aim of this research is to expand on the understanding of missing people, by examining adults' behaviours while missing and determining if distinct behavioural themes exist. Based on previous literature it was hypothesised that three behavioural themes will be present; dysfunctional, escape, and unintentional. Thirty-six behaviours were coded from 362 missing person police reports and analysed using smallest space analysis (SSA). This produced a spatial representation of the behaviours, showing three distinct behavioural themes. Seventy percent of the adult missing person reports were classified under one dominant theme, 41% were ‘unintentional’, 18% were ‘dysfunctional’, and 11% were ‘escape’. The relationship between a missing person's dominant behavioural theme and their assigned risk level and demographic characteristics were also analysed. A significant association was found between the age, occupational status, whether they had any mental health issues, and the risk level assigned to the missing person; and their dominant behavioural theme. The findings are the first step in the development of a standardised checklist for a missing person investigation. This has implications on how practitioners prioritise missing adults, and interventions to prevent individuals from going missing. Copyright © 2016 John Wiley & Sons, Ltd.

Disappeared Persons and Homicide in El Salvador

During 2012-2013, the homicide rate in El Salvador came down from 69.9 to 42.2 per 100,000 population following a truce between the leaders of the two major gangs, “Mara Salvatrucha” and “Barrio 18”, and government. But despite the apparent successes of the truce, it was speculated that the drop in murders could have been due to the killers simply hid the bodies of their victims. This paper aims at determining whether gangs effectively disappeared their victims to cut down the official counts of murders, or they committed these crimes for other reasons. The results from this study suggest that Salvadoran gangs had been using disappearance as a resource to gain sustained social control among residents of already gang-dominated areas, that together with homicide, disappearance is part of a process of territorial spread and strategic strengthening by which these groups are enhancing their capabilities to interfere in the alliances of Mexican drug trafficking organizations with Central American criminal organizations specializing in the transshipment of drugs and in providing access to local markets to distribute and sell drugs. Our findings show that the risk for disappearance has been large even before the truce was in place and that actually, it continues as such and going through a process of geographic expansion.

Adherence to antiretroviral therapy and its determinants among persons living with HIV/AIDS in Bayelsa state, Nigeria

Background: A high level of adherence is required to achieve the desired outcomes of antiretroviral therapy. There is paucity of information about adherence to combined antiretroviral therapy in Bayelsa State of southern Nigeria. Objectives: The objectives of the study were to determine the level of adherence to combined antiretroviral therapy among the patients, evaluate the improvement in their immune status and identify reasons for sub-optimal adherence to therapy. Methods: The cross-sectional study involved administration of an adapted and pretested questionnaire to 601 consented patients attending the two tertiary health institutions in Bayesla State, Nigeria: The Federal Medical Centre, Yenagoa and the Niger-Delta University Teaching Hospital Okolobiri. The tool was divided into various sections such as socio-demographic data, HIV knowledge and adherence to combined antiretroviral therapy. Information on the patient's CD4+ T cells count was retrieved from their medical records. Adherence was assessed by asking patients to recall their intake of prescribed doses in the last fourteen days and subjects who had 95-100% of the prescribed antiretroviral drugs were considered adherent. Results: Three hundred and forty eight (57.9%) of the subjects were females and 253 (42.1%) were males. The majority of them, 557 (92.7%) have good knowledge of HIV and combined anti-retroviral therapy with a score of 70.0% and above. A larger proportion of the respondents, 441 (73.4%), had > 95% adherence. Some of the most important reasons giving for missing doses include, “simply forgot” 147 (24.5%), and “wanted to avoid the side-effects of drugs” 33(5.5%). There were remarkable improvements in the immune status of the subjects with an increment in the proportion of the subjects with CD4+ T cells count of greater than 350 cells/mm3 from 33 (5.5%) at therapy initiation to 338 (56.3%) at study period (p<0.0001). Conclusion: The adherence level of 73.4% was low which calls for intervention and improvement. The combined antiretroviral therapy has significantly improved the immune status of the majority of patients which must be sustained. “Simply forgot” was the most important reason for missing doses.

A communication partner training program: Assessing conversational behaviors and attitudes towards communication in Persons with Aphasia and their Communication Partners

This study examined the conversational behaviors of eleven dyads consisting of a person with aphasia (PWA) and their familiar communication partner (CP), and investigated changes in behaviors as a result of attending a communication partner-training program CPT). Attitudes about communication were examined and related to conversational behaviors observed pre- and post- training. Results indicated that CPs and PWA used significantly more facilitating behaviors than barrier behaviors, although most dyads experienced some barriers. A comparison of pre-and post-CPT conversations revealed a significant interaction between time and type of behavior, with the increase in the number of facilitators approaching significance. Overall, persons with aphasia and their conversational partners expressed positive attitudes about communication. There were no significant correlations between scores on attitude surveys and behaviors pre or post-training. This study demonstrated that these dyads employed facilitative conversational behaviors even before CPT, and that facilitative behaviors can increase after a one-day training workshop.

Dual layer solid phase extraction based on molecular imprinting technology: Seeking a route to enhance selectivity for trace analysis of pesticide residues in olive oil.

Aiming to introduce a multiresidue analysis for the trace detection of pesticide residues belonging to organophosphorus and triazine classes from olive oil samples, a new sample preparation methodology comprising the use of a dual layer of “tailor-made” molecularly imprinted polymers (MIPs) SPE for the simultaneous extraction of both pesticides in a single procedure has been attempted. This work has focused on the implementation of a dual MIP-layer SPE procedure (DL-MISPE) encompassing the use of two MIP layers as specific sorbents. In order to achieve higher recovery rates, the amount of MIP layers has been optimized as well as the influence of MIP packaging order. The optimized DL-MISPE approach has been used in the preconcentration of spiked organic olive oil samples with concentrations of dimethoate and terbuthylazine similar to the maximum residue limits and further quantification by HPLC. High recovery rates for dimethoate (95%) and terbuthylazine (94%) have been achieved with good accuracy and precision. Overall, this work constitutes the first attempt on the development of a dual pesticide residue methodology for the trace analysis of pesticide residues based on molecular imprinting technology. Thus, DL-MISPE constitutes a reliable, robust, and sensitive sample preparation methodology that enables preconcentration of the target pesticides in complex olive oil samples, even at levels similar to the maximum residue limits enforced by the legislation.