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Mental health services in Cambodia required rebuilding in their entirety after their destruction during conflict in the 1970s. During the late 1990s there was rapid growth and development of professional mental health training and education. Currently, basic mental healthcare is available primarily in urban areas and is provided by a mixture of government, non-government and private services. Despite the initial rapid growth of services and the development of a national mental health strategy in 2010, significant challenges remain in achieving an acceptable, standardised level of mental healthcare nationally.
Concurrent chemotherapy with radiotherapy is the standard treatment for locoregionally advanced nasopharyngeal cancer. Cetuximab can be used in the treatment of head and neck squamous cell carcinoma. However, the randomised studies that led to approval for its use in this setting excluded nasopharyngeal cancer. In the context of limited data for the use of cetuximab in nasopharyngeal cancer in the medical literature, this review aimed to summarise the current evidence for its use in both primary and recurrent or metastatic disease.
A literature search was performed using the keywords ‘nasopharyngeal neoplasm’, ‘cetuximab’ and ‘Erbitux’.
Twenty studies were included. There were no randomised phase III trials, but there were nine phase II trials. The use of cetuximab in the treatment of nasopharyngeal carcinoma has been tested in various settings, including in combination with induction chemotherapy and concurrent chemoradiotherapy, and in the palliative setting.
There is no evidence of benefit from the addition of cetuximab to standard management protocols, and there is some evidence of increased toxicity. There is more promise for its use in metastatic or locally recurrent settings. This review draws together the existing evidence and could provide a focus for future studies.
Evidence from the literature shows that clinicians’ knowledge of rules and legislation surrounding driving can often be poor. A closed-loop audit was conducted to gauge the level of driving advice given to patients with dizziness.
The clinical notes of 100 patients referred to the vertigo clinic at a tertiary referral centre were retrospectively searched for evidence of driving advice. Education sessions were undertaken and a patient information leaflet was developed before a second cycle of the audit.
Results and conclusion
The proportion of patients having documented evidence of receiving driving advice increased from 6.3 per cent to 10.4 per cent. It is therefore clear that, despite this improvement, a significant proportion of patients’ notes did not contain documentation about driving. This is likely because of many reasons, including individual interpretation by clinicians. This paper provides a reminder of the rules, and discusses their interpretation and implementation in an increasingly medicolegal environment.
Born into a kingdom where the king prohibited female inheritance, the eponymous heroine of the thirteenth–century Old French romance Silence was raised as a boy, much to the frustration of Nature and satisfaction of Nurture. Silence's education in masculine courtly behaviour and in the arts of war as her father's only heir was so successful that ‘He (sic) [became] … a valiant and noble knight;/ no king or count was ever better’ (‘Chevaliers est vallans et buens,/ Mellor n'engendra rois ne cuens’). Silence's true gender was only unmasked when he/she captured the prophet Merlin, who could only be seized if tricked by a woman. At the end of the tale, Nature recovered ‘her rights’ (‘sa droiture’) over Silence's body and restored her feminine appearance, whereupon Silence, who became known as Silentia rather than Silentius, abandoned her masculine knightly attire and married the king.
With its focus on violence, power and knighthood, chivalry appears first and foremost as a masculine social ideal in both medieval literature and life. Carrying arms and engaging personally in knightly forms of combat were male preserves; it was unnatural for women to participate in them. As Nature admonished Silence, before she reassumed her true gender:
‘It's a very nasty thing you're doing to me, leading this sort of life.
You [as a woman] have no business going off into the forest, jousting, hunting, shooting off arrows.
Desist from all of this!’ …
‘Go to a chamber and learn to sew!’
Yet the centrality of aristocratic ladies to courtly life and lordship allowed women to participate in chivalric culture in ways that were not entirely divorced from those of their male kin. Although women often featured in romances as lovers or unattainable figures for whom aristocratic men performed various feats of arms, they also appeared as agents, rather than as purely passive recipients of male affection or admiration. This chapter considers how far chivalric practices, values and modes of conduct were gendered, and explores how far female experiences differed from those of men between the twelfth and early fourteenth centuries. It adopts a broad definition of chivalry that encompasses the lifestyles and ideals of behaviour of those persons who belonged to the aristocracy. It also recognises that chivalric literature was interwoven with gendered ideas and stereotypes that reflected many of the tenets of elite society.
To verify the previously untested assumption that eating more salad enhances vegetable intake and determine if salad consumption is in fact associated with higher vegetable intake and greater adherence to the Dietary Guidelines for Americans (DGA) recommendations.
Individuals were classified as salad reporters or non-reporters based upon whether they consumed a salad composed primarily of raw vegetables on the intake day. Regression analyses were applied to calculate adjusted estimates of food group intakes and assess the likelihood of meeting Healthy US-Style Food Pattern recommendations by salad reporting status.
Cross-sectional analysis of data collected in 2011–2014 in What We Eat in America, the dietary intake component of the National Health and Nutrition Examination Survey.
US adults (n 9678) aged ≥20 years (excluding pregnant and lactating women).
On the intake day, 23 % of adults ate salad. The proportion of individuals reporting salad varied by sex, age, race, income, education and smoking status (P<0·001). Compared with non-reporters, salad reporters consumed significantly larger quantities of vegetables (total, dark green, red/orange and other), which translated into a two- to threefold greater likelihood of meeting recommendations for these food groups. More modest associations were observed between salad consumption and differences in intake and likelihood of meeting recommendations for protein foods (total and seafood), oils and refined grains.
Study results confirm the DGA message that incorporating more salads in the diet is one effective strategy (among others, such as eating more cooked vegetables) to augment vegetable consumption and adherence to dietary recommendations concerning vegetables.
Six titanomagnetites from a differentiated alkaline intrusion have been studied using microscopie, chemical, and X-ray techniques. The titanomagnetites are homogeneous; with differentiation their FeO and TiO2 contents decrease, and Fe2O3 increases. The titanomagnetite course of crystallization extends from close to the ulvöspinel-magnetite join, near to ulvöspinel, towards magnetite. The recalculated normative compositions of three titanomagnetites indicate that they are essentially Fe3O4-(γ-FeTiO3)-(γ-Fe2O3)solid solutions. The changing chemistry of the titanomagnetites is ascribed primarily to variations in the chemistry of the magma during differentiation.
The Kabwe Zn-Pb deposit (central Zambia) consists of a cluster of mixed sulfide and non-sulfide orebodies. The sulfide ores comprise sphalerite, galena, pyrite, chalcopyrite and accessory Ge-sulfides (±Ga and In). The non-sulfide ores comprise: (1) willemite-dominated zones encasing massive sulfide orebodies and (2) oxide-dominated alteration bands, overlying both the sulfide and Zn-silicate orebodies. This study focuses on the Ge, In and Ga distribution in the non-sulfide mineralization, and was carried out on a suite of Kabwe specimens, housed in the Natural History Museum Ore Collection (London). Petrography confirmed that the original sulfides were overprinted by at least two contrasting oxidation stages dominated by the formation of willemite (W1 and W2), and a further event characterized by weathering-related processes. Oxygen isotopic analyses have shown that W1 and W2 are unrelated genetically and furthermore not related to supergene Zn-Pb-carbonates in the oxide-dominated assemblage. The δ18O composition of 13.9–15.7‰ V-SMOW strongly supports a hydrothermal origin for W1. The δ18O composition of W2 (−3.5‰ to 0‰ V-SMOW) indicates that it precipitated from groundwaters of meteoric origin in either a supergene or a low-T hydrothermal environment. Gallium and Ge show a diversity of distribution among the range of Zn-bearing minerals. Gallium has been detected at the ppm level in W1, sphalerite, goethite and hematite. Germanium occurs at ppm levels in W1 and W2, and in scarcely detectable amounts in hemimorphite, goethite and hematite. Indium has low concentrations in goethite and hematite. These different deportments among the various phases are probably due to the different initial Ga, In and Ge abundances in the mineralization, to the different solubilities of the three elements at different temperatures and pH values, and finally to their variable affinities with the various minerals formed.
The recycling of nutrients from animal excreta has occurred naturally for a very long time. For centuries scavenging pigs and poultry consumed undigested grain from cattle manure. More recently, however, interest in large-scale recycling of animal manures has arisen from a need to reduce the problems of pollution associated with large, intensive livestock units. To date the development of the use of animal excreta as feeds for livestock has been largely confined to those countries in which many thousands of livestock are kept on relatively small areas of land, for example the beef feedlots of the USA.
The trend towards increased size of livestock unit is universal. In England and Wales the number of large livestock holdings increased three-fold in the period 1967 to 1977 (Table 1). There is little doubt that this trend will continue, as farmers strive towards achieving greater economies of scale. In consequence, there is increasing need to develop methods to utilize the manure produced from large livestock units in ways which do not give rise to environmental pollution.
Macroscopic algae can be found in large open ponds or harvested from the sea. Macro algae includes three distinct groups based on colour: green, brown and red. They are unique in containing secondary metabolites that can be extracted and used for various purposes. This review examines the antimicrobial properties (bacteria, viruses and fungi) of macro algae and its extracts to improve poultry health and performance. This includes body weight gain, feed conversion efficiency and carcass yield improvements in broilers and egg weight and shell quality in layers. As an example, in one study, 35-day body weight of broilers was increased 7.6% with the inclusion of 0.5% Undaria pinnatifida (brown macroalgae) to the diet. The investigations discussed show the diversity of the species available and broad scope where research has been done and the potential for the future.
Trans-10, cis-12 CLA is produced as an intermediary during the biohydrogenation of linoleic acid (C18:2 n-6) in the rumen and has been shown to be a potent inhibitor of milk fat synthesis in ruminants. The production of trans-10, cis-12 CLA in the rumen is affected by dietary concentrate: forage ratio (Kucuk et al., 2001), rumen pH and the amount and source of linoleic acid in the diet. However, the interaction between oil source, carbohydrate source and pH on the production of trans-10, cis-12 CLA is unclear (Beam et al., 2000). The objectives of the current study were to determine the effects of oil source, carbohydrate source and pH on the biohydrogenation of linoleic acid and production of trans-10, cis-12 CLA in vitro.
Long-chain polyunsaturated fatty acids (PUFAs) are essential components of cellular membranes and are associated with prostaglandin synthesis. Supplementing ewes with long-chain PUFAs during gestation has been demonstrated to increase gestation length and improve lamb vigour (Capper et al., 2002). Furthermore, increasing the dietary vitamin E supplied to pregnant ewes is reported to increase lamb growth rate (Gentry et al., 1992). However, fish oil supplementation during lactation may reduce milk component yield and lamb growth rate (Capper et al., 2002). The objective of this experiment was to investigate the effects of dietary long-chain PUFA and vitamin E supplementation of pregnant ewes on lamb performance.
There is anecdotal evidence that certain sheep breeds, reared in a particular way, produce unusual or characteristic tastes in cooked meat. Such effects could be linked to differences in meat fatty acid composition associated with the consumption of different diets. This study investigated eating quality and fat composition in 4 distinctively different breed x feeding system groups.
Four groups of 20 ram lambs were obtained as follows: Pure Soays (SO) finished off grass in April from commercial breeders; Pure Welsh Mountain (WM) finished off upland grass in October from ADAS Pwllpeiran; Suffolk x Mules from Harper Adams College finished off concentrates (grains) (SC) in April; and Suffolk x mules from the same source finished off grass (SG) in May. The animals were transported to Langford where they were slaughtered in Bristol University's abattoir.
It is reported that supplementing pregnant ewes with supra-optimal levels of vitamin E improves neonatal lamb vigour and growth rate (Merrell, 1998). The biochemical mechanism behind these observations has yet to be elucidated as several studies report negligible placental vitamin E transfer in ruminants (Van Saun et al., 1989); consequently, lambs may be clinically deficient in this nutrient at birth and achieve a satisfactory vitamin E status via colostrum ingestion. Lamb vitamin E status may be further diminished by the addition of polyunsaturated fatty acids (PUFAs) to the maternal diet. However, PUFA supplementation demonstrably enhances foetal and neonatal development in human studies (Morley, 1998) although these effects have not been investigated in ruminants to any depth. The objective of this experiment was to investigate the effects of dietary vitamin E in combination with long-chain PUFA supplementation of ewes on ewe and lamb performance.
Feeding lambs diets formulated to be synchronous in terms of hourly energy and protein supply to the rumen has been reported to improve the efficiency of energy utilisation (Richardson et al. 1999). In a previous study Sinclair et al. (1995) reported that the efficiency of microbial protein production was improved when animals were fed a synchronous diet. The objectives of the present study were to investigate whether the changes in metabolism reported by Richardson et al. (1999) may be related to rumen microbial protein production and diet digestibility.
Unprotected n-3 PUFA supplements fed to ruminants are subject to lipolysis and biohydrogenation in the rumen (Wachira et al. 1998). Improving the n-3 PUFA content of ruminant products therefore requires some form of protection of dietary lipid from microbial activity in the rumen. The in-vitro incubation of PUFA sources offers the opportunity of rapidly determining the level of protection offered against ruminal biohydrogenation. The objectives of the current experiment were therefore to determine the biohydrogenation of a number of sources containing a-linolenic acid using the in-vitro gas production technique.
The long-chain polyunsaturated fatty acids (PUFA) docosahexaenoic acid (DHA) and arachidonic acid (AA) are the most abundant fatty acids in the brain and are vital for its correct development and for that of the nervous system (Huang and Craig-Schmidt, 1996). Ruminant diets are low in DHA and its precursor alpha-linolenic acid. In addition, dietary PUFAs are substantially hydrogenated in the rumen. Consequently, it may be argued that the diets of pregnant and lactating ewes may be deficient in DHA and that a response to supplementation may be observed. Studies involving the supplementation of pregnant ewes with supraoptimal levels of vitamin E have shown that lambs born to supplemented dams are more vigorous immediately after birth and have higher liveweight gains (Merrell, 1998). The objective of this experiment was to investigate the effects of dietary long-chain PUFA in combination with vitamin E supplementation of ewes on ewe and lamb performance.