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Stroke and transient ischaemic attack (TIA) remain leading causes of mortality and morbidity globally. Although mortality rates have been in decline, the number of people affected by stroke has risen. These patients have a range of long-term needs and often present to primary care. Furthermore, many of these patients have multimorbidities which increase the complexity of their healthcare. Long-term impacts from stroke/TIA along with care needs for other morbidities can be challenging to address because care can involve different healthcare professionals, both specialist and generalist. In the ideal model of care, such professionals would work collaboratively to provide care. Despite the commonality of multimorbidity in stroke/TIA, gaps in the literature remain, particularly limited knowledge of pairings or clusters of comorbid conditions and the extent to which these are interrelated. Moreover, integrated care practices are less well understood and remain variable in practice. This article argues that it is important to understand (through research) patterns of multimorbidity, including number, common clusters and types of comorbidities, and current interprofessional practice to inform future directions to improve long-term care.
To explore recent mothers’ views of the health visiting antenatal contact in England.
English health visitors are mandated to be in contact with all women in the third trimester of pregnancy. The aim of this antenatal contact is to assess the needs of the family before the birth and support preparation for parenthood. Recent data show that this contact is provided fragmentarily and not always face-to-face. More information on how women view this contact could inform service provision.
Twenty-nine mothers with a baby less than 1 year old were recruited via social media and word of mouth. Having had antenatal contact with a health visitor was not a requirement to participate in the study. Women took part in face-to-face or phone interviews and all recordings were transcribed verbatim. Data were analysed using systematic thematic analysis.
Eleven women had contact with a health visitor during pregnancy: nine through a home visit, one via a letter and one via a phone call. The remaining 18 women were asked about what they would have wanted from an antenatal contact. Three themes were identified: relationship building, information provision, and mode and time of contact. Some participants who had experienced a home visit reported building rapport with their health visitor before the postnatal period, but not everyone had this experience. Women reported requesting and receiving information about the health visiting service and the role of the health visitor. Finally, women suggested different modes of contact, suggesting a letter or that the information about health visiting could be provided by a midwife. A few women preferred a home visit. These study findings show women were unclear regarding the aim of the health visitor antenatal contact. As such, the contact is unlikely to reach its full potential in supporting parents-to-be.
This study investigated the effects of a maternal dyslipidaemic (DLP) diet on lipid metabolism, microbial counts in faeces and hepatic and intestinal morphology in rat offspring with respect to sex during different phases of life. Wistar rats (dams) were fed a control (CTL) or DLP during gestation and lactation. After weaning, CTL and DLP offspring were fed a standard diet. The effects of a maternal DLP on body composition, biochemical parameters, faecal microbiota and intestinal and hepatic histomorphometric characteristics in rat offspring were evaluated at 30 and 90 d of age. The DLP diet during gestation and lactation caused lower birth weight and a greater weight gain percentage at the end of the 90-d period in both male and female offspring. Female pups from DLP dams had higher liver fat levels compared with CTL (P≤0·001) at 90 d of age. Males from DLP dams had greater visceral fat weight and lower Lactobacillus spp. faecal counts at 90 d of age (P≤0·001) as well as lower faecal fat excretion (P≤0·05) and Bacteroides spp. faecal counts (P≤0·001) at 30 d of age when compared with pups from CTL dams. However, both dams and DLP pups showed damage to intestinal villi. A maternal DLP alters intestinal function and lipid metabolism in a sex-specific manner and is a potential predisposing factor for health complications in offspring from the juvenile period to the adult period.
Dance interventions are pleasant social activities that are often offered to people with dementia in care settings. Effectiveness of dance as a psychosocial intervention for people with dementia has been studied to some extent, but several methodological issues remain unexplored. This review aimed to analyze studies on dance interventions for people with dementia and to identify practice recommendations for the development of these interventions.
An electronic database search was run in December 2017 to identify records of dance interventions for people with dementia. We included all studies regardless of experimental design. Selected records were analyzed according to five criteria: study design and intentions of interventions; profile of participants and in/exclusion criteria; treatment indications and contraindications; description and performance of the interventions; and involved physical, cognitive, psychological, and social processes in dance.
Fourteen records were included in which various study designs were observed. Description and performance of the interventions were well documented. Nine practice recommendations for implementing dance interventions were identified according to primary intentions of the intervention (therapeutic or recreational): indications; contra-indications; participant profile; dosage; session sequencing; setting of intervention; observance/attendance; contributors and facilitators;and assessments.
Dance is a holistic intervention that can be implemented with a therapeutic or a leisure intention. Practice recommendations about dance interventions remain incomplete and insufficiently studied. Such recommendations could be helpful for clinicians to implement dance interventions in facilities where they work to better target people who could benefit from them, and for researchers to develop research in this field.
Chikungunya virus (CHIKV) is an arbovirus transmitted by Aedes mosquitoes that was first identified in Brazil in 2014. It causes a febrile illness characterised by severe arthralgia and rash. Our group investigated a suspected CHIKV outbreak in Governador Valadares, state of Minas Gerais, Brazil and from 25 acute-phase patients, 10 had qRT-PCR positive sera samples and had E1 partial sequence amplified and Sanger sequenced. Samples were identified as East/Central/South African (ECSA) genotype by phylogenetic analysis and clustered with CHIKV sequences isolated in the neighbour state of Bahia. Our findings confirm previous predictions that ECSA genotype would spread through northeast and southeast of Brazil.
To identify generational differences in the dietary patterns of Brazilian adults born between 1934 and 1975.
A cross-sectional study from the baseline of the multicentre Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort. Year of birth was categorized into three birth generations: Traditionalists (born between 1934 and 1945); Baby Boomers (born between 1946 and 1964); and Generation X (born between 1965 and 1975). Food consumption was investigated using an FFQ. Latent class analysis (LCA) was used to identify data-driven dietary patterns.
Individuals (n 15 069) aged 35–74 years.
A three-class model was generated from the LCA for each birth generation. Generation X presented higher energy intakes (kJ/kcal) from soft drinks (377·4/90·2) and sweets (1262·3/301·7) and lower energy intakes from fruit (1502·5/359·1) and vegetables (311·3/74·4) than Baby Boomers (283·7/67·8, 1047·7/250·4, 1756·0/419·7 and 365·3/87·3, respectively) and Traditionalists (186·2/44·5, 518·8/124·0, 1947·7/465·5 and 404·6/96·7, respectively). For Baby Boomers and Generation X, we found food patterns with similar structures: mixed pattern (22·7 and 29·7 %, respectively), prudent pattern (43·5 and 34·9 %, respectively) and processed pattern (33·8 and 35·4 %, respectively). Among Traditionalists, we could also identify mixed (30·9 %) and prudent (21·8 %) patterns, and a third pattern, named restricted dietary pattern (47·3 %).
The younger generation presented higher frequencies of consuming a pattern characterized by a low nutritional diet, compared with other generations, indicating that they may age with a greater burden of chronic diseases. It is important to develop public health interventions promoting healthy foods, focusing on the youngest generations.
We describe the larval developmental stages and life cycle of the dracunculid nematode Mexiconema cichlasomae in both the intermediate, Argulus yucatanus (Crustacea: Branchiura), and definitive hosts, Cichlasoma urophthalmus (Perciformes: Cichlidae), from the Celestun tropical coastal lagoon, Yucatan, Mexico. The morphological analyses showed significant differences between the total length of L1 found in M. cichlasomae gravid female and L2–L3 in A. yucatanus. This result indicates that the M. cichlasomae larval development occurs in the intermediate host. We obtained sequences from the small subunit (SSU) ribosomal marker from larval stages of M. cichlasomae in A. yucatanus and adult nematodes in C. urophthalmus. Our morphological and molecular results support conspecificity between M. cichlasomae larvae in A. yucatanus and the adult stages in C. urophthalmus. We briefly discuss the phylogenetic position of M. cichlasomae among the Daniconematidae, and provide evidence of the monophyly of the daniconematids associated with branchiurid intermediate hosts. Based on the phylogenetic results, we support the transfer of the Mexiconema genus to the family Skrjabillanidae and do not support the lowering of family Daniconematidae to subfamily.
This study assessed the effects of diet supplementation with industrial processing by-products of acerola (Malpighia emarginata D.C.), cashew (Anacardium occidentale L.) and guava (Psidium guajava L.) fruit on the intestinal health and lipid metabolism of female Wistar rats with diet-induced dyslipidaemia. Female rats were randomly divided into five groups: healthy control, dyslipidaemic control and dyslipidaemic experimental receiving acerola, cashew or guava processing by-products. Fruit processing by-products were administered (400 mg/kg body weight) via orogastric administration for 28 consecutive days. Acerola, cashew and guava by-products caused body weight reduction (3·42, 3·08 and 5·20 %, respectively) in dyslipidaemic female rats. Dyslipidaemic female rats receiving fruit by-products, especially from acerola, presented decreased faecal pH, visceral fat, liver fat and serum lipid levels, as well as increased faecal moisture, faecal fat excretion, faecal Bifidobacterium spp. and Lactobacillus spp. counts and amounts of organic acids in faeces. Administration of the tested fruit processing by-products protected colon and liver from tissue damage (e.g. destruction of liver and colon cells and increased fat deposition in hepatocytes) induced by dyslipidaemic diet. Dietary fibres and phenolic compounds in tested fruit by-products may be associated with these positive effects. The industrial fruit processing by-products studied, mainly from acerola, exert functional properties that could enable their use to protect the harmful effects on intestinal health and lipid metabolism caused by dyslipidaemic diet.
The present study evaluated the effects of maternal dyslipidaemia on blood pressure (BP), cardiorespiratory physiology and biochemical parameters in male offspring. Wistar rat dams were fed either a control (CTL) or a dyslipidaemic (DLP) diet during pregnancy and lactation. After weaning, both CTL and DLP offspring received standard diet. On the 30th and 90th day of life, blood samples were collected for metabolic analyses. Direct measurements of BP, respiratory frequency (RF), tidal volume (VT) and ventilation (VE) under baseline condition, as well as during hypercapnia (7 % CO2) and hypoxia (KCN, 0·04 %), were recorded from awake 90-d-old male offspring. DLP dams exhibited raised serum levels of total cholesterol (TC) (4·0-fold), TAG (2·0-fold), VLDL+LDL (7·7-fold) and reduced HDL-cholesterol (2·4-fold), insulin resistance and hepatic steatosis at the end of lactation. At 30 d of age, the DLP offspring showed an increase in the serum levels of TC (P<0·05) and VLDL+LDL (P<0·05) in comparison with CTL offspring. At 90 d of age, DLP offspring exhibited higher mean arterial pressure (MAP, approximately 34 %). In the spectral analysis, the DLP group showed augmented low-frequency (LF) power and LF:high-frequency (HF) ratio when compared with CTL offspring. In addition, the DLP animals showed a larger delta variation in arterial pressure after administration of the ganglionic blocker (P=0·0003). We also found that cardiorespiratory response to hypercapnia and hypoxia was augmented in DLP offspring. In conclusion, the present data show that maternal dyslipidaemia alters cardiorespiratory physiology and may be a predisposing factor for hypertension at adulthood.
A Système probatoire pour l’observation de la terre (SPOT) mosaic of King George Island, the largest (1250 Km2) of the South Shetland Islands, West Antarctica, shows its major morphological features. Three main ice domes and 70 glacier drainage basins, covering 92.7% of the King George Island area, strongly controlled by the subglacial morphology and drained by relatively fast-moving tidewater outlet glaciers, were delineated. A general retreat of ice fronts through four decades, more intensely on the eastern side of the island (to the Bransfield Strait), resulted in the loss of about 7% of the glacial cover area. Superficial snow fades were derived from SPOT multispectral imagery and, together with field observations, allowed the transient-snowline elevation to be obtained The latter is estimated to have risen from about 200-250 m in the mid-1950s to 300-350 m by 1988. Spot radio-echo sounding surveys give an overview of the bedrock morphology.
In this research, zinc chloride has been used as precursor and zinc oxide nanostructures have been synthesized by Sol-Gel process, using deionized water and 2-propanol as solvents in order to evaluate their influence on the final materials and their properties. Thin films of synthesized samples were deposited on glass substrates by the dipping method. The structure and morphology of crystals were characterized by X-ray diffraction (XRD) and scanning electron microscopy (SEM) respectively. The electrical response of the samples to CO was investigated at different operating temperatures and sensitivity curves are presented for samples synthesized in water and 2-propanol (IsOH) solvents. The SEM analysis revealed that ZnO thin films have yielded to different morphologies depending on the solvent, and material was found on the non-immersed side of the substrate attributable to migration during the dip-coating process. XRD analysis shows that the samples present the ZnO wurtzite structure. In EDS analysis it was found the presence of chlorine on the sample, opening the possibility the presence of zinc oxychloride.
This study aimed to assess the prevalence and spatial distribution of bovine cysticercosis in the state of Goiás, Brazil; to verify its association with epidemiological variables, and to establish the economical losses for beef farms. A set of 23 255 979 bovines from 246 municipalities were slaughtered from 2007 through 2014. The prevalence of bovine cysticercosis was 0·53% [95% confidence interval (95% CI) 0·5295–0·5354]. The Central mesoregion showed a higher risk [odds ratio (OR) = 4·44; 95% CI 4·2936–4·5895] for detecting infected animals with cysticerci compared with those raised at North and Northeast mesoregion (OR = 1·02 and OR = 1·02). The microregion of Goiânia had a higher risk for bovine cysticercosis occurrence (OR = 11·05, 95% CI 10·6933–11·4099) compared with the microregion of São Miguel do Araguaia (OR = 1). None of the epidemiological variables evaluated in this study was significantly associated (P > 0·05) with bovine cysticercosis prevalence.
In conclusion, the prevalence of bovine cysticercosis in the state of Goiás, Brazil, was 0·53% and some mesoregions and microregions presented a higher risk for its occurrence. The economical losses due to its occurrence during the period ranged from US$9 260 728·57 to 11 313 816·67. These results highlighted the needs of adopting prophylactic measures and the development of political strategies in specific regions in order to control this zoonose and reduce the economical losses for beef production chain and the costs for public health.
To determine the effects of lipid-based nutrient supplements (LNS) on children’s Hb, linear growth and development, compared with supplementation with micronutrient powder (MNP).
The study was a two-arm parallel-group randomized controlled trial, where participants received either LNS or MNP for daily consumption during 6 months. Supplements were delivered by staff at government-run health centres. Hb, anthropometric, motor development, language development and problem-solving indicators were measured by trained research assistants when children were 12 months of age.
The study was conducted in five rural districts in the Province of Ambo in the Department of Huánuco, Peru.
We enrolled 6-month-old children (n 422) at nineteen health centres.
Children who received LNS had a higher mean Hb concentration and lower odds of anaemia than those who received MNP. No significant differences in height-for-age, weight-for-height or weight-for-age Z-score, or stunting and underweight prevalence, were observed. Provision of LNS was associated with a higher pre-verbal language (gestures) score, but such effect lost significance after adjustment for covariates. Children in the LNS group had higher problem-solving task scores and increased odds of achieving this cognitive task than children in the MNP group. No significant differences were observed on receptive language or gross motor development.
LNS between 6 and 12 months of age increased Hb concentration, reduced anaemia and improved cognitive development in children, but showed no effects on anthropometric indicators, motor or language development.
The aim of the Ionosphere Prediction Service (IPS) project is to design and develop a prototype platform to translate the prediction and forecast of the ionosphere effects into a service customized for specific GNSS user communities. The project team is composed by Telespazio (coordinator), Nottingham Scientific Ltd, Telespazio Vega Deutschland, the University of Nottingham, the University of Rome “Tor Vergata” and the Italian Istituto Nazionale di Geofisica e Vulcanologia (INGV). The IPS development is conceived of two concurrent activities: prototype service design and development & research activity that will run along the whole project. Service design and development is conceived into four phases: user requirements collection, architecture specification, implementation and validation of the prototype. A sub-activity analyses also the integration feasibility in the Galileo Service center, located in Madrid. The research activity is the scientific backbone of IPS that will provide the models and algorithms for the forecasting products.
Introduction: The following adverse outcomes have been described in patients treated in hospital for opioid overdose: pulmonary edema, cardiac dysrhythmias, neurologic injury secondary to hypoxia, prolonged opioid toxicity, recurrent opioid toxicity. In addition, patients who take an overdose of fentanyl may develop fentanyl induced chest rigidity, a life-threatening complication that appears to be uniquely related to fentanyl. The prevalence of adverse outcomes and the clinical course of patients that develop these complications have been described in patients who have taken an overdose of heroin. However, in British Columbia there has been a dramatic increase in the number of patients who overdose on fentanyl and other ultrapotent opioids. The proportion of illicit drug overdose deaths in British Columbia for which fentanyl was detected was only 5% in 2012 but, by 2016, this proportion had increased to 62%. It is very important to know the prevalence of adverse outcomes and the clinical course of patients that develop these adverse outcomes in patients with an overdose of fentanyl or another ultrapotent opioid. Methods: We are completing a retrospective cohort study to evaluate the prevalence of the following adverse outcomes for patients treated in hospital for an opioid overdose: i) pulmonary edema, ii) cardiac dysrhythmias, iii) fentanyl induced chest rigidity, iv) neurologic injury secondary to hypoxia, v) prolonged opioid toxicity, vi) recurrent opioid toxicity. Health records of patients treated for opioid overdose in the emergency departments of six greater Vancouver hospitals from Jan 1, 2014 to Dec 31, 2016 are being reviewed. Results: All Institutional approvals have been obtained. The dataset of 3600 ED visits for opioid overdose has been obtained and 160 health records have now been reviewed as of January 8, 2017. We will describe the type and prevalence (with 95% confidence intervals) of complications sustained by these patients. Conclusion: The results of this study will guide management of opioid overdose in a setting were ultrapotent opioids are commonly ingested. All health records will have been reviewed and the data analysis completed by May 2017.
In this paper, we establish new characterization results concerning totally umbilical hypersurfaces of the hyperbolic space
, under suitable constraints on the behavior of the Lorentzian Gauss map of complete hypersurfaces having some constant higher order mean curvature. Furthermore, working with different warped product models for
and supposing that certain natural inequalities involving two consecutive higher order mean curvature functions are satisfied, we study the rigidity and the nonexistence of complete hypersurfaces immersed in
Helminths in aquatic invertebrate hosts have been overlooked in comparison with vertebrate hosts. Therefore, the known diversity, ecology and distribution of these host–parasite systems are very limited in terms of their taxonomic diversity, habitat and geographic regions. In this study we examined the published literature on helminth parasites of aquatic invertebrates from Latin America and the Caribbean (LAC) to identify the state of the knowledge in the region and to identify patterns of helminth diversity. Results showed that 67% of the literature is from Argentina, Mexico and Brazil. We found records for 772 host–parasite associations. Most records relate to medically or economically important hosts. Molluscs were the most studied host group with 377 helminth records (80% trematodes). The lymnaeids and planorbids were the most studied molluscs across LAC. Arthropods were the second most studied host group with 78 helminth records (trematodes 38%, cestodes 24% and nematodes 20%), with shrimps and crabs being the most studied hosts. Host species with the largest number of helminth taxa were those with a larger sampling effort through time, usually in a small country region. No large geographical-scale studies were identified. In general, the knowledge is still too scarce to allow any zoogeographical or helminth diversity generalization, as most hosts have been studied locally and the studies on invertebrate hosts in LAC are substantially uneven among countries.