Book chapters will be unavailable on Saturday 24th August between 8am-12pm BST. This is for essential maintenance which will provide improved performance going forwards. Please accept our apologies for any inconvenience caused.
To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Implementation of high-quality, dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) is critical to improving survival from out-of-hospital cardiac arrest (OHCA). However, despite some studies demonstrating the use of a metronome in a stand-alone setting, no research has yet demonstrated the effectiveness of a metronome tool in improving DA-CPR in the context of a realistic 911 call or using instructions that have been tested in real-world emergency calls.
Use of the metronome tool will increase the proportion of callers able to perform CPR within the target rate without affecting depth.
The prospective, randomized, controlled study involved simulated 911 cardiac arrest calls made by layperson-callers and handled by certified emergency medical dispatchers (EMDs) at four locations in Salt Lake City, Utah USA. Participants were randomized into two groups. In the experimental group, layperson-callers received CPR pre-arrival instructions with metronome assistance. In the control group, layperson-callers received only pre-arrival instructions. The primary outcome measures were correct compression rate (counts per minute [cpm]) and depth (mm).
A total of 148 layperson-callers (57.4% assigned to experimental group) participated in the study. There was a statistically significant association between the number of participants who achieved the target compression rate and experimental study group (P=.003), and the experimental group had a significantly higher median compression rate than the control group (100 cpm and 89 cpm, respectively; P=.013). Overall, there was no significant correlation between compression rate and depth.
An automated software metronome tool is effective in getting layperson-callers to achieve the target compression rate and compression depth in a realistic DA-CPR scenario.
Scott G, Barron T, Gardett I, Broadbent M, Downs H, Devey L, Hinterman EJ, Clawson J, Olola C. Can a software-based metronome tool enhance compression rate in a realistic 911 call scenario without adversely impacting compression depth for dispatcher-assisted CPR? Prehosp Disaster Med. 2018;33(4):399–405
Systems of management of beef cows in the hills and uplands seek to make use of the cow's ability to utilise body tissue to maintain production during periods of undernutrition in winter and to replenish body reserves from relatively inexpensive summer grazing.
In spring-calving cows, the periods of winter undernutrition occur during late pregnancy and the early months of lactation. On upland farms, cows with adequate body reserves (condition score 3.5) at the beginning of winter, fed less than 50 MJ ME per day during the final 3 months of gestation and 70 MJ ME per day during the first 2 months of lactation, will lose about 1.5 units of body condition but such a regime will not necessarily result in biologically significant production penalties. Fertilised ryegrass swards maintained at 8 cm sward surface height during the grazing season will support levels of milk production of around 11 kg per day, calf growth rates of the order of 1.2 kg per day and allow full recovery of cow body weight and condition. In hill herds, the magnitude of losses in weight and condition over winter must be restricted to the extent of the recovery which the quality of summer grazing will support.
Similar considerations apply in autumn-calving herds, where the greater part or all of lactation coincides with the period of winter feeding. Cows calving at a body condition score of 3.0 can be fed 75 MJ ME per day from before to one month after mating without prejudicing reproductive performance, and 60-65 MJ ME per day from then until turnout. Where good quality pasture is available, milk production will increase from around 5 to more than 9 kg per day following turnout, calf performance will be enhanced by delaying weaning and cows will recover in full the weight and condition lost during winter. In the hill situation, calves may require to be weaned at turnout if full cow recovery is to be achieved.
Studies on the nutrition of the weaned suckled calf indicate that a policy of feeding weaned calves inexpensively during winter to gain between 0.3 and 0.5 kg per day may constitute a viable alternative to the traditional practice of selling calves in the autumn. Such animals will achieve significantly higher growth rates at pasture in the following summer than calves fed more generously and gaining weight more rapidly during winter.
On some hill farms where opportunities for the conservation of winter fodder are limited but where there is plentiful summer grazing, a system of June calving followed by a short lactation, and in which calves are only very moderately fed over winter, merits consideration.
The areas in which further research is most urgently required to effect significant improvements in efficiency are those concerned with the relationship between nutrition and reproductive efficiency and the induction of twinning in cows.
In cases of non-fatal self-harm, suicide notes are a major risk factor for repeated self-harm and suicide. Suicide notes can now be left on new media services, emails or text messages, as well as on paper.
In a group of people who had harmed themselves, we aimed to compare new media note-leavers with paper note-leavers and characterise these groups demographically and by risk factors.
Clinical notes of patients who presented with non-fatal self-harm to two London emergency departments were anonymously searched for mentions of new media use. These were categorised and risk factors were compared for those who had left a new media note, a paper note, or no note to establish differences in risk of note-leaving.
New media note-leaving was associated with younger age and substance use; both risk factors for repeated self-harm. However, suicidal intent remained highest in paper note-leavers.
Paper note-leavers remain at greatest risk, however new media note leaving is still correlated with risk factors related to repeated self-harm and suicide. Clinicians should enquire about new media use during emergency department assessments of self-harm.
Early recognition of an acute myocardial infarction (AMI) can increase the patient’s likelihood of survival. As the first point of contact for patients accessing medical care through emergency services, emergency medical dispatchers (EMDs) represent the earliest potential identification point for AMIs. The objective of the study was to determine how AMI cases were coded and prioritized at the dispatch point, and also to describe the distribution of these cases by patient age and gender.
No studies currently exist that describe the EMD’s ability to correctly triage AMIs into Advanced Life Support (ALS) response tiers.
The retrospective descriptive study utilized data from three sources: emergency medical dispatch, Emergency Medical Services (EMS), and emergency departments (EDs)/hospitals. The primary outcome measure was the distributions of AMI cases, as categorized by Chief Complaint Protocol, dispatch priority code and level, and patient age and gender. The EMS and ED/hospital data came from the Utah Department of Health (UDoH), Salt Lake City, Utah. Dispatch data came from two emergency communication centers covering the entirety of Salt Lake City and Salt Lake County, Utah.
Overall, 89.9% of all the AMIs (n=606) were coded in one of the three highest dispatch priority levels, all of which call for ALS response (called CHARLIE, DELTA, and ECHO in the studied system). The percentage of AMIs significantly increased for patients aged 35 years and older, and varied significantly by gender, dispatch level, and chief complaint. A total of 85.7% of all deaths occurred among patients aged 55 years and older, and 88.9% of the deaths were handled in the ALS-recommended priority levels.
Acute myocardial infarctions may present as a variety of clinical symptoms, and the study findings demonstrated that more than one-half were identified as having chief complaints of Chest Pain or Breathing Problems at the dispatch point, followed by Sick Person and Unconscious/Fainting. The 35-year age cutoff for assignment to higher priority levels is strongly supported. The Falls and Sick Person Protocols offer opportunities to capture atypical AMI presentations.
ClawsonJJ, GardettI, ScottG, FivazC, BarronT, BroadbentM, OlolaC. Hospital-Confirmed Acute Myocardial Infarction: Prehospital Identification Using the Medical Priority Dispatch System. Prehosp Disaster Med. 2018;33(1):29–35.
Until recently, the main selection focus in UK dairy goats has been on milk yield. To develop a selection index suitably weighted for a variety of traits, it is important to understand the genetic relationships between production, health and fertility traits. This study focussed on three aspects of reproduction that are of interest to goat breeders. (1) Out of season (OOS) kidding ability: goats are highly seasonal breeders so achieving consistent, year-round dairy production presents a challenge. It may be possible to select for extended or shifted breeding cycles, however, there are no published studies on the genetic basis of seasonal kidding ability, and a genetic correlation with milk production in dairy goats; (2) age at first kidding (AFK): a reduced AFK offers the opportunity for more rapid genetic improvement, as well as reducing the amount of time and resources required to raise the animals to producing age; (3) pseudopregnancy (PPG): as it is difficult to diagnose pregnancy within 30 days of mating, high herd levels of PPG could add a significant delay in breeding replacement animals, or commencing a new lactation. Using records from 9546 goats, the objective of this study was to investigate the genetic relationships between the reproductive traits described above, and the production traits 520-day milk yield (MY520), lifetime milk yield (MYLife) and lifetime number of days in milk (DIMLife). The ‘out of season’ phenotype was defined as week of kidding relative to the 4 weeks of the year where the highest average number of births occur. Incidences of PPG that occurred during the first lactation were used as cases, while goats with none were assigned as controls. Relevant fixed and random effects were fitted in the models. In line with other reproduction traits, heritability estimates were low ranging from 0.08 to 0.11. A negative genetic correlation was found between AFK and MY520 (−0.22±0.10), whereas a positive genetic correlation was found between PPG and DIMLife (0.58±0.11). Pseudopregnancy and OOS were positively genetically correlated (0.36±0.15). All other genetic correlations were very low. The results of this study indicate that selection for the reproductive traits analysed is feasible, without adversely affecting MYLife.
The number of cells in bovine and ovine embryos is reduced when steer serum which can generate high concentrations of ammonia in vitro is included in the culture system (Kuran et al., 1998). Moreover, production of embryos in synthetic oviduct fluid (SOF) medium supplemented with this serum causes fetal oversize (Sinclair et al., 1998). The present study investigated the effect of the same high ammonia-producing steer serum in a two-phase culture system on bovine embryo development and blastocyst cell numbers.
The experimental design was a 2 x 2 factorial with 5 replicates and involved a total of 928 bovine oocytes that were matured and fertilized in vitro (IVF = Day 0). Presumptive zygotes were cultured in SOF supplemented with 10% v/v steer serum (SOF+SS; n=461) or with amino acids plus 0.4% w/v crystalline BSA (SOFaaBSA; n=467) for an initial period of 48 h following IVF.
Background: Lesbian, gay and bisexual individuals experience more anxiety and depression than heterosexual people. Little is known about their comparative treatment response to psychological interventions. Aims: To compare sociodemographic/clinical characteristics and treatment outcomes across sexual orientation groups, for adults receiving primary care psychological interventions from Improving Access to Psychological Therapies (IAPT) services in London, adjusting for possible confounders. Method: Data from 188 lesbian women, 222 bisexual women, 6637 heterosexual women, 645 gay men, 75 bisexual men and 3024 heterosexual men were analysed from pre-treatment and last treatment sessions. Males and females were analysed separately. Results: Before treatment, lesbian and bisexual women were more likely to report clinical levels of impairment (Work and Social Adjustment Scale) than heterosexual women; there were no significant differences in depression (PHQ-9) or anxiety (GAD-7). Bisexual men were more likely to meet depression caseness than gay men but less likely to meet anxiety caseness than gay or heterosexual men. Compared with heterosexual women, lesbian and bisexual individuals showed smaller reductions in depression and impairment, controlling for age, ethnicity, employment, baseline symptoms, number of sessions and intervention type. Bisexual women experienced significantly smaller reductions in anxiety than heterosexual women and were less likely to show recovery or reliable recovery. There were no significant differences in treatment outcomes between gay, bisexual and heterosexual men. Conclusions: Reasons for poorer outcomes in lesbian and bisexual women require investigation, for example lifetime trauma or stigma/discrimination regarding gender or sexual orientation in everyday life or within therapy services.
Parts of southern Belize are designated as a corridor for the jaguar Panthera onca but the Maya region remains understudied. We therefore studied jaguar habitat use, activity patterns, and interactions with people in Blue Creek, a Maya village in a human-dominated tropical landscape in southern Belize. We used camera traps to detect jaguar presence, and interviews to assess local people's attitudes to and perceptions of jaguars. We recorded 28 independent photographic events during 1,200 camera-trap nights (i.e. a relative abundance index of 2.3 jaguars per 100 trap days). Seven individual jaguars were identified. Jaguars preferred lowland broad-leaf tropical forest and were detected more often during daylight, in contrast to findings from previous studies. Attitudes towards jaguars were largely positive: 88% of respondents (n = 48) did not fear jaguars living around the village, and 81% understood the positive effect that jaguars have on the ecosystem. Although 92% of respondents reported seeing a jaguar within the previous 2 years, attacks on livestock in the village were rare, with only two occurrences in the previous 3 years. Ecotourism has grown rapidly in Belize in recent years, and Blue Creek is home to several natural tourist attractions and an eco-lodge that brings tourists, school groups, and researchers to the village. Ecotourism has provided an economic incentive for village investment in conservation, and 94% of respondents stated that preservation of wildlife, including jaguars, was beneficial to their well-being.
Introduction: The NZ Government has set the goal of a smoke-free country by 2025. Research has shown that NZ dentists engage little in promotion of smoking cessation amongst their patients. The knowledge of, and attitudes towards, smoking cessation interventions of NZ dental students has not previously been reported.
Aims: To investigate smoking cessation intervention practices of clinical dental students and explore perceived barriers to their delivery.
Methods: A survey was conducted of all students in the three clinical years of the 5-year New Zealand dental training programme.
Results: The response rate was 73.7%. At least half of the participants did not recall the inclusion of smoking cessation intervention information in the curriculum. The majority (70.9%) used a routine protocol to identify smokers. Almost two-thirds felt that smoking cessation interventions are important, whilst two-fifths felt it is their duty as a health professional. Lack of knowledge and time were the most common barriers.
Conclusions: Although most dental students identify patients who smoke, the majority provide no cessation intervention services. This appears to be due to a lack of knowledge about available organisations and referral procedures. As future health professionals, dental students need better education in this area.
We report on the progress of the compilation and analysis of the Durham/UKST galaxy redshift survey. This survey will probe a large contiguous volume of space within a 1500 sq. deg. area of sky around the SGP. It will contain redshifts of ∼ 4000 galaxies of bJ < 17m providing detailed information about the structure of the Universe on large scales. Large features on scales of ∼ 100h−1 Mpc are clearly visible on examination of the completed section of the survey, although a statistical analysis of the survey by means of the two-point correlation function is close to zero on scales of r > 10h−1 Mpc.
A technique for separating the radio continuum emission of the Galaxy into its thermal and nonthermal components has been recently developed by Broadbent, Haslam and Osborne (1989). In this the thermal component is identified by its detailed correlation with the 60 μm infrared emission as observed by IRAS after the subtraction of zodiacal light and the HI-associated dust emission. This technique has been applied to the 408 MHz allsky survey of Haslam et al. (1982). A model of the distribution of synchrotron emissivity in the galactic disk has then been derived including information on the other tracers of spiral structure (HI, CO and giant HII regions) in order to account in detail for the observed nonthermal emission. The spiral arm pattern has two pairs of arms emanating from a central ellipse. The function describing the underlying variation of synchrotron emissivity with galactocentric radius is zero at the centre, rises to a sharp peak and then falls off slowly beyond 3 kpc. Using a scale length of the variation of cosmic ray electron density derived from γ-ray observations, we find that the scale length of the magnetic field variation must be as long as 22 kpc. This agrees with the scale length derived assuming equipartition between energy densities of magnetic field and cosmic rays. The variation of emissivity with height above the plane deduced by Phillipps et al. (1981) when included in our model gives good fits to the observed cuts across the plane. We have modelled the variation of the galactic magnetic field across a spiral arm as a gaussian. In order to fit the peaks in the galactic plane profile σ=0.2 kpc and a maximum compression of the field in the arm of 3.5:1 is required. These parameters are compatible with the results of N-body simulations of spiral arm formation which treat gas clouds as the unit particles. A detailed description of the model is about to be submitted for publication.
Studies indicate that risk of mortality is higher for patients admitted
to acute hospitals at the weekend. However, less is known about clinical
outcomes among patients admitted to psychiatric hospitals.
To investigate whether weekend admission to a psychiatric hospital is
associated with worse clinical outcomes.
Data were obtained from 45 264 consecutive psychiatric hospital
admissions. The association of weekend admission with in-patient
mortality, duration of hospital admission and risk of readmission was
investigated using multivariable regression analyses. Secondary analyses
were performed to investigate the distribution of admissions, discharges,
in-patient mortality, episodes of seclusion and violent incidents on
different days of the week.
There were 7303 weekend admissions (16.1%). Patients who were aged
between 26 and 35 years, female or from a minority ethnic group were more
likely to be admitted at the weekend. Patients admitted at the weekend
were more likely to present via acute hospital services, other
psychiatric hospitals and the criminal justice system than to be admitted
directly from their own home. Weekend admission was associated with a
shorter duration of admission (B coefficient –21.1 days,
95% CI –24.6 to –17.6, P<0.001) and an increased risk
of readmission in the 12 months following index admission (incidence rate
ratio 1.13, 95% CI 1.08 to 1.18, P<0.001), but
in-patient mortality (odds ratio (OR) = 0.79, 95% CI 0.51 to 1.23,
P = 0.30) was not greater than for weekday admission.
Fewer episodes of seclusion occurred at the weekend but there was no
significant variation in deaths during hospital admission or violent
incidents on different days of the week.
Being admitted at the weekend was not associated with an increased risk
of in-patient mortality. However, patients admitted at the weekend had
shorter admissions and were more likely to be readmitted, suggesting that
they may represent a different clinical population to those admitted
during the week. This is an important consideration if mental healthcare
services are to be implemented across a 7-day week.
Previous research has shown that measuring the size and content of patients’ drawings of their illness can reveal their perceptions and predict recovery. This study aimed to assess the usefulness of analyzing kinematic features of drawings.
A pilot observational study was conducted with 15 patients who had been hospitalized with a stroke 8 to 11 months previously. They were asked to draw a picture of what they thought had happened to their brain and describe the drawing using an electronic inking pen and digitizing tablet. Analysis of kinematic data (time to draw/write, drawing/writing speed, and pen pressure) was conducted using MovAlyzeR® software. Evaluations of physical functioning, quality of life, illness perceptions, and emotional well-being were administered, and correlations with kinematic measures assessed.
Stronger pen pressure was associated with perceptions of greater control over the stroke. Faster drawing was correlated with greater worry about a recurrent stroke and the perception that the effects of the stroke would last longer. Needing more time to write was associated with perceptions of fewer consequences of the stroke. No associations between kinematic measures and indicators of stroke severity, physical, or emotional well-being were shown.
Kinematic measures of stroke patients’ drawings of their brain and comments were associated with illness perceptions and not measures of physical or emotional health status. The addition of kinematic analysis may add further utility to the assessment of patients’ drawings of their illness. More studies need to be performed with larger sample sizes and other patient groups.
Among the most important stimuli for developing the FLAIR multi-object spectroscopy system on the 1.2-m UK Schmidt Telescope was its potential for carrying out large-scale redshift surveys of galaxies of intermediate magnitude (B <~ 17). During FLAIR’s lengthy development period, these objects provided the yardstick by which the system’s performance was measured, and a number of limited-area redshift surveys were carried out. We are now following these with a 1-in-3 survey over the 60 fields of the ROE/Durham Galaxy Catalogue to produce a redshift map of some 4000 galaxies out to a distance of ~ 300h−1 Mpc (where the parameter h is the Hubble constant expressed as a fraction of 100 kms−1 Mpc−1). In this paper we summarise the results from our redshift surveys to highlight the capabilities of FLAIR. We present a status report on the current large-scale survey, and show that the recently-introduced FLAIR II system will speed its progress considerably.
We report on a redshift survey of ∼ 4000 galaxies of B ≲ covering a 1500 square degree area of sky around the SGP region. This 1-in-3 sampled survey probes a contiguous volume of 4 × 106 Mpc3 to a depth of 300 h−1 Mpc. The survey has been compiled using the fibrelinked spectroscopy system, FLAIR, on the UK Schmidt Telescope and has produced high quality redshift maps giving a clear visual picture of structure in the universe as well as providing an excellent data base for a statistical analysis of galaxy clustering. Filamentary and sheet-like features are clearly discernible to the eye in the completed sections of the survey although the redshift two-point correlation function is consistent with zero on scales of r ≳ 10h−1 Mpc. The survey, which is now substantially complete, demonstrates the potential of the FLAIR spectroscopy system for extending this project to a medium-deep galaxy redshift survey of the whole of the southern sky on timescales which would remain competitive with other surveys under construction.
Objectives: Medical technology is a large and expanding industry. Introducing new medical devices is important but several challenges exist in implementing the optimal method of evaluation. Both objective and subjective measures can be used for evaluation. The former is the mainstay of evaluation, yet subjective assessment is often the basis for the introduction of new medical technology. The aim of this study was to determine the interaction and concordance between objective and subjective assessment of new medical technology.
Methods: This study used both objective performance measures and subjective user perceptions in the evaluation of a new medical device designed to improve the accuracy of gravity-assisted delivery of intravenous fluids, compared with the current, widely used “roller-clamp” device. The concordance of objective and subjective assessments was evaluated using comparative analysis.
Results: Objective assessment of the accuracy of intravenous fluid delivery revealed no difference between the two devices (p = .636). Subjective assessment revealed that the new device was perceived to be significantly more accurate (p = .001). This lack of concordance can be partially explained by both device and demand characteristics.
Conclusions: This case study reveals a significant discordance between the objective and subjective assessments. It provides some explanation for why new medical devices are adopted without objective evidence of benefit. This phenomenon has been termed “persuasive design” and its influence should be controlled for in the evaluation, purchase and introduction of new medical devices. This should help reduce the risk and associated cost of premature introduction.