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 firstname.lastname@example.org
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.
Inefficient health service utilisation puts pressure on health systems and may cause such negative individual consequences as over-medicalisation or exacerbation of health problems. While previous research has considered the key relevance of health literacy (HL) for efficient use of health services, the results of that research have been somewhat inconclusive. Possible reasons for diverging results of prior research may be grounded in different measurement concepts of HL and the disregarding of age-specific effects. This paper analyses the association between individuals’ HL typology based on a two-dimensional concept and indicators of health service utilisation measured by registered data covering the number of doctor visits and medication costs. Our results confirm a significant interaction effect between age and HL typology. The age-related increase in health service utilisation is strongest for individuals with the combination of high subjective HL but low health-related knowledge, while the smallest increase is for individuals with the constellation of high subjective HL combined with high health-related knowledge. Individuals with specific constellations of HL (that is, individuals with high subjective HL but low health-related knowledge) are associated with reduced service utilisation in younger ages but higher service utilisation in later stages of life, compared to other groups. These results are likely to be attributed to a higher external health-related locus of control and more traditional paternalistic role expectations in such groups.
We investigate unramified extensions of number fields with prescribed solvable Galois group G and certain extra conditions. In particular, we are interested in the minimal degree of a number field K, Galois over
, such that K possesses an unramified G-extension. We improve the best known bounds for the degree of such number fields K for certain classes of solvable groups, in particular for nilpotent groups.
40Ar/39Ar and U–Pb data from five structural domains constrain the late Neoproterozoic – early Palaeozoic tectonothermal history of the eastern part of the East African–Antarctic Orogen in Sør Rondane. A total of 27 new Ar/Ar ages span 570–474 Ma, roughly corresponding to the age range of three generations of syn- to post-tectonic granitoids. The ages are distinct for the five structural domains. The oldest cooling ages come from the weakly deformed southern part of the SW Terrane of Sør Rondane (SW Terrane S), a sliver of a Tonian island arc, which escaped much of the late Neoproterozoic accretionary deformation. This terrane was intruded by the oldest and largest granitoid complex at c. 640–620 Ma. The oldest Ar/Ar amphibole and biotite ages of 570–524 Ma are from the Main Shear Zone, along the northern margin of the SW Terrane S sliver. It hosts granites of age c. 584–570 Ma strung out along the shear zone. Two younger granitoid phases are recorded in the adjacent four terranes to the west, north and east of the SW Terrane S, and correlate with the younger group of Ar/Ar biotite ages spanning 513–474 Ma. We interpret the magmatic and cooling history of duration > 150 Ma to reflect repeated phases of accretion, magmatism and reactivation, that is, collage-style tectonism, partly pre-dating the incorporation of Sør Rondane into Gondwana. The study area first accreted to the cryptic Valkyrie Craton in Tonian times, was then ‘sandwiched’ between the Kalahari and Indo-Antarctica cratons, and experienced extensional tectonics and elevated heat flux due to lithospheric delamination, which resulted in slow cooling during the Pan-African Orogeny.
Based on the concept of limited and open access orders (LAO/OAO), this paper explains what appears to be a paradox: how was it possible that a former civil war country, Mozambique, which had been extremely successful in attracting foreign direct investment (FDI) and which the International Monetary Fund praised as a great Sub-Sahara African success story in 2007, only a few years later found itself on the brink of a new civil war? We argue that the destabilization of the country was the result of a toxic mix of domestic politics and a massive inflow of FDI. FDI provided rents to an increasingly dominant state party, FRELIMO, which could be appropriated one-sidedly. It then used these rents to oppress RENAMO, its previous civil war enemy and currently its main opposition party, to monopolize power. This strategy seemed to be successful until RENAMO, faced with the risk of being politically marginalized (and of losing its rents accordingly), returned to armed conflict in 2013. By analyzing the links between the macro-level of national politics and the micro-level of an enterprise and by embedding the interplay between polity and economy into an international context, the paper also makes a theoretical contribution to the LAO/OAO concept.
This chapter examines the formation of a new anti-impunity Transnational Legal Order (TLO), its institutionalization, and its consequences. Socio-legal scholarship and recent research on responses to the mass violence unfolding in the Darfur region of Sudan, beginning in 2003, provide insights into strengths and limits of the new anti-impunity TLO. Based on a comparative eight-country study, involving in depth interviews in four social fields (human rights, diplomacy, humanitarian aid, media) and an analysis of 3,387 media reports, I review judicial steps taken on Darfur, conditions supporting them, and their consequences, interpreting them in terms of the transnational legal ordering approach. The case of Darfur shows the anti-impunity TLO at work, displaying it as a force that delegitimizes mass violence. Yet, it also shows impediments to institutionalization in the form of hostile state actors, fields with potentially competing agendas, including diplomacy and humanitarian aid, internal contradictions, and lack of enforcement power. Nation-level forces filter cultural effects of intervention, resulting in diminished concordance between the international and the global realms and across nation states.
The common recommendation that adults with onset of mental illness after the age of 65 should receive specialised psychogeriatric treatment is based on limited evidence.
To compare factors related to psychiatric acute admission in older adults who have no previous psychiatric history (NPH) with that of those who have a previous psychiatric history (PPH).
Cross-sectional cohort study of 918 patients aged ≥65 years consecutively admitted to a general adult psychiatric acute unit from 2005 to 2014.
Patients in the NPH group (n = 526) were significantly older than those in the PPH group (n = 391) (77.6 v. 70.9 years P < 0.001), more likely to be men, married or widowed and admitted involuntarily. Diagnostic prevalence in the NPH and PPH groups were 49.0% v. 8.4% (P < 0.001) for organic mental disorders, 14.6% v. 30.4% (P < 0.001) for psychotic disorders, 30.2% v. 55.5% (P < 0.001) for affective disorders and 20.7% v. 13.3% (P = 0.003) for somatic disorders. The NPH group scored significantly higher on the Health of the Nation Outcome Scale (HoNOS) items agitated behaviour; cognitive problems; physical illness or disability and problems with activities of daily living, whereas those in the PPH group scored significantly higher on depressed mood. Although the PPH group were more likely to report suicidal ideation, those in the NPH group were more likely to have made a suicide attempt before the admission.
Among psychiatric patients >65 years, the subgroup with NPH were characterised by more physical frailty, somatic comorbidity and functional and cognitive impairment as well as higher rates of preadmission suicide attempts. Admitting facilities should be appropriately suited to manage their needs.
Protein-losing enteropathy is an infrequent but severe condition occurring after Fontan procedure. The multifactorial pathogenesis remains unclear and no single proposed treatment strategy has proven universally successful. Therefore, we sought to describe different treatment strategies and their effect on clinical outcome and mortality.
Material and Methods:
We performed a retrospective observational study. From the total cohort of 439 Fontan patients treated in our institution during the study period 1986–2019, 30 patients (6.8%) with protein-losing enteropathy were identified. Perioperative, clinical, echocardiographic, laboratory, and invasive haemodynamic findings and treatment details were analysed.
Median follow-up after disease onset was 13.1 years [interquartile range 10.6]. Twenty-five patients received surgical or interventional treatment for haemodynamic restrictions. Medical treatment, predominantly pulmonary vasodilator and/or systemic anti-inflammatory therapy with budesonide, was initiated in 28 patients. In 15 patients, a stable remission could be achieved by medical or surgical procedures (n = 3 each), by combined multimodal therapy (n = 8), or ultimately by cardiac transplantation (n = 1). Phrenic palsy, bradyarrhythmia, Fontan pathway stenosis, and absence of a fenestration were significantly associated with development of protein-losing enteropathy (p = 0.001–0.48). Ten patients (33.3%) died during follow-up; 5-year survival estimate was 96.1%. In unadjusted analysis, medical therapy with budesonide and pulmonary vasodilator therapy in combination was associated with improved survival.
Protein-losing enteropathy is a serious condition limiting survival after the Fontan procedure. Comprehensive assessment and individual treatment strategies are mandatory to achieve best possible outcome. Nevertheless, relapse is frequent and long-term mortality substantial. Cardiac transplantation should be considered early as treatment option.
Thrombocytopenia is a risk factor for patent ductus arteriosus. Immature and mature platelets exhibit distinct haemostatic properties; however, whether platelet maturity plays a role in postnatal, ductus arteriosus closure is unknown.
In this observational study, counts of immature and mature platelets (=total platelet count − immature platelet count) were assessed on days 1, 3, and 7 of life in very low birth weight infants (<1500 g birth weight). We performed echocardiographic screening for haemodynamically significant patent ductus arteriosus on day 7.
Counts of mature platelets did not differ on day 1 in infants with (n = 24) and without (n = 45) haemodynamically significant patent ductus arteriosus, while infants with significant patent ductus arteriosus exhibited lower counts of mature platelet on postnatal days 3 and 7. Relative counts of immature platelets (fraction, in %) were higher in infants with patent ductus arteriosus on day 7 but not on days 1 and 3. Receiver operating characteristic curve analysis unraveled associations between both lower mature platelet counts and higher immature platelet fraction (percentage) values on days 3 and 7, with haemodynamically significant ductus arteriosus. Logistic regression analysis revealed that mature platelet counts, but not immature platelet fraction values, were independent predictors of haemodynamically significant patent ductus arteriosus.
During the first week of postnatal life, lower counts of mature platelets and higher immature platelet fraction values are associated with haemodynamically significant patent ductus arteriosus. Lower counts of mature platelet were found to be independent predictors of haemodynamically significant patent ductus arteriosus.
Giardia lamblia is a causative agent of persistent diarrhoea widespread in regions with low hygienic standards. Laboratory research is based on cloned lines issuing from various patient isolates typed in the late 1980s and 90s using restriction analysis and serology. In the present study, we compared the well-characterized strain WBC6 with another clone of the parent WB isolate termed WBA1 and with a clone from another isolate, GS/M-83-H7, using shotgun mass spectrometry proteomics. We identified 398 proteins differentially expressed between the GS and both WB isolates and 97 proteins differentially expressed between the two WB isolates. We investigated the expression levels of the predominant variant-specific surface proteins (VSPs) in each clone and matched the previously described major VSPs of each strain to the corresponding open reading frame sequences identified by whole-genome sequencing efforts. Furthermore, since the original WB isolate comes from a patient treated with metronidazole, we compared the susceptibilities of the strains to nitro compounds, as well the expression levels of enzymes involved in nitro reduction and on the corresponding enzyme activities and found distinct differences between the three strains.
The paper presents a highly efficient GaN-based synchronous buck converter suitable for switching in the lower GHz range. The module includes a very compact 2-stage GaN half-bridge converter MMIC (monolithic microwave integrated circuit) for low parasitic inductances between switches and drivers and a hybrid output network with core-less inductors to avoid ferrite losses. At 1 GHz switching frequency the buck converter achieves with pulse-width modulated (PWM) input signals power loop conversion efficiencies up to 78% for 40 V operation and output voltages up to 33 V. For 100 MHz the power loop efficiencies peak at 87.5% for 14.5 W conversion to 25 V. By changing the output network to a 2nd order low-pass with 700 MHz cut-off frequency the module has been characterized for the use as a supply modulator in very broadband envelope tracking systems with modulation bandwidths of up to 500 MHz. For 1 GHz switching frequency the power-added efficiency peaks at 74% for a 90% duty-cycle PWM input signal. The novelty of this work is that for the first time a buck converter design proves highest flexibility supporting different applications from very compact DC converters to microwave power amplifier efficiency enhancement techniques as well as efficient high frequency switching up to 1 GHz.
Prevention of mental ill health has been declared a major task by the European Commission; and an early detection and intervention in psychosis in terms of an indicated (secondary) prevention in persons already seeking help for mental problems is increasingly approached across Europe both on research as well as clinical level, a mixture of both dominating. The growing interest in this field of research across Western and Western-Central Europe becomes apparent in the rapidly increasing number of publications on this topic since the turn of the century that has nearly increased by the factor of 5. The 3 leading European countries in this are Germany, the United Kingdom and Switzerland.
Despite the very well reception of the ‘prevention idea’ by clinicians, researchers, relatives of patients with psychosis and clients and first promising results of early detection and/or early intervention studies, critics caution against the percentage of false-positive predictions by current prodromal criteria and the possibly unnecessary initiation of an antipsychotic psychological and/or pharmacological treatment along with its risks of unwanted side effects including early stigmatization. Supporters, however, argue that these short-comings will be overcome in the course of time and that the potential of new benign preventive interventions was just about to be discovered as well as caution against self-stigmatization by odd, eccentric behaviours and loss of functioning not recognized as part of an illness but attributed to the person him-/herself.
In future, joint efforts across clinical and scientific disciplines as well as countries will be required to enhance predictive accuracy, to develop broadly applicable and risk-adapted interventions, to provide help to all in need, to extend preventive efforts to other psychiatric disorders and to possibly reach the ultimate aim, a primary prevention of mental disorders.
The establishment phase of an early detection centre for prodromal psychosis is introduced and characterised, along with its detaining and promoting factors within a universal multi-payer health care system.
Across the first six years (1998–2003), users' characteristics are compared between different diagnostic groups and to the local population statistics; and, for an exemplary 12-months period (3-1-2002 to 2-28-2003), the characteristics of telephone contacts with the service are studied.
Rising steadily in number across the first three years, 872 persons, predominately of German citizenship and higher education, consulted the service until 2003, 326 with first-episode psychosis and 144 not fulfilling criteria for a current or beginning psychosis. Of the 402 putatively prodromal patients, 94% reported predictive basic symptoms, 68.9% attenuated and 20.6% transient psychotic symptoms. Most contacts by persons meeting any prodromal criterion were initiated by mental health professionals (psychiatrists or psychologists) and counselling services.
Supported by public awareness campaigns, an early detection service is well received by its users and private practitioners as reflected by the large proportion of referrals from the latter. However, persons of non-German background as well as of lower education were underrepresented indicating that these sub-groups should be approached by tailored programmes.