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.
The impacts of the COVID-19 pandemic affect all groups in society. People with intellectual disability are especially vulnerable to the physical, mental and social effects of the pandemic. Cognitive impairments can limit understanding of information to protect them relying on carers to be vigilant on their behalf during quarantine. Restrictions on usual activities are likely to induce mental stress especially among those who are autistic leading to an escalation in challenging behaviours, risk of placement breakdown, and increased the use of psychotropic medication. People with intellectual disability are vulnerable to exploitation by others where the usual community supports no longer function to protect them. In future pandemics, it is important that lessons are learned from the impacts COVID-19 has on people with intellectual disability. Collecting the evidence through a rigorous approach should help to empower people with intellectual disability and their carers to face future outbreaks of infectious diseases
A diverse assemblage of moderately well-preserved radiolarians occurs in the Ordovician cherts of the Crawford Group in the Southern Uplands terrane of the Scottish borders. A total of 8 genera and 11 species are described. Taxa present correlate to the Middle Ordovician Pygodus anserinus biozone. Key species identified include: Proventocitum procerulum, Inanigutta gansuensis, Inanigutta sp. cf. I. complanata, Inanibigutta sp. cf. I. verrucula, Inanibigutta sp. cf. I. pinglianensis, ?Inanibigutta inconstans, ?Inanihella penrosei, Haplentactinia armillata, ?Oriundogutta ramificans and Syntagentactinia sp. A new species Haplotaeniatum albaensis is introduced here and described on the basis of details of skeletal architecture observed using microcomputed tomography, demonstrating the potential of this technique as a tool for improving the understanding of radiolarian taxonomy.
We prove that Cuntz semigroups of C*-algebras satisfy Edwards' condition with respect to every quasitrace. This condition is a key ingredient in the study of the realization problem of functions on the cone of quasitraces as ranks of positive elements. In the course of our investigation, we identify additional structure of the Cuntz semigroup of an arbitrary C*-algebra and of the cone of quasitraces.
International ‘naming and shaming’ campaigns rely on domestic civil society organizations (CSOs) for information on local human rights conditions. To stop this flow of information, some governments restrict CSOs, for example by limiting their access to funding. Do such restrictions reduce international naming and shaming campaigns that rely on information from domestic CSOs? This article argues that on the one hand, restrictions may reduce CSOs’ ability and motives to monitor local abuses. On the other hand, these organizations may mobilize against restrictions and find new ways of delivering information on human rights violations to international publics. Using a cross-national dataset and in-depth evidence from Egypt, the study finds that low numbers of restrictions trigger shaming by international non-governmental organizations. Yet once governments impose multiple types of restrictions, it becomes harder for CSOs to adapt, resulting in fewer international shaming campaigns.
Blood glucose level (BGL) is routinely assessed by paramedics in the out-of-hospital setting. Most commonly, BGL is measured using a blood sample of capillary origin analyzed by a hand-held, point-of-care glucometer. In some clinical circumstances, the capillary sample may be replaced by blood of venous origin. Given most point-of-care glucometers are engineered to analyze capillary blood samples, the use of venous blood instead of capillary may lead to inaccurate or misleading measurements.
The aim of this prospective study was to compare mean difference in BGL between venous and capillary blood from healthy volunteers when measured using a capillary-based, hand-held, point-of-care glucometer.
Using a prospective observational comparison design, 36 healthy participants provided paired samples of blood, one venous and the other capillary, taken near simultaneously. The BGL values were similar between the two groups. The capillary group had a range of 4.3mmol/l, with the lowest value being 4.4mmol/l and 8.7mmol/l the highest. The venous group had a range of 2.7mmol/l, with the lowest value being 4.1mmol/l and 7.0mmol/l the highest.
For the primary research question, the mean BGL for the venous sample group was 5.3mmol/l (SD = 0.6), compared to 5.6mmol/l (SD = 0.8) for the capillary group. This represented a statistically significant difference of 0.3mmol/l (P = .04), but it did not reach the a priori established point of clinical significance (1.0mmol/l). Pearson’s correlation coefficient for capillary versus venous indicated moderate correlation (r = 0.42).
In healthy, non-fasted people in a non-clinical setting, a statistically significant, but not clinically significant, difference was found between venous- and capillary-derived BGL when measured using a point-of-care, capillary-based glucometer. Correlation between the two was moderate. In this context, using venous samples in a capillary-based glucometer is reasonable providing the venous sample can be gathered without exposure of the clinician to risk of needle-stick injury. In clinical settings where physiological derangement or acute illness is present, capillary sampling would remain the optimal approach.
Some of the most immediate health effects of the 2008 economic crisis concerned the mind, not the body. Rates of generalized anxiety, chronic depression, and even suicide spiked in many European societies. This viewpoint highlights the role of mental health professionals in responding to this emergency, and argues that their sustained mobilization is necessary to its long-term resolution.
Hispanics/Latinos in the United States are less aware of their cholesterol levels and have a higher burden of associated adverse cardiovascular and cerebrovascular outcomes than non-Latino whites. Investigations of the associations between cholesterol levels and cognition in this population have often occurred within the context of metabolic syndrome and are limited to select lipids despite the fact that triglycerides (TGs) may be more relevant to the health of Hispanics/Latinos.
Baseline data from the Hispanic Community Health Study/Study of Latinos, collected from 2008 to 2011, was used to investigate the associations of lipid levels (i.e., TG, total cholesterol, TC; low-density and high-density lipoprotein cholesterol, LDL-C and HDL-C) with cognition (i.e., learning, memory, verbal fluency, and digit symbol substitution, DSS), adjusting for relevant confounders.
In 7413 participants ages 45 to 74 years from Central American, Cuban, Dominican, Mexican, Puerto Rican, and South American backgrounds, separate, fully adjusted linear regression models revealed that TG levels were inversely associated with DSS performance; however, this relationship was no longer significant once additional cardiovascular disease risk factors were added to the model (p = .06). TC and LDL-C levels (separately) were positively associated with learning and verbal fluency regardless of adjustments (p-values < .05). Separate analyses investigating the effect modification by background and sex revealed a particularly robust association between TC levels and DSS performance for Puerto Ricans and Central Americans (albeit in opposite directions) and an inverse relationship between TG levels and DSS performance for women (p-values < .02).
It is important to consider individual lipid levels and demographic characteristics when investigating associations between cholesterol levels and cognition in Hispanics/Latinos.
Whether maternal obesity and gestational weight gain (GWG) are associated with early-childhood development in low-income, urban, minority populations, and whether effects differ by child sex remain unknown. This study examined the impact of prepregnancy BMI and GWG on early childhood neurodevelopment in the Columbia Center for Children’s Environmental Health Mothers and Newborns study. Maternal prepregnancy weight was obtained by self-report, and GWG was assessed from participant medical charts. At child age 3 years, the Psychomotor Development Index (PDI) and Mental Development Index (MDI) of the Bayley Scales of Infant Intelligence were completed. Sex-stratified linear regression models assessed associations between prepregnancy BMI and pregnancy weight gain z-scores with child PDI and MDI scores, adjusting for covariates. Of 382 women, 48.2% were normal weight before pregnancy, 24.1% overweight, 23.0% obese, and 4.7% underweight. At 3 years, mean scores on the PDI and MDI were higher among girls compared to boys (PDI: 102.3 vs. 97.2, P = 0.0002; MDI: 92.8 vs. 88.3, P = 0.0001). In covariate-adjusted models, maternal obesity was markedly associated with lower PDI scores in boys [b = −7.81, 95% CI: (−13.08, −2.55), P = 0.004], but not girls. Maternal BMI was not associated with MDI in girls or boys, and GWG was not associated with PDI or MDI among either sex (all-P > 0.05). We found that prepregnancy obesity was associated with lower PDI scores at 3 years in boys, but not girls. The mechanisms underlying this sex-specific association remain unclear, but due to elevated obesity exposure in urban populations, further investigation is warranted.
Inadequate protein quality may be a risk factor for poor growth. To examine the effect of a macronutrient–micronutrient supplement KOKO Plus (KP), provided to infants from 6 to 18 months of age, on linear growth, a single-blind cluster-randomised study was implemented in Ghana. A total of thirty-eight communities were randomly allocated to receive KP (fourteen communities, n 322), a micronutrient powder (MN, thirteen communities, n 329) and nutrition education (NE, eleven communities, n 319). A comparison group was followed cross-sectionally (n 303). Supplement delivery and morbidity were measured weekly and anthropometry monthly. NE education was provided monthly. Baseline, midline and endline measurements at 6, 12 and 18 months included venous blood draws, diet, anthropometry, morbidity, food security and socio-economics. Length-for-age Z-score (LAZ) was the primary outcome. Analyses were intent-to-treat using mixed-effects regressions adjusted for clustering, sex, age and baseline. No differences existed in mean LAZ scores at endline (−1·219 (sd 0·06) KP, −1·211 (sd 0·03) MN, −1·266 (sd 0·03) NE). Acute infection prevalence was lower in the KP than NE group (P = 0·043). Mean serum Hb was higher in KP infants free from acute infection (114·02 (sd 1·87) g/l) than MN (107·8 (sd 2·5) g/l; P = 0·047) and NE (108·8 (sd 0·99) g/l; P = 0·051). Compliance was 84·9 % (KP) and 87·2 % (MN) but delivery 60 %. Adjusting for delivery and compliance, LAZ score at endline was significantly higher in the KP v. MN group (+0·2 LAZ; P = 0·026). A macro- and micronutrient-fortified supplement KP reduced acute infection, improved Hb and demonstrated a dose–response effect on LAZ adjusting consumption for delivery.
Fasciola jacksoni is a significant contributor to the health and mortality of Asian elephants, particularly those in Sri Lanka. Despite the impact of fascioliasis on elephant populations, it is a neglected veterinary disease with limited taxonomic understanding. Molecular characterization and phylogenetic analysis of F. jacksoni were carried out to evaluate its suggested basal position in the Fasciolidae. Adult worms were collected during post-mortem of elephants, and eggs were collected from living elephants in National parks across Sri Lanka. Using the mitochondrial genes nicotinamide dehydrogenase subunit 1 (nad1) and cytochrome oxidase subunit 1 (cox1), and a partial 28S ribosomal DNA (28S rDNA), DNA sequences were generated from the F. jacksoni adult and egg material. Maximum likelihood (ML) phylogenetic analyses did not resolve F. jacksoni to be basal to the Fasciolidae. Furthermore, the ML analyses showed that the genus Fasciola was not monophyletic and that F. jacksoni was a sister species to the deer liver fluke Fascioloides magna. A clear framework is required to determine the taxonomic status of F. jacksoni and this current study provides the first detailed application of molecular techniques from multiple hosts across Sri Lanka with the production of reference DNA sequences for this important parasite.
Micronutrient supplementation is recommended in Ebola Virus Disease (EVD). However, there is limited data on its therapeutic impacts. This study evaluated the association between vitamin A supplementation and mortality outcomes in EVD patients.
This retrospective cohort study accrued patients with EVD admitted to five International Medical Corps run Ebola Treatment Units (ETU) in two countries from 2014-2015. Protocolized treatments with antimicrobials and micronutrients were used at all ETUs. However, due to resource limitations and care variations, only a subset of patients received vitamin A. Standardized data on demographics, clinical characteristics, malaria status, and Ebola virus RT-PCR cycle threshold (CT) values were collected. The outcome of interest was mortality compared between cases treated with 200,000 International Units of vitamin A on care days one and two and those not. Propensity scores (PS) based on the first 48-hours of care were derived using the covariates of age, duration of ETU function, malaria status, CT values, symptoms of confusion, hemorrhage, diarrhea, dysphagia, and dyspnea. Treated and non-treated cases were matched 1:1 based on nearest neighbors with replacement. Covariate balance met predefined thresholds. Mortality proportions between cases treated and untreated with vitamin A were compared using generalized estimating equations to calculate relative risks (RR) with associated 95% confidence intervals (CI).
There were 424 cases analyzed, with 330 (77.8%) being vitamin A-treated cases. The mean age was 30.5 years and 57.0% were female. The most common symptoms were diarrhea (86%), anorexia (81%), and vomiting (77%). Mortality proportions among cases untreated and treated with vitamin A were 71.9% and 55.0%, respectively. In a propensity-matched analysis, mortality was significantly lower among cases receiving vitamin A (RR = 0.77 95%; CI:0.59-0.99; p = 0.041).
Early vitamin A supplementation was associated with reduced mortality in EVD patients and should be provided routinely during future epidemics.
Sri Lanka has experienced a multitude of natural and man-made disasters during the last five decades. Man-made destructions were common during the 30-year-long conflict period. Though the local system in the country was able to manage the dead in such circumstances, the South-Asian tsunami in 2004 highlighted the limitations and deficiencies of the system that was in place to handle the management of the dead during major disasters. Though the first Disaster Management Act was introduced in 2005, it has no mentioning regarding management of dead in mass disasters. Inappropriate handling of the dead could hinder the establishment of the identity of the dead, loss of valuable forensic evidence, and dignified burial. Hence, the families could experience difficulties in calming insurances and inheritance, resulting in economic hardships. In this backdrop, the forensic community strongly felt the necessity of stipulating best practices in managing dead.
To critically assess the measures taken to improve the standards of managing dead in mass disasters in Sri Lanka over the past 15 years.
The process of drafting guidelines for management of dead was initiated with a series of consultative meetings with the Disaster Preparedness and Response Unit of the Ministry of Health, the Disaster Management Centre (DMC) and the Institute of Forensic Medicine and Toxicology (IFMT) in collaboration with the College of Forensic Pathologists of Sri Lanka. A working group representing forensic and legal experts, military, police, fire brigade department, and disaster management were involved in drafting these guidelines. Further guidelines for the effective conduct of mass burials following mass disasters were also prepared and published in 2007.
Despite all these efforts the efficacy of managing dead in recent mass disasters is still far from satisfactory.
Floods are common worldwide and are the leading cause of fatalities. They are destructive to property, crops, and livestock, and leave survivors homeless or displaced to evacuation camps.
To explore the needs of family survivors of floods in Molepolole, determine assistance received and needed, and identify coping strategies used to deal with the impact and effects of floods.
Jordan (2015) model of disaster survivors’ hierarchy of needs guided the study. Purposive sampling selected six families, and seven participants from these families enrolled in the study. A pilot-tested semi-structured interview guide collected data. Data were analyzed using the content style.
The study findings confirmed that survivors of floods had immediate and long-term needs, and these were classified into basic, safety, recovery, stress reaction, grief and loss, and growth. Not all survivors were grateful for the assistance they received following floods. Survivors used varied coping strategies to deal with their stressors. The study was conducted in Molepolole, hence, the findings may not be applicable in other settings. Individuals were interviewed on behalf of the entire family.
There is a need for a multidisciplinary team which will keep the community at the forefront in tackling flood mitigation and developing policies specific to floods. Policies will include indigenous flood mitigation practices and will strengthen awareness of communities to improve knowledge, skills, and attitude. More research is needed on the needs of each survivor.
Sri Lanka has a rapidly aging population with an exponential rise in chronic morbidity. There had been no parallel development of palliative and end-of-life care-specific approach in health care.
To implement sustainable palliative and end-of-life care services in Sri Lanka through the existing systems and resources by advocacy, collaboration, and professional commitment.
Sri Lanka Medical Association established a volunteer task force for palliative and end-of-life care (PCTF) in October 2016, which comprised of multi-disciplinary health care professionals, legal fraternity, and civil society. PCTF identified the need for sensitizing the general public on the importance of palliative care, for standard guidelines and formal training for practicing health care professionals engaged in hospital and community-based palliative care. These needs are addressed through activities of PCTF in collaboration with the Ministry of Health.
Representing the National Steering Committee of Palliative Care, the members of the PCTF were instrumental in developing the National Strategic Framework to fill the major gap of affordable quality palliative care in the country. PCTF also published the “Palliative Care Manual for Management of Non-Cancer Patients” as a preliminary guide for health care professionals. The draft document on the End-of-Life Care Guidelines has been formulated and is currently being reviewed by the relevant medical and legal stakeholders. PCTF has organized CME lectures on palliative care all over the country for health care professionals, and also conducted lectures, exhibitions, and mass media programs to sensitize the public on palliative care.
Within a brief period, PCTF has played a key role to recognize palliative care by contributing to policy making, training, and public sensitization in palliative and end-of-life care in Sri Lanka.
Oceanic islands are hotspots of biodiversity due to their high levels of endemism, with the Canary Islands being a notable example. A previous molecular study on the biogeography and host associations of haemogregarines (Apicomplexa: Adeleorina) infecting lizards from this archipelago detected seven parasite haplogroups. These haplogroups exhibited high host-specificity and geographical structure, suggesting that they might correspond to distinct biological identities. In this study, along with sequencing a longer fragment of the 18S rRNA, we further explore the distinctiveness of these parasites by analysing their morphology, effects on host erythrocytes and parasitaemia levels. These lines of evidence together with their genetics, host associations, frequency of occurrence and geographical distribution support them as different biological entities. As such, we describe seven new species: Karyolysus canariensis sp. nov., Karyolysus galloti sp. nov., Karyolysus stehlini sp. nov., Karyolysus gomerensis sp. nov., Karyolysus atlanticus sp. nov., Karyolysus tinerfensis sp. nov. and Karyolysus makariogeckonis sp. nov. These new taxa are further examples of endemic diversity in the Canarian archipelago. They also contribute to clarify the taxonomy within the Apicomplexa, a phylum estimated to have one of the lowest percentages of described species.
One-dimensional hybrid Distributed Bragg Reflector (DBR) is constructed using Tris (8-hydroxy) quinoline aluminum (Alq3) molecules and Titanium dioxide (TiO2) nanoparticles via spin coating process. Light emission from thin films of low molecular weight organic semiconductor of Alq3 is dominated by excitons. This material has been widely used as a superior emitter for organic light emitting diodes. Titanium dioxide (TiO2) is an inorganic semiconductor with a high band gap. Photoluminescence (PL) of thin films of Alq3 showed a broad PL peak at 530 nm. In DBR structures, PL quenching is observed but there is no shift in the PL peak of the Alq3. The PL quenching is tentatively attributed to energy transfer via sensitization to wide band gap TiO2 layers. A simple excitonic model is suggested to explain the observation. Fabrication process and optical properties of the structure are presented.
This study sets an example of an economic evaluation of a model dengue vaccination strategy for Sri Lanka, following a mandatory pre-vaccination screening strategy.
A decision analytic Markov model was developed to estimate the cost-effectiveness of a predicted dengue vaccination strategy over a time horizon of 10 years. The cost effectiveness of dengue vaccination strategy for seropositive individuals was estimated in terms of incremental cost effectiveness ratio (ICER) (cost per additional quality adjusted life-year [QALY]). District-specific ICER values and the budget impact for dengue vaccine were estimated with appropriate sensitivity analyses, also taking the variability of the pre-vaccination screening test performance into consideration.
The ICER for the predicted vaccination strategy following pre-vaccination screening was 4,382 USD/QALY for Sri Lanka. There was a significant regional variation in vaccine cost effectiveness. The disaggregated regional incidence of dengue and the need to perform pre-vaccination screening affects the cost effectiveness estimates significantly, where a safer version of the vaccine has the potential to become cost saving in high incidence districts.
The cost effectiveness of the predicted dengue vaccination strategy following pre-vaccination screening showed a significant regional variation across the districts of Sri Lanka. District-wise disease incidence and the need for pre-vaccination screening was found to be the most significant factors affecting the cost effectiveness of the vaccine.
Computerized cognitive behavioural therapy (cCBT) has been developed to address economic and clinical issues around limited access to evidence-based therapy. Supported cCBT (variously termed iCBT or eCBT) has been developed to address issues with the effectiveness of, and engagement with, cCBT. There has been no in-depth qualitative exploration of the patient experience of eCBT within the UK, which might aid improving its effectiveness. The aim of this study was to explore patient experience of eCBT in one inner-city National Health Service (NHS) Improving Access to Psychological Therapies (IAPT) service using a semi-structured interview and Thematic Analysis methodology. Ten patients took part. Six main themes were identified: (1) Being Offered eCBT; (2) How eCBT Compares with Self-help; (3) The Patient's State of Mind; (4) The Relationship with the Supporter; (5) Preferring to Talk; (6) eCBT's Value as a Treatment. Participants in this study indicated a preference for face-to-face talking therapy, but were clear that they could form a therapeutic relationship via asynchronous messaging. They reported clinical benefit from the eCBT programme and online relationship, and acknowledged that accessing this immediately was valuable. Issues around the process of selecting patients for eCBT, including with regard to acknowledging or mitigating any negative emotional effects of eCBT, and how to offer and support users with it, are discussed.