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.
Stereotactic ablative body radiotherapy (SABR) for spine metastases is associated with a risk of vertebral compression fracture (VCF). The aim of this study was to determine the rate of VCF at one UK institution and evaluate the use of the Spinal Instability Neoplastic Score (SINS) to predict these.
Materials and methods:
A retrospective analysis of all patients who underwent SABR for spinal metastases between 2014 and 2018 at one UK institution was performed. Basic demographic data were collected, and SINS prior to SABR was calculated. The primary outcome was VCF rate. Secondary outcomes included time to VCF and need for surgical intervention following VCF.
A total of 48 oligometastases were treated with a median follow-up of 20·5 months. A maximum of two vertebral bodies were treated. The median baseline SINS was calculated as 3. The median dose was 26 Gy in three fractions. Two patients were reported to have VCF and both were successfully conservatively managed.
SABR for spine oligometastases is being performed safely with low VCF rates which are comparable with those in international publications. This may be as a result of strict adherence to criteria for delivery of SABR with low pre-treatment SINS.
Here we report the findings from excavations at the open-air Middle Palaeolithic site of Alapars-1 in central Armenia. Three stratified Palaeolithic artefact assemblages were found within a 6-m-thick alluvial-aeolian sequence, located on the flanks of an obsidian-bearing lava dome. Combined sedimentological and chronological analyses reveal three phases of sedimentation and soil development. During Marine Oxygen Isotope Stages 5–3, the manner of deposition changes from alluvial to aeolian, with a development of soil horizons. Techno-typological analysis and geochemical sourcing of the obsidian artefacts reveal differential discard patterns, source exploitation, and artefact densities within strata, suggesting variability in technological organization during the Middle Palaeolithic. Taken together, these results indicate changes in hominin occupation patterns from ephemeral to more persistent in relation to landscape dynamics during the last interglacial and glacial periods in central Armenia.
Vitamin D deficiency is recognised as a public health problem globally, and a high prevalence of deficiency has previously been reported in Australia. This study details the prevalence of vitamin D deficiency in a nationally representative sample of Australian adults aged ≥25 years, using an internationally standardised method to measure serum 25-hydroxyvitamin D (25(OH)D) concentrations and identifies demographic and lifestyle factors associated with vitamin D deficiency. We used data from the 2011–2013 Australian Health Survey (n 5034 with complete information on potential predictors and serum 25(OH)D concentrations). Serum 25(OH)D concentrations were measured by a liquid chromatography-tandem MS that is certified to the reference measurement procedures developed by the National Institute of Standards and Technology, Ghent University and the US Centers for Disease Control and Prevention. Vitamin D deficiency and insufficiency were defined as serum 25(OH)D concentrations <50 nmol/l and 50 to <75 nmol/l, respectively. Overall, 20 % of participants (19 % men; 21 % women) were classified as vitamin D deficient, with a further 43 % classified as insufficient (45 % men; 42 % women). Independent predictors of vitamin D deficiency included being born in a country other than Australia or the main English-speaking countries, residing in southern (higher latitude) states of Australia, being assessed during winter or spring, being obese, smoking (women only), having low physical activity levels and not taking vitamin D or Ca supplements. Given our increasingly indoor lifestyles, there is a need to develop and promote strategies to maintain adequate vitamin D status through safe sun exposure and dietary approaches.
For the first time since the introduction of the Canadian Charter of Rights and Freedoms, Canada is in an armed conflict with an insurgency that has actively recruited Canadians and directed them to use or promote violence against Canada. In the result, the Canadian government may ask its soldiers to target and kill fellow Canadians abroad or to assist allies in doing so. This situation raises a host of novel legal issues, including the question of “targeted killing.” This matter arose for the United Kingdom in 2015 when it directed the use of military force against several Britons believed to be plotting a terrorist attack against the United Kingdom from abroad. This incident sparked a report from the British Parliament highlighting legal dilemmas. This article does the same for Canada by focusing on the main legal implications surrounding a targeted killing by the Canadian government of a Canadian citizen abroad. This exercise shows that a Canadian policy of targeted killing would oblige Canada to make choices on several weighty legal matters. First, the article discusses the Canadian public law rules that apply when the Canadian Armed Forces deploy in armed conflicts overseas. It then analyzes international law governing state uses of military force, including the regulation of the use of force (jus ad bellum) and the law of armed conflict (jus in bello). It also examines an alternative body of international law: that governing peacetime uses of lethal force by states. The article concludes by weaving together these areas of law into a single set of legal questions that would necessarily need to be addressed prior to the targeted killing of a Canadian abroad.
The rise of Urban Agriculture projects across the UK has led to a surge of interest in their efficacy and resulting social impacts. Real Food Wythenshawe is a Lottery-funded urban food project in the UK that aims to teach the population of Wythenshawe to grow their own food and to cook from scratch. The area, popularly referred to as ‘Europe's largest council estate’, suffers from high levels of deprivation and has been described as a ‘food desert’ due to a perceived lack of access to fresh fruit and vegetables (Small World Consulting, 2013). In order to encourage Wythenshawe residents to grow their own food and to increase access to fresh fruit and vegetables, Real Food Wythenshawe aims to transform unused areas of land into growing spaces, such as allotments and community gardens. This paper focuses on research conducted at a community garden in Wythenshawe, established by Real Food Wythenshawe as an example of a ‘meanwhile’ or temporary growing site for people affected by cancer. The research investigated the impact of the growing activities on community garden participants through a series of observations and interviews. The findings suggest that the benefits of the space were multiple and diverse, ranging from increased growing knowledge to therapeutic effects, while there has been minimal effect on participants’ dietary behavior. The organization of the community garden also raises questions over some of the practicalities of temporary urban growing sites and highlights the tensions that can arise between small community growing groups and larger institutions with control over land use. These findings add to a growing body of research that considers the value of growing in the city and reflects on the role of community gardening in deprived urban areas of the UK.
The variable content of human breast milk suggests that its routine fortification may result in sub-optimal nutritional intakes and growth. In a pragmatic trial, we randomised infants born below 30 weeks of gestation to either the intervention (Igp) of fortifying milk on measured composition according to birth weight criteria and postmenstrual age (PMA) or our routine practice (RPgp) of fortifying on assumed milk composition to target 3·8–4·4 g protein/kg per d and 545–629 kJ/kg per d. Milk composition was measured using the MIRIS® Human Milk Analyser. Percentage fat mass (%FM) was measured using PEA POD (COSMED). The effects of macronutrient intakes and clinical variables on growth were assessed using mixed model analysis. Mean measured protein content (1·6 g/100 ml) was higher than the assumed value (1·4 g/100 ml), often leading to lower amounts of fortifier added to the milk of intervention infants. At discharge (Igp v. RPgp), total protein (3·2 (sd 0·3) v. 3·4 (sd 0·4) g; P=0·067) and energy (456 (sd 39) v. 481 (sd 48) kJ; P=0·079) intakes from all nutrition sources, weight gain velocity (11·4 (sd 1·4) v. 12·1 (sd 1·6) g/kg per d; P=0·135) and %FM (13·7 (sd 3·6) v.13·6 (sd 3·5) %; P=0·984) did not significantly differ between groups. A protein intake >3·4 g/kg per d reduced %FM by 2 %. Nutrition and growth was not improved by targeting milk fortification according to birth weight criteria and PMA using measured milk composition, compared with routine practice. Targeting fortification on measured composition is labour intensive, requiring frequent milk sampling and precision measuring equipment, perhaps reasons for its limited practice. Guidance around safe upper levels of milk fortification is needed.
Ternary systems of 152Eu(III), bulk bentonite and ethylenediaminetetraacetic acid (EDTA) ([Eu] = 7.9 × 10–10 M; pH = 6.0–7.0) have been studied. Without EDTA, there was slow uptake in a two-stage process, with initial rapid sorption of Eu(III) (96%), followed by slower uptake of a much smaller fraction (3.0% over a period of one month). The reversibility of Eu(III) binding was tested by allowing Eu(III) to sorb to bentonite for 1–322 days. EDTA was added to the pre-equilibrated Eu bentonite systems at 0.01 M, a concentration that was sufficient to suppress sorption in a system where EDTA was present prior to the contact of Eu(III) with bentonite. A fraction of the Eu was released instantaneously (30–50%), but a significant amount remained bound. With time, the amount of Eu(III) retained by the bentonite reduced, with a slow fraction dissociation rate constant of approximately 4.3 × 10–8 s–1 (values in the range 2.2 × 10–8 – 1.0 × 10–7 s–1) for pre-equilibration times ≥7 days. Eventually, the amount of Eu(III) remaining bound to the bentonite was within error of that when EDTA was present prior to contact (4.5% ± 0.6), although in systems with pre-equilibration times >100 days, full release took up to 500 days. Europium interactions with colloidal bentonite were also studied, and the dissociation rate constant measured by a resin competition method. For the colloids, more Eu was found in the slowly dissociating fraction (60–70%), but the first-order dissociation rate constant was faster, with an average rate constant of 8.8 × 10–7 s–1 and a range of 7.7 × 10–7 –9.5 × 10–7 s–1. For both bulk and colloidal bentonite, although slow dissociation was observed for Eu(III), there was no convincing evidence for 'irreversible' binding.
To explore the association between diet and socio-economic position for 2007–2009 and investigate trends in socio-economic inequalities in the Scottish diet between 2001 and 2009.
UK food purchase data (collected annually from 2001 to 2009) were used to estimate household-level consumption data. Population mean food consumption, nutrient intakes and energy density were estimated by quintiles of an area-based index of multiple deprivation. Food and nutrient intakes estimated were those targeted for change in Scotland and others indicative of diet quality. The slope and relative indices of inequality were used to assess trends in inequalities in consumption over time.
Scottish households (n 5020).
Daily consumption of fruit and vegetables (200 g, 348 g), brown/wholemeal bread (17 g, 26·5 g), breakfast cereals (16 g, 27 g) and oil-rich (21 g, 40 g) and white fish (77 g, 112 g) were lowest, and that of total bread highest (105 g, 91·5 g) in the most deprived compared with the least deprived households, respectively, for the period 2007–2009. With regard to nutrients, there was no association between deprivation and the percentage of food energy from total fat and saturated fat; however, non-milk extrinsic sugar intakes (15·5 %, 14·3 %) and energy density (741 kJ/100 g, 701 kJ/100 g) were significantly higher in the most deprived households. The slope and relative indices of inequality showed that inequalities in intakes between 2001 and 2009 have changed very little.
There was no evidence to suggest that the difference in targeted food and nutrient intakes between the least and most deprived has decreased compared with previous years.
Frequent consumption of energy-dense foods has been strongly implicated in the global increase of obesity. The World Cancer Research Fund suggests a population-level energy density (ED) goal for diets of 523 kJ/100 g (125 kcal/100 g) as desirable for reducing weight gain and related co-morbidities. However, there is limited information about the ED of diets of contemporary populations. The aims of the present study were to (1) estimate the mean ED of the Scottish diet, (2) assess differences in ED over time by socio-economic position, by household (HH) composition and for HH meeting dietary targets for fat and fruit and vegetables, and (3) assess the relationship between ED and the consumption of foods and nutrients, which are indicative of diet quality. ED of the diet was estimated from food (including milk) from UK food purchase survey data. The average ED of the Scottish diet was estimated as 718 kJ/100 g with no change between the survey periods 2001 and 2009. Individuals living in the most deprived areas had a higher mean ED than those living in the least deprived areas (737 v. 696 kJ/100 g). Single-parent HH had the highest mean ED (765 kJ/100 g) of all the HH surveyed. The mean ED of HH achieving dietary targets for fat and fruit and vegetables was 576 kJ/100 g compared with 731 kJ/100 g for non-achievers. HH within the lowest quintile of ED were, on average, closest to meeting most dietary guidelines. Food purchase data can be used to monitor the quality of the diet in terms of dietary ED of the population and subgroups defined by an area-based measure of socio-economic status.
Monitoring changes in the food and nutrient intake of a nation is important for informing the design and evaluation of policy. Surveys of household food consumption have been carried out annually in the UK since 1940 and, despite some changes over the years 1940–2000, the method used for the Expenditure and Food Survey (Living Costs and Food Survey from 2008) has been fundamentally the same since 2001. Using these surveys an analytical procedure was devised to compare food consumption and nutrient intake in Scotland with the Scottish dietary targets, and monitor change. This method takes into account contributions to composite foods and losses due to food preparation, as well as inedible and edible waste. There were few consistent improvements in consumption of foods or nutrients targeted for change over the period 2001–9. A significant but small increase was seen in mean fruit and vegetable consumption (259 g/d in 2001, 279 g/d in 2009, equating to an increase of less than 3 g/person per year). There was also a significant decrease in the percentage of food energy from SFA (15·5 % in 2001, 15·1 % in 2009) and from non-milk extrinsic sugars (15·5 % in 2001, 14·8 % in 2009), concurrent with a reduction in whole milk consumption and soft drink consumption, respectively. These small changes are encouraging, but highlight the time taken for even modest changes in diet to occur. To achieve a significant impact on the health of the present Scottish population, the improvements in diet will need to be greater and more rapid.
To explore associations of early infant feeding with (i) eating patterns in the second year of life and (ii) weight status in the fourth year of life in a prospective cohort of children in Scotland.
Growing Up in Scotland (GUS) longitudinal birth cohort study (2005–2008).
Children aged 9–12 months (n 5217) followed through to 45–48 months.
Infant feeding was associated with eating patterns, defined by using SPSS two-step cluster analysis, in the second year of life. Children who were ever breast-fed compared with never breast-fed (adjusted OR = 1·48, 95 % CI 1·27, 1·73) were more likely to have a positive eating pattern (Cluster 2). Children who started complementary feeding at 4–5 months or 6–10 months compared with 0–3 months (adjusted OR = 1·32, 95 % CI 1·09, 1·59 or AOR = 1·50, 95 % CI 1·19, 1·89) were more likely to belong to Cluster 2. Breast-feeding was negatively associated with being overweight or obese in the fourth year of life compared with no breast-feeding (adjusted OR = 0·81, 95 % CI 0·81, 1·01). Introduction of complementary feeding at 4–5 months compared with 0–3 months was negatively associated with being overweight or obese (adjusted OR = 0·74, 95 % CI 0·57, 0·97).
Breast-feeding and introduction of complementary feeding after 4 months were associated with a positive eating pattern in the second year of life. Introduction of complementary feeding at 4–5 months compared with 0–3 months was negatively associated with being overweight or obese.
The architectural historian Roderick Gradidge, referring to the 1900s, wrote that ‘in architecture there have never been such opportunities for younger men as there were at the turn of the century’. Arnold Mitchell is an architect typical of those who took advantage of such opportunities, a man (women were yet to have the chance) who saw the economic and aesthetic potential for new architecture, both nationally and internationally. Understanding the nature of architectural practice should not be reliant solely upon knowledge of the stellar architects of any given period. It depends upon integrating others, one or two rungs down the ladder but who achieved success in their own sphere, into the corpus examined, in order to achieve a fuller understanding of the profession.
To determine the extent to which weight gain and eating behaviours in infancy predict later adiposity.
Population-based, prospective, longitudinal birth cohort study. Weights collected in infancy were used to calculate Z-scores for weight gain to age 1 year conditional on birth weight (CWG). To avoid multiple significance tests, variables from the parent questionnaire completed at age 1 year describing eating avidity were combined using general linear modelling to create an infancy avidity score. Anthropometry, skinfold thicknesses and bioelectrical impedance data collected at age 7–8 years were combined using factor analysis, to create an adiposity index.
Members of the Gateshead Millennium Study cohort with data at both time points (n 561).
CWG in infancy significantly predicted adiposity at age 7 years, but related more strongly to length and lean mass. High adiposity (> 90th internal percentile) at age 7 years was significantly associated with high CWG (relative risk 2·76; 95 % CI 1·5, 5·1) in infancy, but less so with raised (> 74th internal percentile) eating avidity in infancy (relative risk 1·87; 95 % CI 0·9, 3·7). However, the majority of children with high weight gain (77·6 %) or avidity (85·5 %) in infancy did not go on to have high adiposity at age 7 years.
Rapid weight gain in infancy and the eating behaviours which relate to it do predict later adiposity, but are more strongly predictive of later stature and lean mass.
Andrew Blake, worked for Dorset Library Service for over ten years,
Julia Hale, Young People's Services Manager for Plymouth Libraries, where she manages the children's and young people's library service for the city,
Emma Sherriff, Outreach Support Officer for Plymouth City Council
Young people aged 11–19 are perceived as a challenging group to engage in using public libraries. This chapter will examine projects delivered by library services in the most deprived areas of the UK's south-west peninsula, endeavouring to connect with some of the most hard-to-reach groups of young people in the region. Our aim is to identify how libraries can go about removing barriers to library use through innovative schemes of outreach work. We conclude with the reasons for successful outcomes.
What are the obstacles to young people's using public libraries?
This is a question we often hear in dialogues with librarians, youth agencies and young people. One stereotype of the younger library user is of the ‘bookish’ loner, socially outcast by their peers. There is also the view that libraries are fundamentally ‘uncool’ and have nothing to offer the 21stcentury teenager. Many librarians already doing positive work with teenagers may view these as unfounded prejudices and lazy clichés; however, there is plenty of evidence on which to base these views, confirmed by dwindling borrower figures amongst this age group.
In 2006, reports from the Audit Commission and the House of Commons Select Committee on Culture, Media and Sport had noted the small (and still reducing) use of public libraries amongst 14–35 year-olds. In response, the Museums, Libraries and Archives Council, Department for Culture, Media and Sport and Laser Foundation commissioned A Research Study of 14–35 year olds for the Future Development of Public Libraries (2006). This report aimed ‘to provide evidence for potential future strategies for the public library service that will result in increased usage amongst the 14–35 age group’. Interviews were held with 15 groups of young people from different parts of the country, chosen without reference to whether they were library members. The researchers found a ‘deeply entrenched negative perception’ of libraries and that the majority of existing and unmodernized libraries were seen as dirty and uncared for, with old and poor stocks and an oppressive atmosphere. ‘Users turned out to be a minority. Even they were reported as disappointed by the breadth and depth of stock and its lack of currency.’