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The Fontan Outcomes Network was created to improve outcomes for children and adults with single ventricle CHD living with Fontan circulation. The network mission is to optimise longevity and quality of life by improving physical health, neurodevelopmental outcomes, resilience, and emotional health for these individuals and their families. This manuscript describes the systematic design of this new learning health network, including the initial steps in development of a national, lifespan registry, and pilot testing of data collection forms at 10 congenital heart centres.
Childhood maltreatment is associated with altered neural reactivity during autobiographical memory (ABM) recall and a pattern of overgeneral memory (OGM). Altered ABM and OGM have been linked with psychopathology and poorer social functioning. The present study investigated the association between altered ABM and subsequent socio-emotional functioning (measured two years later) in a sample of adolescents with (N = 20; maltreatment group, MT) and without (N = 17; non-MT group) documented childhood maltreatment histories.
At baseline, adolescents (aged 12.6 ± 1.45 years) were administered the Autobiographical Memory Test to measure OGM. Participants also recalled specific ABMs in response to emotionally valenced cue words during functional MRI. Adolescents in both groups underwent assessments measuring depressive symptoms and prosocial behavior at both timepoints. Regression analyses were carried out to predict outcome measures at follow-up controlling for baseline levels.
In the MT group, greater OGM at baseline significantly predicted reduced prosocial behavior at follow-up and showed a trend level association with elevated depressive symptoms. Patterns of altered ABM-related brain activity did not significantly predict future psycho-social functioning.
The current findings highlight the potential value of OGM as a cognitive mechanism that could be targeted to reduce risk of depression in adolescents with prior histories of maltreatment.
Chemical weed control remains a widely used component of integrated weed management strategies because of its cost-effectiveness and rapid removal of crop pests. Additionally, dicamba-plus-glyphosate mixtures are a commonly recommended herbicide combination to combat herbicide resistance, specifically in recently commercially released dicamba-tolerant soybean and cotton. However, increased spray drift concerns and antagonistic interactions require that the application process be optimized to maximize biological efficacy while minimizing environmental contamination potential. Field research was conducted in 2016, 2017, and 2018 across three locations (Mississippi, Nebraska, and North Dakota) for a total of six site-years. The objectives were to characterize the efficacy of a range of droplet sizes [150 µm (Fine) to 900 µm (Ultra Coarse)] using a dicamba-plus-glyphosate mixture and to create novel weed management recommendations utilizing pulse-width modulation (PWM) sprayer technology. Results across pooled site-years indicated that a droplet size of 395 µm (Coarse) maximized weed mortality from a dicamba-plus-glyphosate mixture at 94 L ha–1. However, droplet size could be increased to 620 µm (Extremely Coarse) to maintain 90% of the maximum weed mortality while further mitigating particle drift potential. Although generalized droplet size recommendations could be created across site-years, optimum droplet sizes within each site-year varied considerably and may be dependent on weed species, geographic location, weather conditions, and herbicide resistance(s) present in the field. The precise, site-specific application of a dicamba-plus-glyphosate mixture using the results of this research will allow applicators to more effectively utilize PWM sprayers, reduce particle drift potential, maintain biological efficacy, and reduce the selection pressure for the evolution of herbicide-resistant weeds.
The seventh-century AD switch from gold to silver currencies transformed the socio-economic landscape of North-west Europe. The source of silver, however, has proven elusive. Recent research, integrating ice-core data from the Colle Gnifetti drill site in the Swiss Alps, geoarchaeological records and numismatic and historical data, has provided new evidence for this transformation. Annual ice-core resolution data are combined with lead pollution analysis to demonstrate that significant new silver mining facilitated the change to silver coinage, and dates the introduction of such coinage to c. AD 660. Archaeological evidence and atmospheric modelling of lead pollution locates the probable source of the silver to mines at Melle, in France.
Alterations in reinforcement-based decision making may be associated with increased psychiatric vulnerability in children who have experienced maltreatment. A probabilistic passive avoidance task and a model-based functional magnetic resonance imaging analytic approach were implemented to assess the neurocomputational components underlying decision making: (a) reinforcement expectancies (the representation of the outcomes associated with a stimulus) and (b) prediction error signaling (the ability to detect the differences between expected and actual outcomes). There were three main findings. First, the maltreated group (n = 18; mean age = 13), relative to nonmaltreated peers (n = 19; mean age = 13), showed decreased activity during expected value processing in a widespread network commonly associated with reinforcement expectancies representation, including the striatum (especially the caudate), the orbitofrontal cortex, and medial temporal structures including the hippocampus and insula. Second, consistent with previously reported hyperresponsiveness to negative cues in the context of childhood abuse, the maltreated group showed increased prediction error signaling in the middle cingulate gyrus, somatosensory cortex, superior temporal gyrus, and thalamus. Third, the maltreated group showed increased activity in frontodorsal regions and in the putamen during expected value representation. These findings suggest that early adverse environments disrupt the development of decision-making processes, which in turn may compromise psychosocial functioning in ways that increase latent vulnerability to psychiatric disorder.
Older people have a higher risk of drug-related problems (DRPs). However, little is known about the prevalence of DRPs in community-dwelling people who screened positive for dementia. Our study aimed to determine (1) the prevalence and types of DRPs and (2) the socio-demographic and clinical variables associated with DRPs in people screened positive for dementia in primary care.
The Dementia: life- and person-centered help in Mecklenburg-Western Pomerania (DelpHi-MV) study is a general practitioner (GP)-based cluster-randomized controlled intervention study to implement and evaluate an innovative concept of collaborative dementia care management in the primary care setting in Germany. Medication reviews of 446 study participants were conducted by pharmacists based on a comprehensive baseline assessment that included a computer-based home medication assessment. ClinicalTrials.gov Identifier: NCT01401582.
A total of 1,077 DRPs were documented. In 414 study participants (93%), at least one DRP was detected by a pharmacist. The most frequent DRPs were administration and compliance problems (60%), drug interactions (17%), and problems with inappropriate drug choice (15%). The number of DRPs was significantly associated with the total number of drugs taken and with a formal diagnosis of a mental or behavioral disorder.
Degree of cognitive impairment (MMSE defined) and formal diagnosis of dementia were not risk factors for an increased number of DRPs. However, the total number of drug taken and the presence of a diagnosis of mental and behavioral disorders were associated with an increased total number of DRPs.
Introduction: Point of care ultrasound has become an established tool in the initial management of patients with undifferentiated hypotension. Current established protocols (RUSH, ACES, etc) were developed by expert user opinion, rather than objective, prospective data. We wished to use reported disease incidence to develop an informed approach to PoCUS in hypotension using a “4 F’s” approach: Fluid; Form; Function; Filling. Methods: We summarized the incidence of PoCUS findings from an international multicentre RCT, and using a modified Delphi approach incorporating this data we obtained the input of 24 international experts associated with five professional organizations led by the International Federation of Emergency Medicine. The modified Delphi tool was developed to reach an international consensus on how to integrate PoCUS for hypotensive emergency department patients. Results: Rates of abnormal PoCUS findings from 151 patients with undifferentiated hypotension included left ventricular dynamic changes (43%), IVC abnormalities (27%), pericardial effusion (16%), and pleural fluid (8%). Abdominal pathology was rare (fluid 5%, AAA 2%). After two rounds of the survey, using majority consensus, agreement was reached on a SHoC-hypotension protocol comprising: A. Core: 1. Cardiac views (Sub-xiphoid and parasternal windows for pericardial fluid, cardiac form and ventricular function); 2. Lung views for pleural fluid and B-lines for filling status; and 3. IVC views for filling status; B. Supplementary: Additional cardiac views; and C. Additional views (when indicated) including peritoneal fluid, aorta, pelvic for IUP, and proximal leg veins for DVT. Conclusion: An international consensus process based on prospectively collected disease incidence has led to a proposed SHoC-hypotension PoCUS protocol comprising a stepwise clinical-indication based approach of Core, Supplementary and Additional PoCUS views.
Introduction: Point of care ultrasound (PoCUS) provides invaluable information during resuscitation efforts in cardiac arrest by determining presence/absence of cardiac activity and identifying reversible causes such as pericardial tamponade. There is no agreed guideline on how to safely and effectively incorporate PoCUS into the advanced cardiac life support (ACLS) algorithm. We consider that a consensus-based priority checklist using a “4 F’s” approach (Fluid; Form; Function; Filling), would provide a better algorithm during ACLS. Methods: The ultrasound subcommittee of the Australasian College for Emergency Medicine (ACEM) drafted a checklist incorporating PoCUS into the ACLS algorithm. This was further developed using the input of 24 international experts associated with five professional organizations led by the International Federation of Emergency Medicine. A modified Delphi tool was developed to reach an international consensus on how to integrate ultrasound into cardiac arrest algorithms for emergency department patients. Results: Consensus was reached following 3 rounds. The agreed protocol focuses on the timing of PoCUS as well as the specific clinical questions. Core cardiac windows performed during the rhythm check pause in chest compressions are the sub-xiphoid and parasternal cardiac views. Either view should be used to detect pericardial fluid, as well as examining ventricular form (e.g. right heart strain) and function, (e.g. asystole versus organized cardiac activity). Supplementary views include lung views (for absent lung sliding in pneumothorax and for pleural fluid), and IVC views for filling. Additional ultrasound applications are for endotracheal tube confirmation, proximal leg veins for DVT, or for sources of blood loss (AAA, peritoneal/pelvic fluid). Conclusion: The authors hope that this process will lead to a consensus-based SHoC-cardiac arrest guideline on incorporating PoCUS into the ACLS algorithm.
We present the first snow/ice chemistry and ice radar results ever collected from South Georgia as part of an initial reconnaissance with the ultimate goal of assessing the feasibility of a South Georgia ice core to reconstruct past climate in the South Atlantic. South Georgia is well situated to capture a record of past atmospheric chemical composition over the South Atlantic and of past variability in the position and intensity of the austral westerlies. The question is how well preserved an ice core record can be recovered from a region experiencing accelerated melting? The results presented in this paper offer only a preliminary step in determining the feasibility of future deep ice coring on South Georgia. However, this initial reconnaissance does provide some basic information including: the chemistry of the atmosphere over South Georgia relative to other Southern Hemisphere ice coring sites; the potential for preservation of ‘annual layers’ in old ice on the island; a possible age for deep ice in the region; and an estimate of glacier health in the lower elevation regions of the island.
One of the largest and longest Salmonella outbreaks in Germany within the last 10 years occurred in central Germany in 2013. To identify vehicles of infection, we analysed surveillance data, conducted a case-control study and food traceback. We identified 267 cases infected with Salmonella Infantis with symptom onset between 16 April and 26 October 2013 in four neighbouring federal states. Results of our study indicated that cases were more likely to have eaten raw minced pork from local butcher's shops [odds ratio (OR) 2·5, 95% confidence interval (CI) 1·1–5·8] and have taken gastric acid-reducing or -neutralizing medication (OR 3·8, 95% CI 1·3–13) than controls. The outbreak was traced back to contaminated raw pork products found in different butcher's shops supplied by one slaughterhouse, to pigs at one farm and to an animal feed producer. Characterization of isolates of human, food, animal, feed, and environmental origin by phage-typing and pulsed-field gel electrophoresis confirmed the chain of infection. Insufficient hygiene standards in the slaughterhouse were the most probable cause of the ongoing transmission. We recommend that persons taking gastric acid suppressants should refrain from consuming raw pork products. Improving and maintaining adequate hygiene standards and process controls during slaughter is important to prevent future outbreaks.
Crossbreeding, considering either terminal or rotational crossing, synthetic breed creation or breed replacement, is often promoted as an efficient strategy to increase farmers’ income through the improvement of productivity of local livestock in developing countries. Sustainability of crossbreeding is however frequently challenged by constraints such as poor adaptation to the local environment or lack of logistic support. In this review, we investigate factors that may influence the long-term success or the failure of crossbreeding programs, based on the scientific literature and country reports submitted for The Second Report on the State of the World’s Animal Genetic Resources for Food and Agriculture. Crossbreeding activities vary widely across species and countries. Its sustainability is dependent on different prerequisites such as continual access to adequate breeding stock (especially after the end of externally funded crossbreeding projects), the opportunity of improved livestock to express their genetic potential (e.g. through providing proper inputs) and integration within a reliable market chain. As formal crossbreeding programs are often associated with adoption of other technologies, they can be a catalyst for innovation and development for smallholders. Given the increasing global demand for animal products, as well as the potential environmental consequences of climate change, there is a need for practical research to improve the implementation of long-term crossbreeding programs in developing countries.
There is an urgent need to understand how climate change, including sea-level rise, is likely to threaten biodiversity and cause secondary effects, such as agro-ecosystem alteration and human displacement. The consequences of climate change, and the resulting sea-level rise within the Forests of East Australia biodiversity hotspot, were modelled and assessed for the 2070–2099 period. Climate change effects were predicted to affect c. 100000 km2, and a rise in sea level an area of 860 km2; this could potentially lead to the displacement of 20600 inhabitants. The two threats were projected to mainly affect natural and agricultural areas. The greatest conservation benefits would be obtained by either maintaining or increasing the conservation status of areas in the northern (Wet Tropics) or southern (Sydney Basin) extremities of the hotspot, as they constitute about half of the area predicted to be affected by climate change, and both areas harbour high species richness. Increasing the connectivity of protected areas for Wet Tropics and Sydney Basin species to enable them to move into new habitat areas is also important. This study provides a basis for future research on the effects on local biodiversity and agriculture.
Whose responsibility is it to tackle climate change? ‘Everyone’s and no one’s’, we might glibly reply. Responsibility is diffused across scales, social groups, sectors, countries and generations. The causes of climate change are implicated in everyday acts of production and consumption and relate to the ways in which societies organise their transportation, housing, energy, water and food systems. Recognising the complex and diffuse agencies and authorities that address climate change, the world of climate politics is no longer limited to the activities of national governments, international organisations and interstate bargaining between states. Increasingly, subnational governments, non-governmental organisations, businesses and individuals are taking responsibility into their own hands, experimenting with bold new approaches to the governance of climate change (Betsill & Bulkeley 2004; Andonova, Betsill & Bulkeley 2009; Selin & VanDeveer 2009b; Bulkeley & Newell 2010; Hoffmann 2011; Bulkeley et al. 2013). The governance of climate change now takes a seemingly bewildering array of forms: carbon markets, certification standards, voluntary workplace schemes, emissions registries, carbon labelling, urban planning codes and so on. Critical to this transformation of the politics of climate change has been the emergence of new forms of transnational governance that cut across traditional state-based jurisdictions, operate across public-private divides and seek to develop new approaches and techniques through which responses are developed. What sets these initiatives apart from other forms of transnational relations is how they not only influence others, but also how they directly intervene in the governing of global affairs in ways that defy conventional understandings of international relations.
This chapter examines the political dynamics underpinning the emergence of TCCG. In the first section of the chapter, we undertake a temporal analysis of the growth of TCCG, focusing on its parallel evolution with the international climate change regime and the broader political-economic shifts outlined in the previous chapter. In the second section of the chapter, our analysis turns to consider the patterns and drivers of private, hybrid and public transnational initiatives over time and to consider the governance functions that are being pursued in these different forms of TCCG. Through this analysis, we seek to capture the process through which climate politics has pluralised by describing and offering explanations for the growth of institutional diversity over time.
In doing so, the three theoretical lenses discussed in Chapter 3 serve as guides for our analysis. The agency-centred perspective is particularly helpful for highlighting the interests of the actors that populate climate politics, their sources of influence and factors underpinning the demand and supply of new forms of transnational governance. The social and system dynamics perspective helps to explain the diffusion of common practices and governance techniques through communities of environmental practitioners and policymakers. Finally, the critical political theory perspective sheds light on the marketisation of a substantial cluster of TCCG initiatives, the ideological underpinnings of these initiatives and the particular constellations of public and private forces that animate them. We use the TCCG database and illustrative case-studies to interrogate these issues illuminating the relationship between the agency of different actors, market logics, functional imperatives and normative contexts.
Our knowledge of transnational governance has been fundamentally shaped by the theoretical perspectives and methodological approaches that have been used to study it (O’Neill et al. 2013, 444). Primarily using a case-study approach revolving around a few high-profile examples, research on transnational governance has focused on the ways in which actors have sought to engage with different forms of transnational governance, the various functions that such arrangements seek to perform and their potential consequences in terms of legitimacy and effectiveness. Such approaches have yielded significant insights into these aspects of transnational governance but cannot, by their very nature, achieve a more comprehensive or systematic view. As O’Neill et al. (2013) suggest, such approaches may be ill-equipped to deal with the challenges of ‘complexity and uncertainty, vertical linkages across multiple scales, horizontal linkages across issue areas, and (often rapidly) evolving problem sets and institutional initiatives’ that beset global environmental governance research, such that new methodological approaches are required. If we regard transnational governance initiatives as having something in common – in terms of what they are seeking to accomplish, or in terms of the ways in which they are organised and constituted – we suggest that methodological innovations capable of creating a more comprehensive account of the overall phenomenon are required.
In order to develop such a broader understanding of the extent and nature of transnational governance in the climate change domain, our approach extends beyond small n case-studies or surveys of one particular type of transnational arrangement through the construction and analysis of a database of sixty transnational climate governance initiatives. This approach enables an analysis of the contours of transnational climate governance in a way that has not been possible within existing methodological approaches, allowing for a more thorough description of who and what are involved, where it is taking place, and how and why it is being pursued.