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There is evidence for the cost-effectiveness of health visitor (HV) training to assess postnatal depression (PND) and deliver psychological approaches to women at risk of depression. Whether this approach is cost-effective for lower-risk women is unknown. There is a need to know the cost of HV-delivered universal provision, and how much it might cost to improve health-related quality of life for postnatal women. A sub-study of a cluster-randomised controlled trial in the former Trent region (England) previously investigated the effectiveness of PoNDER HV training in mothers at lower risk of PND. We conducted a parallel cost-effectiveness analysis at 6-months postnatal for all mothers with lower-risk status attributed to an Edinburgh Postnatal Depression Scale (EPDS) score <12 at 6-weeks postnatal.
Intervention HVs were trained in assessment and cognitive behavioural or person-centred psychological support techniques to prevent depression. Outcomes examined: quality-adjusted life-year (QALY) gains over the period between 6 weeks and 6 months derived from SF-6D (from SF-36); risk-of-depression at 6 months (dichotomising 6-month EPDS scores into lower risk (<12) and at-risk (⩾12).
In lower-risk women, 1474 intervention (63 clusters) and 767 control participants (37 clusters) had valid 6-week and 6-month EPDS scores. Costs and outcomes data were available for 1459 participants. 6-month adjusted costs were £82 lower in intervention than control groups, with 0.002 additional QALY gained. The probability of cost-effectiveness at £20 000 was very high (99%).
PoNDER HV training was highly cost-effective in preventing symptoms of PND in a population of lower-risk women and cost-reducing over 6 months.
Through this study we aimed to assess the educational level and employment status of adults with CHD in Germany.
Data were acquired from an online survey carried out in 2015 by the German National Register for Congenital Heart Defects. A total of 1458 adults with CHD participated in the survey (response rate: 37.6%). For 1198 participants, detailed medical information, such as main cardiac diagnosis and information from medical reports, was available.
Of the participants surveyed (n=1198), 54.5% (n=653) were female, and the mean age was 30 years. The majority of respondents (59.4%) stated that they had high education levels and that they were currently employed (51.1%). Patients with simple CHD had significantly higher levels of education (p<0.001) and were more likely to be employed (p=0.01) than were patients with complex CHD.
More than half of the participants had high education levels and the majority were employed. The association between CHD and its severity and individuals’ educational attainment should be investigated more closely in future studies.
Exercise during pregnancy has beneficial effects on maternal and offspring’s health in humans and mice. The underlying mechanisms remain unclear. This comparative study aimed to determine the long-term effects of an exercise program on metabolism, weight gain, body composition and changes in hormones [insulin, leptin, brain-derived neurotrophic factor (BDNF)]. Pregnant women (n=34) and mouse dams (n=44) were subjected to an exercise program compared with matched controls (period I). Follow-up in the offspring was performed over 6 months in humans, corresponding to postnatal day (P) 21 in mice (period II). Half of the mouse offspring was challenged with a high-fat diet (HFD) for 6 weeks between P70 and P112 (period III). In period I, exercise during pregnancy led to 6% lower fat content, 40% lower leptin levels and an increase of 50% BDNF levels in humans compared with controls, which was not observed in mice. After period II in humans and mice, offspring body weight did not differ from that of the controls. Further differences were observed in period III. Offspring of exercising mouse dams had significantly lower fat mass and leptin levels compared with controls. In addition, at P112, BDNF levels in offspring were significantly higher from exercising mothers while this effect was completely blunted by HFD feeding. In this study, we found comparable effects on maternal and offspring’s weight gain in humans and mice but different effects in insulin, leptin and BDNF. The long-term potential protective effects of exercise on biomarkers should be examined in human studies.
The results of extensive experimental testing of an aero-engine air-oil separator are presented and discussed. The study focuses on the pressure loss of the system. Oil enters the device in the form of dispersed droplets. Subsequently, separation occurs by centrifuging larger droplets towards the outer walls and by film formation at the inner surface of a rotating porous material, namely an open-cell metal foam. The work described here is part of a study led jointly by the Karlsruhe Institute of Technology (KIT) and the University of Nottingham (UNott) within a recent EU project.
The goal of the research is to increase the separation efficiency to mitigate oil consumption and emissions, while keeping the pressure loss as low as possible. The aim is to determine the influencing factors on pressure loss and separation efficiency. With this knowledge, a correlation can eventually be derived. Experiments were conducted for three different separator configurations, one without a metal foam and two with metal foams of different pore sizes. For each configuration, a variety of engine-like conditions of air mass flow rate, rotational speed and droplet size was investigated. The experimental results were used to validate and improve the numerical modelling.
Results for the pressure drop and its dependencies on air mass flow rate and the rotational speed were analysed. It is shown that the swirling flow and the dissipation of angular momentum are the most important contributors to the pressure drop, besides the losses due to friction and dissipation caused by the flow passing the metal foam. It was found that the ratio of the rotor speed and the tangential velocity of the fluid is an important parameter to describe the influence of rotation on the pressure loss. Contrary to expectations, the pressure loss is not necessarily increased with a metal foam installed.
The present study investigated the population dynamics of Exhippolysmata oplophoroides in an area influenced by upwelling, focusing on reproductive period, sex ratio, growth rate, longevity, mortality, relative growth and size of sex change. We also tested the hypothesis that the appendices internae increased in size with sex change from the male to the simultaneous hermaphrodite phase as possible replacements for the male appendices masculinae, which are reduced or lost at sex change. Population structure was assessed by the distribution of size frequency in three demographic groups: male phase, hermaphrodite phase with, and without embryos. For relative growth analysis, the length of the following structures was measured: carapace, second pleuron, first pereopod, second pereopod, appendices internae of the second to fifth pleopods, and appendix masculina. Smaller size classes were composed only by male-phase individuals. The sex ratio was significantly biased towards the simultaneous hermaphrodite phase. Reproduction was continuous in the population throughout the year. Slower growth rates but higher maximum body sizes than those estimated at other locations in south-eastern Brazil were observed in the population studied. Cooler temperatures and higher nutrient levels associated with upwelling may have produced this pattern of reproduction and growth, similar to that found in more southerly austral latitudes. We also found that sex change influences the relative growth of body structures such as the second pereopods, appendices internae, and appendix masculina, and hypotheses on the adaptive value of such allometric growth are proposed.
Most patients born with CHD nowadays reach adulthood, and thus quality of life, life situation, and state of medical care aspects are gaining importance in the current era. The present study aimed to investigate whether patients’ assessment depends on their means of occupation. The findings are expected to be helpful in optimising care and for developing individual treatment plans.
The present study was based on an online survey conducted in cooperation with patient organisations. Participants were recruited from the database of the German National Register for Congenital Heart Defects. In total, 1828 individuals (777 males, 1051 females) took part. Participants were asked to rate aspects such their state of health on a six-tier scale (1=worst specification). Response behaviour was measured against the background of occupational details.
Training for or pursuing a profession was found to be significantly associated with participants’ rating of five of the six examined aspects (p<0.05). Sex seemed to play an important part in four of the six aspects.
An optimal treatment plan for adults with CHD should always consider aspects such as sex and employment status. To work out such an optimal and individual treatment plan for each adult CHD patient, an objective tool to measure patients’ actual CHD-specific knowledge precluding socially accepted response bias would be very useful.
The Dark Energy Survey is undertaking an observational programme imaging 1/4 of the southern hemisphere sky with unprecedented photometric accuracy. In the process of observing millions of faint stars and galaxies to constrain the parameters of the dark energy equation of state, the Dark Energy Survey will obtain pre-discovery images of the regions surrounding an estimated 100 gamma-ray bursts over 5 yr. Once gamma-ray bursts are detected by, e.g., the Swift satellite, the DES data will be extremely useful for follow-up observations by the transient astronomy community. We describe a recently-commissioned suite of software that listens continuously for automated notices of gamma-ray burst activity, collates information from archival DES data, and disseminates relevant data products back to the community in near-real-time. Of particular importance are the opportunities that non-public DES data provide for relative photometry of the optical counterparts of gamma-ray bursts, as well as for identifying key characteristics (e.g., photometric redshifts) of potential gamma-ray burst host galaxies. We provide the functional details of the DESAlert software, and its data products, and we show sample results from the application of DESAlert to numerous previously detected gamma-ray bursts, including the possible identification of several heretofore unknown gamma-ray burst hosts.
First 405 GHz and 212 GHz solar flare observations were obtained during short campaigns while the new solar submillimeter-wave telescope (SST) was still undergoing adjustments at the CASLEO El Leoncito observatory in the Argentina Andes. We show here preliminary results for a large X1.1 class X-ray event occurred on 2000 March 22, which exhibited a small submm-w continuum response to the slow (minutes) bulk flare emission, and numerous subsecond spikes (100-300 ms), the brightest spikes reaching about 180 and 50 s.f.u. at 405 and 212 GHz, respectively.
Ketamine and non-ketamine N-methyl-d-aspartate receptor antagonists (NMDAR antagonists) recently demonstrated antidepressant efficacy for the treatment of refractory depression, but effect sizes, trajectories and possible class effects are unclear.
We searched PubMed/PsycINFO/Web of Science/clinicaltrials.gov until 25 August 2015. Parallel-group or cross-over randomized controlled trials (RCTs) comparing single intravenous infusion of ketamine or a non-ketamine NMDAR antagonist v. placebo/pseudo-placebo in patients with major depressive disorder (MDD) and/or bipolar depression (BD) were included in the analyses. Hedges’ g and risk ratios and their 95% confidence intervals (CIs) were calculated using a random-effects model. The primary outcome was depressive symptom change. Secondary outcomes included response, remission, all-cause discontinuation and adverse effects.
A total of 14 RCTs (nine ketamine studies: n = 234; five non-ketamine NMDAR antagonist studies: n = 354; MDD = 554, BD = 34), lasting 10.0 ± 8.8 days, were meta-analysed. Ketamine reduced depression significantly more than placebo/pseudo-placebo beginning at 40 min, peaking at day 1 (Hedges' g = −1.00, 95% CI −1.28 to −0.73, p < 0.001), and loosing superiority by days 10–12. Non-ketamine NMDAR antagonists were superior to placebo only on days 5–8 (Hedges' g = −0.37, 95% CI −0.66 to −0.09, p = 0.01). Compared with placebo/pseudo-placebo, ketamine led to significantly greater response (40 min to day 7) and remission (80 min to days 3–5). Non-ketamine NMDAR antagonists achieved greater response at day 2 and days 3–5. All-cause discontinuation was similar between ketamine (p = 0.34) or non-ketamine NMDAR antagonists (p = 0.94) and placebo. Although some adverse effects were more common with ketamine/NMDAR antagonists than placebo, these were transient and clinically insignificant.
A single infusion of ketamine, but less so of non-ketamine NMDAR antagonists, has ultra-rapid efficacy for MDD and BD, lasting for up to 1 week. Development of easy-to-administer, repeatedly given NMDAR antagonists without risk of brain toxicity is of critical importance.
Approximately 6000 children are born with CHD in Germany each year. It is increasingly rare that these children die from their chronic illness. In the present study, data recorded in the National Register for Congenital Heart Defects with respect to the prevalence of specific lesions and sex distribution are compared with that recorded in a published German prevalence study (Prevalence Study) and with the meta-analysis by van der Linde et al.
A descriptive data analysis was performed using a minimal data set. The demographic data included sex and birth year; the medical data comprised the cardiovascular diagnosis according to the short list of the International Paediatric and Congenital Cardiac Code.
As the data analysis shows, the National Register is a clinical register including primarily clinical cases/cases relevant to healthcare. The prevalence values and sex ratios recorded in the register are closer to the values given in the literature than those determined by the Prevalence Study. Severe CHD was slightly over-represented in the National Register compared with the van der Linde et al meta-analysis. The deviations with respect to prevalence values are within an acceptable range.
With its 48,000 patients, the National Register plays a unique and important role for research in the field of CHD. Samples from the National Register can be used as a gold standard for future studies, as the patient population registered in it can be considered representative of CHD in Germany and Europe.
Pet owners desire treats with adequate nutritional profiles, functional benefits, long-lasting properties and an interactive nature. Therefore, it is pivotal to understand the digestion characteristics of treats produced by different processing methods and having variable nutritional composition. The objective of the present study was to measure in vitro disappearance characteristics of selected categories of commercially available treats. In vitro procedures developed by Boisen and Eggum in 1991 were modified to handle larger sample sizes. Treat samples were evaluated in triplicate. Following incubation, in vitro DM disappearance (DMD) was calculated. In vitro DMD of selected treats varied widely. For the gastric phase, DMD ranged from 6·9 to 88·8 %, whereas intestinal phase digestion resulted in a DMD range of 10·7–100·0 % (P < 0·05). Because of differences in treat composition and size, they were divided into six categories: Biscuit, Bone, Chew, Dental, Meat Product and Rawhide. In general, Bone was the least digestible treat category in both gastric and intestinal phases. Meat Product and Rawhide treats had a DMD of 71·5–100 % after the intestinal phase, whereas Biscuit had values above 93 %. Chew and Dental treats had a wide DMD range (54·5–100 %). Understanding the DMD of commercially available treats is important to verify their safety for consumption and potential digestibility once ingested. These data indicate wide variation in DMD among and within different treat categories. This information will assist pet food sale associates, pet owners and veterinarians to make more educated decisions when it relates to selection and recommendations about commercially available treats. Future work is needed to expand the knowledge on in vitro DMD and safety of treats and to further investigate their impact on in vivo DM digestibility once fed to dogs.
Depression in mothers during pregnancy and in the postnatal period has been recognized to have wide-ranging adverse impacts on offspring. Our study examines some of the outcomes and long-term economic implications experienced by offspring who have been exposed to perinatal depression.
We analysed the effects of perinatal depression on child development outcomes of children at ages 11 and 16 years from the community-based South London Child Development Study. Economic consequences were attached to those outcomes through simple decision-analytic techniques, building on evidence from studies of epidemiology, health-related quality of life, public sector costs and employment. The economic analysis takes a life-course perspective from the viewpoints of the public sector, individual and society.
Additional risks that children exposed to perinatal depression develop emotional, behavioural or cognitive problems ranged from 5% to 21%. In addition, there was a high risk (24%) that children would have special educational needs. We present results in the form of cost consequences attached to adverse child outcomes. For each child exposed to perinatal depression, public sector costs exceeded £3030, costs due to reduced earnings were £1400 and health-related quality of life loss was valued at £3760.
Action to prevent or treat mothers' depression during pregnancy and after birth is likely to reduce public sector costs, increase earnings and improve quality of life for children who were exposed to the condition.
We have studied Cu2S absorber layers prepared by physical vapor deposition (PVD) by calibrated spectral photoluminescence (PL) and by confocal PL as function of temperature T and excitation fluxes to obtain the absolute PL-yield at an excitation flux equivalent to the AM1.5 spectrum and to calculate the splitting of the quasi-Fermi levels (QFL) µ = Ef,n-Ef,p and the absorption coefficient α(E), both in the temperature range 20 K ≤ T ≤ 400 K. The PL-spectra reveal two peaks at E1 = 1.17 eV and E2 = 1.3 eV, of which the low energy peak is only detectable at temperatures T < 200 K. The samples show an impressive QFL-splitting of µ > 700 meV at 300 K associated with a pseudo band gap of Eg = 1.25 eV. The high energy peak shows an unexpected temperature behavior, namely an increase of the PL-yield with rising temperature at variance with the behavior of QFL-splitting that decreases with rising T from extrapolated T = 0K value of µ = 1.3 eV. The PL-yield versus temperature will be discussed in terms of different defect states in the band gap. Our observations indicate that, contrary to common believe, it is not the PL-yield, but rather the QFL-splitting that is the comprehensive indicator of the quality of the excited state in an illuminated semiconductor. A further examination of the lateral variation of the opto-electronic properties by confocal PL shows a strong correlation between the QFL-splitting, the Urbach energy EU and the optical band gap Eopt, respectively.
Little is known about political polarization in German public opinion. This article offers an issue-based perspective and explores trends of opinion polarization in Germany. Public opinion polarization is conceptualized and measured as alignment of attitudes. Data from the German General Social Survey (1980 to 2010) comprise attitudes towards manifold issues, which are classified into several dimensions. This study estimates multilevel models that reveal general and issue- as well as dimension-specific levels and trends in attitude alignment for both the whole German population and sub-groups. It finds that public opinion polarization has decreased over the last three decades in Germany. In particular, highly educated and more politically interested people have become less polarized over time. However, polarization seems to have increased in attitudes regarding gender issues. These findings provide interesting contrasts to existing research on the American public.
Neuroimaging studies have demonstrated an association between lithium (Li) treatment and brain structure in human subjects. A crucial unresolved question is whether this association reflects direct neurochemical effects of Li or indirect effects secondary to treatment or prevention of episodes of bipolar disorder (BD).
To address this knowledge gap, we compared manually traced hippocampal volumes in 37 BD patients with at least 2 years of Li treatment (Li group), 19 BD patients with <3 months of lifetime Li exposure over 2 years ago (non-Li group) and 50 healthy controls. All BD participants were followed prospectively and had at least 10 years of illness and a minimum of five episodes. We established illness course and long-term treatment response to Li using National Institute of Mental Health (NIMH) life charts.
The non-Li group had smaller hippocampal volumes than the controls or the Li group (F2,102 = 4.97, p = 0.009). However, the time spent in a mood episode on the current mood stabilizer was more than three times longer in the Li than in the non-Li group (t51 = 2.00, p = 0.05). Even Li-treated patients with BD episodes while on Li had hippocampal volumes comparable to healthy controls and significantly larger than non-Li patients (t43 = 2.62, corrected p = 0.02).
Our findings support the neuroprotective effects of Li. The association between Li treatment and hippocampal volume seems to be independent of long-term treatment response and occurred even in subjects with episodes of BD while on Li. Consequently, these effects of Li on brain structure may generalize to patients with neuropsychiatric illnesses other than BD.