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Background: Standardized magnetic resonance imaging (MRI) guidelines published in 2015 by the Europoean MAGNIMS group and in 2016 by the CMSC are important for the diagnosis and monitoring of patients with multiple sclerosis (MS) and for the appropriate use of MRI in routine clinical practice. Methods: Two panels of experts convened to update existing guidelines for a standardized MRI protocol. The MAGNIMS panel convened in Graz, Austria in April 2019. The CMSC NAIMS panel met separately and independently in Newark, USA in October 2019. Subsequently, the MAGNIMS, NAIMS, and CMSC working groups combined their efforts to reach an international consensus Results: The revised guidelines on MRI in MS merges recommendations from MAGNIMS, CMSC, and NAIMS to improve the use of MRI for diagnosis, prognosis and monitoring of individuals with MS. 3D acquisitions are emphasized for optimal comparison over time. Core brain sequences include a 3D-T2wFLAIR for lesion identification and monitoring treatment effectiveness. Gadolinium-based contrast is recommended for diagnostic studies and judicious use for routine monitoring of MS patients. DWI sequences are recommended for PML safety monitoring. Conclusions: The international consensus guidelines strive for global acceptance of a useful and usable standard of care for patients with MS.
Fosamine ammonium (Krenite®) is a foliar herbicide that primarily targets woody plant species; however, formal evaluations of its efficacy and potential for non-target impacts are scarce in the literature. The few tests of fosamine ammonium that exist focus primarily on its use in open environments, and the value of fosamine ammonium in controlling invasive understory shrubs is unclear. Here, we test the impact of fosamine ammonium on invasive common buckthorn (Rhamnus cathartica L.) and co-occurring herbaceous plants across six forest sites in Minnesota, USA. Rhamnus cathartica treated with fosamine ammonium had a 95% mortality rate, indicating high efficacy of fosamine ammonium for use against R. cathartica. Non-target impacts varied between forbs and graminoids such that forb cover was reduced by up to 85%, depending on site, whereas graminoid cover was sparse and impacts of fosamine ammonium on graminoids were unclear. These results indicate that while fosamine ammonium can provide effective control of R. cathartica and other understory shrubs, there is potential for significant non-target impacts following its use. We therefore suggest that land managers carefully consider the timing, rate, and application method of fosamine ammonium to achieve desired target and non-target impacts.
A relatively small proportion of patients account for a disproportionate share of healthcare utilization and cost with, on average, 1% of patients responsible for 20-25% of cost, 5% of patients for 40% and 10% for two thirds. These “high-utilizers” frequently suffer from co-morbid medical and psychiatric illnesses, but they are not well characterized in terms of diagnoses, current treatment patterns, or long-term outcomes. We sought to characterize further such patients at a large inner city acute care hospital.
We applied a validated tool, Patients At Risk for Re-hospitalization, to the entire hospital population and then performed a mixed methods (quantitative/qualitative) study of 100 patients judged to be at high risk (>67%) of re-hospitalization during the ensuing year.
Of over 130,000 patients, 6,000 were identified. These individuals were overwhelmingly non-elderly adults (96% ages 18-64). Most common medical diagnoses were hypertension (49%), asthma (41%), diabetes (33%), and HIV/AIDS (32%). Schizophrenia, bipolar illness, or other psychosis was found in 48%. Over two-thirds had substance abuse diagnoses. Although 56% had made at least one emergency department visit in the past two years, only 37% had seen a primary care provider. Patient interviews revealed high rates of unstable housing, social isolation, and failure to appreciate the severity of health problems.
High utilizers of general health care have very high rates of serious mental illness and substance abuse. Interviews suggest need for improved medical/psychiatric coordination with community outreach. Although such interventions are resource intense, the economic and health benefits may be large.
A diverse Permian crinoid fauna is reported from the Taiyuan Formation, Dajian Member (Asselian) at Anyang, northeastern Henan Province of the North China Craton. The specimens are well preserved, including articulated crowns and cups. The fauna contains representatives of each of the major Paleozoic crinoid clades: Cladida (including the Flexibilia), Disparida, and Camerata. Identified genera suggest a greater affinity with North American faunas than with Tethyan faunas. Four new species, Neoprotencrinus anyangensis, Ulocrinus qiaoi, Artichthyocrinus limani, and Synbathocrinus chenae, are proposed herein.
Striving better to uncover causal effects, political science is amid a revolution in micro-empirical research designs and experimental methods. This methodological development—although quite promising in delivering new findings and discovering the mechanisms that underlie previously known associations—raises new and unnerving ethical issues that have yet to be confronted by our profession. We believe that addressing these issues proactively by generating strong, internal norms of disciplinary regulation is preferable to reactive measures, which often come in the wake of public exposés and can lead to externally imposed regulations or centrally imposed internal policing.
Weeds are often spatially aggregated in maize fields, and the level of
aggregation varies across and within fields. Several annual weed species are
present in maize fields before postemergence herbicide application, and
herbicides applied will control several species at a time. The goal of this
study was to assess the spatial distribution of multispecies weed
infestation in maize fields. Ground-based imagery was used to map weed
infestations in rain-fed maize fields. Image segmentation was used to
extract weed cover information from geocoded images, and an expert-based
threshold of 0.102% weed cover was used to generate maps of weed
presence/absence. From 19 site-years, 13 (68%) demonstrated a random spatial
distribution, whereas six site-years demonstrated an aggregated spatial
pattern of either monocotyledons, dicotyledons, or both groups. The results
of this study indicated that monocotyledonous and dicotyledonous weed groups
were not spatially segregated, but discriminating these weed groups slightly
increased the chances of detecting an aggregated pattern. It was concluded
that weeds were not always spatially aggregated in maize fields. These
findings emphasize the need for techniques allowing the assessment of weed
aggregation prior to conducting site-specific weed management.
Despite the commonly held belief that there is a high degree of intergenerational continuity in maltreatment, studies to date suggest a mixed pattern of findings. One reason for the variance in findings may be related to the measurement approach used, which includes a range of self-report and official indicators of maltreatment and both cross-sectional and longitudinal designs. This study attempted to shed light on the phenomenon of intergenerational continuity of maltreatment by examining multiple indicators of perpetration of maltreatment in young adults and multiple risk factors across different levels within an individual's social ecology. The sample included 166 women who had been placed in out-of-home care as adolescents (>85% had a substantiated maltreatment incident) and followed into young adulthood, and included three waves of adolescent data and six waves of young adult data collected across 10 years. The participants were originally recruited during adolescence as part of a randomized controlled trial examining the efficacy of the Treatment Foster Care Oregon intervention. Analyses revealed weak to modest associations among the three indicators of perpetration of maltreatment in young adulthood, that is, official child welfare records, self-reported child welfare system involvement, and self-reported maltreatment (r = .03–.51). Further, different patterns of prediction emerged as a function of the measurement approach. Adolescent delinquency was a significant predictor of subsequent self-reported child welfare contact, and young adult partner risk was a significant predictor of perpetration of maltreatment as indexed by both official child welfare records and self-reported child welfare contact. In addition, women who were originally assigned to the intervention condition reported perpetrating less maltreatment during young adulthood. Implications for measurement and interventions related to reducing the risk for intergenerational transmission of risk are discussed.
It is clinically important to understand the factors that increase the likelihood of the frequent and recurrent suicide attempts seen in those with borderline personality disorder (BPD). Although several studies have examined this subject in a cross-sectional manner, the aim of this study was to determine the most clinically relevant baseline and time-varying predictors of suicide attempts over 16 years of prospective follow-up among patients with BPD.
Two-hundred and ninety in-patients meeting Revised Diagnostic Interview for Borderlines (DIB-R) and DSM-III-R criteria for BPD were assessed during their index admission using a series of semistructured interviews and self-report measures. These subjects were then reassessed using the same instruments every 2 years. The generalized estimating equations (GEE) approach was used to model the odds of suicide attempts in longitudinal analyses, controlling for assessment period, yielding an odds ratio (OR) and 95% confidence interval (CI) for each predictor.
Nineteen variables were found to be significant bivariate predictors of suicide attempts. Eight of these, seven of which were time-varying, remained significant in multivariate analyses: diagnosis of major depressive disorder (MDD), substance use disorder (SUD), post-traumatic stress disorder (PTSD), presence of self-harm, adult sexual assault, having a caretaker who has completed suicide, affective instability, and more severe dissociation.
The results of this study suggest that prediction of suicide attempts among borderline patients is complex, involving co-occurring disorders, co-occurring symptoms of BPD (self-harm, affective reactivity and dissociation), adult adversity, and a family history of completed suicide.
Foot-and-mouth disease (FMD) is one of the most serious transboundary, contagious viral diseases of cloven-hoofed livestock, because it can spread rapidly with high morbidity rates when introduced into disease-free herds or areas. Epidemiological simulation modeling can be developed to study the hypothetical spread of FMD and to evaluate potential disease control strategies that can be implemented to decrease the impact of an outbreak or to eradicate the virus from an area. Spatial analysis, a study of the distributions of events in space, can be applied to an area to investigate the spread of animal disease. Hypothetical FMD outbreaks can be spatially analyzed to evaluate the effect of the event under different control strategies. The main objective of this paper is to review FMD-related articles on FMD epidemiology, epidemiological simulation modeling and spatial analysis with the focus on disease control. This review will contribute to the development of models used to simulate FMD outbreaks under various control strategies, and to the application of spatial analysis to assess the outcome of FMD spread and its control.
Methods for the analysis of the joint transmission of two phenotypes are described and used to determine the extent to which lipoprotein concentrations share a common genetic and/or environmental background. Analysis of data on 160 Caucasian nuclear families revealed that the observed phenotypic association between high-density cholesterol (HDL) and low-density cholesterol (LDL) could be accounted for in terms of common family environmental effects alone (estimated genetic correlation, ρG = −0·132±0·136; estimated residual environmental correlation, ρR = 0·065±0·230). The association between HDL and very-low-density cholesterol (VLDL) could not be accounted for in terms of family environmental effects alone. For HDL and VLDL the residual environmental correlation was significant while the genetic correlation was not (ρG = −0·111±0·214, ρR = −0·421±0·172). The correlation between LDL and VLDL also could not be accounted for in terms of common family environmental effects alone, although here a genetic relationship appears to be the important factor (ρG = 0·330±0·192, ρR = 0·010±0·217).
As part of the Canadian Galactic Plane Survey (CGPS) we have imaged the polarized emission from the plane of the Milky Way at 1420 MHz, covering 1200 square degrees with arc-minute resolution. Structure on all scales is represented by combining aperture-synthesis data with single-antenna data. The survey depicts the Magneto-Ionic Medium at a resolution that matches images of other components of the Interstellar Medium within the CGPS database (http://www4.cadc.hia.nrc.gc.ca).
The Global Magneto-Ionic Medium Survey (GMIMS) is a project to map the diffuse polarized emission over the entire sky, Northern and Southern hemispheres, from 300 MHz to 1.8 GHz. With an angular resolution of 30–60 arcmin and a frequency resolution of 1 MHz or better, GMIMS will provide the first spectro-polarimetric data set of the large-scale polarized emission over the entire sky, observed with single-dish telescopes. GMIMS will provide an invaluable resource for studies of the magneto-ionic medium of the Galaxy in the local disk, halo, and its transition.
The prevalence and frequency of comorbidity of possible bipolar disorder was examined with attention-deficit hyperactivity disorder (ADHD) in a nonreferred population of twins. Children and adolescents aged 7 to 18 years with a history of manic symptoms were identified from a population-based twin sample obtained from state birth records (n = 1610). The sample was enriched for ADHD; however, there was also a random control sample (n = 466), which allowed a look at the population prevalence of the disorder. Juveniles with threshold or below threshold manic episodes were further assessed for comorbidity with Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) and population-defined ADHD subtypes (from latent class analysis) using Fisher's exact test. Nine juveniles who exhibited DSM-IV manic (n = 1), hypomanic (n = 2) or below threshold episodes (n = 6) were identified. The population prevalence of broadly defined mania in the random sample was 0.2%. The possible manic episodes showed significant comorbidity with population-defined severe combined and talkative ADHD subtypes. It can be concluded that there is a significant association of bipolar symptoms with two population-defined subtypes of ADHD. Episodes of possible bipolar disorders as defined by DSM-IV are uncommon in this nonreferred sample. Children and adolescents with ADHD appear to be only modestly at increased risk for bipolar disorders.
The goal of this study is to determine the prevalence and age of onset of Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSMIV; American Psychiatric Association, 1994) and latent class-derived attention deficit/hyperactivity disorder (ADHD) subtypes in a population-based twin sample of boys and girls. Missouri birth records identified families with a twin pair 7 to 18 years of age. Telephone screening interviews for ADHD symptoms were completed for 5007 families. Diagnostic assessments were administered to 564 families with at least one twin meeting screening criteria, plus 183 control families. Prevalence and age of onset for both ADHD nosologies were calculated by sex and zygosity from parent report data. The prevalence of any DSM-IV ADHD was 6.2% overall, 7.4% in boys and 3.9% in girls. The inattentive subtype was most common in boys; the combined subtype was most common in girls. The mean age of onset of symptoms in children with any DSM-IV ADHD was 3.5 years, with no significant differences between boys and girls. Prevalences of latent class defined ADHD subtypes also varied by sex with the severe inattentive and combined classes more common in boys than girls. The age of onset of symptoms did not differ between boys and girls but were higher than in the DSM-IV subtypes. Findings in this twin sample showed that clinically significant ADHD, defined by either DSM-IV or latent class criterion, has an early age of onset and is more common in boys than girls. As clinical samples are most commonly composed of male combined subtypes, the inattentive subtype of both sexes in the general population is an under- treated segment of the general population.
Background. Genetic influences have been shown to play a major role in determining the risk of attention-deficit hyperactivity disorder (ADHD). In addition, prenatal exposure to nicotine and/or alcohol has also been suggested to increase risk of the disorder. Little attention, however, has been directed to investigating the roles of genetic transmission and prenatal exposure simultaneously.
Method. Diagnostic telephone interview data from parents of Missouri adolescent female twin pairs born during 1975–1985 were analyzed. Logistic regression models were fitted to interview data from a total of 1936 twin pairs (1091 MZ and 845 DZ pairs) to determine the relative contributions of parental smoking and drinking behavior (both during and outside of pregnancy) as risk factors for DSM-IV ADHD. Structural equation models were fitted to determine the extent of residual genetic and environmental influences on ADHD risk while controlling for effects of prenatal and parental predictors on risk.
Results. ADHD was more likely to be diagnosed in girls whose mothers or fathers were alcohol dependent, whose mothers reported heavy alcohol use during pregnancy, and in those with low birth weight. Controlling for other risk factors, risk was not significantly increased in those whose mothers smoked during pregnancy. After allowing for effects of prenatal and childhood predictors, 86% of the residual variance in ADHD risk was attributable to genetic effects and 14% to non-shared environmental influences.
Conclusions. Prenatal and parental risk factors may not be important mediators of influences on risk with much of the association between these variables and ADHD appearing to be indirect.