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Introduction: Depending on the time and day of initial Emergency Department (ED) presentation, some patients may require a return to the ED the following day for ultrasound examination. Return visits for ultrasound may be time and resource intensive for both patients and the ED. Qualitative experience suggests that a percentage of return ultrasounds could be performed at a non-ED facility. Our objective was to undertake a retrospective audit of return for ultrasound usage, patterns and outcomes at 2 academic EDs. Methods: A retrospective review of all adult patients returning to the ED for ultrasound at both LHSC ED sites in 2016 was undertaken. Each chart was independently reviewed by two emergency medicine consultants. Charts were assessed for day and time of initial presentation and return, type of ultrasound ordered, and length of ED stay on initial presentation and return visit. Opinion based questions were considered by reviewers, including urgency of diagnosis clarification required, if symptoms were still present on return, and if any medical or surgical treatment or follow up was arranged based on ultrasound results. Agreement between reviewers was assessed. Results: After eliminating charts for which the return visit was not for a scheduled ultrasound examination, 328 patient charts were reviewed. 63% of patients were female and median [IQR] age was 40 years [27-56]. Abdomen/pelvis represented 50% of the ultrasounds; renal 24%; venous Doppler 15.9%. Symptoms were still present and documented in 79% of cases. 22% of cases required a medical intervention and 9% an immediate surgical intervention. 11% of patients were admitted to hospital on their return visit. Outpatient follow-up based on US results was initiated in 29% of cases. Median [IQR] combined LOS was 479.5 minutes [358.5-621.75]. Agreement between reviewers for opinion based questions was poor (63%-96%). Conclusion: Ideally, formal ultrasound should be available on a 24 hour basis for ED patients in order to avoid return visits. A percentage of return for ultrasound examinations do not result in any significant change in treatment. Emergency departments should consider the development of pathways to avoid return visits for follow up ultrasound when possible. The low incidence of surgical treatment in those returning for US suggests that this population could be served in a non-hospital setting. Further research is required to support this conclusion.
The short-term impact of prolonged grief disorder (PGD) following bereavement is well documented. The longer term sequelae of PGD however are poorly understood, possibly unrecognized, and may be incorrectly attributed to other mental health disorders and hence undertreated.
The aims of this study were to prospectively evaluate the prevalence of PGD three years post bereavement and to examine the predictors of long-term PGD in a population-based cohort of bereaved cancer caregivers.
A cohort of primary family caregivers of patients admitted to one of three palliative care services in Melbourne, Australia, participated in the study (n = 301). Sociodemographic, mental health, and bereavement-related data were collected from the caregiver upon the patient's admission to palliative care (T1). Further data addressing circumstances around the death and psychological health were collected at six (T2, n = 167), 13 (T3, n = 143), and 37 months (T4, n = 85) after bereavement.
At T4, 5% and 14% of bereaved caregivers met criteria for PGD and subthreshold PGD, respectively. Applying the total PGD score at T4, linear regression analysis found preloss anticipatory grief measured at T1 and self-reported coping measured at T2 were highly statistically significant predictors (both p < 0.0001) of PGD in the longer term.
For almost 20% of caregivers, the symptoms of PGD appear to persist at least three years post bereavement. These findings support the importance of screening caregivers upon the patient's admission to palliative care and at six months after bereavement to ascertain their current mental health. Ideally, caregivers at risk of developing PGD can be identified and treated before PGD becomes entrenched.
Post-translocation monitoring is fundamental for assessing translocation success and identifying potential threats. We measured outcomes for four cohorts of tuatara Sphenodon punctatus translocated to warmer climates outside of their ecological region, to understand effects of climate warming. Translocation sites were on average 2–4 °C warmer than the source site. We used three short-term measures of success: survival, growth and reproduction. Data on recaptures, morphometric measurements, and reproduction were gathered over 2.5 years following release. Although decades of monitoring will be required to determine long-term translocation success in this species, we provide an interim measure of population progress and translocation site suitability. We found favourable recapture numbers, growth of founders and evidence of reproduction at most sites, with greater increases in body mass observed at warmer, less densely populated sites. Variable growth in the adult population at one translocation site suggested that higher population density, intraspecific competition, and lower water availability could be responsible for substantial weight loss in multiple individuals, and we make management recommendations to reduce population density. Overall, we found that sites with warmer climates and lower population densities were potentially beneficial to translocated tuatara, probably because of enhanced temperature-dependent and density-dependent growth rates. We conclude that tuatara could benefit from translocations to warmer sites in the short term, but further monitoring of this long-lived species is required to determine longer-term population viability following translocation. Future vulnerability to rising air temperatures, associated water availability, and community and ecosystem changes beyond the scope of this study must be considered.
Svetlozarite, previously described as a new member of the mordenite group of zeolites, is reinterpreted as a multiply twinned and highly faulted dachiardite. X-ray diffraction study and transmission electron microscopy revealed (001) twins and (100) stacking faults. The former are attributed at least mainly to the insertion of a b glide plane between dachiardite sheets at each twin interface, which preserves the 5-ring linkages between the sheets. The latter are associated with loss of the C face-centring relation, and are attributed to replacement of shared 5-rings by linked 4-rings in the dachiardite sheets. Further study is needed to determine whether the structural faults in the dachiardite structures are chemically controlled.
The transition from inland- to streaming-style ice flow near to and upstream from the onset to Ice Stream D, West Antarctica, is investigated using the force-balance technique. Basal drag provides the majority of the flow resistance over the study area but is substantially modified by non-local stress gradients. Lateral drag increases with distance downstream, balancing ∼50–100% of the driving stress at the onset. Longitudinal stress gradients (LSG) are also found to be significant, an observation that distinguishes ice flow in this region from the inland- and streaming-flow regimes that bound it, in which LSG are usually negligible. LSG decrease the spatial variability in basal drag and sliding speed and increase the area of the bed over which frictional melting occurs. Overall, LSG decrease the resistive influence of basal stress concentrations and increase the spatial uniformity of basal sliding. These observations suggest that streaming flow develops as an integrated response to the physical interaction between the ice and its bed over an extended region upstream from the onset, rather than being solely due to changes in basal characteristics at the onset. An implication is that non-steady-flow behavior upstream from the onset may ultimately propagate downstream and result in non-steady behavior at the onset.
Lower and middle income countries (LMICs) are home to >80% of the global population, but mental health researchers and LMIC investigator led publications are concentrated in 10% of LMICs. Increasing research and research outputs, such as in the form of peer reviewed publications, require increased capacity building (CB) opportunities in LMICs. The National Institute of Mental Health (NIMH) initiative, Collaborative Hubs for International Research on Mental Health reaches across five regional ‘hubs’ established in LMICs, to provide training and support for emerging researchers through hub-specific CB activities. This paper describes the range of CB activities, the process of monitoring, and the early outcomes of CB activities conducted by the five research hubs.
The indicators used to describe the nature, the monitoring, and the early outcomes of CB activities were developed collectively by the members of an inter-hub CB workgroup representing all five hubs. These indicators included but were not limited to courses, publications, and grants.
Results for all indicators demonstrate a wide range of feasible CB activities. The five hubs were successful in providing at least one and the majority several courses; 13 CB recipient-led articles were accepted for publication; and nine grant applications were successful.
The hubs were successful in providing CB recipients with a wide range of CB activities. The challenge remains to ensure ongoing CB of mental health researchers in LMICs, and in particular, to sustain the CB efforts of the five hubs after the termination of NIMH funding.
This paper briefly describes the principle of operation and science goals of the AMANDA high energy neutrino telescope located at the South Pole, Antarctica. Results from an earlier phase of the telescope, called AMANDA-BIO, demonstrate both reliable operation and the broad astrophysical reach of this device, which includes searches for a variety of sources of ultrahigh energy neutrinos: generic point sources, Gamma-Ray Bursts and diffuse sources. The predicted sensitivity and angular resolution of the telescope were confirmed by studies of atmospheric muon and neutrino backgrounds. We also report on the status of the analysis from AMANDA-II, a larger version with far greater capabilities. At this stage of analysis, details of the ice properties and other systematic uncertainties of the AMANDA-II telescope are under study, but we have made progress toward critical science objectives. In particular, we present the first preliminary flux limits from AMANDA-II on the search for continuous emission from astrophysical point sources, and report on the search for correlated neutrino emission from Gamma Ray Bursts detected by BATSE before decommissioning in May 2000. During the next two years, we expect to exploit the full potential of AMANDA-II with the installation of a new data acquisition system that records full waveforms from the in-ice optical sensors.
The development and spread of glyphosate-resistant (GR) horseweed has increased the use of dicamba as an alternative herbicide treatment. Research evaluated suspected glyphosate-resistant horseweed populations from DeKalb (GR-1) and Cherokee (GR-2) counties, Alabama, for response to glyphosate, dicamba, and glyphosate + dicamba. Populations used for resistance determination were tested at rosette and bolt growth stages. Glyphosate resistance evaluation treatments ranged from 0 to 36.0 kg ae ha−1. Data confirmed that GR-1 and GR-2 horseweed populations were 3.0 to 38 times more resistant to glyphosate than the susceptible population, according to population, data type, and growth stage at treatment. GR-1 and GR-2 populations were further evaluated for response to dicamba. Dicamba was applied at 0 to 1.12 kg ai ha−1, both with and without the addition of glyphosate at 1.12 kg ae ha−1. All populations had similar tolerance to dicamba, with the exception of GR-2 treated at the rosette growth stage, which had ~2-fold greater tolerance. When glyphosate was tank-mixed with dicamba, the response of GR populations was similar to that of dicamba alone. Therefore, any potential resistance-management benefit of tank-mixing dicamba with glyphosate may be negated when one is attempting to control GR horseweed. Conversely, adding glyphosate to dicamba drastically enhanced control of the susceptible population at both growth stages.
Suicide is a devastating public health problem and very few biological treatments have been found to be effective for quickly reducing the intensity of suicidal ideation (SI). We have previously shown that a single dose of ketamine, a glutamate N-methyl-d-aspartate (NMDA) receptor antagonist, is associated with a rapid reduction in depressive symptom severity and SI in patients with treatment-resistant depression.
We conducted a randomized, controlled trial of ketamine in patients with mood and anxiety spectrum disorders who presented with clinically significant SI (n = 24). Patients received a single infusion of ketamine or midazolam (as an active placebo) in addition to standard of care. SI measured using the Beck Scale for Suicidal Ideation (BSI) 24 h post-treatment represented the primary outcome. Secondary outcomes included the Montgomery–Asberg Depression Rating Scale – Suicidal Ideation (MADRS-SI) score at 24 h and additional measures beyond the 24-h time-point.
The intervention was well tolerated and no dropouts occurred during the primary 7-day assessment period. BSI score was not different between the treatment groups at 24 h (p = 0.32); however, a significant difference emerged at 48 h (p = 0.047). MADRS-SI score was lower in the ketamine group compared to midazolam group at 24 h (p = 0.05). The treatment effect was no longer significant at the end of the 7-day assessment period.
The current findings provide initial support for the safety and tolerability of ketamine as an intervention for SI in patients who are at elevated risk for suicidal behavior. Larger, well-powered studies are warranted.
High speed photometry of several accreting binaries was obtained using the McDonald Observatory 2.1m telescope and ARGOS CCD photometer. A broad-band filter (BVR) was used in order to maximize flux and maintain a short (1-10s) integration time on faint targets. Such observations obtained over several years allow for variability study over time scales covering many orders of magnitude. Observations and analysis for several binaries are summarized.
The study of life histories involves the full span of life, from egg or sperm through reproduction and death. The ways in which individuals maximize progeny production and survival are about as diverse as the populations and species themselves. Research interest in life history is therefore strongly comparative, looking at the variation in life-history characteristics within populations, within species and among related species. As with ecology in general, we search for patterns in nature and develop hypotheses and theories, which account for the trends that we observe, and prompt new observations in a cycle of efforts to refine knowledge.
Understanding of life histories is fundamental to insect ecology, and we have covered many examples of life-history studies already in this book, and more will follow. Behavioral traits that promote fitness were covered in Chapter 2, and the evolution of life histories of social insects was discussed in Chapter 3. Chapter 4 included discussion of wing polymorphism in planthoppers (Figure 4.5), and jousting and territoriality of Pemphigus aphids (Figure 4.11). Density effects on planthopper fecundity and wing polymorphism were involved with competition (Chapter 5, Figure 5.8), and egg-laying schedules of a fruit fly were described in Chapter 9 (Figure 9.10). We noted also in Chapter 9 the differences between pro-ovigenic and synovigenic egg production, and the marked differences in survival of progeny portrayed in survivorship curves. In Chapter 6 different strategies of yucca moths were noted among true pollinators and two classes of cheaters (Figure 6.14). We also saw divergence of life-history types in scarab beetles (Figure 6.16) and the constraints on ovariole number and fecundity of parasitoid wasps and flies (Figure 8.4). Indeed, the study of life-history traits runs throughout ecology, and this is how it should be, because understanding the evolution of whole life histories is at the heart of understanding insects, and the evolutionary pathways along which they have traveled. This point is taken up again in the last section of this chapter on applications.
Everybody is conscious of insects, and even concerned about them. In fact, we each have an ecological relationship with their kind. We share our houses and gardens with them, our walks and picnics, and our adventures. So should we not understand them? Their richness in species and interactions, their beauty and behavioral intricacy, all enrich our lives if we understand who they are, and what they are doing. Therefore, the ecology of insects is for everybody.
Eisner (2003, p. 1), in his latest book, For Love of Insects, starts by writing that “This book is about the thrill of discovery.” And, Wilson (1994, p. 191), in his autobiographical, Naturalist, advised, “Love the organisms for themselves first, then strain for general explanations, and, with good fortune, discoveries will follow. If they don't, the love and the pleasure will have been enough.” Here is sound advice from two of the greatest practitioners of entomology and ecology, for discovery is thrilling, and the deeper the fascination one develops, the greater will be the discoveries that follow.
This book concludes with discussions on the broadest biological patterns we can observe on this Earth, and the reasons for their existence. We also examine smaller scales of variation that would be seen on the landscape and ecosystem levels. In doing so we pick up various topics discussed in previous chapters, such as the roles of time and space as influences on species richness, and expand this view to the global level, showing that the same factors remain important as we scale up our perspective to interactions on Earth. We also look at the paleobiological record again, as we did in Chapter 1 to note the long evolutionary history of insects, but in this section we examine the record for clues on what might be expected as global changes occur, and if predictions are possible.