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This volume in the highly respected Cambridge History of Science series is devoted to exploring the history of modern science using national, transnational, and global frames of reference. Organized by topic and culture, its essays by distinguished scholars offer the most comprehensive and up-to-date nondisciplinary history of modern science currently available. Essays are grouped together in separate sections that represent larger regions: Europe, Africa, the Middle East, South Asia, East and Southeast Asia, the United States, Canada, Australia, New Zealand, Oceania, and Latin America. Each of these regional groupings ends with a separate essay reflecting on the analysis in the preceding chapters. Intended to provide a balanced and inclusive treatment of the modern world, contributors analyze the history of science not only in local, national, and regional contexts but also with respect to the circulation of knowledge, tools, methods, people, and artifacts across national borders.
We study dynamo action in rotating, plane layer Boussinesq convection in the absence of inertia. This allows a decomposition of the velocity into a thermal part driven by buoyancy, and a magnetic part driven by the Lorentz force. We have identified three families of solutions, defined in terms of what is the dominant contribution to the velocity. In weak field dynamos the dominant contribution is the thermal component, in super strong field dynamos the dominant contribution is magnetic and in strong field dynamos the two components are comparable. For each of these solutions we investigate the force balance in the momentum equation to determine the relative importance of the viscous, buoyancy, Coriolis and magnetic forces. We do this by extracting the solenoidal part of the individual terms in the momentum equation, thereby removing their pressure contributions. This is numerically preferable to the more common practice of taking the curl of the momentum equation, which introduces an extra derivative. We find that, irrespective of the type of dynamo solution, the dynamics is controlled by the horizontal forces (in projection). Furthermore, in the progression from weak to strong to super strong dynamos, we find that the viscous forces in the thermal equation become negligible, thereby leading to a balance between buoyancy and Coriolis forces. On the other hand, no corresponding trend is observed in the magnetic part of the momentum equation: the viscous stresses always remain significant. This can be attributed to the different degrees of smoothness of the Coriolis and Lorentz forces, the latter having contributions from strong, filamentary structures. We discuss how our findings relate to dynamo solutions in which viscosity plays no role whatsoever – so-called Taylor states.
To identify discrete approaches to specialist healthcare support for older care home residents in the UK and to estimate their prevalence.
Internationally, a range of new initiatives are emerging to meet the multiple and complex healthcare needs of care home residents. However, little is known about their relative effectiveness and, given their heterogeneity, a classification scheme is required to enable research staff to explore this.
A UK survey collected information on the funding, age, coverage, aims, staffing and activities of 64 specialist care home support services. Latent class analysis (LCA) was used to allocate the sample into subgroups with similar characteristics.
Three classes were identified. Class 1 (55% of sample) contained services with a high probability of providing scheduled input (regular preplanned visits) and support for all residents and a moderate probability of undertaking medication management, but a low probability of training care home staff (‘predominantly direct care’). Class 2 (23% of sample) had a moderate/high probability of providing scheduled input, support for all residents, medication management and training (‘direct and indirect care’). Class 3 (22% of sample) had a low probability of providing scheduled input, support for all residents and medication management, but a high probability of providing training for care home staff (‘predominantly indirect care’). Consultants were more likely to be members of services in Class 1 than Class 2, and Class 2 than Class 3.
LCA offers a promising approach to the creation of a taxonomy of specialist care home support services. The skills and knowledge required by healthcare staff vary between classes, raising important issues for service design. The proposed classification can be used to explore the extent to which different organisational forms are associated with better resident, process and service outcomes.
In 2013, a task force was developed to discuss the future of the Canadian pediatric neurology workforce. The consensus was that there was no indication to reduce the number of training positions, but that the issue required continued surveillance. The current study provides a 5-year update on Canadian pediatric neurology workforce data.
Names, practice types, number of weekly outpatient clinics, and dates of certification of all physicians currently practicing pediatric neurology in Canada were obtained. International data were used to compute comparisons between countries. National data sets were used to provide information about the number of residency positions available and the number of Canadian graduates per year. Models for future projections were developed based on published projected population data and trends from the past decade.
The number of pediatric neurologists practicing in Canada has increased 165% since 1994. During this period, wait times have not significantly shortened. There are regional discrepancies in access to child neurologists. The Canadian pediatric neurology workforce available to see outpatient consultations is proportionally less than that of USA. After accounting for retirements and emigrations, the number of child neurologists being added to the workforce each year is 4.9. This will result in an expected 10-year increase in Canadian pediatric neurologists from 151 to 200.
Despite an increase in the number of Canadian child neurologists over the last two decades, we do not predict that there will be problems with underemployment over the next decade.
This is a case study of the U.S. pharmaceutical producer, Merck & Co. By 1940 this was one of the leading pharmaceutical producers in the United States, and the company went on to become one of the global industry leaders after World War II. It was founded in 1891 as the U.S. subsidiary of a much larger German pharmaceutical company, E. Merck of Darmstadt. The existing understanding of Merck & Co.’s history emphasizes how it was reacquired by the American branch of the Merck family after wartime sequestration, and from then onward it pursued a path of development separate from its former parent. This article revisits that history of the company and shows how the two Mercks began to cooperate and share technology and manufacturing know-how during the 1930s, something that was particularly to the advantage of Merck & Co.
In the National Institutes of Health (NIH) Clinical Center, patients colonized or infected with vancomycin-resistant Enterococcus (VRE) are placed in contact isolation until they are deemed “decolonized,” defined as having 3 consecutive perirectal swabs negative for VRE. Some decolonized patients later develop recurrent growth of VRE from surveillance or clinical cultures (ie, “recolonized”), although that finding may represent recrudescence or new acquisition of VRE. We describe the dynamics of VRE colonization and infection and their relationship to receipt of antibiotics.
In this retrospective cohort study of patients at the National Institutes of Health Clinical Center, baseline characteristics were collected via chart review. Antibiotic exposure and hospital days were calculated as proportions of VRE decolonized days. Using survival analysis, we assessed the relationship between antibiotic exposure and time to VRE recolonization in a subcohort analysis of 72 decolonized patients.
In total, 350 patients were either colonized or infected with VRE. Among polymerase chain reaction (PCR)-positive, culture (Cx)-negative (PCR+/Cx−) patients, PCR had a 39% positive predictive value for colonization. Colonization with VRE was significantly associated with VRE infection. Among 72 patients who met decolonization criteria, 21 (29%) subsequently became recolonized. VRE recolonization was 4.3 (P = .001) and 2.0 (P = .22) times higher in patients with proportions of antibiotic days and antianaerobic antibiotic days above the median, respectively.
Colonization is associated with clinical VRE infection and increased mortality. Despite negative perirectal cultures, re-exposure to antibiotics increases the risk of VRE recolonization.
Childhood maltreatment is one of the strongest predictors of adulthood depression and alterations to circulating levels of inflammatory markers is one putative mechanism mediating risk or resilience.
To determine the effects of childhood maltreatment on circulating levels of 41 inflammatory markers in healthy individuals and those with a major depressive disorder (MDD) diagnosis.
We investigated the association of childhood maltreatment with levels of 41 inflammatory markers in two groups, 164 patients with MDD and 301 controls, using multiplex electrochemiluminescence methods applied to blood serum.
Childhood maltreatment was not associated with altered inflammatory markers in either group after multiple testing correction. Body mass index (BMI) exerted strong effects on interleukin-6 and C-reactive protein levels in those with MDD.
Childhood maltreatment did not exert effects on inflammatory marker levels in either the participants with MDD or the control group in our study. Our results instead highlight the more pertinent influence of BMI.
Declaration of interest
D.A.C. and H.W. work for Eli Lilly Inc. R.N. has received speaker fees from Sunovion, Jansen and Lundbeck. G.B. has received consultancy fees and funding from Eli Lilly. R.H.M.-W. has received consultancy fees or has a financial relationship with AstraZeneca, Bristol-Myers Squibb, Cyberonics, Eli Lilly, Ferrer, Janssen-Cilag, Lundbeck, MyTomorrows, Otsuka, Pfizer, Pulse, Roche, Servier, SPIMACO and Sunovian. I.M.A. has received consultancy fees or has a financial relationship with Alkermes, Lundbeck, Lundbeck/Otsuka, and Servier. S.W. has sat on an advisory board for Sunovion, Allergan and has received speaker fees from Astra Zeneca. A.H.Y. has received honoraria for speaking from Astra Zeneca, Lundbeck, Eli Lilly, Sunovion; honoraria for consulting from Allergan, Livanova and Lundbeck, Sunovion, Janssen; and research grant support from Janssen. A.J.C. has received honoraria for speaking from Astra Zeneca, honoraria for consulting with Allergan, Livanova and Lundbeck and research grant support from Lundbeck.
Research suggests that a significant minority of hospital in-patients could be more appropriately supported in the community if enhanced services were available. However, little is known about these individuals or the services they require.
To identify which individuals require what services, at what cost.
A ‘balance of care’ (BoC) study was undertaken in northern England. Drawing on routine electronic data about 315 admissions categorised into patient groups, frontline practitioners identified patients whose needs could be met in alternative settings and specified the services they required, using a modified nominal group approach. Costing employed a public-sector approach.
Community care was deemed appropriate for approximately a quarter of admissions including people with mild-moderate depression, an eating disorder or personality disorder, and some people with schizophrenia. Proposed community alternatives drew heavily on carer support services, community mental health teams and consultants, and there was widespread consensus on the need to increase out-of-hours community services. The costs of the proposed community care were relatively modest compared with hospital admission. On average social care costs increased by approximately £60 per week, but total costs fell by £1626 per week.
The findings raise strategic issues for both national policymakers and local service planners. Patients who could be managed at home can be characterised by diagnosis. Although potential financial savings were identified, the reported cost differences do not directly equate to cost savings. It is not clear whether in-patient beds could be reduced. However, existing beds could be more efficiently used.
The protein leverage hypothesis proposes that the need to prioritise protein intake drives excess energy intake (EI) when the dietary ratio of protein to fat and carbohydrate is reduced. We hypothesised that cats may become prone to overconsuming energy content when moderate protein diets were offered, and considered the potential influence of fat and carbohydrate on intake. To determine the effect of dietary protein and macronutrient profile (MNP) on EI, weight and body composition, cats (1–4 years) were offered food in excess of energy requirements (ER). A total of six diets were formulated, containing moderate (approximately 7 % w/w; approximately 22 % metabolisable energy (ME)) or high (approximately 10 % w/w; approximately 46 % ME) protein and varying levels of carbohydrate and fat. For 4 weeks, 120 cats were offered 100 % of their individual ER of a diet at the MNP selected by adult cats (50:40:10 protein energy ratio:fat energy ratio:carbohydrate energy ratio). EI, body weight (BW), body composition, activity and palatability were measured. Subsequently, cats were offered one of the six diets at 200 % of their individual ER for 4 weeks when measurements were repeated. Cats offered excess high protein diets had higher EI (kJ/kg) throughout, but at 4 weeks BW was not significantly different to baseline. Cats offered excess moderate protein diets reduced EI and gradually lost weight (average loss of 0·358 (99 % CI 0·388, 0·328) kg), irrespective of fat:carbohydrate and initial palatability. The data do not support the protein leverage hypothesis. Furthermore, cats were able to adapt intake of a wet diet with high protein in an overfeeding environment within 28 d.
The theory of mean field electrodynamics, now celebrating its fiftieth birthday, has had a profound influence on our modelling of cosmical dynamos, greatly enhancing our understanding of how such dynamos may operate. Here I discuss some of its undoubted triumphs, but also some of the problems that can arise in a mean field approach to dynamos in fluids (or plasmas) that are both highly turbulent and also extremely good electrical conductors, as found in all astrophysical settings.
Sleep medicine is a truly multidisciplinary field that covers psychiatric, neurological and respiratory conditions. As the field has developed it has become increasingly clear that there is a great deal of overlap between sleep and psychiatric disorders and it is therefore essential for psychiatrists to have some knowledge of sleep medicine. Even those disorders, such as obstructive sleep apnoea, that may seem to be outside the remit of psychiatry can have complex and important interactions with psychiatric conditions. In this article we give a brief overview of the range of sleep disorders a psychiatrist might encounter, how they are recognised, investigated and treated, and how they relate to psychiatric conditions.
Be aware of the range of sleep disorders that might be encountered in psychiatric practice
Understand how these sleep disorders affect mental health
Have a broad understanding of how these disorders are investigated and treated
DECLARATION OF INTEREST
H.S. has accepted speaker fees from Janssen Pharmaceuticals.
A critical question in invasion biology involves the relative importance of propagule rain and community invasibility. For plant invasions, invasibility is often related to disturbance, but few studies of forest invaders have simultaneously investigated both canopy and ground-level disturbance. We investigated the relative importance of seed rain, canopy disturbance, and soil disturbance in a mature forest in Maryland on the recruitment of four invasive species: wine raspberry (Rubus phoenicolasius Maxim.), Japanese barberry (Berberis thunbergii DC), multiflora rose (Rosa multiflora Thunb.), and Japanese stiltgrass [Microstegium vimineum (Trin.) A. Camus]. Using complete censuses of a 9-ha plot at two points in time (2011–12 and 2014), we mapped new recruits, and related their locations to canopy and soil disturbance, as well as to a seed rain index based on locations of reproducing plants and seed-dispersal kernels.
We found that propagule rain, as measured by the seed rain index, was a significant predictor of recruitment for B. thunbergii, R. phoenicolasius, and M. vimineum. For R. multiflora, seed sources were not located, precluding assessment of propagule rain, but recruitment was linked to canopy disturbance, as was recruitment of M. vimineum. However, because reproduction of R. phoenicolasius and, in some years, of B. thunbergii is higher in treefall gaps, these gaps experience higher propagule rain, with the result that recruitment is indirectly associated with these gaps. Ground-layer disturbance was an important predictor of recruitment only for B. thunbergii. Our findings reveal that the importance of propagule rain is the most consistent driver of recruitment, but canopy or ground-layer disturbance promotes recruitment of some invasive plant species.
This article starts with a brief review of the UK Supreme Court's decision in the Montgomery case. Although much of the focus in discussing the case has been on the disclosure of risk, an important aspect of the model of consent contained in the judgment is that of dialogue. The model of informed consent set out in Montgomery suggests shared decision-making as the norm. Central to shared decision-making, however, is an awareness of values and of how values can vary between people. We introduce values-based practice as an approach that is entirely in keeping with the precepts of the Montgomery judgment. We go on to review how values-based practice and shared decision-making are relevant to psychiatric practice, using as examples recovery practice and compulsory detention under the Mental Health Act 1983.
•Appreciate that a new test of consent has been established as of a result of the UK Supreme Court's Montgomery ruling
•Learn about the role of values-based practice as a partner to evidence-based practice in implementing Montgomery
•Understand how values-based practice and Montgomery together support shared decision-making in psychiatry
Health anxiety and medically unexplained symptoms cost the National
Health Service (NHS) an estimated £3 billion per year in unnecessary
costs with little evidence of patient benefit. Effective treatment is
rarely taken up due to issues such as stigma or previous negative
experiences with mental health services. An approach to overcome this
might be to offer remotely delivered psychological therapy, which can be
just as effective as face-to-face therapy and may be more accessible and
To investigate the clinical outcomes and cost-effectiveness of remotely
delivered cognitive–behavioural therapy (CBT) to people with high health
anxiety repeatedly accessing unscheduled care (trial registration:
A multicentre randomised controlled trial (RCT) will be undertaken in
primary and secondary care providers of unscheduled care across the East
Midlands. One hundred and forty-four eligible participants will be
equally randomised to receive either remote CBT (6–12 sessions) or
treatment as usual (TAU). Two doctoral research studies will investigate
the barriers and facilitators to delivering the intervention and the
factors contributing to the optimisation of therapeutic outcome.
This trial will be the first to test the clinical outcomes and
cost-effectiveness of remotely delivered CBT for the treatment of high
The findings will enable an understanding as to how this intervention
might fit into a wider care pathway to enhance patient experience of
The present study examined the energy (kilojoule) content of Australian fast-food menu items over seven years, before and after introduction of menu board labelling, to determine the impact of the introduction of the legislation.
Analysis of the median energy contents per serving and per 100g of fast-food menu items. Change in energy content of menu items across the years surveyed and differences in energy content of standard and limited-time only menu items were analysed.
Five of Australia’s largest fast food chains: Hungry Jack’s, KFC, McDonald’s, Oporto and Red Rooster.
All standard and limited-time only menu items available at each fast-food chain, collected annually for seven years, 2009–2015.
Although some fast-food chains/menu item categories had significant increases in the energy contents of their menus at some time points during the 7-year period, overall there were no significant or systematic decreases in energy following the introduction of menu labelling (P=0·19 by +17 kJ/100 g, P=0·83 by +8 kJ/serving). Limited-time only items were significantly higher in median energy content per 100 g than standard menu items (+74 kJ/100 g, P=0·002).
While reformulation across the entire Australian fast-food supply has the potential to positively influence population nutrient intake, the introduction of menu labelling legislation in New South Wales, Australia did not lead to reduced energy contents across the five fast-food chains. To encourage widespread reformulation by the fast-food industry and enhance the impact of labelling legislation, the government should work with industry to set targets for reformulation of nutrient content.
The long-term stability of mechanically exfoliated MoS2 flakes was compared for storage in the air and storage under vacuum. Significant changes in MoS2 flakes were observed for samples stored in the air, whereas similar flakes on samples stored in vacuum underwent no change. Small speckles were observed to appear on the surface of flakes stored in the air, followed by thinning and eventual decomposition of MoS2 flakes. The speckles are suspected to be formed by oxidation of MoS2 in the presence of atmospheric oxygen and water molecules, resulting in the formation of hydrated MoO3.
In order better to understand the processes that lead to the generation of magnetic fields of finite amplitude, we study dynamo action driven by turbulent Boussinesq convection in a rapidly rotating system. In the limit of infinite Prandtl number (the ratio of viscous to thermal diffusion) the inertia term drops out of the momentum equation, which becomes linear in the velocity. This simplification allows a decomposition of the velocity into a thermal part driven by buoyancy, and a magnetic part driven by the Lorentz force. While the former velocity defines the kinematic dynamo problem responsible for the exponential growth of the magnetic field, the latter encodes the magnetic back reaction that leads to the eventual nonlinear saturation of the dynamo. We argue that two different types of solution should exist: weak solutions in which the saturated velocity remains close to the kinematic one, and strong solutions in which magnetic forces drive the system into a new strongly magnetised state that is radically different from the kinematic one. Indeed, we find both types of solutions numerically. Interestingly, we also find that, in our inertialess system, both types of solutions exist on the same subcritical branch of solutions bifurcating from the non-magnetic convective state, in contrast with the more traditional situation for systems with finite inertia in which weak and strong solutions are thought to exist on different branches. We find that for weak solutions, the force balance is the same as in the non-magnetic case, with the horizontal size of the convection varying as the one-third power of the Ekman number (the ratio of viscous to Coriolis forces), which gives rise to very small cells at small Ekman numbers (i.e. high rotation rates). In the strong solutions, magnetic forces become important and the convection develops on much larger horizontal scales. However, we note that even in the strong cases the solutions never properly satisfy Taylor’s constraint, and that viscous stresses continue to play a role. Finally, we discuss the relevance of our findings to the study of planetary dynamos in rapidly rotating systems such as the Earth.