To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Questions have been raised regarding differences in the standards of care that patients receive when they are admitted to or discharged from in-patient units at weekends.
To compare the quality of care received by patients with anxiety and depressive disorders who were admitted to or discharged from psychiatric hospital at weekends with those admitted or discharged during the ‘working week’.
Retrospective case-note review of 3795 admissions to in-patient psychiatric wards in England. Quality of care received by people with depressive or anxiety disorders was compared using multivariable regression analyses.
In total, 795 (20.9%) patients were admitted at weekends and 157 (4.8%) were discharged at weekends. There were minimal differences in quality of care between those admitted at weekends and those admitted during the week. Patients discharged at weekends were less likely to be given sufficient notification (48 h) in advance of being discharged (OR = 0.55, 95% CI 0.39–0.78), to have a crisis plan in place (OR = 0.65, 95% CI 0.46–0.92) or to be given medication to take home (OR = 0.45, 95% CI 0.30–0.66). They were also less likely to have been assessed using a validated outcome measure (OR = 0.70, 95% CI 0.50–0.97).
There is no evidence of a ‘weekend effect’ for patients admitted to psychiatric hospital at weekends, but the quality of care offered to those who were discharged at weekends was relatively poor, highlighting the need for improvement in this area.
While the Victorian ideal of the public park is well understood, we know less of how local governors sought to realize this ideal in practice. This article is concerned with park-making as a process – contingent, unstable, open – rather than with parks as outcomes – determined, settled, closed. It details how local governors bounded, designed and regulated park spaces to differentiate them as ‘spaces apart’ within the city, and how this programme of spatial governance was obstructed, frustrated and diverted by political, environmental and social forces. The article also uses this historical analysis to provide a new perspective on the future prospects of urban parks today.
To examine demographic and behavioural correlates of frequent consumption of fast food among Australian secondary school students and explore the associations between fast food consumption and social/environmental factors.
Cross-sectional survey using a web-based self-report questionnaire.
Secondary schools across all Australian states and territories.
Students aged 12–17 years participating in the 2012–2013 National Secondary Students’ Diet and Activity survey (n 8392).
Overall, 38 % of students surveyed reported consuming fast food at least weekly. Being male, residing in lower socio-economic areas and metropolitan locations, having more weekly spending money and working at a fast food outlet were all independently associated with consuming fast food once a week or more, as were several unhealthy eating (low vegetable intake and high sugary drink and snack food intake) and leisure (low physical activity and higher commercial television viewing) behaviours and short sleep duration. Frequent fast food consumption and measured weight status were unrelated. Students who agreed they go to fast food outlets with their family and friends were more likely to report consuming fast food at least weekly, as were those who usually ‘upsize’ their fast food meals and believe fast food is good value for money.
These results suggest that frequent fast food consumption clusters with other unhealthy behaviours. Policy and educational interventions that reach identified at-risk groups are needed to reduce adolescent fast food consumption at the population level. Policies placing restrictions on the portion sizes of fast food may also help adolescents limit their intake.
Stationary ice-penetrating radar (sIPR) systems can be used to monitor temporal changes in electromagnetically sensitive properties of glaciers and ice sheets. We describe a system intended for autonomous operation in remote glacial environments, and document its performance during deployments in cold and temperate settings. The design is patterned after an existing impulse radar system, with the addition of a fibre-optic link and timing module to control transmitter pulses, a micro-UPS (uninterruptable power supply) to prevent uncontrolled system shutdown and a customized satellite telemetry scheme. Various implementations of the sIPR were deployed on the Kaskawulsh Glacier near an ice-marginal lake in Yukon, Canada, for 44–77 days in summers 2014, 2015 and 2017. Pronounced perturbations to englacial radiostratigraphy were observed commensurate with lake filling and drainage, and are interpreted as changes in englacial water storage. Another sIPR was deployed in 2015–2016 on ice island PII-A-1-f, which originated from the Petermann Glacier in northwest Greenland. This system operated autonomously for almost a year during which changes in thickness of the ice column were clearly detected.
In a context of hyper-diversity and social polarisation, it has been suggested that public parks constitute crucial arenas in which to safeguard deliberative democracy and foster social relations that bind loosely connected strangers. Drawing on empirical research, we offer a more circumspect and nuanced understanding of the – nonetheless vital – role that parks can play in fostering civic norms that support the capacity for living with difference. As ‘spaces apart’, parks have distinctive atmospheres that afford opportunities for convivial encounters in which ‘indifference to difference’ underpins ‘openness to otherness’. As places in which difference is rendered routine and unremarkable, the potency of parks for social cohesion derives from fleeting and unanticipated interactions and the weak ties they promote, rather than strong bonds of community that tend to solidify lines of cultural differentiation. Both by design and unintentionally, regulation and law can serve to foster or constrain the conditions that sustain conviviality.
The present study aimed to identify whether discretionary food consumption declined in an intervention focused primarily on promoting fruit and vegetable consumption. We also aimed to identify potential mediators explaining intervention effects on discretionary food consumption.
Secondary analysis of data from the ShopSmart study, a randomised controlled trial involving a 6-month intervention promoting fruit and vegetable consumption. Linear regression models examined intervention effects on discretionary food consumption at intervention completion (T2). A half-longitudinal mediator analyses was performed to examine the potential mediating effect of personal and environmental factors on the association between the intervention effects and discretionary food consumption. Indirect (mediated) effects were tested by the product of coefficients method with bootstrapped se using Andrew Hayes’ PROCESS macro for SPSS.
Women were recruited via the Coles FlyBuys loyalty card database in socio-economically disadvantaged suburbs of Melbourne, Australia.
Analyses included 225 women (116 intervention and 109 control).
Compared with controls, intervention participants consumed fewer discretionary foods at T2, after adjusting for key confounders (B = −0·194, 95 % CI −0·378, −0·010 servings/d; P = 0·039). While some mediators were associated with the outcome (taste, outcome expectancies, self-efficacy, time constraints), there was no evidence that they mediated intervention effects.
The study demonstrated that a behavioural intervention promoting fruit and vegetable consumption among socio-economically disadvantaged participants was effective in reducing discretionary food intake. Although specific mediators were not identified, researchers should continue searching for mechanisms by which interventions have an effect to guide future programme design.
Concerns have repeatedly been expressed about the quality of physical healthcare that people with psychosis receive.
To examine whether the introduction of a financial incentive for secondary care services led to improvements in the quality of physical healthcare for people with psychosis.
Longitudinal data were collected over an 8-year period on the quality of physical healthcare that people with psychosis received from 56 trusts in England before and after the introduction of the financial incentive. Control data were also collected from six health boards in Wales where a financial incentive was not introduced. We calculated the proportion of patients whose clinical records indicated that they had been screened for seven key aspects of physical health and whether they were offered interventions for problems identified during screening.
Data from 17 947 people collected prior to (2011 and 2013) and following (2017) the introduction of the financial incentive in 2014 showed that the proportion of patients who received high-quality physical healthcare in England rose from 12.85% to 31.65% (difference 18.80, 95% CI 17.37–20.21). The proportion of patients who received high-quality physical healthcare in Wales during this period rose from 8.40% to 13.96% (difference 5.56, 95% CI 1.33–10.10).
The results of this study suggest that financial incentives for secondary care mental health services are associated with marked improvements in the quality of care that patients receive. Further research is needed to examine their impact on aspects of care that are not incentivised.
Emergency physicians play an important role in providing care at the end-of-life as well as identifying patients who may benefit from a palliative approach. Several studies have shown that emergency medicine (EM) residents desire further training in palliative care. We performed a national cross-sectional survey of EM program directors. Our primary objective was to describe the number of Canadian postgraduate EM training programs with palliative and end-of-life care curricula.
A 15-question survey in English and French was sent by email to all program directors of both the Canadian College of Family Physicians emergency medicine (CCFP(EM)) and the Royal College of Physicians and Surgeons of Canada emergency medicine (RCPSC-EM) postgraduate training programs countrywide using FluidSurveys™ with a modified Dillman approach.
We received a total of 26 responses from the 36 (response rate = 72.2%) EM postgraduate programs in Canada. Ten out of 26 (38.5%) programs had a structured educational program pertaining to palliative and end-of-life care. Lectures or seminars were the exclusive choice to teach content. Clinical palliative medicine rotations were mandatory in one out of 26 (3.8%) programs. The top two barriers to implementation of palliative and end-of-life care curricula were lack of time (84.6%) and curriculum development concerns (80.8%).
Palliative and end-of-life care training within EM has been identified as an area of need. This cross-sectional survey demonstrates that a minority of Canadian EM programs have palliative and end-of-life care curricula. It will be important for all EM training programs, RCPSC-EM and CCFP(EM), in Canada, to develop an agreed upon set of competencies and to structure their curricula around them.
It has been proposed that vascular disease is the mechanism linking depression and cognition, but prospective studies have not supported this hypothesis. This study aims to investigate the inter-relationships between depressive symptoms, cognition and cerebrovascular disease using a well-characterised prospective cohort.
Data came from waves 1 (2005–2007) and 2 (2007–2009) of the Sydney Memory and Ageing Study (n = 462; mean age = 78.3 years).
At wave 1, there was an association between depressive symptoms and white matter hyperintensity (WMH) volume [b = 0.016, t(414) = 2.34, p = 0.020]. Both depressive symptoms [b = −0.058, t(413) = −2.64, p = 0.009] and WMH volume [b = −0.011, t(413) = −3.77, p < 0.001], but not stroke/transient ischaemic attack (TIA) [b = −0.328, t(413) = −1.90, p = 0.058], were independently associated with lower cognition. Prospectively, cerebrovascular disease was not found to predict increasing depressive symptoms [stroke/TIA: b = −0.349, t(374.7) = −0.76, p = 0.448; WMH volume: b = 0.007, t(376.3) = 0.875, p = 0.382]. Depressive symptoms predicted increasing WMH severity [b = 0.012, t(265.9) = −3.291, p = 0.001], but not incident stroke/TIA (odds ratio = 0.995; CI 0.949–1.043; p = 0.820). When examined in separate models, depressive symptoms [b = −0.027, t(373.5) = −2.16, p = 0.032] and a history of stroke/TIA [b = −0.460, t(361.2) = −4.45, p < 0.001], but not WMH volume [b = 0.001, t(362.3) = −0.520, p = 0.603], predicted declines in cognition. When investigated in a combined model, a history of stroke/TIA remained a predictor of cognitive decline [b = −0.443, t(360.6) = −4.28, p < 0.001], whilst depressive symptoms did not [b = −0.012, t(359.7) = −0.96, p = 0.336].
This study is contrasted with previous prospective studies which indicate that depressive symptoms predict cognitive decline independently of vascular disease. Future research should focus on further exploring the vascular mechanisms underpinning the relationship between depressive symptoms and cognition.
Increasing longevity and the strain on state and occupational pensions have brought into question long-held assumptions about the age of retirement, and raised the prospect of a workplace populated by ageing workers. In the United Kingdom the default retirement age has gone, incremental increases in state pension age are being implemented and ageism has been added to workplace anti-discrimination laws. These changes are yet to bring about the anticipated transformation in workplace demographics, but it is coming, making it timely to ask if the workplace is ready for the ageing worker and how the extension of working life will be managed. We report findings from qualitative case studies of five large organisations located in the United Kingdom. Interviews and focus groups were conducted with employees, line managers, occupational health staff and human resources managers. Our findings reveal a high degree of uncertainty and ambivalence among workers and managers regarding the desirability and feasibility of extending working life; wide variations in how older workers are managed within workplaces; a gap between policies and practices; and evidence that while casualisation might be experienced negatively by younger workers, it may be viewed positively by financially secure older workers seeking flexibility. We conclude with a discussion of the challenges facing employers and policy makers in making the modern workplace fit for the ageing worker.
The present qualitative study aimed to gain an in-depth understanding of participants’ attitudes, knowledge, perceived effectiveness (a person’s belief that his/her behaviour can contribute to environmental preservation) and behaviours relating to a sustainable eating pattern.
One-to-one interviews (either face-to-face or by telephone) were conducted following a structured interview schedule, audio-recorded, transcribed verbatim and analysed using inductive thematic analysis in NVivo 10.
Victorian (Australia) adult participants recruited via online advertisements, flyers on community advertisement boards and letterbox drops.
Twenty-four participants (mean age 40 years, range 19–69 years; thirteen female, eleven male) were interviewed.
Participants reported that environmental impact was not an important influence on their food choice. Participants displayed limited knowledge about a sustainable eating pattern, with most unaware of the environmental impact of food-related behaviours. Most participants believed sustainable eating would be only slightly beneficial to the environment. Participants reported undertaking limited sustainable food behaviours currently and were more willing to undertake a food behaviour if they perceived additional benefits, such as promoting health or supporting the local community.
The study suggests consumers need further information about a sustainable eating pattern and the environmental impact of food choice. The findings highlight some of the barriers that will need to be addressed when promoting this kind of eating pattern and that a range of interventions will be necessary.
The purpose of the current study was to examine associations of individual and aggregated screen-based behaviours, and total sitting time, with healthy and unhealthy dietary intakes among adolescents.
Cross-sectional study of adolescents. Participants self-reported durations of television viewing, computer use, playing electronic games (e-games), total sitting time, daily servings of fruits and vegetables, and frequency of consumption of sugar-sweetened beverages (SSB), diet beverages, fast foods and discretionary snacks. Logistic regression models were conducted to identify associations of screen-based behaviours, total screen time and total sitting time with dietary intakes.
Adolescents (n 939) in School Year 11 (mean age 16·8 years).
The results showed that watching television (≥2 h/d) was positively associated with consuming SSB and diet beverages each week and consuming discretionary snacks at least once daily, whereas computer use (≥2 h/d) was inversely associated with daily fruit and vegetable intake and positively associated with weekly fast-food consumption. Playing e-games (any) was inversely associated with daily vegetable intake and positively associated with weekly SSB consumption. Total screen (≥2 h/d) and sitting (h/d) times were inversely associated with daily fruit and vegetable consumption, with total screen time also positively associated with daily discretionary snack consumption and weekly consumption of SSB and fast foods.
Individual and aggregated screen-based behaviours, as well as total sitting time, are associated with a number of indicators of healthy and unhealthy dietary intake. Future research should explore whether reducing recreational screen time improves adolescents’ diets.
Users of mental health service are concerned about changes in clinicians providing their care, but little is known about their impact.
To examine associations between changes in staff, and patient satisfaction and quality of care.
A national cross-sectional survey of 3379 people aged 18 or over treated in secondary care for schizophrenia or schizoaffective disorder.
Nearly 41.9% reported at least one change in their key worker during the previous 12 months and 10.5% reported multiple changes. Those reporting multiple changes were less satisfied with their treatment and less likely to report having a care plan, knowing how to obtain help when in a crisis or to have had recommended physical health assessments.
Frequent changes in staff providing care for people with psychosis are associated with poorer quality of care. Greater efforts need to be made to protect relational continuity of care for such patients.
Efforts to assess and improve the quality of mental health services are often hampered by a lack of information on patient outcomes. Most mental health services in England have been routinely collecting Health of the Nation Outcome Scales (HoNOS) data for some time. In this article we illustrate how clinical teams have used HoNOS data to identify areas where performance could be improved. HoNOS data have the potential to give clinical teams the information they need to assess the quality of care they deliver, as well as develop and test initiatives aimed at improving the services they provide.
To examine demographic and behavioural correlates of high consumption of soft drinks (non-alcoholic sugar-sweetened carbonated drinks excluding energy drinks) among Australian adolescents and to explore the associations between high consumption and soft drink perceptions and accessibility.
Cross-sectional self-completion survey and height and weight measurements.
Australian secondary schools.
Students aged 12–17 years participating in the 2012–13 National Secondary Students’ Diet and Activity (NaSSDA) survey (n 7835).
Overall, 14 % of students reported consuming four or more cups (≥1 litres) of soft drinks each week (‘high soft drink consumers’). Demographic factors associated with high soft drink consumption were being male and having at least $AU 40 in weekly spending money. Behavioural factors associated with high soft drink consumption were low fruit intake, consuming energy drinks on a weekly basis, eating fast foods at least once weekly, eating snack foods ≥14 times/week, watching television for >2 h/d and sleeping for <8 h/school night. Students who perceived soft drinks to be usually available in their home, convenient to buy and good value for money were more likely to be high soft drink consumers, as were students who reported usually buying these drinks when making a beverage purchase from the school canteen/vending machine.
High soft drink consumption clusters with other unhealthy lifestyle behaviours among Australian secondary-school students. Interventions focused on reducing the availability of soft drinks (e.g. increased taxes, restricting their sale in schools) as well as improved education on their harms are needed to lower adolescents’ soft drink intake.
Democratic therapeutic community (DTC) treatment has been used for many years in an effort to help people with personality disorder. High-quality evidence from randomised controlled trials (RCTs) is absent.
To test whether DTC treatment reduces use of in-patient services and improves the mental health of people with personality disorder.
An RCT of 70 people meeting DSM-IV criteria for personality disorder (trial registration: ISRCTN57363317). The intervention was DTC and the control condition was crisis planning plus treatment as usual (TAU). The primary outcome was days of in-patient psychiatric treatment. Secondary outcomes were social function, mental health status, self-harm and aggression, attendance at emergency departments and primary care, and satisfaction with care. All outcomes were measured at 12 and 24 months after randomisation.
Number of in-patient days at follow-up was low among all participants and there was no difference between groups. At 24 months, self- and other directed aggression and satisfaction with care were significantly improved in the DTC compared with the TAU group.
DTC is more effective than TAU in improving outcomes in personality disorder. Further studies are required to confirm this conclusion.
Prototyping is interwoven with nearly all product, service, and systems development efforts. A prototype is a pre-production representation of some aspect of a concept or final design. Prototyping often predetermines a large portion of resource deployment in development and influences design project success. This review surveys literature sources in engineering, management, design science, and architecture. The study is focused around design prototyping for early stage design. Insights are synthesized from critical review of the literature: key objectives of prototyping, critical review of major techniques, relationships between techniques, and a strategy matrix to connect objectives to techniques. The review is supported with exemplar prototypes provided from industrial design efforts. Techniques are roughly categorized into those that improve the outcomes of prototyping directly, and those that enable prototyping through lowering of cost and time. Compact descriptions of each technique provide a foundation to compare the potential benefits and drawbacks of each. The review concludes with a summary of key observations, highlighted opportunities in the research, and a vision of the future of prototyping. This review aims to provide a resource for designers as well as set a trajectory for continuing innovation in the scientific research of design prototyping.
A general method is described for estimating the position, integrated flux density and the second moments of the flux density distribution for sources in a two dimensional map. The method requires accurate knowledge of the beam shape of the telescope. Uncertainty estimates and significance levels of the source parameters are easily obtained.
To examine associations between dietary intakes of fathers and their children at child age 20 months, 3·5 years and 5 years, and to determine if fathers’ intake predicts change in children’s intake between 20 months and 3·5 and 5 years of age.
The diets of fathers and their first-born children participating in the longitudinal Melbourne Infant Feeding Activity and Nutrition Trial (InFANT) Program were assessed using FFQ and three 24 h recalls, respectively.
Sixty-two pre-existing first-time parent groups were selected from fourteen local government areas within a 60 km radius of Deakin University Burwood, Victoria, Australia.
Fathers and their first-born children at 20 months (n 317), 3·5 years (n 214) and 5 years of age (n 208).
Positive associations were found between fathers’ and children’s intakes of fruit and sweet snacks at 20 months (P=0·001) and 5 years of age (P=0·012). Fathers’ intake at child age 20 months was associated with change in children’s intake for fruit, sweet snacks and sugar-sweetened beverages between child age 20 months and 3·5 years, and for sweet snacks and sugar-sweetened beverages between child age 20 months and 5 years (all P<0·05). After adjustment for maternal intake, fathers’ intake of sweet snacks remained a predictor of change in children’s sweet snack intake between 20 months and 3·5 years of age (P=0·03).
Associations between the dietary intakes of fathers and their children commence at a young age and continue through early childhood. Fathers should be included in future interventions aimed at improving children’s diets.