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Treatment for hoarding disorder is typically performed by mental health professionals, potentially limiting access to care in underserved areas.
We aimed to conduct a non-inferiority trial of group peer-facilitated therapy (G-PFT) and group psychologist-led cognitive–behavioural therapy (G-CBT).
We randomised 323 adults with hording disorder 15 weeks of G-PFT or 16 weeks of G-CBT and assessed at baseline, post-treatment and longitudinally (≥3 months post-treatment: mean 14.4 months, range 3–25). Predictors of treatment response were examined.
G-PFT (effect size 1.20) was as effective as G-CBT (effect size 1.21; between-group difference 1.82 points, t = −1.71, d.f. = 245, P = 0.04). More homework completion and ongoing help from family and friends resulted in lower severity scores at longitudinal follow-up (t = 2.79, d.f. = 175, P = 0.006; t = 2.89, d.f. = 175, P = 0.004).
Peer-led groups were as effective as psychologist-led groups, providing a novel treatment avenue for individuals without access to mental health professionals.
Declaration of interest
C.A.M. has received grant funding from the National Institutes of Health (NIH) and travel reimbursement and speakers’ honoraria from the Tourette Association of America (TAA), as well as honoraria and travel reimbursement from the NIH for serving as an NIH Study Section reviewer. K.D. receives research support from the NIH and honoraria and travel reimbursement from the NIH for serving as an NIH Study Section reviewer. R.S.M. receives research support from the National Institute of Mental Health, National Institute of Aging, the Hillblom Foundation, Janssen Pharmaceuticals (research grant) and the Alzheimer's Association. R.S.M. has also received travel support from the National Institute of Mental Health for Workshop participation. J.Y.T. receives research support from the NIH, Patient-Centered Outcomes Research Institute and the California Tobacco Related Research Program, and honoraria and travel reimbursement from the NIH for serving as an NIH Study Section reviewer. All other authors report no conflicts of interest.
Children with CHD and acquired heart disease have unique, high-risk physiology. They may have a higher risk of adverse tracheal-intubation-associated events, as compared with children with non-cardiac disease.
Materials and methods
We sought to evaluate the occurrence of adverse tracheal-intubation-associated events in children with cardiac disease compared to children with non-cardiac disease. A retrospective analysis of tracheal intubations from 38 international paediatric ICUs was performed using the National Emergency Airway Registry for Children (NEAR4KIDS) quality improvement registry. The primary outcome was the occurrence of any tracheal-intubation-associated event. Secondary outcomes included the occurrence of severe tracheal-intubation-associated events, multiple intubation attempts, and oxygen desaturation.
A total of 8851 intubations were reported between July, 2012 and March, 2016. Cardiac patients were younger, more likely to have haemodynamic instability, and less likely to have respiratory failure as an indication. The overall frequency of tracheal-intubation-associated events was not different (cardiac: 17% versus non-cardiac: 16%, p=0.13), nor was the rate of severe tracheal-intubation-associated events (cardiac: 7% versus non-cardiac: 6%, p=0.11). Tracheal-intubation-associated cardiac arrest occurred more often in cardiac patients (2.80 versus 1.28%; p<0.001), even after adjusting for patient and provider differences (adjusted odds ratio 1.79; p=0.03). Multiple intubation attempts occurred less often in cardiac patients (p=0.04), and oxygen desaturations occurred more often, even after excluding patients with cyanotic heart disease.
The overall incidence of adverse tracheal-intubation-associated events in cardiac patients was not different from that in non-cardiac patients. However, the presence of a cardiac diagnosis was associated with a higher occurrence of both tracheal-intubation-associated cardiac arrest and oxygen desaturation.
In 2013, New York State mandated that, during influenza season, unvaccinated healthcare personnel (HCP) wear a surgical mask in areas where patients are typically present. We found that this mandate was associated with increased HCP vaccination and decreased HCP visits to the hospital Workforce Health and Safety Department with respiratory illnesses and laboratory-confirmed influenza.
The US federal government invests in the development of medical countermeasures for addressing adverse health effects to the civilian population from chemical, biological, and radiological or nuclear threats. We model the potential economic spillover effects in day-to-day burn care for a federal investment in a burn debridement product for responding to an improvised nuclear device.
We identify and assess 4 primary components for projecting the potential economic spillover benefits of a burn debridement product: (1) market size, (2) clinical effectiveness and cost-effectiveness, (3) product cost, and (4) market adoption rates. Primary data sources were the American Burn Association’s 2015 National Burn Repository Annual Report of Data and published clinical studies used to gain European approval for the burn debridement product.
The study results showed that if approved for use in the United States, the burn debridement product has potential economic spillover benefits exceeding the federal government’s initial investment of $24 million a few years after introduction into the burn care market.
Economic spillover analyses can help to inform the prioritizing of scarce resources for research and development of medical countermeasures by the federal government. Future federal medical countermeasure research and development investments could incorporate economic spillover analysis to assess investment options. (Disaster Med Public Health Preparedness. 2017;11:711–719)
A large-scale public health emergency, such as a severe influenza pandemic, can generate large numbers of critically ill patients in a short time. We modeled the number of mechanical ventilators that could be used in addition to the number of hospital-based ventilators currently in use.
We identified key components of the health care system needed to deliver ventilation therapy, quantified the maximum number of additional ventilators that each key component could support at various capacity levels (ie, conventional, contingency, and crisis), and determined the constraining key component at each capacity level.
Our study results showed that US hospitals could absorb between 26,200 and 56,300 additional ventilators at the peak of a national influenza pandemic outbreak with robust pre-pandemic planning.
The current US health care system may have limited capacity to use additional mechanical ventilators during a large-scale public health emergency. Emergency planners need to understand their health care systems’ capability to absorb additional resources and expand care. This methodology could be adapted by emergency planners to determine stockpiling goals for critical resources or to identify alternatives to manage overwhelming critical care need. (Disaster Med Public Health Preparedness. 2015;9:634–641)
An enormous effort is underway worldwide to attempt to detect gravitational waves. If successful, this will open a new frontier in astronomy. An essential portion of this effort is being carried out in Australia by the Australian Consortium for Interferometric Gravitational Astronomy (ACIGA), with research teams working at the Australia National University, University of Western Australia, and University of Adelaide involving scientists and students representing many more institutions and nations. ACIGA is developing ultrastable high-power continuous-wave lasers for the next generation interferometric gravity wave detectors; researching the problems associated with high optical power in resonant cavities; opening frontiers in advanced interferometry configurations, quantum optics, and signal extraction; and is the world's leader in high-performance vibration isolation and suspension design. ACIGA has also been active in theoretical research and modelling of potential astronomical gravitational wave sources, and in developing data analysis detection algorithms. ACIGA has opened a research facility north of Perth, Western Australia, which will be the culmination of these efforts. This paper briefly reviews ACIGA's research activities and the prospects for gravitational wave astronomy in the southern hemisphere.
Recent Hα surveys such as SHS and IPHAS have improved the completeness of the Galactic planetary nebula (PN) census. We now know of ∼3000 PNe in the Galaxy, but this is far short of most estimates, typically ~25 000 or more for the total population. The size of the Galactic PN population is required to derive an accurate estimate of the chemical enrichment rates of nitrogen, carbon, and helium. In addition, a high PN count (>20 000) is strong evidence that most main-sequence stars of mass 1–8 M⊙ will go through a PN phase, while a low count (<10 000) argues that special conditions (e.g. close binary interactions) are required to form a PN. We describe a technique for finding hundreds more PNe using the existing data collections of the digital sky surveys, thereby improving the census of Galactic PNe.
It’s them blessed Yorkshire an’ Welsh colliers as does it … It’s a union strike this is, not a men’s strike.
(Mrs Bower, February 1912)
We are not dealing with niceties here. We shall not be constitutionalised out of a defence of our jobs. Area by Area will decide, and in my opinion it will have a domino effect.
(Michael McGahey, March 1984)
In March 1984, Yorkshire pickets made the short motorway journey south to the Nottinghamshire coalfield. They sought solidarity against pit closures. Most Nottinghamshire miners rejected the call and continued to work, protected when necessary by large numbers of police, both local and imported. In the months that followed, the reputed solidarity of these mining communities was often expressed not in opposition to employer or government but against their own trade union. On May Day, working and striking miners each demonstrated outside the Mansfield headquarters of the Nottinghamshire Area of the National Union of Mineworkers. Their officials were themselves divided in their vehement responses to the passions of the divided and massive demonstration. The working majority in the county gained the public approval of Margaret Thatcher. Litigation by miners opposed to the strike led eventually to the sequestration of the assets of the National Union of Mineworkers. Eventually the divisions and animosities of the year-long dispute produced a breakaway union.
The images vividly portray organised labour’s most decisive defeat of the Thatcher years − the sense of a movement in disarray and incapable of responding effectively to a concerted and distinctive political challenge. The divisions of 1984 contrasted with a decade earlier, when the second miners’ strike within two years had provoked the Heath government into calling an election. The result was a defeat that was narrow, but definitive. Heath’s eviction fed myths about the industrial and potential political strength of miners that sustained the victors and aggrieved the vanquished. The reversal a decade later was not a simple matter of Heathite irresolution succeeded by Thatcherite determination. The later victory owed much to the complexities of mining trade unionism. Understanding of the Thatcher years can be developed by analysis of a major adversary.
Having surveyed ≈ 10% of the sky, we have identified more than 130 PN candidates by surveying multicolour Digitized Sky Survey (DSS), Sloan Digitized Sky Survey (SDSS), and combined [O III], Hα and [S II] images. In a first imaging and spectroscopy campaign, 51 objects were identified as true and probable PNe. This work presents an additional 17 probable or possible PNe identified since that study. The majority of these candidates are situated at Galactic latitudes |b| > 5^, with the exception of seven objects located closer to the Galactic plane. Using the techniques described here that do not require any new survey data, we anticipate that many more PNe are waiting to be found, perhaps as many as 90.