We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save 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 saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
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 saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved 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.
In times of health reform, fiscal restraint and population aging, it becomes increasingly imperative to understand what must be done to better link research and policy in the health area. In this paper, the major determinants of healthy aging are discussed in terms of current conceptual frameworks of health, measurement, methodologies, and data sources. In order to maximize the benefit for the health of current and future Canadian seniors, policy recommendations are made to Statistics Canada, Health Canada, and the Seniors Independence Research Program (SIRP) which cover a range of issues related to measurement and data sources, health services, health status, economic status, and education.
An accurate estimate of the average number of hand hygiene opportunities per patient hour (HHO rate) is required to implement group electronic hand hygiene monitoring systems (GEHHMSs). We sought to identify predictors of HHOs to validate and implement a GEHHMS across a network of critical care units.
Design:
Multicenter, observational study (10 hospitals) followed by quality improvement intervention involving 24 critical care units across 12 hospitals in Ontario, Canada.
Methods:
Critical care patient beds were randomized to receive 1 hour of continuous direct observation to determine the HHO rate. A Poisson regression model determined unit-level predictors of HHOs. Estimates of average HHO rates across different types of critical care units were derived and used to implement and evaluate use of GEHHMS.
Results:
During 2,812 hours of observation, we identified 25,417 HHOs. There was significant variability in HHO rate across critical care units. Time of day, day of the week, unit acuity, patient acuity, patient population and use of transmission-based precautions were significantly associated with HHO rate. Using unit-specific estimates of average HHO rate, aggregate HH adherence was 30.0% (1,084,329 of 3,614,908) at baseline with GEHHMS and improved to 38.5% (740,660 of 1,921,656) within 2 months of continuous feedback to units (P < .0001).
Conclusions:
Unit-specific estimates based on known predictors of HHO rate enabled broad implementation of GEHHMS. Further longitudinal quality improvement efforts using this system are required to assess the impact of GEHHMS on both HH adherence and clinical outcomes within critically ill patient populations.
Gravitational waves from coalescing neutron stars encode information about nuclear matter at extreme densities, inaccessible by laboratory experiments. The late inspiral is influenced by the presence of tides, which depend on the neutron star equation of state. Neutron star mergers are expected to often produce rapidly rotating remnant neutron stars that emit gravitational waves. These will provide clues to the extremely hot post-merger environment. This signature of nuclear matter in gravitational waves contains most information in the 2–4 kHz frequency band, which is outside of the most sensitive band of current detectors. We present the design concept and science case for a Neutron Star Extreme Matter Observatory (NEMO): a gravitational-wave interferometer optimised to study nuclear physics with merging neutron stars. The concept uses high-circulating laser power, quantum squeezing, and a detector topology specifically designed to achieve the high-frequency sensitivity necessary to probe nuclear matter using gravitational waves. Above 1 kHz, the proposed strain sensitivity is comparable to full third-generation detectors at a fraction of the cost. Such sensitivity changes expected event rates for detection of post-merger remnants from approximately one per few decades with two A+ detectors to a few per year and potentially allow for the first gravitational-wave observations of supernovae, isolated neutron stars, and other exotica.
Poor motivation to engage in goal-oriented behavior has been recognized as a hallmark feature of schizophrenia spectrum disorders (SZ). Low drive in SZ may be related to anticipating rewards as well as to poor working memory. However, few studies to date have examined beliefs about self-efficacy and satisfaction for future rewards (anticipatory pleasure). Additionally, few studies to date have examined how these deficits may impact SZ patients’ real world functioning.
Method:
The present study examined SZ patients’ (n = 57) anticipatory pleasure, working memory, self-efficacy and real world functioning in relation to their negative symptom severity.
Results:
Results revealed that SZ patients’ negative symptom severity was related to decisions in effort allocation and reward probability, working memory deficits, self-efficacy and anticipatory pleasure for future reward. Effort allocation deficits also predicted patients’ daily functioning skills.
Conclusions:
SZ patients with high levels of negative symptoms are not merely effort averse, but have more difficulty effectively allocating effort and anticipating pleasure engaging in effortful activities. It may be the case that continuously failing to achieve reinforcement from engagement and participation may lead SZ patients to form certain negative beliefs about their abilities which contributes to amotivation and cognitive deficits. Lastly, our findings provide further support for a link between SZ patients functional daily living skills their effort allocation.
This study used a single case experimental design to investigate the use of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) among a sample of individuals with depression and anxiety who also presented with borderline personality disorder (BPD). Eight women received individual treatment with the UP over the course of 14–16 treatment sessions, and were assessed for anxiety and depression severity on a weekly basis over a 2–6 week baseline period and throughout treatment. Three of the eight participants demonstrated reliable pre- to post-treatment clinical improvements on depression and stress scales, and one participant demonstrated a reliable reduction on an anxiety scale. Two participants demonstrated a reliable improvement in overall anxiety. The results indicate that the UP applied to individuals diagnosed with primary BPD may lead to clinical improvement in depression, stress and anxiety for some individuals. However, the majority of individuals with BPD in our sample did not show strong improvement, and this suggests the need for additional sessions of UP or an intervention that focuses on the symptoms of BPD specifically for some women.
Key learning aims
(1) To describe the applicability of the Unified Protocol in the treatment of individuals with borderline personality and co-occurring anxiety or depression.
(2) To understand the value of utilizing a transdiagnostic approach as an alternative to diagnosis-specific approaches to treatment.
(3) To identify the four core modules of the Unified Protocol and describe the general format for individual treatment.
Current estimates are that around 3,000 of the 6,000 languages now spoken may become extinct during the next century. Some 4,000 of these existing languages have never been described, or described only inadequately. This book is a guide for linguistic fieldworkers who wish to write a description of the morphology and syntax of one of these many under-documented languages. It uses examples from many languages both well known and virtually unknown; it offers readers one possible outline for a grammatical description, with many questions designed to help them address the key topics. The appendices offer guidance on text and elicited data, and on sample reference grammars which readers might wish to consult.
Inorganic calcite precipitation experiments were conducted to determine whether inducing specific orientations of calcite crystal growth can cause the enrichment of cations larger than Ca. Malonic acid (CH2(COOH)), a di-carboxylic acid, was used to poison growth on acute kink sites, promoting growth on obtuse kink sites, causing calcite crystals elongated along their c-axes to form in a mechanism similar to that seeninthe growth of E. huxleyi coccoliths. Calcite was precipitated with a range of malonic acid concentrations (0 to 10-1 M), and 9x10-5 M of either SrCl2 or MgCl2. The results show that calcite crystals precipitated in the presence of large malonic acid concentrations show significant elongation along the c axis, and suggest that increasing malonate concentrations corresponded with increasing DSr. Experiments with 10-1 M malonic acid caused elevated DSr comparable to that predicted for E. huxleyi coccolith calcite (Langer et al., 2006).
Despite extensive research on organizational virtue, our understanding about factors that promote virtue within organizations remains unclear. Drawing on upper echelon theory, we examine the relationship between five top management team (TMT) characteristics and organizational virtue orientation (OVO)—the integrated set of values and beliefs that support ethical traits and virtuous behaviors of an organization. Specifically, we utilize prospectuses of initial public offering (IPO) firms and 10-K post-IPO filings to explore how TMT composition with respect to member age, tenure, education, functional background, and gender influences OVO. Additionally, we examine the moderating effects of organizational size, and argue that the more expansive structures and processes associated with larger organizations diminish the main relationships. Our findings, using two sources of data, are consistent, but somewhat mixed in their support for our hypotheses. Overall, TMT characteristics do appear to influence OVO, but in more complex and counterintuitive ways than initially expected.
The Iranian Empire emerged in the third century in the interstices of the Silk Road that increasingly linked the markets of the Mediterranean and the Near East with South, Central, and East Asia. The ensuing four centuries of Iranian rule corresponded with the heyday of trans-Eurasian trade, as the demand of moneyed imperial elites across the continent for one another's high-value commodities stimulated the development of long-distance networks. Despite its position at the nexus of trans-continental and trans-oceanic commerce, accounts of Iran in late antiquity relegate trade to a marginal role in its political economy. The present article seeks to foreground the contribution of trans-continental mercantile networks to the formation of Iran and to argue that its development depended as much on the political economies of its western and eastern neighbours as on internal Near Eastern factors.
The Omani basement is located spatially distant from the dominantly juvenile Arabian–Nubian Shield (ANS) to its west, and its relationship to the amalgamation of those arc terranes has yet to be properly constrained. The Jebel Ja'alan (NE Oman) basement inlier provides an excellent opportunity to better understand the Neoproterozoic tectonic geography of Oman and its relationship to the ANS. To understand the origin of this basement inlier, we present new radiogenic isotopic data from igneous bodies in Jebel Ja'alan. U–Pb and 40Ar/39Ar geochronological data are used to constrain the timing of magmatism and metamorphism in the jebel. Positive εHf and εNd values indicate a juvenile origin for the igneous lithologies. Phase equilibria modelling is used to constrain the metamorphic conditions recorded by basement. Pressure–temperature (P–T) pseudosections show that basement schists followed a clockwise P–T path, reaching peak metamorphic conditions of c. 650–700°C at 4–7.5 kbar, corresponding to a thermal gradient of c. 90–160°C/kbar. From the calculated thermal gradient, in conjunction with collected trace-element data, we interpret that the Jebel Ja'alan basement formed in an arc environment. Geochronological data indicate that this juvenile arc formed during Tonian time and is older than basement further west in Oman. We argue that the difference in timing is related to westwards arc accretion and migration, which implies that the Omani basement represents its own tectonic domain separate to the ANS and may be the leading edge of the Neoproterozoic accretionary margin of India.
A model of the growth and decay of the Antarctic Peninsula Ice Sheet during the last glacial/interglacial cycle is used to identify the main controls on ice sheet behavior. Using as input glaciological assumptions derived by W. F. Budd and I. N. Smith (1982, Annals of Glaciology 3, 42–49), bedrock topography, isostatic compensation, and mass balance relationships, the model is driven by sea-level change over the last 40,000 yr in association with assumed changes in the rate of melting beneath ice shelves. An ice sheet dome over 3.5 km thick grows on the offshore shelf and straits west of the Antarctic Peninsula and reaches a maximum at 18,000 yr B.P. Collapse begins at 14,000 yr B.P. but becomes rapid and continuous after 10,000 yr B.P. The present stable ice cover is achieved at 6500 yr B.P. Ice growth and decay are characterized by thresholds which separate periods of steady state from periods of rapid transition; the thresholds usually relate to topography. Tests show that ice sheet behavior is most sensitive to sea-level change, basal marine melting, and accumulation and is less sensitive to isostasy, spatial variation in accumulation, calving rates, and ice flow parameterization. Tests of the model against field evidence show good agreement in places, as well as discrepancies which require further work.
Universal screening for postpartum depression is recommended in many countries. Knowledge of whether the disclosure of depressive symptoms in the postpartum period differs across cultures could improve detection and provide new insights into the pathogenesis. Moreover, it is a necessary step to evaluate the universal use of screening instruments in research and clinical practice. In the current study we sought to assess whether the Edinburgh Postnatal Depression Scale (EPDS), the most widely used screening tool for postpartum depression, measures the same underlying construct across cultural groups in a large international dataset.
Method
Ordinal regression and measurement invariance were used to explore the association between culture, operationalized as education, ethnicity/race and continent, and endorsement of depressive symptoms using the EPDS on 8209 new mothers from Europe and the USA.
Results
Education, but not ethnicity/race, influenced the reporting of postpartum depression [difference between robust comparative fit indexes (∆*CFI) < 0.01]. The structure of EPDS responses significantly differed between Europe and the USA (∆*CFI > 0.01), but not between European countries (∆*CFI < 0.01).
Conclusions
Investigators and clinicians should be aware of the potential differences in expression of phenotype of postpartum depression that women of different educational backgrounds may manifest. The increasing cultural heterogeneity of societies together with the tendency towards globalization requires a culturally sensitive approach to patients, research and policies, that takes into account, beyond rhetoric, the context of a person's experiences and the context in which the research is conducted.
Older people with dementia are at increased risk of physical decline and falls. Balance and mood are significant predictors of falls in this population. The aim of this study was to determine the effect of a tailored home-based exercise program in community-dwelling older people with dementia.
Methods:
Forty-two participants with mild to moderate dementia were recruited from routine health services. All participants were offered a six-month home-based, carer-enhanced, progressive, and individually tailored exercise program. Physical activity, quality of life, physical, and psychological assessments were administered at the beginning and end of the trial.
Results:
Of 33 participants (78.6%) who completed the six-month reassessment ten (30%) reported falls and six (18%) multiple falls during the follow-up period. At reassessment, participants had better balance (sway on floor and foam), reduced concern about falls, increased planned physical activity, but worse knee extension strength and no change in depression scores. The average adherence to the prescribed exercise sessions was 45% and 22 participants (52%) were still exercising at trial completion. Those who adhered to ≥70% of prescribed sessions had significantly better balance at reassessment compared with those who adhered to <70% of sessions.
Conclusions:
This trial of a tailored home-based exercise intervention presents preliminary evidence that this intervention can improve balance, concern about falls, and planned physical activity in community-dwelling older people with dementia. Future research should determine whether exercise interventions are effective in reducing falls and elucidate strategies for enhancing uptake and adherence in this population.
At least in conventional hydrostatic ice-sheet models, the numerical error associated with grounding line dynamics can be reduced by modifications to the discretization scheme. These involve altering the integration formulae for the basal traction and/or driving stress close to the grounding line and exhibit lower – if still first-order – error in the MISMIP3d experiments. MISMIP3d may not represent the variety of real ice streams, in that it lacks strong lateral stresses, and imposes a large basal traction at the grounding line. We study resolution sensitivity in the context of extreme forcing simulations of the entire Antarctic ice sheet, using the BISICLES adaptive mesh ice-sheet model with two schemes: the original treatment, and a scheme, which modifies the discretization of the basal traction. The second scheme does indeed improve accuracy – by around a factor of two – for a given mesh spacing, but $\lesssim 1$ km resolution is still necessary. For example, in coarser resolution simulations Thwaites Glacier retreats so slowly that other ice streams divert its trunk. In contrast, with $\lesssim 1$ km meshes, the same glacier retreats far more quickly and triggers the final phase of West Antarctic collapse a century before any such diversion can take place.