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 firstname.lastname@example.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 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.
Introduction: Patients with chronic diseases are known to benefit from exercise. Such patients often visit the emergency department (ED). There are few studies examining prescribing exercise in the ED. We wished to study if exercise prescription in the ED is feasible and effective. Methods: In this pilot prospective block randomized trial, patients in the control group received routine care, whereas the intervention group received a combined written and verbal prescription for moderate exercise (150 minutes/week). Both groups were followed up by phone at 2 months. The primary outcome was achieving 150 min of exercise per week. Secondary outcomes included change in exercise, and differences in reported median weekly exercise. Comparisons were made by Mann-Whitney and Fishers tests (GraphPad). Results: Follow-up was completed for 22 patients (11 Control; 11 Intervention). Baseline reported median (with IQR) weekly exercise was similar between groups; Control 0(0-0)min; Intervention 0(0-45)min. There was no difference between groups for the primary outcome of 150 min/week at 2 months (Control 3/11; Intervention 4/11, RR 1.33 (95%CI 0.38-4.6;p=1.0). There was a significant increase in median exercise from baseline in both groups, but no difference between the groups (Control 75(10-225)min; Intervention 120(52.5-150)min;NS). 3 control patients actually received exercise prescription as part of routine care. A post-hoc comparison of patients receiving intervention vs. no intervention, revealed an increase in patients meeting the primary target of 150min/week (No intervention 0/8; Intervention 7/14, RR 2.0 (95%CI 1.2-3.4);p=0.023). Conclusion: Recruitment was feasible, however our study was underpowered to quantify an estimated effect size. As a significant proportion of the control group received the intervention (as part of standard care), any potential measurable effect was diluted. The improvement seen in patients receiving intervention and the increase in reported exercise in both groups (possible Hawthorne effect) suggests that exercise prescription for ED patients may be beneficial.
Introduction: The positive health outcomes of exercise have been well-studied, and exercise prescription has been shown to reduce morbidity in several chronic health conditions. However, patient attitudes around the prescription of exercise in the emergency department (ED) have not been explored. The aim of our pilot study is to explore patients’ willingness and perceptions of exercise being discussed and prescribed in the ED. Methods: This study is a survey of patients who had been previously selected for exercise prescription in a pilot study conducted at a tertiary care ED. This intervention group were given a standardized provincial written prescription to perform moderate exercise for 150 minutes per week. Participants answered a discharge questionnaire and were followed up by a telephone interview 2 months later. A structured interview of opinions around exercise prescription was conducted. Questions included a combination of non-closed style interview questions and Likert scale. Patients rated prescription detail, helpfulness and likelihood on a Likert scale from 1-5 (1 being strongly disagree and 5 being strongly agree). Median values (+/-IQRs) are presented, along with dominant themes. Results: 17 people consented to exercise prescription and follow up surveys. 2 were excluded due to hospital admission. 15 participants were enrolled and completed the discharge survey. Two-month follow up survey response rate was 80%. Patients rated the detail given in their prescription as 5 (+/-1). Helpfulness of prescription was rated as 4 (+/-2). Likelihood to continue exercising based on the prescription was rated as 4 (+/-2). 11/12 participants felt that exercise should be discussed in the Emergency Department either routinely or on a case-by-case basis.1 participant felt it should not be discussed at all. Conclusion: Our study demonstrates that most patients are open to exercise being discussed during their Emergency Department visit, and that the prescription format was well-received by study participants.
The synthesis telescopes at Fleurs and Molonglo have been used to map 50 supernova remnants. Additional specialized software to process the maps has been developed, and Parkes observations have been used to supply short spacing information missing from the maps.
8.4 GHz linear polarization maps, obtained with the Parkes radio telescope, are presented for six southern supernova remnants. These results are compared with published and unpublished polarization maps at 5 GHz to derive the magnetic field direction and Faraday rotation measure distribution.
These results are part of a program to map the magnetic fields in galactic supernova remnants and complement our program to obtain high-resolution maps of galactic SNRs using the Molonglo Observatory Synthesis Telescope; five new Molonglo maps are presented here.
The Molonglo Observatory synthesis telescope (MOST) of the University of Sydney (Mills 1981) produces maps of the 843 MHz continuum emission from fields of width 23′, 46′ or 70′ arc. The telescope comprises two co-linear east-west cylindrical paraboloids each 2186λ in length and separated by a gap of 43λ. For each paraboloid a phasing network (Durdin et al. 1984) generates a comb of 64 contiguous fan beams. Mapping is accomplished in real time during a 12-h observation by overlaying, in the map plane, the instantaneous cross-correlations of corresponding beams. The synthesized point-source response (beam) produced by this method has a width of 43″ (E-W) by 43″ cosec δ (N-S).
Contributors to this Special Issue of the Cognitive Behaviour Therapist have considered the kind of infrastructure that should be in place to best support and guide CBT supervisors, providing practical advice and extensive procedural guidance. Here we briefly summarize and discuss in turn the 10 papers within this Special Issue, including suggestions for further enhancements. The first paper, by Milne and Reiser, conceptualized this infrastructure in terms of an ‘SOS’ (supporting our supervisors) framework, from identifying supervision competencies, to training, evaluation and feedback strategies. The next nine papers illustrate this framework with specific technical innovations, educational enhancements and procedural issues, or through comprehensive quality improvement systems, all designed to support supervisors. These papers suggest an assortment of workable infrastructure developments: two large-scale and comprehensive initiatives, some promising proposals and technologies, and a series of local, exploratory work. Collectively, they provide us with models for further developing evidence-based cognitive-behavioural supervision, and offer practical suggestions for giving supervisors the tools and support to maximize their supervisees’ learning, and to improve the associated client outcomes. Much research and development work remains to be done, and successful implementation will require institutional and political support, as well as cross-cultural adaptations. We conclude with an optimistic assessment of progress toward addressing some of the infrastructure improvements required to adequately support supervisors.
A foodborne outbreak with 49 cases (22 culture positive for Campylobacter sp.) following a wedding party in the East of England was investigated. A retrospective cohort study identified an association between consumption of chicken liver pâté and infection with Campylobacter jejuni/coli. There was a statistically significant association between dose (amount of chicken liver pâté eaten) and the risk of disease [‘tasted’: odds ratio (OR) 1·5, 95% confidence interval (CI) 0·04–∞; ‘partly eaten’: OR 8·4, 95% CI 1·4–87·5; ‘most or all eaten’: OR 36·1, 95% CI 3·3–2119). The local authority found evidence that the preparation of chicken livers breached Food Standards Agency's guidelines. This epidemiological investigation established a clear dose–response relationship between consumption of chicken liver pâté and the risk of infection with Campylobacter. The continuing need to raise public awareness of the risk to human health posed by undercooked chicken liver is evident.
Healthcare-associated hepatitis B virus (HBV) outbreaks have been reported in the USA and from several countries in Europe. Patient-to-patient transmission of HBV in these settings has been linked to several different types of exposure but one of the most common exposures implicated is the use of ‘finger-stick’ lancet devices for blood glucose testing. This article is an account of the investigations into a series of HBV outbreaks linked to the use of lancing devices in community healthcare settings in the UK. Between February 2004 and December 2006, nine individuals with acute HBV infection were reported to five local units of the Health Protection Agency. Investigations identified a further 12 individuals with HBV infection in residents in these settings. The epidemiological and environmental evidence suggests that HBV transmission occurred mostly from a significant breakdown in infection control measures in blood glucose testing. The occurrence of these outbreaks has highlighted the confusion that exists and the need for clear recommendations regarding the use of such devices in the UK.
A 12-month abattoir study was undertaken from January 2003. We collected 7492 intestinal samples from cattle, sheep and pigs at slaughter. Rectal samples were taken from cattle and sheep and caecal samples from pigs. They were examined for verocytotoxigenic E. coli (VTEC) O157, Salmonella, thermophilic Campylobacter and Yersinia enterocolitica. Data were collected on the animal from which the sample came and this information was analysed to look at potential risk factors for carriage of these organisms. Logistic regression models were run where an adequate number of positive results were available. This revealed that VTEC O157 carriage in cattle was associated with the summer period and that age was a protective factor. Salmonella carriage in pigs was associated with lairage times >12 h, the North East and not feeding when there was no bedding available. In cattle, carriage was associated with the summer period, the Eastern region of GB and dairy animals. In sheep a spring seasonal effect was seen, which coincided with the lambing period. The carriage of thermophilic Campylobacter in cattle was associated with single-species abattoirs, with age a protective factor. In sheep, winter was a risk period with lairage management influential. For pigs, lairage times of <12 h were found to be associated with carriage. A seasonal trend for carriage of Y. enterocolitica in all species was demonstrated with the period December–May a risk. For cattle, age was also a risk factor; for sheep feeding in the lairage and for pigs being held overnight were risk factors.
Adverse events during the perinatal period have traditionally been thought to contribute to the risk of febrile seizures although an association has not been found in large epidemiological studies. Disease-discordant twins provide a means to assess the role of non-shared environmental factors while matching for confounding factors and avoiding difficulties of epidemiological studies in singletons. This study aimed to examine the association of obstetric events and febrile seizures in a community-based twin study. Twenty-one twin pairs discordant for febrile seizures were ascertained from a community-based twin register. Obstetric events were scored using the McNeil-Sjöström Scale for Obstetric Complications and expressed as a summary score (OC score). The frequency of individual obstetric events in affected and unaffected twins, the within-pair differences in OC scores and other markers of perinatal risk including birthweight, birth order and Apgar scores were examined. No significant difference was found in the frequency of individual obstetric events, nor in OC scores between affected and unaffected twins. No differences in birth weight, birth order, 1- or 5-minute Apgar scores were observed. Our results confirm previous findings that obstetric events are not associated with the risk of febrile seizures.
An abattoir survey was undertaken to determine the prevalence of foodborne zoonotic organisms colonizing cattle, sheep and pigs at slaughter in Great Britain. The study ran for 12 months from January 2003, involved 93 abattoirs and collected 7703 intestinal samples. The design was similar to two previous abattoir surveys undertaken in 1999–2000 allowing comparisons. Samples were examined for VTEC O157, Salmonella, thermophilic Campylobacter and Yersinia enterocolitica. The prevalence of VTEC O157 faecal carriage was 4·7% in cattle, 0·7% in sheep and 0·3% in pigs. A significant decrease in sheep was detected from the previous survey (1·7%). Salmonella carriage was 1·4% in cattle, a significant increase from the previous survey of 0·2%. In sheep, faecal carriage was 1·1% a significant increase from the previous survey (0·1%). In pigs, carriage was 23·4%, consistent with the previous study. Thermophilic Campylobacter spp. were isolated from 54·6% of cattle, 43·8% of sheep and 69·3% of pigs. Y. enterocolitica was isolated from 4·5% of cattle, 8·0% of sheep and 10·2% of pigs.
An alternative method for seeding catalyst nanoparticles for carbon nanotubes and nanowires growth is presented. Ni nanoparticles are formed inside a 450 nm SiO2 film on (100) Si wafers through the implantation of Ni ions at fluences of 7.5×1015 and 1.7×1016 ions cm−2 and post-annealing treatment at 700, 900 and 1100 °C. After exposed to the surface by HF dip etching, the Ni nanoparticles are used as catalyst for the growth of vertically aligned carbon nanotubes by direct current plasma enhanced chemical vapor deposition.
The identification of genetic factors that confer susceptibility to the epilepsies has to date been the focus of genetic efforts in this field. Few studies have assessed the genetic contribution to disease course in epilepsy, yet an understanding of the genetic influences on epilepsy outcome is key to developing new therapeutic strategies. The aim of this study was to assess the genetic contributions to epilepsy outcome in twin pairs concordant for epilepsy. We studied 37 epilepsy concordant twin pairs (27 monozygotic, 10 dizygotic) in whom there were no recognized environmental contributions (e.g., acquired brain injury) to epilepsy, and in whom the most likely cause for epilepsy was a shared genetic susceptibility. Clinical outcome was determined using the binary measure of Seizure Status (seizure remission or recurrence) and on a six-category ordinal Outcome Scale. Epilepsy outcome was independent of age of seizure onset, age at assessment and major epilepsy syndrome diagnosis. The proportion of twin pairs concordant for Seizure Status was 0.81 (22/27) for monozygous and 1.0 (10/10) for dizygous pairs, p = 0.3. Within-pair correlation in outcome (Outcome Scale) was 0.60 (95% CI: 0.32, 0.78) in monozygous and 0.78 (0.48, 0.92) in dizygous pairs. These data provide no evidence for genetic influences on epilepsy outcome independent of those that contribute to disease susceptibility. The observed high correlations for outcome suggest that, for epilepsy, susceptibility genes also have a major influence on outcome.
The seasonal and spatial pattern of diet composition of a population of wild rabbits Oryctolagus cuniculus L. occupying a southern Portuguese montado was estimated using the n-alkane technique. The diet was analysed in terms of components that are relevant to habitat management. The dietary categories considered were gum cistus leaves and flowers, cork oak and holm oak seedlings and acorns, cereals, olive tree regrowth and grass-forb species. The objectives were to assess the changes in diet across seasons in relation to the reproductive cycle of the rabbits, and to relate these changes to herbaceous biomass availability and to habitat structure, in terms of density of scrub cover and accessibility to arable crops. The results demonstrated that the diet was dominated by grass-forbs, and cereals when they were available. Browse was an important component of the diet and became more important in a year of low herbaceous biomass availability and in areas dominated by dense scrub. A similar phenomenon was observed in relation to consumption of acorns in winter. Seasonal and spatial variation in diet composition suggested a strategy aimed at maintaining a high quality diet. This was supported by the observed high dry matter digestibility of the diet during most of the year. The relevance of growing arable crops and providing fodder, as a means of increasing the carrying capacity of montados for rabbits and protecting the natural regeneration of trees, is discussed.
Armadillos are a very diverse group ranging from non-fossorial Tolypeutini through to the powerful diggers like the giant armadillo Priodontes maximus to the totally subterranean Chlamyphorini. A previous study demonstrated a close relationship between the relative length of the olecranon of the ulna (index of fossorial ability, IFA) and the fossorial ability of armadillos. This study examines a wide range of limb proportions to explore the biomechanical correlates with fossorial ability. The study demonstrates that the indices of the forelimb (brachial index, shoulder moment index and IFA) do correlate well with digging habits, but also reveals some interesting exceptions, particularly in the most fossorial and most cursorial forms. On the other hand, the hindlimb indices apparently do not correlate with digging habits, but seem to be influenced more by body size. The correlations among the forelimb indices are quite strong and positive but correlations between forelimb and hindlimb indices are negative or very low. It is apparent that there is still much to be learned about structure and function in armadillos.
Patch clamp recordings from ion channels often show periods of repetitive activity, known as bursts, which are noticeably separated from each other by periods of inactivity. Depending on the type of channel, such recordings may exhibit (conductance) levels between the closed (zero) level and the fully open level. Properties of bursts are less subject to problems that arise from recording than are properties for individual sojourns at different levels, and study of bursting behaviour provides important information about the finer structure of the underlying channel gating process. For a general finite state space continuous-time Markov chain model allowing one or more nonzero conductance levels, the present paper establishes results about the semi-Markov structure of a single burst and of a sequence of bursts, and uses this in a unified approach to properties of both theoretical and empirical bursts. The distribution and moments of particular burst properties, including the total charge transfer, the total sojourn time and the total number of visits to specified conductance levels during a burst, are derived. Various extensions are also described.
The existing scale for assessing competence in cognitive therapy (CTS) dates from 1988 and only the
previous version of 1980 has been validated to any extent. A revised version, the CTS-R, was devised to improve on
the CTS by: eliminating overlap between items, improving on the scaling system, and defining items more clearly.
Kolb's well-known educational model was used as a guideline. In the new 14-item scale, three new items measure
general therapeutic flair, the facilitation of emotional expression, and therapist's non-verbal behaviours (optional). We hypothesized that the CTS-R would prove more user friendly and demonstrate satisfactory reliability and validity. Twenty-one mental health professionals undergoing training in cognitive therapy provided 102 video-tapes of therapy
with 34 patients, reflecting three stages of therapy. The tapes were rated by four expert raters, in a balanced design.
The CTS-R showed high internal consistency and adequate average inter-rater reliability. Reliability for individual
items varied widely among pairs of raters. Validity was demonstrated by improved ratings of competence for trainees
who saw patients early and later during the course of training. Although raters found the CTS-R a more useful tool
than the CTS and satisfactory reliability and validity were demonstrated, more refinement is needed in item definition.
The study has led to modifications in the CTS-R, which are in the process of evaluation.