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Pressure on large fluvial lowlands has increased tremendously during the past twenty years because of flood control, urbanization, and increased dependence upon floodplains and deltas for food production. This book examines human impacts on lowland rivers, and discusses how these changes affect different types of riverine environments and flood processes. Surveying a global range of large rivers, it provides a primary focus on the lower Rhine River in the Netherlands and the Lower Mississippi River in Louisiana. A particular focus of the book is on geo-engineering, which is described in a straight-forward writing style that is accessible to a broad audience of advanced students, researchers, and practitioners in global environmental change, fluvial geomorphology and sedimentology, and flood and water management.
This is the first report on the association between trauma exposure and depression from the Advancing Understanding of RecOvery afteR traumA(AURORA) multisite longitudinal study of adverse post-traumatic neuropsychiatric sequelae (APNS) among participants seeking emergency department (ED) treatment in the aftermath of a traumatic life experience.
We focus on participants presenting at EDs after a motor vehicle collision (MVC), which characterizes most AURORA participants, and examine associations of participant socio-demographics and MVC characteristics with 8-week depression as mediated through peritraumatic symptoms and 2-week depression.
Eight-week depression prevalence was relatively high (27.8%) and associated with several MVC characteristics (being passenger v. driver; injuries to other people). Peritraumatic distress was associated with 2-week but not 8-week depression. Most of these associations held when controlling for peritraumatic symptoms and, to a lesser degree, depressive symptoms at 2-weeks post-trauma.
These observations, coupled with substantial variation in the relative strength of the mediating pathways across predictors, raises the possibility of diverse and potentially complex underlying biological and psychological processes that remain to be elucidated in more in-depth analyses of the rich and evolving AURORA database to find new targets for intervention and new tools for risk-based stratification following trauma exposure.
The Triassic–Jurassic Upper Karoo Group of the Mid-Zambezi Basin (MZB; Zimbabwe) includes a thick succession of terrestrial sediments with high palaeontological potential that has been neglected since the 1970s. Here, we review the Upper Karoo Group stratigraphy, present detailed sedimentological work and identify new vertebrate-bearing sites at several measured sections along the southern shore of Lake Kariba. These fossil-bearing sites fall within the Pebbly Arkose and Forest Sandstone formations, and are the first to be recorded from the region since the discovery of Vulcanodon karibaensis nearly 50 years ago. The unique and diverse assemblage of aquatic and terrestrial fauna reported includes phytosaurs, metoposaurid amphibians, lungfish, non-dinosaurian archosauromorphs and non-sauropod sauropodomorph dinosaurs. This improvement of Upper Karoo Group biostratigraphy is important in refining its temporal resolution, and impacts both regional and global studies. Finally, the new fossil sites demonstrate the palaeontological importance of the MZB and its role in providing a holistic understanding of early Mesozoic ecosystems in southern Gondwana.
This work investigated the photophysical pathways for light absorption, charge generation, and charge separation in donor–acceptor nanoparticle blends of poly(3-hexylthiophene) and indene-C60-bisadduct. Optical modeling combined with steady-state and time-resolved optoelectronic characterization revealed that the nanoparticle blends experience a photocurrent limited to 60% of a bulk solution mixture. This discrepancy resulted from imperfect free charge generation inside the nanoparticles. High-resolution transmission electron microscopy and chemically resolved X-ray mapping showed that enhanced miscibility of materials did improve the donor–acceptor blending at the center of the nanoparticles; however, a residual shell of almost pure donor still restricted energy generation from these nanoparticles.
This article provides an overview of selected ongoing international efforts that have been inspired by Edward Zigler's vision to improve programs and policies for young children and families in the United States. The efforts presented are in close alignment with three strategies articulated by Edward Zigler: (a) conduct research that will inform policy advocacy; (b) design, implement, and revise quality early childhood development (ECD) programs; and (c) invest in building the next generation of scholars and advocates in child development. The intergenerational legacy left by Edward Zigler has had an impact on young children not only in the United States, but also across the globe. More needs to be done. We need to work together with a full commitment to ensure the optimal development of each child.
The dynamics of choice and self-selection are central features of politics but absent from most experimental designs. We show how designs that incorporate choice, by allowing some subjects the option to receive or avoid treatment, can be extended by randomizing conditional on subjects’ treatment choices to answer further questions of interest while preserving statistical power. We apply this design to study how the gender of messengers for the #MeToo social movement conditions who receives the movement’s message and how they respond. Our results, from both convenience and nationally representative samples, suggest that #MeToo movement’s message reaches a wide audience with the intended effect. The potential for backlash in response to the message appears limited but more likely when this message is delivered by a woman.
Few studies have examined burnout in psychosocial oncology clinicians. The aim of this systematic review was to summarize what is known about the prevalence and severity of burnout in psychosocial clinicians who work in oncology settings and the factors that are believed to contribute or protect against it.
Articles on burnout (including compassion fatigue and secondary trauma) in psychosocial oncology clinicians were identified by searching PubMed/MEDLINE, EMBASE, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, and the Web of Science Core Collection.
Thirty-eight articles were reviewed at the full-text level, and of those, nine met study inclusion criteria. All were published between 2004 and 2018 and included data from 678 psychosocial clinicians. Quality assessment revealed relatively low risk of bias and high methodological quality. Study composition and sample size varied greatly, and the majority of clinicians were aged between 40 and 59 years. Across studies, 10 different measures were used to assess burnout, secondary traumatic stress, and compassion fatigue, in addition to factors that might impact burnout, including work engagement, meaning, and moral distress. When compared with other medical professionals, psychosocial oncology clinicians endorsed lower levels of burnout.
Significance of results
This systematic review suggests that psychosocial clinicians are not at increased risk of burnout compared with other health care professionals working in oncology or in mental health. Although the data are quite limited, several factors appear to be associated with less burnout in psychosocial clinicians, including exposure to patient recovery, discussing traumas, less moral distress, and finding meaning in their work. More research using standardized measures of burnout with larger samples of clinicians is needed to examine both prevalence rates and how the experience of burnout changes over time. By virtue of their training, psychosocial clinicians are well placed to support each other and their nursing and medical colleagues.
The early phase of the coronavirus disease 2019 (COVID-19) pandemic and ongoing efforts for mitigation underscore the importance of universal travel and symptom screening. We analyzed adherence to documentation of travel and symptom screening through a travel navigator tool with clinical decision support to identify patients at risk for Middle East Respiratory Syndrome.
During the past decade, genetics research has allowed scientists and clinicians to explore the human genome in detail and reveal many thousands of common genetic variants associated with disease. Genetic risk scores, known as polygenic risk scores (PRSs), aggregate risk information from the most important genetic variants into a single score that describes an individual’s genetic predisposition to a given disease. This article reviews recent developments in the predictive utility of PRSs in relation to a person’s susceptibility to breast cancer and coronary artery disease. Prognostic models for these disorders are built using data from the UK Biobank, controlling for typical clinical and underwriting risk factors. Furthermore, we explore the possibility of adverse selection where genetic information about multifactorial disorders is available for insurance purchasers but not for underwriters. We demonstrate that prediction of multifactorial diseases, using PRSs, provides population risk information additional to that captured by normal underwriting risk factors. This research using the UK Biobank is in the public interest as it contributes to our understanding of predicting risk of disease in the population. Further research is imperative to understand how PRSs could cause adverse selection if consumers use this information to alter their insurance purchasing behaviour.
To describe characteristics of self-identified popular diet followers and compare mean BMI across these diets, stratified by time following diet.
Cross-sectional, web-based survey administered in 2015.
Non-localised, international survey.
Self-selected followers of popular diets (n 9019) were recruited to the survey via social media and email announcements by diet community leaders, categorised into eight major diet groups.
General linear models were used to compare mean BMI among (1) short-term (<1 year) and long-term (≥1 year) followers within diet groups and (2) those identifying as ‘try to eat healthy’ (TTEH) to all other diet groups, stratified by time following the specific diet. Participants were 82 % female, 93 % White and 96 % non-Hispanic. Geometric mean BMI was lower (P < 0·05 for all) among longer-term followers (≥1 year) of whole food, plant-based (WFPB), vegan, whole food and low-carb diets compared with shorter-term followers. Among those following their diet for 1–5 years (n 4067), geometric mean BMI (kg/m2) were lower (P < 0·05 for all) for all groups compared with TTEH (26·4 kg/m2): WFPB (23·2 kg/m2), vegan (23·5 kg/m2), Paleo (24·6 kg/m2), vegetarian (25·0 kg/m2), whole food (24·6 kg/m2), Weston A. Price (23·5 kg/m2) and low-carb (24·7 kg/m2).
Our findings suggest that BMI is lower among individuals who made active decisions to adhere to a specific diet, particularly more plant-based diets and/or diets limiting highly processed foods, compared with those who simply TTEH. BMI is also lower among individuals who follow intentional eating plans for longer time periods.
We describe 14 yr of public data from the Parkes Pulsar Timing Array (PPTA), an ongoing project that is producing precise measurements of pulse times of arrival from 26 millisecond pulsars using the 64-m Parkes radio telescope with a cadence of approximately 3 weeks in three observing bands. A comprehensive description of the pulsar observing systems employed at the telescope since 2004 is provided, including the calibration methodology and an analysis of the stability of system components. We attempt to provide full accounting of the reduction from the raw measured Stokes parameters to pulse times of arrival to aid third parties in reproducing our results. This conversion is encapsulated in a processing pipeline designed to track provenance. Our data products include pulse times of arrival for each of the pulsars along with an initial set of pulsar parameters and noise models. The calibrated pulse profiles and timing template profiles are also available. These data represent almost 21 000 h of recorded data spanning over 14 yr. After accounting for processes that induce time-correlated noise, 22 of the pulsars have weighted root-mean-square timing residuals of
in at least one radio band. The data should allow end users to quickly undertake their own gravitational wave analyses, for example, without having to understand the intricacies of pulsar polarisation calibration or attain a mastery of radio frequency interference mitigation as is required when analysing raw data files.
Improving the quality of care on psychiatric inpatient wards has been a major focus in recent mental health policy, a recurrent criticism being that contact between staff and patients is limited in time and therapeutic value. Change is unlikely to be achieved without recruitment and retention of a high quality and well-motivated work force.
The NHS commissioned national inpatient mental health staff morale study is intended to inform service planning and policy by delivering evidence on the morale of the inpatient mental health workforce and the clinical, organisational, architectural and human resources factors that influence it.
100 wards in 17 area ‘Trusts’ are participating in the study, in addition to 40 community teams. The study will take place over two years, and has 6 modules:
1. A quantitative questionnaire for all staff in participating wards and
2. A comparison group in 20 community mental health teams and 20 crisis teams.
3. Case studies of 10 wards scoring in the top and bottom quartile for indicators of morale.
4. Repeated questionnaires for 20 wards in the second year to investigate how morale changes over time.
5. Staff who leave the wards in the course of the first year will be asked their reasons for leaving.
6. Links between rates of staff sickness and morale will be investigated.
Questionnaires have been distributed to 3,500 staff with a response rate of 65%, results from which will be presented in 2009.
Fatigue and depression are among the most frequent symptoms in multiple sclerosis (MS), affecting up to 90% of patients at onset or during the course of the disease. Repetitive transcranial magnetic stimulation (rTMS) has proven safe and efficacious for treating depression.
To perform a randomized, sham-controlled pilot study to evaluate effects of deep rTMS on fatigue and depression in patients with multiple sclerosis.
28 MS-patients underwent 18 sessions of deep rTMS over 6 weeks. 10 patients underwent sham stimulation, 9 patients stimulation of the left prefrontal cortex (PFC) (18 Hz, 120% motor threshold (MT)) and 9 patients of the motor cortex (MC) (5 Hz, 90% MT). Following the treatment, patients were observed for further 6 weeks. Effects on fatigue were evaluated with the Fatigue Severity Scale (FSS) Depression was assessed by Becks Depression Inventory (BDI).
There was no significant change of BDI or FSS in sham group, as well as in PFC group over all time points. However BDI in MC group showed a significant decrease already in early treatment phase (-25.74% ± 24.36%, p = 0.013) and continued decrease over treatment period with maximum in follow up phase (-39.23% ± 21.57, p = 0.001). In FSS, MC group showed a trend to decrease during treatment period and the effect becomes significant in follow up phase (-26,72% ± 16.30%, p = 0.001).
Our data suggests that deep rTMS may have positive influence on depression and fatigue. Intrestingly, comparable effects on both symptoms were observed in MC group but not in PFC or in sham group.
Dans le cadre de la sécurisation du circuit du médicament, une EPP a été réalisée pour mettre en évidence le nombre d’erreurs identifiées lors de la préparation des piluliers dans le cadre de la DJIN des patients hospitalisés en psychiatrie.
Matériels et méthode
Menée de janvier à décembre 2014, cette étude prospective a permis de recenser et de typer les erreurs identifiées lors de la préparation des piluliers. Quotidiennement et de manière aléatoire, 4 chariots sur 10 étaient entièrement contrôlés. Les 6 autres ne l’étaient que partiellement, à raison de 2 piluliers choisis au hasard par chariot. Les résultats obtenus correspondent au nombre d’erreurs rapporté au nombre d’ordonnances contrôlées, par service et par mois.
Résultats et discussion
En 2014, le pourcentage d’erreurs identifiées pour le service de psychiatrie est de 6,04 %, soit 1 erreur toutes les 26 lignes. Ce résultat est conforme aux données de la littérature (6–7 %)*, contrairement à celui obtenu pour l’ensemble de l’hôpital (7,78 %). En effet, le service de psychiatrie témoigne d’une certaine stabilité en raison d’une chronicité des pathologies traitées et d’une protocolisation des prises en charge. Les patients sont ainsi souvent suivis depuis longtemps et leur traitement ne change que ponctuellement. Cependant, malgré cette sécurité apparente, la vigilance de l’équipe soignante est essentielle : sur les 1300 ordonnances non contrôlées, 79 erreurs n’auraient donc pas été interceptées par la pharmacie, si le même pourcentage d’erreurs est appliqué.
Le double contrôle lors de la préparation des traitements est essentiel. Il permet d’intercepter les erreurs à la pharmacie, mais aussi dans le service clinique. À l’heure où l’exercice de l’infirmier est à la médicalisation, l’infirmier reste le dernier verrou avant le patient.