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Lymphopenia is common in adults who have had a Fontan operation although its aetiology and clinical implications remain unknown. Previous work suggests an association between lymphopenia and both liver disease and splenomegaly. The objective of this study was to assess the prevalence of lymphopenia in adults with a Fontan circulation and evaluate its associations with risk factors and clinical outcomes. Using a retrospective cohort study design, we studied 73 adult Fontan patients (age 25.0 ± 8.4 years) who had a complete blood count and abdominal imaging performed. Patients with protein-losing enteropathy were excluded. Clinical data were extracted from hospital records. The mean white blood cell count was 6580 ± 220/ml with a mean lymphocyte count of 1223 ± 508/ml. Lymphopenia, defined as lymphocyte count <1000/ml, was present in 23 (32%) patients. Patients with lymphopenia had a lower total white blood cell count (5556 ± 2517 versus 7136 ± 1924/ml, p = 0.009) and a lower platelet count (162 ± 69 versus 208 ± 69 k/ml, p = 0.008). Lymphopenia was also associated with findings of portal hypertension, including splenomegaly (36 versus 14%, p = 0.04), varices (22 versus 6%, p = 0.04), and ascites (39 versus 14%, p = 0.02). Lymphopenia did not correlate with any cardiac imaging, haemodynamic or exercise testing variables. In conclusion, lymphopenia is common in adult Fontan patients and is associated with markers of portal hypertension. Larger studies are needed to better define the relationship between lymphopenia and clinical outcomes.
The objectives of this study were to obtain patient evaluations of the content, structure, and delivery modality of Meaning-Centered Pain Coping Skills Training (MCPC), a novel psychosocial intervention for patients with advanced cancer and pain. MCPC aims to help patients connect with valued sources of meaning in their lives (e.g., family relationships), while providing training in evidence-based cognitive and behavioral skills (e.g., guided imagery) to reduce pain.
Semi-structured interviews were conducted with 12 patients with stage IV solid tumor cancers and persistent pain. Transcripts were analyzed using methods from applied thematic analysis.
When evaluating MCPC's educational information and skills training descriptions, participants described ways in which this content resonated with their experience. Many coped with their pain and poor prognosis by relying on frameworks that provided them with a sense of meaning, often involving their personally held religious or spiritual beliefs. They also expressed a need for learning ways to cope with pain in addition to taking medication. A few participants offered helpful suggestions for refining MCPC's content, such as addressing common co-occurring symptoms of sleep disturbance and fatigue. Concerning MCPC's structure and delivery modality, most participants preferred that sessions include their family caregiver and described remote delivery (i.e., telephone or videoconference) as being more feasible than attending in-person sessions.
Significance of results
Participants were interested in an intervention that concurrently focuses on learning pain coping skills and enhancing a sense of meaning. Using remote delivery modalities may reduce access barriers (e.g., travel) that would otherwise prevent many patients from utilizing psychosocial services.
Recent investigations now suggest that cerebrovascular reactivity (CVR) is impaired in Alzheimer’s disease (AD) and may underpin part of the disease’s neurovascular component. However, our understanding of the relationship between the magnitude of CVR, the speed of cerebrovascular response, and the progression of AD is still limited. This is especially true in patients with mild cognitive impairment (MCI), which is recognized as an intermediate stage between normal aging and dementia. The purpose of this study was to investigate AD and MCI patients by mapping repeatable and accurate measures of cerebrovascular function, namely the magnitude and speed of cerebrovascular response (τ) to a vasoactive stimulus in key predilection sites for vascular dysfunction in AD.
Thirty-three subjects (age range: 52–83 years, 20 males) were prospectively recruited. CVR and τ were assessed using blood oxygen level-dependent MRI during a standardized carbon dioxide stimulus. Temporal and parietal cortical regions of interest (ROIs) were generated from anatomical images using the FreeSurfer image analysis suite.
Of 33 subjects recruited, 3 individuals were excluded, leaving 30 subjects for analysis, consisting of 6 individuals with early AD, 11 individuals with MCI, and 13 older healthy controls (HCs). τ was found to be significantly higher in the AD group compared to the HC group in both the temporal (p = 0.03) and parietal cortex (p = 0.01) following a one-way ANCOVA correcting for age and microangiopathy scoring and a Bonferroni post-hoc correction.
The study findings suggest that AD is associated with a slowing of the cerebrovascular response in the temporal and parietal cortices.
Biodiversity offsetting aims to achieve at least no net loss of biodiversity by fully compensating for residual development-induced biodiversity losses after the mitigation hierarchy (avoid, minimize, remediate) has been applied. Actions used to generate offsets can include securing site protection, or maintaining or enhancing the condition of targeted biodiversity at an offset site. Protection and maintenance actions aim to prevent future biodiversity loss, so such offsets are referred to as averted loss offsets. However, the benefits of such approaches can be highly uncertain and opaque, because assumptions about the change in likelihood of loss as a result of the offset action are often implicit. As a result, the gain generated by averting losses can be intentionally or inadvertently overestimated, leading to offset outcomes that are insufficient for achieving no net loss of biodiversity. We present a method and decision tree to guide consistent and credible estimation of the likelihood of biodiversity loss for a proposed offset site with and without protection, for use when calculating the amount of benefit associated with the protection component of averted loss offsets. In circumstances such as when a jurisdictional offset policy applies to most impacts, plausible estimates of averted loss can be very low. Averting further loss of biodiversity is desirable, and averted loss offsets can be a valid approach for generating tangible gains. However, overestimation of averted loss benefits poses a major risk to biodiversity.
Natural disasters are increasing in frequency and impact; they cause widespread disruption and adversity throughout the world. The Canterbury earthquakes of 2010–2011 were devastating for the people of Christchurch, New Zealand. It is important to understand the impact of this disaster on the mental health of children and adolescents.
To report psychiatric medication use for children and adolescents following the Canterbury earthquakes.
Dispensing data from community pharmacies for the medication classes antidepressants, antipsychotics, anxiolytics, sedatives/hypnotics and methylphenidate are routinely recorded in a national database. Longitudinal data are available for residents of the Canterbury District Health Board (DHB) and nationally. We compared dispensing data for children and adolescents residing in Canterbury DHB with national dispensing data to assess the impact of the Canterbury earthquakes on psychotropic prescribing for children and adolescents.
After longer-term trends and population adjustments are considered, a subtle adverse effect of the Canterbury earthquakes on dispensing of antidepressants was detected. However, the Canterbury earthquakes were not associated with higher dispensing rates for antipsychotics, anxiolytics, sedatives/hypnotics or methylphenidate.
Mental disorders or psychological distress of a sufficient severity to result in treatment of children and adolescents with psychiatric medication were not substantially affected by the Canterbury earthquakes.
To investigate the manipulation of electromagnetic properties of two-dimensional materials, this effort characterizes charge transfer behavior of colloidal COF-5 (covalent organic framework) in the presence of various metal ions. A series of metal chloride compounds was introduced to COF-5 in solution and solid film phases and the interaction of the material with electromagnetic radiation was monitored across the visible region using electronic absorption spectroscopy. Notable changes were observed, quantified, and discussed for copper (II) chloride (CuCl2), chromium (III) chloride (CrCl3), and iron (III) chloride (FeCl3) with COF-5. Ligand-to-metal and metal-to-ligand charge transfer are explored as a possible mechanism for the observed electronic behaviors.
A growing body of research suggests that deficient emotional self-regulation (DESR) is common and morbid among attention-deficit/hyperactivity disorder (ADHD) patients. The main aim of the present study was to assess whether high and low levels of DESR in adult ADHD patients can be operationalized and whether they are clinically useful.
A total of 441 newly referred 18- to 55-year-old adults of both sexes with Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition (DSM-5) ADHD completed self-reported rating scales. We operationalized DESR using items from the Barkley Current Behavior Scale. We used receiver operator characteristic (ROC) curves to identify the optimal cut-off on the Barkley Emotional Dysregulation (ED) Scale to categorize patients as having high- versus low-level DESR and compared demographic and clinical characteristics between the groups.
We averaged the optimal Barkley ED Scale cut-points from the ROC curve analyses across all subscales and categorized ADHD patients as having high- (N = 191) or low-level (N = 250) DESR (total Barkley ED Scale score ≥8 or <8, respectively). Those with high-level DESR had significantly more severe symptoms of ADHD, executive dysfunction, autistic traits, levels of psychopathology, and worse quality of life compared with those with low-level DESR. There were no major differences in outcomes among medicated and unmedicated patients.
High levels of DESR are common in adults with ADHD and when present represent a burdensome source of added morbidity and disability worthy of further clinical and scientific attention.
Lieder and Griffiths rightly urge that computational cognitive models be constrained by resource usage, but they should go further. The brain's primary function is to regulate resource usage. As a consequence, resource usage should not simply select among algorithmic models of “aspects of cognition.” Rather, “aspects of cognition” should be understood as existing in the service of resource management.
Coral reefs have experienced extensive degradation across the world over the last 50 years as a result of a variety of stressors operating at a range of spatial and temporal scales. In order to assess whether declines are continuing, or if reefs are recovering, detailed baseline information is required from across wide spatial scales. Unfortunately, for some regions this information is not readily available, making future reef trajectories difficult to determine. Here we characterized the current benthic community state for coral reefs in the Wakatobi region of Indonesia, one of the most biodiverse marine regions in the world. We surveyed 10 reef sites (5, 10 and 15 m depth) to explore spatial variation in coral reef benthic communities and provide a detailed baseline. Previous data (2002–2011) were available for coral, sponges, algae and soft coral at six of our study sites. Using this information, we determined if any changes had occurred in dominance of these benthic groups. We found that benthic assemblage composition differed significantly over relatively small spatial scales (2–10 km) and hard coral cover was highly variable, ranging from 7–48% (average 19.5% ± 1.5 SE). While coral cover appears to have declined at all sites where data were available since 2002, we found little evidence for widespread increases in other benthic groups or regime shifts. Our study provides a comprehensive baseline dataset for the region that can be used in the future to determine rates of change in benthic communities.
The Murchison Widefield Array (MWA) is an open access telescope dedicated to studying the low-frequency (80–300 MHz) southern sky. Since beginning operations in mid-2013, the MWA has opened a new observational window in the southern hemisphere enabling many science areas. The driving science objectives of the original design were to observe 21 cm radiation from the Epoch of Reionisation (EoR), explore the radio time domain, perform Galactic and extragalactic surveys, and monitor solar, heliospheric, and ionospheric phenomena. All together
programs recorded 20 000 h producing 146 papers to date. In 2016, the telescope underwent a major upgrade resulting in alternating compact and extended configurations. Other upgrades, including digital back-ends and a rapid-response triggering system, have been developed since the original array was commissioned. In this paper, we review the major results from the prior operation of the MWA and then discuss the new science paths enabled by the improved capabilities. We group these science opportunities by the four original science themes but also include ideas for directions outside these categories.
Preoperative mechanical ventilation is associated with morbidity and mortality following CHD surgery, but prior studies lack a comprehensive analysis of how preoperative respiratory support mode and timing affects outcomes.
We retrospectively collected data on children <18 years of age undergoing cardiac surgery at an academic tertiary care medical centre. Using multivariable regression, we examined the association between modes of preoperative respiratory support (nasal cannula, high-flow nasal cannula/noninvasive ventilation, or invasive mechanical ventilation), escalation of preoperative respiratory support, and invasive mechanical ventilation on the day of surgery for three outcomes: operative mortality, postoperative length of stay, and postoperative complications. We repeated our analysis in a subcohort of neonates.
A total of 701 children underwent 800 surgical procedures, and 40% received preoperative respiratory support. Among neonates, 243 patients underwent 253 surgical procedures, and 79% received preoperative respiratory support. In multivariable analysis, all modes of preoperative respiratory support, escalation in preoperative respiratory support, and invasive mechanical ventilation on the day of surgery were associated with increased odds of prolonged length of stay in children and neonates. Children (odds ratio = 3.69, 95% CI 1.2–11.4) and neonates (odds ratio = 8.97, 95% CI 1.31–61.14) on high-flow nasal cannula/noninvasive ventilation had increased odds of operative mortality compared to those on room air.
Preoperative respiratory support is associated with prolonged length of stay and mortality following CHD surgery. Knowing how preoperative respiratory support affects outcomes may help guide surgical timing, inform prognostic conversations, and improve risk stratification models.
Weed seeds with mechanical damage are more susceptible to mortality in soil than nondamaged seeds. In this study we introduce a colorimetric assay to distinguish mechanically damaged weed seeds from nondamaged weed seeds. Our objectives were to 1) compare steepates from mechanically damaged seeds against steepates from nondamaged seeds for their capacities to reduce resazurin—a nontoxic, water-soluble dye that changes color and light absorbance properties in response to pH; and 2) use light absorbance data from steepate-resazurin solutions to create classification trees for distinguishing damaged from nondamaged weed seeds. Species in this study included barnyardgrass, curly dock, junglerice, kochia, oakleaf datura, Palmer amaranth, spurred anoda, stinkgrass, tall morningglory, and yellow foxtail. Seeds of each species were subjected to mechanical damage treatments that collectively represented a range of damage severities. Damaged and nondamaged seeds were individually soaked in water to produce steepates that were combined with resazurin. Light absorbance properties of steepate-resazurin solutions indicated that for all species except kochia, damaged seeds reduced resazurin to greater extents than nondamaged seeds. Prediction accuracy rates for classification trees that used absorbance values as predictor variables were conditioned by species and damage type. Prediction accuracy rates were relatively low (66% to 86% accurate) for lightly damaged seeds, especially grass weed seeds. Prediction accuracy rates were high (91% to 99% accurate) for severely damaged seeds of specific broadleaf and grass weeds. Steepate-resazurin solutions that successfully separated seeds took no more than 32 h to produce. The results of this study indicate that the resazurin assay is a method for quickly distinguishing damaged from nondamaged weed seeds. Because rapid assessments of seed intactness may accelerate the development of tactics for reducing the number of weed seeds in soil, we advocate further development of resazurin assays by laboratories studying methods for weed seedbank depletion.
Experiments were carried out in high Reynolds number turbulent boundary layers over rough surfaces of diverse geometries. Roughness configurations varied in element height, distribution (random versus ordered), shape and spacing. Rough surfaces comprising of two superposed element geometries were also tested. All flows were free of transitional effects with
upwards of 40 000 and
ratios above 73. The wall-pressure spectrum and turbulent velocity profiles revealed that the roughness element spacing has the greatest impact on the turbulent structures in the boundary layer. The high-frequency scaling on shear friction velocity,
, (Meyers et al.J. Fluid Mech., vol. 768, 2015, pp. 261–293) was validated and
was shown to be the viscous contribution to the overall surface drag. An empirical formula for the pressure drag on roughness elements was developed to reflect the finding that the pressure drag is a function of only two variables: sparseness ratio
and roughness Reynolds number
. Results also suggest that the viscous contribution to drag approaches a constant non-zero value at high Reynolds numbers, and ‘fully rough-wall flow’ may occur at higher
than previously thought.
Biological anthropologists interested in population interactions compare biological relationships among living populations, among past populations, and between living and past populations. To do this, we utilize datasets that can be compared equivalently across space and time. One such source of data comes from dental morphological traits, nonmetric characteristics observable on the crown surfaces of teeth. Tooth morphology is largely under genetic control and less affected by environmental factors than many other tissue systems (Hillson 1996; Larsen and Kelley 1991; Scott et al. 2018), and therefore presents an effective dataset with which to trace intrapopulation variation, interpopulation relationships, and microevolution.
Mount Achernar moraine is a terrestrial sediment archive that preserves a record of ice-sheet dynamics and climate over multiple glacial cycles. Similar records exist in other blue ice moraines elsewhere on the continent, but an understanding of how these moraines form is limited. We propose a model to explain the formation of extensive, coherent blue ice moraine sequences based on the integration of ground-penetrating radar (GPR) data with ice velocity and surface exposure ages. GPR transects (100 and 25 MHz) both perpendicular and parallel to moraine ridges at Mount Achernar reveal an internal structure defined by alternating relatively clean ice and steeply dipping debris bands extending to depth, and where visible, to the underlying bedrock surface. Sediment is carried to the surface from depth along these debris bands, and sublimates out of the ice, accumulating over time (>300 ka). The internal pattern of dipping reflectors, combined with increasing surface exposure ages, suggest sequential exposure of the sediment where ice and debris accretes laterally to form the moraine. Subsurface structure varies across the moraine and can be linked to changes in basal entrainment conditions. We speculate that higher concentrations of debris may have been entrained in the ice during colder glacial periods or entrained more proximal to the moraine sequence.
In recent years, unmanned aerial vehicle (UAV) technology has expanded to include UAV sprayers capable of applying pesticides. Very little research has been conducted to optimize application parameters and measure the potential of off-target movement from UAV-based pesticide applications. Field experiments were conducted in Raleigh, NC during spring 2018 to characterize the effect of different application speeds and nozzle types on target area coverage and uniformity of UAV applications. The highest coverage was achieved with an application speed of 1 m s−1 and ranged from 30% to 60%, whereas applications at 7 m s−1 yielded 13% to 22% coverage. Coverage consistently decreased as application speed increased across all nozzles, with extended-range flat-spray nozzles declining at a faster rate than air-induction nozzles, likely due to higher drift. Experiments measuring the drift potential of UAV-applied pesticides using extended-range flat spray, air-induction flat-spray, turbo air–induction flat-spray, and hollow-cone nozzles under 0, 2, 4, 7, and 9 m s−1 perpendicular wind conditions in the immediate 1.75 m above the target were conducted in the absence of natural wind. Off-target movement was observed under all perpendicular wind conditions with all nozzles tested but was nondetectable beyond 5 m away from the target. Coverage from all nozzles exhibited a concave-shaped curve in response to the increasing perpendicular wind speed due to turbulence. The maximum target coverage in drift studies was observed when the perpendicular wind was 0 and 8.94 m s−1, but higher turbulence at the two highest perpendicular wind speeds (6.71 and 8.94 m s−1) increased coverage variability, whereas the lowest variability was observed at 2.24 m s−1 wind speed. Results suggested that air-induction flat-spray and turbo air–induction flat-spray nozzles and an application speed of 3 m s−1 provided an adequate coverage of target areas while minimizing off-target movement risk.
Needlestick and sharps injury (NSSI) is a common occupational hazard of orthopedic surgery training. The purpose of this study was to examine the incidence and surrounding circumstances of intraoperative NSSI in orthopedic surgery residents and fellows and to examine postexposure reporting.
A 35-question cross-sectional survey.
The study was conducted by orthopedic surgery residents and faculty at a nonprofit regional hospital.
The questionnaire was distributed to US allopathic orthopedic surgery residency and fellowship programs; 300 orthopedic surgery trainees participated in the survey.
Of 223 trainees who had completed at least 1 year of residency, 172 (77.1%) sustained an NSSI during residency, and 57 of 63 trainees (90.5%) who had completed at least 4 years sustained an NSSI during residency. The most common causes of NSSI were solid needles, followed by solid pins or wires. The surgical activity most associated with NSSI was wound closure, followed by fracture fixation. The type of surgery most frequently associated with NSSI was orthopedic trauma, followed by hip and knee arthroplasty. Of 177 trainees who had sustained a prior NSSI, 99 (55.9%) failed to report all events to their institution’s occupational health department.
The incidence of NSSI during residency training is high, with >90% of trainees in their fifth year or later of training having received an injury during their training, with a mean of >4 separate events. Most trainees with an NSSI did not report all of their events, which implies that changes are needed in the incident reporting process universally.