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Collaborative care can support the treatment of depression in people with long-term conditions, but long-term benefits and costs are unknown.
To explore the long-term (24-month) effectiveness and cost-effectiveness of collaborative care in people with mental-physical multimorbidity.
A cluster randomised trial compared collaborative care (integrated physical and mental healthcare) with usual care for depression alongside diabetes and/or coronary heart disease. Depression symptoms were measured by the symptom checklist-depression scale (SCL-D13). The economic evaluation was from the perspective of the English National Health Service.
191 participants were allocated to collaborative care and 196 to usual care. At 24 months, the mean SCL-D13 score was 0.27 (95% CI, −0.48 to −0.06) lower in the collaborative care group alongside a gain of 0.14 (95% CI, 0.06-0.21) quality-adjusted life-years (QALYs). The cost per QALY gained was £13 069.
In the long term, collaborative care reduces depression and is potentially cost-effective at internationally accepted willingness-to-pay thresholds.
Understanding individual differences in temperament traits enables us to investigate the relationship between those traits with animal production and welfare. One aspect of dairy cow temperament that is particularly important to study is aggression. Stress caused by aggressive interactions can negatively affect behaviour and feed intake (Olofsson, 1999), and cause some cows to alter their feeding times to avoid aggressive interactions (Miller and Wood-Gush, 1991). The objective of this study was to characterise the competitive ‘style’ of individual cows. The following questions were addressed: 1) are cows consistent in how they express aggression over time at a standard length feedface, 2) does the parity, feedface length, stage of lactation and social dominance rank have an effect on aggressive behaviour?
Management and general treatment approaches
Penny J. M. Banerjee, East Midlands Centre for Forensic Mental Health, Arnold Lodge, Leicester, UK,
Simon Gibbon, East Midlands Centre for Forensic Mental Health, Arnold Lodge, Leicester, UK,
Nick Huband, Nottinghamshire Healthcare NHS Trust, Nottingham, UK
An experimental, microbially enhanced soybean product (MEPRO) was evaluated as a replacement for fishmeal (FM). Assessment of feedstuffs should include estimation of digestibility as well as pig performance and in combination with dietary additives. Digestibility values determined in growing pigs may not apply to nursery pigs; thus, standardized ileal digestibility (SID) of amino acids (AA) in MEPRO and FM were determined using 30±1.6 kg BW ileal-cannulated barrows (n=6) and 9.8±1.2 kg BW barrows (n=37; serial slaughter). Experimental diets included MEPRO, FM and nitrogen free where FM and MEPRO were included as the sole protein source. The SID of AAs was 3% to 5% lower in MEPRO than FM when fed to 30 kg pigs. The SID of arginine and methionine was greater (P<0.05) in MEPRO than FM when fed to 10 kg pigs. The SID of AAs was 12% to 20% lower in FM when fed to 10 v. 30 kg pigs but only 3% to 9% lower in MEPRO. A total of 336 barrows and gilts were weaned at 21 days of age (initial BW=6.1±0.8 kg) and used in a performance trial. Pens of pigs were assigned to one of the six experimental diets (8 pens/diet in two blocks). Treatment diets were fed in Phase I (7 days) and Phase II (14 days) with all pigs fed a common Phase III diet (14 days). Experimental diets included (1) negative control (NEG) containing corn, soybean meal and whey, (2) NEG+acidifier, (3) NEG+FM (POS), (4) POS+acidifier (POS A+), (5) NEG+MEPRO (MEPRO) and (6) MEPRO+acidifier. The FM and MEPRO were included at 7.5% and 5.0% in Phase I and II diets, respectively. Diets were formulated to meet the standard nutrient requirements for weaned pigs. Pig BW and feed disappearance was measured weekly and fecal scores were measured daily for the first 14 days post-weaning as an indicator of post-weaning diarrhea syndrome (PWDS). Performance (BW, daily gain, feed intake and gain : feed) was not significantly different among treatments. Treatment for PWDS occurred on different days in each block. Analysis of fecal score was completed separately by block. Pigs fed the NEG diets had higher (P=0.02) fecal scores than pigs fed the POS diets on days 2 and 3 (block 1) and higher (P<0.05) than pigs fed MEPRO or POS diets and diets with dietary acidifier on days 6 and 3 (block 2). The MEPRO holds promise as an alternative to FM in nursery pig diets.
Setting priorities in the field of infectious diseases requires evidence-based and robust baseline estimates of disease burden. Therefore, the European Centre for Disease Prevention and Control initiated the Burden of Communicable Diseases in Europe (BCoDE) project. The project uses an incidence- and pathogen-based approach to measure the impact of both acute illness and sequelae of infectious diseases expressed in disability-adjusted life years (DALYs). This study presents first estimates of disease burden for four pathogens in Germany. The number of reported incident cases adjusted for underestimation served as model input. For the study period 2005–2007, the average disease burden was estimated at 33 116 DALYs/year for influenza virus, 19 115 DALYs/year for Salmonella spp., 8708 DALYs/year for hepatitis B virus and 740 DALYs/year for measles virus. This methodology highlights the importance of sequelae, particularly for hepatitis B and salmonellosis, because if omitted, the burden would have been underestimated by 98% and 56%, respectively.
Management and general treatment approaches
Penny J. M. Banerjee, Consultant Forensic Psychiatrist, East Midlands Centre for Forensic Mental Health, Arnold Lodge, Leicester, UK,
Simon Gibbon, Consultant Forensic Psychiatrist, East Midlands Centre for Forensic Mental Health, Arnold Lodge, Leicester, UK,
Nick Huband, Research Fellow, Division of Psychiatry, Nottinghamshire Healthcare NHS Trust, Nottingham, UK
Summary It is important that personality disorders are properly assessed as they are common conditions that have a significant impact on an individual's functioning in all areas of life. Individuals with personality disorder are more vulnerable to other psychiatric disorders, and personality disorders can complicate recovery from severe mental illness. This chapter reviews the classification of personality disorder and some common assessment instruments. It also offers a structure for the assessment of personality disorder.
Historically, health professions have not always agreed on how best to conceptualise, categorise and define personality disorders. Although there are still many divergent views, there has been an increased consensus following the publication of definitions of personality disorder in ICD-10 (World Health Organization, 1992) and DSM-IV (American Psychiatric Association, 1994). In 2003, the Department of Health, in conjunction with the National Institute for Mental Health in England, produced Personality Disorder: No Longer a Diagnosis of Exclusion (National Institute for Mental Health in England, 2003). This document outlined the need for provision of mental health services (both general and forensic) for people with a diagnosis of personality disorder, and emphasised the importance of practitioners having skills in identifying and assessing personality disorder in order to appropriately treat a person's difficulties.
Prevalence and comorbidity of personality disorders
Personality disorders are common conditions (Coid et al, 2006a) that, by definition, run a prolonged course and are often associated with poor outcome (Stone, 1993; Skodol et al, 2005) and increased mortality (Harris & Barraclough, 1998). In a general population study of British households, Coid et al (2006a) found a weighted prevalence of 4.4% for a diagnosis of any personality disorder. The weighted prevalence for each individual personality disorder varied between 0.06 and 1.9%, with obsessive–compulsive, avoidant, schizoid and borderline subtypes being the most common. Dependent and schizotypal personality disorders were the least prevalent (the study identified no cases of histrionic or narcissistic personality disorder, suggesting that these disorders are particularly rare in the general population). Comorbidity within personality disorders is common; thus, patients with personality disorder are likely to fulfil diagnostic criteria for more than one subtype of personality disorder. In Coid et al's (2006a) sample, 54% had only one personality disorder, 22% had two, 11% had three and 14% had between four and eight personality disorders.
Ludwig’s Bustard Neotis ludwigii, endemic to Africa’s south-west arid zone, is susceptible to collisions with overhead power lines. Limited data from the south-eastern part of its range suggest that this factor may threaten its survival. We estimated transmission line collision rates for Ludwig’s Bustard across its South African range to assess the effect of this mortality on the population. Conservatively, collision rates averaged at least 0.63 ± 0.12 fatal collisions per km of transmission line per year, with relatively little regional variation. Despite being less abundant, the larger males were more collision-prone than females, which might account for the female-biased population. Extrapolating collision rates across the range of the species suggests that 4,000–11,900 birds are killed annually on high-voltage transmission lines. Actual mortality on overhead lines is probably much greater, given biases in carcass detection (crippling, scavenging and habitat biases), as well as the fact that our estimate excludes mortality on lower voltage distribution lines and telephone wires. Given an estimated global population of 56,000–81,000 birds in the late 1980s, the demographic invariant method suggests that such mortality is unsustainable. This result supports the recent upgrading of the conservation status of Ludwig’s Bustard from ‘Least Concern’ to ‘Endangered’, and highlights the need for further research on this problem.
The fabrication of 250 Å thick, undoped, single crystal silicon on insulator by lateral solid phase epitaxial growth from amorphous silicon on oxide patterned (001) silicon substrates is reported. Amorphous silicon was grown by low pressure chemical vapor deposition at 525°C using disilane. Annealing at temperatures between 540 and 570°C is used to accomplish the lateral epitaxial growth. The process makes use of a Si/Si1-xGex/Si stacked structure and selective etching. The thin Si1-xGex etch stop layer (x=0.2) is deposited in the amorphous phase and crystallized simultaneously with the Si layers. The lateral growth distance of the epitaxial region was 2.5 μm from the substrate seed window. This represents a final lateral to vertical aspect ratio of 100:1 for the single crystal silicon over oxide regions after selective etching of the top sacrificial Si layer. The effects of Ge incorporation on the lateral epitaxial growth process are also discussed. The lateral epitaxial growth rate of 20% Ge alloys is enhanced by roughly a factor of three compared to the rate of Si films at an anneal temperature of 555°C. Increased random nucleation rates associated with Ge alloy films are shown to be an important consideration when employing Si1-xGex to enhance lateral growth or as an etch stop layer.
Limited reaction processing (LRP), a new technique which provides precise control of thermally driven surface reactions, was used to grow multilayer structures composed of semiconductors and insulators. Results are presented for group IV-based materials including epitaxial Si, SiGe alloys, SiO2, and polysilicon. III–V materials such as GaAs, AlGaAs, and InGaAs have also been successfully grown. A number of diagnostic techniques were used to define the advantages and capabilities of LRP, including TEM, SIMS and AES. In addition, some preliminary device results are presented.
SiGe/Si superlattices were grown using limited reaction processing in a chamber which allows both W-halogen and Hg arc wafer illumination. Each multilayer structure was fabricated in-situ by changing the gas composition between high temperature cycles. Commensurate SiGe alloy layers as thin as 15 nm were reproducibly deposited and were examined using transmission electron microscopy, sputtering Auger electron spectroscopy,and Rutherford backscattering. Preliminary results are presented on UV/ozone cleaning of LRP substrates to remove residual carbon contamination in-situ prior to film deposition.
Limited reaction processing has been used to grow thin, high quality layers of epitaxial silicon, silicon dioxide, and polycrystalline silicon. Multiple layers of these materials were deposited in – situ to demonstrate control of layer thicknesses, interface transition regions, and interface cleanliness. MOS and p-n junction structures were fabricated which exhibit electrical characteristics comparable to those of devices produced by conventional techniques.
In an effort to extend the performance limits of semiconductors, devices based on heterojunctions rather than homojunctions are being investigated with great interest. Heterojunctions allow certain device design constraints to be relaxed because the charge distribution, electric field, and potential can be tailored extensively, permitting better device structures to be utilized. Silicon technology today enjoys a firm grip on a large portion of the electronics industry due in part to its superior material properties.
This study is concerned with the fundamental limitations imposed by cascade mixing and recoil implantation on the depth resolution of secondary ion mass spectrometry (SIMS), and the effects of these limitations on the determination of impurity profiles in semiconductors.
We present experimental results of measurements on atomically, or near atomically abrupt impurity profiles in Si using magnetic sector (Cameca) and quadrupole (Atomica) SIMS machines. The analysis conditions and samples have been chosen to minimize instrument (crater wall resputtering) and surface (equilibration time) effects. Under such conditions the leading edge of an abrupt signal is smeared to a complimentary error function, while the trailing edge exhibits an exponential decay reminiscent of recoil implantation profiles.
Modifications of the Boltzmann Transport Equation (BTE) approach to ion implantation in multilayer targets will be shown to provide a first principles calculation of such SIMS knock-on phenomena, which is in good agreement with the empirical results.