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Sleep disturbance is a symptom of and a well-known risk factor for depression. Further, atypical functioning of the HPA axis has been linked to the pathogenesis of depression. The purpose of this study was to examine the role of adolescent HPA axis functioning in the link between adolescent sleep problems and later depressive symptoms. Methods: A sample of 157 17–18 year old adolescents (61.8% female) completed the Pittsburgh Sleep Quality Inventory (PSQI) and provided salivary cortisol samples throughout the day for three consecutive days. Two years later, adolescents reported their depressive symptoms via the Center for Epidemiological Studies Depression Scale (CES-D). Results: Individuals (age 17–18) with greater sleep disturbance reported greater depressive symptoms two years later (age 19–20). This association occurred through the indirect effect of sleep disturbance on the cortisol awakening response (CAR) (indirect effect = 0.14, 95%CI [.02 -.39]). Conclusions: One pathway through which sleep problems may lead to depressive symptoms is by up-regulating components of the body’s physiological stress response system that can be measured through the cortisol awakening response. Behavioral interventions that target sleep disturbance in adolescents may mitigate this neurobiological pathway to depression during this high-risk developmental phase.
A national need is to prepare for and respond to accidental or intentional disasters categorized as chemical, biological, radiological, nuclear, or explosive (CBRNE). These incidents require specific subject-matter expertise, yet have commonalities. We identify 7 core elements comprising CBRNE science that require integration for effective preparedness planning and public health and medical response and recovery. These core elements are (1) basic and clinical sciences, (2) modeling and systems management, (3) planning, (4) response and incident management, (5) recovery and resilience, (6) lessons learned, and (7) continuous improvement. A key feature is the ability of relevant subject matter experts to integrate information into response operations. We propose the CBRNE medical operations science support expert as a professional who (1) understands that CBRNE incidents require an integrated systems approach, (2) understands the key functions and contributions of CBRNE science practitioners, (3) helps direct strategic and tactical CBRNE planning and responses through first-hand experience, and (4) provides advice to senior decision-makers managing response activities. Recognition of both CBRNE science as a distinct competency and the establishment of the CBRNE medical operations science support expert informs the public of the enormous progress made, broadcasts opportunities for new talent, and enhances the sophistication and analytic expertise of senior managers planning for and responding to CBRNE incidents.
Psychosocial stress during childhood and adolescence is associated with alterations in the hypothalamic–pituitary–adrenal (HPA) axis and with heightened inflammation, both of which are implicated in poor health; however, factors that may protect against these effects relatively early in life are not well understood. Thus, we examined whether psychosocial resources protect against stress-related alterations in the HPA axis and heightened inflammation in a sample of 91 late adolescents. Participants completed measures of various stressors (major life events, daily interpersonal stress, early adversity), and psychosocial resources (mastery, optimism, self-esteem, and positive reappraisal). They also completed the Trier Social Stress Test and provided saliva and blood samples for the assessment of cortisol and interleukin-6 reactivity. Each of the stressors was associated with lower cortisol reactivity. Additionally, associations with major life events and daily stress were moderated by psychological resources, such that more life events and daily stress were associated with decreased HPA reactivity among adolescents with lower levels of psychological resources, but not among those with higher levels of psychological resources. This pattern of findings was observed only for cortisol reactivity and not for interleukin-6 reactivity. Findings suggest that psychological resources may counteract the effects of certain adversity-related decreases in cortisol reactivity.
The term ‘mood stabiliser’ is ill-defined and lacks clinical utility. We propose a framework to evaluate medications and effectively communicate their mood stabilising properties – their acute and prophylactic efficacy across the domains of mania and depression. The standardised framework provides a common definition to facilitate research and clinical practice.
Declaration of interest
The Treatment Algorithm Group (TAG) was supported logistically by Servier who provided financial assistance with travel and accommodation for those TAG members travelling interstate or overseas to attend the meeting in Sydney (held on 18 November 2017). None of the committee were paid to participate in this project and Servier have not had any input into the content, format or outputs from this project.
Background: Neuropsychological assessments are used in hospitals to examine brain-behaviour relationships, and are an integral part of care for medically complex patients. Unfortunately, waitlists can be lengthy. We gathered information regarding best-practice guidelines and physician referral patterns in an effort to better manage the neuropsychology waitlist at a pediatric hospital. Methods: We conducted: 1) A semi-structured telephone survey with 4 Canadian, pediatric, hospital-based neuropsychology services; 2) An electronic survey distributed to referring physicians at CHEO; 3) A focus group for CHEO neurologists and neurosurgeons. Results: The telephone survey indicated that there are no clear, best-practice guidelines for pediatric neuropsychologists working in a tertiary, pediatric hospital. The electronic survey revealed some confusion about neuropsychology services and indicated the need for better communication between neuropsychology and referral sources. The focus group revealed that demand for neuropsychology services far outstrips supply and confirmed the need for better communication. Conclusions: The results confirmed the need for best-practice guidelines to be developed around delivering neuropsychology services within a pediatric tertiary care setting, as well as continuing to work closely with neurology and neurosurgery to ensure that the neuropsychological needs of their patients are met.
Factors associated with relapse among children who are discharged after reaching a threshold denoted ‘recovered’ from moderate acute malnutrition (MAM) are not well understood. The aim of this study was to identify factors associated with sustained recovery, defined as maintaining a mid-upper-arm circumference≥12·5 cm for 1 year after release from treatment. On the basis of an observational study design, we analysed data from an in-depth household (HH) survey on a sub-sample of participants within a larger cluster randomised controlled trial (cRCT) that followed up children for 1 year after recovery from MAM. Out of 1497 children participating in the cRCT, a subset of 315 children participated in this sub-study. Accounting for other factors, HH with fitted lids on water storage containers (P=0·004) was a significant predictor of sustained recovery. In addition, sustained recovery was better among children whose caregivers were observed to have clean hands (P=0·053) and in HH using an improved sanitation facility (P=0·083). By contrast, socio-economic status and infant and young child feeding practices at the time of discharge and HH food security throughout the follow-up period were not significant. Given these results, we hypothesise that improved water, sanitation and hygiene conditions in tandem with management of MAM through supplemental feeding programmes have the possibility to decrease relapse following recovery from MAM. Furthermore, the absence of associations between relapse and nearly all HH-level factors indicates that the causal factors of relapse may be related mostly to the child’s individual, underlying health and nutrition status.
The presence of an extrasolar planet can be revealed when it passes in front of its host star, reducing the star's apparent brightness by ∼ 1%. We are monitoring a large sample (of order 104) of stars using our own 0.5 m telescope at Siding Spring Observatory, Australia, in search of such transiting planets.
Using automated scans of Tautenburg Schmidt plates with the APM facility in Cambridge (UK) the mean tangential motion of two globular clusters, M3 and M92, is determined directly with respect to a well defined extragalactic reference frame. In both fields five pairs of plates centred on the cluster with epoch differences from 20 to 27 years were measured. In the independent proper motion determination with 1200 to 2300 reference galaxies for each pair of plates we used 3rd order polynomials and a stepwise regression method. The mean absolute cluster p.m. corrected for systematic effects dependent on the coordinates was obtained with an accuracy of ±0.03 arcsec/century for M3 and ±0.06 arcsec/century for M92.
We present spectroscopic observations of ~200 giant stars in two fields toward the Galactic bulge. The positions of fields 588 and 589 are at l,b = (8,7) and (12,3), respectively, which corresponds to a Galactocentric distance of ~1.6 kpc for the stars in the bulge. The K giants were selected from color-magnitude and color-color diagrams produced by scans of B, R and I plates from the APM machine. The spectra were obtained with the MX multi-object spectrograph at the Steward 90″ telescope, and with the Red Channel spectrograph at the MMT. Radial velocities good to ≪ 10 km/s were obtained from cross-correlation techniques. A grid of ~100 standard stars was built to calibrate spectrophotometric indices that provide abundances and luminosities.
The aim of this analysis was to test if changes in insomnia symptoms and global sleep quality are associated with coinciding changes in depressed mood among older adults. We report on results yielded from secondary analysis of longitudinal data from a clinical trial of older adults (N = 49) aged 55 to 80 years who reported at least moderate levels of sleep problems. All measures were collected at baseline and after the trial ten weeks later. We computed change scores for two separate measures of disturbed sleep, the Athens Insomnia Scale (AIS) and the Pittsburgh Sleep Quality Index (PSQI), and tested their association with change in depressed mood (Beck Depression Inventory-II; BDI-II) in two separate linear regression models adjusted for biological covariates related to sleep (sex, age, body mass index, and NF-κB as a biological marker previously correlated with insomnia and depression). Change in AIS scores was associated with change in BDI-II scores (β = 0.38, p < 0.01). Change in PSQI scores was not significantly associated with change in BDI-II scores (β = 0.17, p = 0.26). Our findings suggest that improvements over ten weeks in insomnia symptoms rather than global sleep quality coincide with improvement in depressed mood among older adults.
Host location by parasites can be achieved by either active or passive mechanisms. In spite of their significance, the efficacy of these methods has been little researched. High fecundity in parasites is discussed in terms of the role it plays in dispersal and transmission. Some concepts developed by mainstream behavioural ecologists are outlined and their relevance to parasitology is indicated. ‘Reproductive value’ is recommended as an appropriate measure of the costs and benefits of behavioural acts. Although costs of reproduction have been rarely studied in parasites, they are likely to occur in cosexual insects, nematodes and crustaceans. Experiments using captive hosts and/or in vitro cultivation could help in the construction of realistic optimality models. We suggest that r- and K-selection theory could assist in the study of the evolution of parasite behaviour. We discuss how parasite populations are dispersed and controlled and consider the implications of overdispersion. WTe outline three sources of signals to which parasites may respond and suggest that understanding evolutionary mechanisms and community organisation of parasites and hosts requires evaluation of fundamental behavioural responses to environmental signals. The study of closely related groups of parasites and their hosts may advance our knowledge of the evolution of parasite life cycles and the evolutionary costs and benefits of behavioural acts.
Results are presented from our ongoing studies of Titan using ALMA during the period 2012-2015, including a confirmation of the previous detection of vinyl cyanide (C2H3CN), as well as the first spatial map for this species on Titan. Simultaneous mapping of HC3N, CH3CN and C2H5CN reveal characteristic abundance patterns for each species that provide insight into their individual photochemical lifetimes, and help inform our understanding of Titan’s unique, time-variable atmospheric chemistry and global circulation. A time-sequence of HC3N maps covering 38 months reveals a dramatic change in the distribution of this gas consistent with high-altitude photochemical production followed by advection towards the southern (winter) pole, combined with rapid loss in the north after Titan’s 2009 seasonal equinox. The 2015 C2H3CN and C2H5CN maps show abundance peaks in Titan’s southern hemisphere, similar to those observed for the short-lived HC3N molecule. The longer-lived CH3CN, on the other hand, remains more concentrated in the north.
Recent media reports have focused on the large increase in antidepressants dispensed in England. We investigated this, focusing on selective serotonin reuptake inhibitors (SSRIs).
To examine the rate of initiation of SSRIs over time and changes over time in the duration of prescribing episodes.
We estimated initiation and duration of SSRI prescribing from 7 025 802 individuals aged over 18 years and registered with a general practice that contributed data to The Health Improvement Network.
Rates of SSRI initiation increased from 1.03 per 100 person-years in 1995 to 2.15 in 2001, but remained stable from then to 2012. The median duration of prescribing episodes increased from 112 to 169 days for episodes starting in 1995 to 2010.
Despite media reports describing an increasing rate of antidepressant prescribing, SSRI initiation rates have stabilised since 2001. However, our results suggest that individuals who take SSRIs are receiving treatment for longer.
For decades, star counts and HR diagrams extending below the main sequence turnoff in globular clusters meant the work of Sandage (1957). The advent of large CCD's at the foci of large telescopes has changed this (McClure et al. 1985, Harris & Hesser 1985, Christian & Heasley 1986, Heasley et al. 1986, Penny & Dickens 1986, Richer & Fahlman 1986, Smith et al. 1986) and made clear that clusters differ in the shapes of their luminosity functions and in the morphology of their HR diagrams. We return here to photographic methods, which can capture an order of magnitude more images and so possibly reveal new details.
Radial velocities of 20 stars members of young clusters and associations located in the inter-Cloud region within 2h < R.A. < 5h tend to be lower than the HI velocities in the same direction. The stellar velocities do not show a pronounced velocity gradiant as observed for the HI from the SMC to the LMC. This suggests that the stellar components belong to the SMC wing. Our photometry and spectroscopy support the view that one of the stars at 4h20m is a foreground HB star.
The HI envelope of the Magellanic System extends well beyond the obvious visible regions of each of the Clouds. Modern optical surveys based on UK Schmidt telescope plates and fast measuring machines are now starting to reveal the complex optical counterparts of some of these HI features.
We present deep CCD photometry of three associations lying between the Magellanic Clouds and sitting on the HI ridge. ZAMS fittings show that these clusters are located at the distance of the Clouds. Furthermore, a slight distance gradient is observed. Main sequences matched to isochrones reveal that these aggregates are very young, no more than 108 years old. An age difference from east to west is also suggested.
Background: Post concussion syndrome (PCS) can affect up to 30% of patients with concussion. Biomarkers of this condition would be beneficial for diagnosis and management. We hypothesized that eye tracking parameters would correlate with microstructural changes of white matter integrity, as measured by diffusion tensor imaging (DTI), in patients with PCS. Methods: Sixty patients with PCS and at least 2 concussions participated in our prospective study. Attention and executive function were tested using Visual Attention Scanning Technology (VAST). In a matching task, the normalized number of visits to master image before making the first selection is used as a surrogate of working memory. We related performance on VAST to white matter integrity using Tract-Based Spatial Statistics of diffusion tensor imaging data. Results: 60 participants (mean age 34.3 years, SD 13.8) had a mean of 4 concussions. There were negative correlations between fractional anisotropy (FA) of the genu, body, and splenium of the corpus callosum and normalized number of visits to master image before first selection (r=-0.432, p=0.001; r=-0.504, p<0.001; and r=-0.388, p=0.002; respectively). A negative correlation was also seen between right cingulum FA and the global processing index (r=-0.349, p=0.006). Conclusions: Impaired performance on eye tracking measures of attention and executive function may reflect alterations in white matter tracts.
Background: The ketogenic diet (KD) is used to treat severe childhood-onset epileptic encephalopathies, such as Infantile Spasms (IS). Unfortunately, limited resources for KD initiation result in treatment delays. We ask if earlier KD treatment of early-onset drug-resistant epilepsy results in better seizure outcomes. Methods: Children who started KD before age 4 years between 2000-present at SickKids Hospital were identified. Six-month seizure outcome was calculated as percent of pre-diet baseline seizure frequency (BSF). Results: 67 children were identified. 30 (44.8%) started KD <2 years old, 37 (55.2%) started KD 2-4 years old. Among <2 years old group, 83.3% achieved 50% reduction in BSF and 36.7% achieved 90% reduction. Among 2-4 year old group, 62.2% achieved 50% reduction in BSF and 24.3% achieved 90% reduction. 38 children had a history of IS; 17 with IS at diet initiation and 21 with past history of IS. 41.2% of the spasms cohort achieved 90% reduction in BSF, compared to 23.8% of the post-spasms cohort. Conclusions: KD was more effective when started before age 2 years than 2-4 years, and more effective in children with IS than in children with past history of IS. A rapid protocol for KD initiation in young infants and children may improve long-term outcomes