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Distinguishing between hypertrophic cardiomyopathy and other causes ofleft ventricular hypertrophy can be difficult in children. We hypothesised that cardiac MRI T1 mapping could improve diagnosis of paediatric hypertrophic cardiomyopathy and that measures of myocardial function would correlate with T1 times and extracellular volume fraction.
Thirty patients with hypertrophic cardiomyopathy completed MRI with tissue tagging, T1-mapping, and late gadolinium enhancement. Left ventricular circumferential strain was calculated from tagged images. T1, partition coefficient, and synthetic extracellular volume were measured at base, mid, apex, and thickest area of myocardial hypertrophy. MRI measures compared to cohort of 19 healthy children and young adults. Mann–Whitney U, Spearman’s rho, and multivariable logistic regression were used for statistical analysis.
Hypertrophic cardiomyopathy patients had increased left ventricular ejection fraction and indexed mass. Hypertrophic cardiomyopathy patients had decreased global strain and increased native T1 (−14.3% interquartile range [−16.0, −12.1] versus −17.3% [−19.0, −15.7], p < 0.001 and 1015 ms [991, 1026] versus 990 ms [972, 1001], p = 0.019). Partition coefficient and synthetic extracellular volume were not increased in hypertrophic cardiomyopathy. Global native T1 correlated inversely with ejection fraction (ρ = −0.63, p = 0.002) and directly with global strain (ρ = 0.51, p = 0.019). A logistic regression model using ejection fraction and native T1 distinguished between hypertrophic cardiomyopathy and control with an area under the receiver operating characteristic curve of 0.91.
In this cohort of paediatric hypertrophic cardiomyopathy, strain was decreased and native T1 was increased compared with controls. Native T1 correlated with both ejection fraction and strain, and a model using native T1 and ejection fraction differentiated patients with and without hypertrophic cardiomyopathy.
The COllaborative project of Development of Anthropometrical measures in Twins (CODATwins) project is a large international collaborative effort to analyze individual-level phenotype data from twins in multiple cohorts from different environments. The main objective is to study factors that modify genetic and environmental variation of height, body mass index (BMI, kg/m2) and size at birth, and additionally to address other research questions such as long-term consequences of birth size. The project started in 2013 and is open to all twin projects in the world having height and weight measures on twins with information on zygosity. Thus far, 54 twin projects from 24 countries have provided individual-level data. The CODATwins database includes 489,981 twin individuals (228,635 complete twin pairs). Since many twin cohorts have collected longitudinal data, there is a total of 1,049,785 height and weight observations. For many cohorts, we also have information on birth weight and length, own smoking behavior and own or parental education. We found that the heritability estimates of height and BMI systematically changed from infancy to old age. Remarkably, only minor differences in the heritability estimates were found across cultural–geographic regions, measurement time and birth cohort for height and BMI. In addition to genetic epidemiological studies, we looked at associations of height and BMI with education, birth weight and smoking status. Within-family analyses examined differences within same-sex and opposite-sex dizygotic twins in birth size and later development. The CODATwins project demonstrates the feasibility and value of international collaboration to address gene-by-exposure interactions that require large sample sizes and address the effects of different exposures across time, geographical regions and socioeconomic status.
There is considerable debate as to the optimal light intensities for growing chickens. This is influencing regulations and industry practices. The present study examines the preference of broiler chickens for light intensity. A choice system was developed to allow determination of the preferences of broiler chickens for light intensity. This system had three light proof pens each with feeders or waterers but different light intensities. There was a connecting transit pen with a light intensity of 1 to 2 lux. This allowed birds access to the pens each with feeders or waterers. There were markedly more chickens observed in the pens each with feeders or waterers and a light intensity of 20 lux than 5 lux. Moreover, more feed was consumed in the 20 lux pens than 5 pens. There were also high numbers of chickens in the transit compartment with its low light intensity (1 to 2 lux) and no feeders or waterers. Broiler chickens exhibited a preference for 20 lux light intensity for feeding compared to 5 lux light intensity. The present study supports the view that there should be a light intensity of at least 20 lux for the areas around the feeders and also suggests that light intensity may be reduced in other areas for resting and other activities.
Refugees report elevated rates of posttraumatic stress disorder (PTSD), but are relatively unlikely to seek help for their symptoms. Mental health stigma is a key barrier to help-seeking amongst refugees. We evaluated the efficacy of an online intervention in reducing self-stigma and increasing help-seeking in refugee men.
Participants were 103 refugee men with PTSD symptoms from Arabic, Farsi or Tamil-speaking backgrounds who were randomly assigned to either receive an 11-module online stigma reduction intervention specifically designed for refugees (‘Tell Your Story’, TYS) or to a wait-list control (WLC) group. Participants completed online assessments of self-stigma for PTSD and help-seeking, and help-seeking intentions and behaviors at baseline, post-intervention, and at a 1 month follow-up.
Intent-to-treat analyses indicated that, compared to the WLC, TYS resulted in significantly smaller increases in self-stigma for seeking help from post-treatment to follow-up (d = 0.42, p = 0.008). Further, participants in the TYS conditions showed greater help-seeking behavior from new sources at follow-up (B = 0.69, 95% CI 0.19–1.18, p = 0.007) than those in the WLC. The WLC showed significantly greater increases in help-seeking intentions from post-intervention to follow-up (d = 0.27, p = 0.027), relative to the TYS group.
This is the first investigation of a mental health stigma reduction program specifically designed for refugees. Findings suggest that evidence-based stigma reduction strategies are beneficial in targeting self-stigma related to help-seeking and increasing help-seeking amongst refugees. These results indicate that online interventions focusing on social contact may be a promising avenue for removing barriers to accessing help for mental health symptoms in traumatized refugees.
In alpine regions of the Qinghai-Tibetan Plateau of China, perennial vetch (Vicia unijuga A. Br.) productivity is often low and variable, constrained by the cold and erratic precipitation environment. The aim of the current study was to identify the soil-environmental modifications needed in harsh alpine environmental conditions for improvement of perennial vetch growth, forage biomass production and seed yield. A 3-year field experiment was conducted in an alpine region of China to evaluate the effects of modified soil temperature and moisture conditions generated by three mulching treatments – plastic film mulching (FM), removal of plastic film mulching at the 30% flowering stage and barley straw mulching – on perennial vetch productivity. Higher mean soil temperature and soil water content were recorded in the FM treatment than in the control and other treatments. This enhanced perennial vetch growth, as indicated by higher photosynthetic rate, higher leaf area index and greater above-ground dry matter, and thus higher seed yield and water productivity. Examination by multiple linear regression showed the relative contribution of mean soil temperature to the variations in photosynthetic rate, above-ground dry matter and seed yield were greater than soil water content, whereas the reverse occurred in seeds/pod. In conclusion, the FM treatment provided adequate soil temperature and water resources to improve photosynthetic rate, above-ground dry matter, seed yield and water productivity, and thus increased the productivity potential for perennial vetch in the alpine region. The current research provides scientific support for large-scale perennial vetch cultivation and management in alpine regions.
We evaluated whether a diagnostic stewardship initiative consisting of ASP preauthorization paired with education could reduce false-positive hospital-onset (HO) Clostridioides difficile infection (CDI).
Single center, quasi-experimental study.
Tertiary academic medical center in Chicago, Illinois.
Adult inpatients were included in the intervention if they were admitted between October 1, 2016, and April 30, 2018, and were eligible for C. difficile preauthorization review. Patients admitted to the stem cell transplant (SCT) unit were not included in the intervention and were therefore considered a contemporaneous noninterventional control group.
The intervention consisted of requiring prescriber attestation that diarrhea has met CDI clinical criteria, ASP preauthorization, and verbal clinician feedback. Data were compared 33 months before and 19 months after implementation. Facility-wide HO-CDI incidence rates (IR) per 10,000 patient days (PD) and standardized infection ratios (SIR) were extracted from hospital infection prevention reports.
During the entire 52 month period, the mean facility-wide HO-CDI-IR was 7.8 per 10,000 PD and the SIR was 0.9 overall. The mean ± SD HO-CDI-IR (8.5 ± 2.0 vs 6.5 ± 2.3; P < .001) and SIR (0.97 ± 0.23 vs 0.78 ± 0.26; P = .015) decreased from baseline during the intervention. Segmented regression models identified significant decreases in HO-CDI-IR (Pstep = .06; Ptrend = .008) and SIR (Pstep = .1; Ptrend = .017) trends concurrent with decreases in oral vancomycin (Pstep < .001; Ptrend < .001). HO-CDI-IR within a noninterventional control unit did not change (Pstep = .125; Ptrend = .115).
A multidisciplinary, multifaceted intervention leveraging clinician education and feedback reduced the HO-CDI-IR and the SIR in select populations. Institutions may consider interventions like ours to reduce false-positive C. difficile NAAT tests.
High-yielding cows may suffer from negative energy balance during early lactation, which can lead to ketosis and delayed ability of returning to cyclicity after calving. Fast recovery after calving is essential when breeding for improved fertility. Traditionally used fertility traits, such as the interval from calving to first insemination (CFI), have low heritabilities and are highly influenced by management decisions. Herd Navigator™ management program samples and analyses milk progesterone and β-hydroxybutyrate (BHB) automatically during milking. In this study, the genetic parameters of endocrine fertility traits (measured from milk progesterone) and hyperketonemia (measured from milk BHB) in early lactation were evaluated and compared with traditional fertility traits (CFI, interval from calving to the last insemination and interval from first to last insemination) and the milk yield in red dairy cattle herds in Finland. Data included observations from 14 farms from 2014 to 2017. Data were analyzed with linear animal models using DMU software and analyses were done for first parity cows. Heritability estimates for traditional fertility traits were low and varied between 0.03 and 0.07. Estimated heritabilities for endocrine fertility traits (interval from calving to the first heat (CFH) and commencement of luteal activity (C-LA)) were higher than for traditional fertility traits (0.19 to 0.33). Five slightly different hyperketonemia traits divided into two or three classes were studied. Linear model heritability estimates for hyperketonemia traits were low, however, when the threshold model was used for binary traits the estimates became slightly higher (0.07 to 0.15). Genetic correlation between CFH and C-LA for first parity cows was high (0.97) as expected since traits are quite similar. Moderate genetic correlations (0.47 to 0.52) were found between the endocrine fertility traits and early lactation milk yield. Results suggest that the data on endocrine fertility traits measured by automatic systems is a promising tool for improving fertility, specifically when more data is available. For hyperketonemia traits, dividing values into three classes instead of two seemed to work better. Based on the current study and previous studies, where higher heritabilities have been found for milk BHB traits than for clinical ketosis, milk BHB traits are a promising indicator trait for resistance to ketosis and should be studied more. It is important that this kind of data from automatic devices is made available to recording and breeding organizations in the future.
Little is known about potential harmful effects as a consequence of self-guided internet-based cognitive behaviour therapy (iCBT), such as symptom deterioration rates. Thus, safety concerns remain and hamper the implementation of self-guided iCBT into clinical practice. We aimed to conduct an individual participant data (IPD) meta-analysis to determine the prevalence of clinically significant deterioration (symptom worsening) in adults with depressive symptoms who received self-guided iCBT compared with control conditions. Several socio-demographic, clinical and study-level variables were tested as potential moderators of deterioration.
Randomised controlled trials that reported results of self-guided iCBT compared with control conditions in adults with symptoms of depression were selected. Mixed effects models with participants nested within studies were used to examine possible clinically significant deterioration rates.
Thirteen out of 16 eligible trials were included in the present IPD meta-analysis. Of the 3805 participants analysed, 7.2% showed clinically significant deterioration (5.8% and 9.1% of participants in the intervention and control groups, respectively). Participants in self-guided iCBT were less likely to deteriorate (OR 0.62, p < 0.001) compared with control conditions. None of the examined participant- and study-level moderators were significantly associated with deterioration rates.
Self-guided iCBT has a lower rate of negative outcomes on symptoms than control conditions and could be a first step treatment approach for adult depression as well as an alternative to watchful waiting in general practice.
The current study evaluated the effect of sowing date (early, mid-August or timely, mid-September) on two winter wheat (Triticum aestivum L.) cultivars (Hereford, Mariboss) with different rates of nitrogen (N) (0–225 kg total N/ha) applied as animal manure (AM; cattle slurry) or mineral fertilizers (N: phosphorus: potassium; NPK). Overwinter plant N uptake and soil mineral N content were determined during 2014/15, while harvest yields (grain, straw, N content) were determined during 2014/15 and 2015/16. Overwinter uptake of N was 14 kg N/ha higher in early than in timely-sown wheat. Despite very different yield levels in 2015 and 2016 harvests, the advantage of early sowing on grain yields was similar (1.1 and 0.9 t/ha); straw yield benefits were greater in 2015 (1.7 t/ha more) than in 2016 (0.4 t/ha more). In 2015 and 2016, N offtake was 35 and 17 kg N/ha higher in early than in timely-sown wheat, respectively. The mineral N fertilizer value of cattle slurry averaged 50%. Early sowing increased the apparent N recovery (ANR) for wheat regardless of nutrient source. However, ANR was substantially higher for NPK (82% in 2015; 52% in 2016) than for AM (39% in 2015; 27% in 2016). Performance of the two cultivars did not differ consistently with respect to the effect of early sowing on crop yield, N concentration and offtake, or ANR. Within the north-west European climatic region, moving the sowing time of winter wheat from mid-September to mid-August provides a significant yield and N offtake benefit.
Insomnia treatment using an internet-based cognitive–behavioural therapy
for insomnia (CBT-I) program reduces depression symptoms, anxiety
symptoms and suicidal ideation. However, the speed, longevity and
consistency of these effects are unknown.
To test the following: whether the efficacy of online CBT-I was sustained
over 18 months; how rapidly the effects of CBT-I emerged; evidence for
distinct trajectories of change in depressive symptoms; and predictors of
A randomised controlled trial compared the 6-week Sleep Healthy Using the
Internet (SHUTi) CBT-I program to an attention control program. Adults
(N=1149) with clinical insomnia and subclinical
depression symptoms were recruited online from the Australian
Depression, anxiety and insomnia decreased significantly by week 4 of the
intervention period and remained significantly lower relative to control
for >18 months (between-group Cohen's d=0.63, 0.47,
0.55, respectively, at 18 months). Effects on suicidal ideation were only
short term. Two depression trajectories were identified using growth
mixture models: improving (95%) and stable/deteriorating (5%) symptoms.
More severe baseline depression, younger age and limited comfort with the
internet were associated with reduced odds of improvement.
Online CBT-I produced rapid and long-term symptom reduction in people
with subclinical depressive symptoms, although the initial effect on
suicidal ideation was not sustained.
This book provides the first edition with an extensive introduction and full commentary of a unique land survey written on papyrus in Greek which derives from that area of southern (Upper) Egypt known as the Apollonopolite (or Edfu) nome and is now preserved in Copenhagen. Dating from the late second century BC, this survey provides a new picture of both landholding and taxation in the area which differs significantly from that currently accepted. The introduction sets this new evidence in its contemporary context, drawing particular attention to what it reveals about the nature of the relations of the Ptolemaic royal administration with local grandees, Egyptian temples and the army. No student of Hellenistic Egypt can afford to ignore this text, which importantly extends our knowledge of Upper Egypt under the Ptolemaic kings and involves some modification to the prevailing picture of landholding in Hellenistic Egypt.
The importance of the Greek land survey from the Apollonopolite (Edfu) nome, published here as P. Haun. IV 70 (119/118 BC), has already been the subject of some discussion in print. Papyri in Greek, as primarily used within the Ptolemaic administration, are far fewer from the Egyptian south than from the north. As a result, until just a decade ago the pattern of land tenure in Middle Egypt tended to dominate the scene, with little account taken of the situation in Upper Egypt. The land survey edited here is crucial to the reassessment currently underway. To add to the interest of this text, the date of the Edfu land survey corresponds to that of surveys from further north – those of P. Tebt. I and IV, from the Arsinoite nome, and BGU XIV, from the Herakleopolite nome. Comparisons, therefore, gain in validity and significance. The editors are happy to be able finally to present the full text of what has survived of the fullest survey yet known from the south.
This edition started life as the successful Cambridge PhD thesis of Thorolf Christensen in 2002. When its first editor left the academic field, his supervisor Dorothy Thompson took some time to assume responsibility for seeing this edition through to publication. It was only when Katelijn Vandorpe, with her demotic expertise and knowledge of the Ptolemaic south, agreed to join the team that the project began to move forward. The result is an edition that is little modified from the editio princeps but has one extra column (col. xvii) and a new introduction which takes account of relevant recent scholarship. Each of the three editors involved is grateful for the input of the other two.
There are other thanks that we wish to record. Adam Bülow-Jacobsen in Copenhagen initially made the text available to Thorolf Christensen to work on for his doctorate. He too provided the fine infrared photographs from which it has been possible to decipher the text (Plates 1–8).