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We propose to combine Collaborative User Experience Design (CUXD) projects with the integrated product and process modelling theory CPM/PDD to formalise the CUXD process model. CPM/PDD is discussed as a Design Theory and Methodology (DTM) to describe a product as well as the product development process based on a clear distinction of characteristics and properties. CUXD is presented as a cross-disciplinary, human-centred development model. It focuses on team collaboration, relates to concepts of Design Thinking, Agile Development as well as Lean UX and it highlights user experience metrics.
Previous studies showed associations of stress and episodes of active disease [1,2]. We reported survey data on psychosocial problems of IBD patients . This study investigates associations of stress with health impairments and analyses a scale of perceived stress as an indicator for psychosocial impairments (construct/criterion validity) .
In a multiregional German survey in 2005, 1083 patients with Crohn's disease (CD) and ulcerative colitis were recruited (gastroenterological practices, university outpatient clinics, patient organization). The questionnaire incorporated WHO's ICF  and established items and scales (i.a. HADS ). Scale construction followed item response theory analysing psychometric properties.
Of the survey responders (58% CD, 65% female, mean age 42yrs), ⅓ reported severe fatigue. Clinically relevant anxiety was observed in 24%, depression in 29% of men and 21% of women. With three items we constructed a scale with good psychometric properties. Three groups (low, moderate, high perceived stress) were identified, differing substantially in reported anxiety/depression and the GIBDI disease activity score.
IBD patients report multiple psychosocial impairments. The scale of perceived stress may identify IBD patients with high demand for psychosocial attendance, if confirmed in independent samples. For enhanced secondary prevention  we propose integration of this psychosocial indicator into the diagnostic process.
The association of MeHg exposure through fish consumption on human autoimmunity remains unclear. Fish also contain n-3 long chain polyunsaturated fatty acids (LCPUFA) that are known to regulate inflammation and mitigate autoimmune disease symptoms. We studied the association of low-level exposure to methylmercury (MeHg) through fish consumption in the SCDS. We examined this association at age 19 years in the SCDS Main Cohort (n = 497). We measured MeHg exposure at 3 time points [prenatal, weighted average (6 months to 19 years) and concurrent (19 years) and LCPUFA status and a panel of 13 autoimmune markers at age 19 years. The autoimmune markers included antinuclear antibodies (ANA), anti-dsDNA and anti-RNP, and total (non-specific) immunoglobulins (Ig) IgG, IgA, and IgM. A combined ANA variable was also calculated based on being within or above reference range for any of the ANA markers; 56% of the subjects met this criterion. Multivariable regression models adjusted for prenatal MeHg, sex and waist circumference, with and without adjustment for LCPUFA, were fit for the three MeHg exposure metrics and each immune marker. Mean (SD) prenatal, weighted average and concurrent MeHg was 6.84 (4.55), 7.46 (2.82), and 10.23 (6.02) ppm, respectively. Combined ANA was positively associated with concurrent MeHg following adjustment for the n6:n3 LCPUFA ratio (β = 0.036, 95%; CI: 0.001, 0.073). Prenatal and average MeHg exposures were not significantly associated with any individual ANA. IgM was negatively associated with concurrent (β = -0.016, 95%CI: -0.016, -0.002), and average (β = -0.042, 95%CI: -0.042, -0.009) MeHg exposure in the models adjusted for n-3, n-6 LCPUFA and when separately adjusted for the n6:n3 LCPUFA ratio. Total (19-year) n-3 PUFA status was negatively associated with anti-RNP (β = -20.355, 95%CI: -36.89, -4.34) and IgG (β = -1.384, 95%CI: -2.682, -0.087). Total n-3 LCPUFA was associated with lower markers of autoimmunity. MeHg exposure at 19 years was associated with higher ANA and lower IgM but only following adjustment for LCPUFA. The clinical significance of these findings is unclear and further research is warranted to determine if these associations precede autoimmune disease development.
Optimal maternal polyunsaturated fatty acid (PUFA) status is essential for foetal development. The desaturase enzymes, encoded by the fatty acid desaturase (FADS) genes, are involved in the endogenous synthesis of long chain (LC)PUFA and influence maternal LCPUFA concentrations. The minor allele of various FADS SNPs has been associated with increased maternal concentrations of the precursors linoleic acid (LA) and α-linolenic acid (ALA), and lower concentrations of the LCPUFA arachidonic acid (AA) and docosahexaenoic acid (DHA); however, there is limited research to date on the influence of FADS genotype on cord PUFA status. The aim of the current study was to investigate the influence of maternal and child genetic variation on cord blood PUFA status in a high fish-eating cohort.
Cord blood samples collected from mother-child pairs (n = 1088) taking part in the Seychelles Child Development Study (SCDS) Nutrition Cohort 2 (NC2) were analysed for total serum PUFA. Maternal (n = 1088) and child genotype (n = 592) were determined for the FADS SNPs rs174537, rs174561, rs174575, and rs3834458. Regression analysis determined associations between maternal and child FADS genotype and cord PUFA status. In all regression models, the major allele homozygote genotype for each SNP was used as the reference group.
Directions of significant associations were as predicted. In mothers, the minor allele homozygote genotype for SNPs rs174537, rs174561 and rs3834458 was associated with lower cord DHA and lower total n-3 PUFA when compared to the major allele homozygous genotype (p < 0.05 for all). The heterozygous genotype was associated with increased concentrations of LA compared to the reference genotype for rs174561 (p = 0.021) and rs383448 (p = 0.023). In children, the heterozygous genotype was associated with lower AA concentrations and lower cord n-6:n-3 ratio for all SNPs (p < 0.05 for all) compared to those with the major allele homozygous genotype. A lower cord AA:LA ratio was also observed for children heterozygous for rs174547, rs174561 and rs174575 (p < 0.05 for all). Contrary to expected, there were no associations between cord PUFA concentrations and child minor allele homozygous genotype.
The current study indicates that variation in maternal and child FADS genotype influences cord PUFA concentrations, despite the high intake of preformed dietary LCPUFA from fish in this population. The sample size for minor allele homozygous children was likely too small to observe any statistically significant associations in the current analysis. Further research is needed to determine whether increased dietary intake can compensate for lower PUFA status as a result of FADS genotype.
We developed an expensiveness index and used the Food Acquisition and Purchase Survey data set to examine empirically whether Supplemental Nutrition Assistance Program (SNAP) participants pay higher prices compared with nonqualifying and qualifying, but nonparticipating, households. Purchasers’ ability to minimize food expenditures has significant effects on the program’s effectiveness and on participants’ food security. Using ordinary least squares and two techniques that control for the endogeneity of SNAP participation, we found no significant effect of SNAP participation on food prices. Moreover, we found that SNAP participants pay, on average, lower prices than do nonparticipants. We conclude by providing suggestions for policy improvements and implications for future research.
We examined morphological awareness and reading achievement in university students in two ways. First, students with and without a self-reported history of reading difficulties were compared on word reading and text reading achievement, and on the reading-related skills of morphological awareness, orthographic processing, and phonological processing. Second, the unique contribution of morphological awareness to reading achievement was examined for a larger sample of first-year university students. Students with a self-reported history of reading difficulties (n = 54) showed moderate to large gaps in each area of reading achievement, and timed reading comprehension appeared more severely impaired than word-reading efficiency. These students had a deficit in morphological awareness that persisted even when (a) phonological awareness and orthographic processing skills, or (b) word-reading accuracy were statistically controlled. In the larger first-year sample (N = 211), morphological awareness contributed to variance in word reading beyond that accounted for by phonological awareness and orthographic processing. Furthermore, of the reading-related skills, only morphological awareness made a unique contribution to reading comprehension beyond variance accounted for by word reading. Taken together, these results demonstrate that morphological awareness makes unique contributions to university students’ reading achievement and is an additional difficulty for students with a self-reported history of reading difficulties.
We present Phantom, a fast, parallel, modular, and low-memory smoothed particle hydrodynamics and magnetohydrodynamics code developed over the last decade for astrophysical applications in three dimensions. The code has been developed with a focus on stellar, galactic, planetary, and high energy astrophysics, and has already been used widely for studies of accretion discs and turbulence, from the birth of planets to how black holes accrete. Here we describe and test the core algorithms as well as modules for magnetohydrodynamics, self-gravity, sink particles, dust–gas mixtures, H2 chemistry, physical viscosity, external forces including numerous galactic potentials, Lense–Thirring precession, Poynting–Robertson drag, and stochastic turbulent driving. Phantom is hereby made publicly available.
Host–parasite dynamics can play a fundamental role in both the establishment success of invasive species and their impact on native wildlife. The net impact of parasites depends on their capacity to switch effectively between native and invasive hosts. Here we explore host-switching, spatial patterns and simple fitness measures in a slow-expanding invasion: the invasion of Asian house geckos (Hemidactylus frenatus) from urban areas into bushland in Northeast Australia. In bushland close to urban edges, H. frenatus co-occurs with, and at many sites now greatly out-numbers, native geckos. We measured prevalence and intensity of Geckobia mites (introduced with H. frenatus), and Waddycephalus (a native pentastome). We recorded a new invasive mite species, and several new host associations for native mites and geckos, but we found no evidence of mite transmission between native and invasive geckos. In contrast, native Waddycephalus nymphs were commonly present in H. frenatus, demonstrating this parasite's capacity to utilize H. frenatus as a novel host. Prevalence of mites on H. frenatus decreased with distance from the urban edge, suggesting parasite release towards the invasion front; however, we found no evidence that mites affect H. frenatus body condition or lifespan. Waddycephalus was present at low prevalence in bushland sites and, although its presence did not affect host body condition, our data suggest that it may reduce host survival. The high relative density of H. frenatus at our sites, and their capacity to harbour Waddycephalus, suggests that there may be impacts on native geckos and snakes through parasite spillback.
To summarize and discuss logistic and administrative challenges we encountered during the Benefits of Enhanced Terminal Room (BETR) Disinfection Study and lessons learned that are pertinent to future utilization of ultraviolet (UV) disinfection devices in other hospitals
Multicenter cluster randomized trial
SETTING AND PARTICIPANTS
Nine hospitals in the southeastern United States
All participating hospitals developed systems to implement 4 different strategies for terminal room disinfection. We measured compliance with disinfection strategy, barriers to implementation, and perceptions from nurse managers and environmental services (EVS) supervisors throughout the 28-month trial.
Implementation of enhanced terminal disinfection with UV disinfection devices provides unique challenges, including time pressures from bed control personnel, efficient room identification, negative perceptions from nurse managers, and discharge volume. In the course of the BETR Disinfection Study, we utilized several strategies to overcome these barriers: (1) establishing safety as the priority; (2) improving communication between EVS, bed control, and hospital administration; (3) ensuring availability of necessary resources; and (4) tracking and providing feedback on compliance. Using these strategies, we deployed ultraviolet (UV) disinfection devices in 16,220 (88%) of 18,411 eligible rooms during our trial (median per hospital, 89%; IQR, 86%–92%).
Implementation of enhanced terminal room disinfection strategies using UV devices requires recognition and mitigation of 2 key barriers: (1) timely and accurate identification of rooms that would benefit from enhanced terminal disinfection and (2) overcoming time constraints to allow EVS cleaning staff sufficient time to properly employ enhanced terminal disinfection methods.
Early recognition of an acute myocardial infarction (AMI) can increase the patient’s likelihood of survival. As the first point of contact for patients accessing medical care through emergency services, emergency medical dispatchers (EMDs) represent the earliest potential identification point for AMIs. The objective of the study was to determine how AMI cases were coded and prioritized at the dispatch point, and also to describe the distribution of these cases by patient age and gender.
No studies currently exist that describe the EMD’s ability to correctly triage AMIs into Advanced Life Support (ALS) response tiers.
The retrospective descriptive study utilized data from three sources: emergency medical dispatch, Emergency Medical Services (EMS), and emergency departments (EDs)/hospitals. The primary outcome measure was the distributions of AMI cases, as categorized by Chief Complaint Protocol, dispatch priority code and level, and patient age and gender. The EMS and ED/hospital data came from the Utah Department of Health (UDoH), Salt Lake City, Utah. Dispatch data came from two emergency communication centers covering the entirety of Salt Lake City and Salt Lake County, Utah.
Overall, 89.9% of all the AMIs (n=606) were coded in one of the three highest dispatch priority levels, all of which call for ALS response (called CHARLIE, DELTA, and ECHO in the studied system). The percentage of AMIs significantly increased for patients aged 35 years and older, and varied significantly by gender, dispatch level, and chief complaint. A total of 85.7% of all deaths occurred among patients aged 55 years and older, and 88.9% of the deaths were handled in the ALS-recommended priority levels.
Acute myocardial infarctions may present as a variety of clinical symptoms, and the study findings demonstrated that more than one-half were identified as having chief complaints of Chest Pain or Breathing Problems at the dispatch point, followed by Sick Person and Unconscious/Fainting. The 35-year age cutoff for assignment to higher priority levels is strongly supported. The Falls and Sick Person Protocols offer opportunities to capture atypical AMI presentations.
ClawsonJJ, GardettI, ScottG, FivazC, BarronT, BroadbentM, OlolaC. Hospital-Confirmed Acute Myocardial Infarction: Prehospital Identification Using the Medical Priority Dispatch System. Prehosp Disaster Med. 2018;33(1):29–35.
To examine the comparability of fruit and vegetable (F&V) intake data in the USA from 2001 to 2014 between data acquired from two national data collection programmes.
Cross-sectional analysis. Linear regression models estimated trends in daily per capita intake of total F&V. Pooled differences in intake of individual F&V (n 109) were examined by processing form (fresh, frozen, canned, dried and juice).
What We Eat in America (WWEIA, 2001–2014) and Loss-Adjusted Food Availability data series (LAFA, 2001–2014).
No temporal trends were observed in daily per capita intake of total F&V from 2001 to 2014 using WWEIA and LAFA. Modest differences between WWEIA and LAFA were observed in mean pooled intake of most individual F&V.
WWEIA and LAFA produced similar estimates of F&V intake. However, WWEIA may be best suited for monitoring intake at the national level because it allows for the identification of individual F&V in foods with multiple ingredients, and it is structured for sub-population analysis and covariate control. LAFA does retain advantages for other research protocols, specifically by providing the only nationally representative estimates of food losses at various points in the food system, which makes it useful for examining the adequacy of the food supply at the agricultural, retail and consumer levels.
The balsam twig aphid Mindarus abietinus Koch (Hemiptera: Aphididae) is a major pest of economic importance for the Christmas tree industry. Global warming during the 21st century could potentially increase local population densities and reinforce the pest status of this aphid in commercial fir (Abies Miller; Pinaceae) plantations in Québec, Canada. During this study, we tested the effects of a warmer environment on colony growth rates of M. abietinus and aphid morph composition during the second generation of its cycle, which is key to colony size growth and potential damage to Christmas trees. We monitored M. abietinus populations on two host fir species and one host fir variety, in order to understand the early season dynamics of this aphid and its host tree. It was possible to distinguish the two overlapping generations of winged aphids leaving colonies, which led to observing a much higher proportion of wingless daughters, produced by the stem mother, than what had previously been reported. Colony growth rates were significantly higher in a warmer environment than in the nearby plantation, suggesting that warmer temperatures in late spring and early summer may provide the suitable conditions required for M. abietinus colonies of greater density.
Whole apples have not been previously implicated in outbreaks of foodborne bacterial illness. We investigated a nationwide listeriosis outbreak associated with caramel apples. We defined an outbreak-associated case as an infection with one or both of two outbreak strains of Listeria monocytogenes highly related by whole-genome multilocus sequence typing (wgMLST) from 1 October 2014 to 1 February 2015. Single-interviewer open-ended interviews identified the source. Outbreak-associated cases were compared with non-outbreak-associated cases and traceback and environmental investigations were performed. We identified 35 outbreak-associated cases in 12 states; 34 (97%) were hospitalized and seven (20%) died. Outbreak-associated ill persons were more likely to have eaten commercially produced, prepackaged caramel apples (odds ratio 326·7, 95% confidence interval 32·2–3314). Environmental samples from the grower's packing facility and distribution-chain whole apples yielded isolates highly related to outbreak isolates by wgMLST. This outbreak highlights the importance of minimizing produce contamination with L. monocytogenes. Investigators should perform single-interviewer open-ended interviews when a food is not readily identified.
The production of livestock feed in the USA is geographically concentrated, which poses several risks. Extreme weather events and disease outbreaks have the potential to disrupt production in these areas, which could reduce the national output of meat, dairy and eggs. Additionally, geographically concentrated livestock and feed production systems have been observed to contribute excessive nutrient loads to surrounding soil and water bodies, thereby threatening environmental sustainability. Geographic relocation of production systems has been proposed as an adaptation strategy to increase system resilience and this could take the shape of more geographically dispersed livestock feed production. We estimate the degree to which the demand for meat, dairy and eggs in the Northeast region is met with current levels of regional feed and livestock production, a term that we refer to as regional self-reliance. We combine mean annual (2001–2010) data on Northeast regional land use; crop output; meat, dairy and egg output; and food consumption with a livestock feed requirements model. An annual mean of over 6.1 million ha of land in the Northeast was dedicated to livestock feed from 2001 to 2010, with nearly 80% located in just three states (Pennsylvania, New York and West Virginia). The region is a net importer of livestock feed (in terms of total digestible nutrients and crude protein), as well as meat, dairy and eggs (in terms of total human-edible energy and protein). This is the result of a confluence of long-term regional trends that include the movement of agricultural production out of the region with a concomitant increase in the regional population and an increase in the national demand for meat, dairy and eggs. Limited slaughter output in the region is a key limiting factor to increasing the region's self-reliance for livestock products.
Toxoplasma gondii and Sarcocystis neurona are protozoan parasites with terrestrial definitive hosts, and both pathogens can cause fatal disease in a wide range of marine animals. Close monitoring of threatened southern sea otters (Enhydra lutris nereis) in California allowed for the diagnosis of dual transplacental transmission of T. gondii and S. neurona in a wild female otter that was chronically infected with both parasites. Congenital infection resulted in late-term abortion due to disseminated toxoplasmosis. Toxoplasma gondii and S. neurona DNA was amplified from placental tissue culture, as well as from fetal lung tissue. Molecular characterization of T. gondii revealed a Type X genotype in isolates derived from placenta and fetal brain, as well as in all tested fetal organs (brain, lung, spleen, liver and thymus). This report provides the first evidence for transplacental transmission of T. gondii in a chronically infected wild sea otter, and the first molecular and immunohistochemical confirmation of concurrent transplacental transmission of T. gondii and S. neurona in any species. Repeated fetal and/or neonatal losses in the sea otter dam also suggested that T. gondii has the potential to reduce fecundity in chronically infected marine mammals through parasite recrudescence and repeated fetal infection.
To examine sociodemographic variations among children <18 years in (1) rates of self-harm visits to emergency departments (EDs) and (2) physician follow-up after the self-harm visit in Alberta.
A retrospective, population-based cohort (2002–2011) of ED visits for self-harm by individuals <18 years was conducted using administrative databases from Alberta, Canada. Individuals were grouped by First Nations status or type of health care premium subsidy (family receipt of government subsidy, human services program subsidy, no subsidy received). Visits from 104 EDs were summarized by crude and directly standardized visit rates (DSVRs) per 100,000 individuals. Kaplan-Meier estimates for median estimated time to physician follow-up were calculated with 95% confidence intervals (CIs).
During the study period, visit rates decreased with the exception of children from families receiving government-sponsored program subsidy (DSVRs 163/100,000 to 250/100,000; p=0.032). First Nations children had disproportionately fewer follow-up visits compared to other children. The median time to follow-up for First Nations children was 39 days (95% CI: 32, 48) compared to 16 days for children from families receiving no subsidy (95% CI: 14, 19), who had the shortest follow-up time after an ED visit.
Sociodemographic differences were evident in ED visit rates as well as the number of and time to physician follow-up visit. The disparities experienced by First Nations children in the follow-up period highlight an opportunity for culturally-grounded risk and needs assessment in the ED to determine and facilitate timely and appropriate follow-up care.
Over 30% of Australasian amphibians are currently threatened with extinction. While habitat loss, introduced species and disease have been identified as major threats, the impacts of climate change are understudied. Threatened frogs fall into distinct biogeographical and ecological groupings that can be linked to specific threats (e.g. mountain- top endemics and climate change; stream-dwelling wet forest frogs and disease; and small island endemics and feral pests). The impacts of gradual climate change over millions of years has isolated specific species into climatic refugia (resulting in restricted geographic ranges), which combined with the ecological traits of these species (e.g. small clutch-size) dramatically increases extinction risk. Australasian frogs demonstrate intrinsic links between biogeographic history, species ecology and conservation status. The solutions to most threats are clear at a broad level, stop land clearing, reduce CO2 emissions and control feral animals; however, declines linked to the disease chytridiomycosis are not easily resolved. Chytridiomycosis is not a universal threat and understanding the causes of variation in impact is critically important. While the threats of land clearing, disease and introduced species are regional and/or species specific, the impacts of climate change must be examined carefully as all species are likely to affected. Here we cover these issues for Australasian frogs, presenting regional examples that highlight threats and avenues for future research and management.
Phylogenetic and biogeographic history
Over 30% of amphibian species are threatened with extinction globally making them the most threatened of the vertebrate groups (Wake and Vredenburg 2008). There are multiple threats to Austral frogs: e.g. disease – critically chytrid fungus for species with more aquatic lifestyles; small clutch size and limited range associated with higher decline or extinction risk; introduced species (Gambusia and trout in Australia, Gillespie and Hero, 1999; Murray et al., 2011; Rattus in New Zealand, Thurley and Bell, 1994; and mongoose in the Pacific Islands, Pernetta and Watling, 1979) and less specific threats, identified in both Austral and global analyses of amphibian declines: e.g. climate change (Hero et al., 2006, 2008; Hof et al., 2011) and habitat loss and fragmentation (Hero et al., 2008). These factors pose serious threats in many other regions of the world (Stuart, 2008) and their impacts vary among species and genera, depending on their current distribution and habitat use (Table 21.1).
We addressed the question of whether syllabic units of the presented language would activate words containing these syllables in the nonpresented language. In two lexical decision experiments using Spanish and German words presented to two groups of late Spanish–German and German–Spanish bilinguals and to two monolingual control groups, target words’ syllable-frequency in the nonpresented language was manipulated. Inhibitory effects of syllable-frequency in the nonpresented language were found only when Spanish–German bilinguals read German L2 words– suggesting that L2 sublexical syllabic units activated L1 syllabic neighbors’ representations that would interfere with L2 target processing. On the contrary, no inhibitory effects but rather a facilitation tendency due to syllable-frequency from the nonpresented German language was obtained for both groups of bilinguals reading Spanish words. This dissociation concerning the spread of activation from sublexical units to lexical representations from bilinguals’ two languages is discussed in terms of structural differences between the two languages.
Surveillance of hospital-acquired infections can be approximated by repeated surveys that are performed in a standardized, cost-effective manner. We developed an integrated software system for serial electronic hospital-wide point prevalence surveys using algorithms that proved highly sensitive and specific over a 5-year period in a large university medical center.