To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Vitamin D deficiency is associated with increased risk of falls and fractures. Assuming this association is causal, we aimed to identify the number and proportion of hospitalisations for falls and hip fractures attributable to vitamin D deficiency [25 hydroxy D (25(OH)D) <50 nmol/L] in Australians aged 65 years and over. We used 25(OH)D data from the 2011/12 Australian Health Survey and relative risks from published meta-analyses to calculate population attributable fractions for falls and hip fracture. We applied these to data published by the Australian Institute of Health and Welfare to calculate the number of events each year attributable to vitamin D deficiency. In men and women combined, 8.3% of hospitalisations for falls (7991 events) and almost 8% of hospitalisations for hip fractures (1315 events) were attributable to vitamin D deficiency. These findings suggest that even in a sunny country such as Australia vitamin D deficiency contributes to a considerable number of hospitalisations as a consequence of falls and for treatment of hip fracture in older Australians; in countries where the prevalence of vitamin D deficiency is higher the impact will be even greater. It is important to mitigate vitamin D deficiency but whether this should occur through supplementation or increased sun exposure needs consideration of the benefits, harms, practicalities, and costs of both approaches.
Hookworms are some of the most widespread of the soil-transmitted helminths (STH) with an estimated 438.9 million people infected. Until relatively recently Ancylostoma ceylanicum was regarded as a rare cause of hookworm infection in humans, with little public health relevance. However, recent advances in molecular diagnostics have revealed a much higher prevalence of this zoonotic hookworm than previously thought, particularly in Asia. This study examined the prevalence of STH and A. ceylanicum in the municipalities of Palapag and Laoang in the Philippines utilizing real-time polymerase chain reaction (PCR) on stool samples previously collected as part of a cross-sectional survey of schistosomiasis japonica. Prevalence of hookworm in humans was high with 52.8% (n = 228/432) individuals positive for any hookworm, 34.5% (n = 149/432) infected with Necator americanus, and 29.6% (n = 128/432) with Ancylostoma spp; of these, 34 were PCR-positive for A. ceylanicum. Considering dogs, 12 (n = 33) were PCR-positive for A. ceylanicum. This is the first study to utilize molecular diagnostics to identify A. ceylanicum in the Philippines with both humans and dogs infected. Control and elimination of this zoonotic hookworm will require a multifaceted approach including chemotherapy of humans, identification of animal reservoirs, improvements in health infrastructure, and health education to help prevent infection.
This manuscript describes the institutional and clinical considerations that apply to the question of whether to mandate opioid dose reduction in patients who have received opioids long-term. It describes how a calamitous rise in addiction and overdose involving opioids has both led to a clinical recalibration by healthcare providers, and to strong incentives favoring forcible opioid reduction by policy making agencies. Neither the 2016 Guideline issued by the Centers for Disease Control and Prevention nor clinical evidence can justify or promote such policies as safe or effective.
The purpose of this study was to examine how exposure to the armed conflict and the tsunami, perceived availability of resources, and perceived helpfulness of religious practices would predict depression, anxiety, posttraumatic stress, and psychosocial functioning in a multi-ethnic sample of Sri Lankan youth. A sample of Tamil (174), Sinhalese (332), and Muslim (215) children (girls=391) between 12 and 19 years (mean age =14.4, sd =1.9), completed a survey including demographic questions and items assessing exposure to the conflict and the tsunami, the perceived availability of resources, and perceived helpfulness of religious practices. Scales assessing depression, anxiety, posttraumatic stress, and psychosocial functioning were also completed. Four hierarchical multiple regression analyses were conducted with exposure to the conflict and tsunami, perceived availability of resources, and perceived helpfulness of religious beliefs as predictors, and with depression, anxiety, posttraumatic stress and psychosocial functioning as outcomes. The results revealed that exposure to the armed conflict significantly predicted posttraumatic stress (R2 =.03, F [1,494] = 12.77, p< .001), while exposure to the tsunami predicted anxiety (R2 =.03, F [2,506] = 7.8, p< .001), and perceived availability of resources predicted depression (R2=.09, F [4,499] = 11.83, p< .001) and psychosocial functioning (R2=.098, F [4,506] = 13.67, p< .001). The results suggest that exposure to traumatic events should not be assumed to be the only or even the most important variable when considering the overall psychological and psychosocial functioning of children in developing countries and traditional cultures. Implications for interventions, policy, and future research are discussed.
Recent literature on philanthropy and business has focused on the returns to businesses and entrepreneurs from giving. In this article, we show how historical context impacts the motivations and organizational forms created over time in philanthropic giving that effect and affect such returns. We do this through the prism of the changing ownership structures in the Scotch whisky industry in the twentieth century using an institutional theory lens. In doing so, we capture the story of three sisters who inherited a Scotch whisky business in the 1940s and transformed it into a hybrid philanthropic-commercial vehicle that remains in operation today. We present an extended theoretical model illustrating the interplay of context, motivation, and organizational structure over time on exchanges of capital in entrepreneurial philanthropy.
Poor performance and ill-health of calves in the pre-wean period can affect future productivity. Increasing numbers of producers are opting to use calf jackets as a means of mitigating the potential negative effects of low ambient temperatures, wind speed and precipitation on growth and health. This study aimed to use a range of noninvasive monitoring technologies to investigate the effects of using calf jackets in the first 3 weeks of life on calf performance and behavioural and physiological parameters. Ninety Holstein-Friesian calves were allocated to one of the two treatments: (i) Jacketed until 21 days of age and (J; n = 44) ii. Nonjacketed (NJ; n = 46). Calves were group housed and fed milk replacer (MR) and concentrate solid feed via automatic feeders. Calves were weaned at day 56, and the experiment was completed at day 63. Health assessments were conducted on a daily basis throughout the experiment using predefined faecal and respiratory scoring protocols. A range of novel, noninvasive monitoring technologies were used to examine the activity, heart rate and thermal profiles of calves on an individual basis throughout the experimental period. There were no differences in calf live weight (LWT), average daily gain (ADG) or feed conversion efficiency (FCE) in J and NJ calves between days 5 to 20. However, NJ calves consumed more MR and had more unrewarded visits to the milk feeder than J calves during this period. Although calf LWT was comparable across treatments in the week following jacket removal (days 21 to 28), both ADG and FCE tended to be greater in NJ calves. There were no treatment differences in calf LWT at the end of the study (d63). When measured over a period of 24 h and at a mean ambient temperature of 7.7°C, skin surface temperature was 6.37°C higher in J calves. Core body temperature was higher in J calves between days 5 to 20; however, there were no differences in IR eye or IR rectal temperature. No differences in lying behaviour occurred, with calves spending 18 and 17 h/day lying between days 5 to 20 and days 21 to 28, respectively. Under the climatic and management conditions described, no significant benefits to calf performance were found as a result of the provision of calf jackets to group-housed calves in the first 3 weeks of life. The higher frequency of unrewarded visits to the milk feeder in NJ calves during the first 3 weeks of life could be suggestive of a lack of satiety in these calves.
Concentrate inclusion levels in dairy cow diets are often adjusted so that the milk yield responses remain economic. While changes in concentrate level on performance is well known, their impact on other biological parameters, including immune function, is less well understood. The objective of this study was to evaluate the effect of concentrate inclusion level in a grass silage-based mixed ration on immune function. Following calving 63 (45 multiparous and 18 primiparous) Holstein Friesian dairy cows were allocated to one of three isonitrogenous diets for the first 70 days of lactation. Diets comprised of a mixture of concentrates and grass silage, with concentrates comprising either a low (30%, LC), medium (50%, MC) or high (70%, HC) proportion of the diet on a dry matter (DM) basis. Daily DM intakes, milk yields and BW were recorded, along with weekly body condition score, milk composition and vaginal mucus scores. Blood biochemistry was measured using a chemistry analyzer, neutrophil phagocytic and oxidative burst assessed using commercial kits and flow cytometry, and interferon-γ production evaluated by ELISA after whole blood stimulation. Over the study period cows on HC had a higher total DM intake, milk yield, fat yield, protein yield, fat+protein yield, protein content, mean BW and mean daily energy balance, and a lower BW loss than cows on MC, whose respective values were higher than cows on LC. Cows on HC and MC had a lower serum non-esterified fatty acid concentration than cows on LC (0.37, 0.37 and 0.50 mmol/l, respectively, P=0.005, SED=0.032), while cows on HC had a lower serum β-hydroxybutyrate concentration than cows on MC and LC (0.42, 0.55 and 0.55 mmol/l, respectively, P=0.002, SED=0.03). Concentrate inclusion level had no effect on vaginal mucus scores. At week 3 postpartum, cows on HC tended to have a higher percentage of oxidative burst positive neutrophils than cows on LC (43.2% and 35.3%, respectively, P=0.078, SED=3.11), although at all other times concentrate inclusion level in the total mixed ration had no effect on neutrophil phagocytic or oxidative burst characteristics, or on interferon-γ production by pokeweed mitogen stimulated whole blood culture. This study demonstrates that for high yielding Holstein Friesian cows managed on a grass silage-based diet, concentrate inclusion levels in early lactation affects performance but has no effect on neutrophil or lymphocyte immune parameters.
Contaminated hands of healthcare workers (HCWs) are an important source of transmission of healthcare-associated infections. Alcohol-based hand sanitizers, while effective, do not provide sustained antimicrobial activity. The objective of this study was to compare the immediate and persistent activity of 2 hand hygiene products (ethanol [61% w/v] plus chlorhexidine gluconate [CHG; 1.0% solution] and ethanol only [70% v/v]) when used in an intensive care unit (ICU).
Prospective, randomized, double-blinded, crossover study
Three ICUs at a large teaching hospital
In total, 51 HCWs involved in direct patient care were enrolled in and completed the study.
All HCWs were randomized 1:1 to either product. Hand prints were obtained immediately after the product was applied and again after spending 4–7 minutes in the ICU common areas prior to entering a patient room or leaving the area. The numbers of aerobic colony-forming units (CFU) were compared for the 2 groups after log transformation. Each participant tested the alternative product after a 3-day washout period.
On bare hands, use of ethanol plus CHG was associated with significantly lower recovery of aerobic CFU, both immediately after use (0.27 ± 0.05 and 0.88 ± 0.08 log10 CFU; P = .035) and after spending time in ICU common areas (1.81 ± 0.07 and 2.17 ± 0.05 log10 CFU; P<.0001). Both the antiseptics were well tolerated by HCWs.
In comparison to the ethanol-only product, the ethanol plus CHG sanitizer was associated with significantly lower aerobic bacterial counts on hands of HCWs, both immediately after use and after spending time in ICU common areas.
Sugarcane is an important forage resource in sub-tropical and tropical areas as it is used during the winter or dry season when the growth rate of pastures is significantly reduced. The current research study assessed the effect of four vertical sections of sugarcane in a pen trial and the level of sugarcane utilization in a grazing trial on the ingestive behaviour and forage intake of two age groups of steers (1 and 2 years old). The pen trial was comprised of two simultaneous 4 × 4 balanced Latin square designs (one for each age group of animals) of four periods, four animals and four feeding treatments, which consisted of four equal vertical sections of sugarcane. Dry matter (DM) and digestible DM (DDM) intake per kilogram of metabolic weight declined gradually from top to bottom of the sugarcane, with no significant differences between the age groups of steers. This difference in intake was associated with a decline in intake of neutral detergent fibre (NDF) as a proportion of the liveweight of the animal and an increase of total chewing time per kilogram of DM or NDF from top to bottom of the sugarcane. It was concluded that the toughness of plant material played a significant role regulating intake, which was higher for the top sections of sugarcane. In the grazing trial, steers of both age groups grazed down sugarcane in three plots over 9 days. Steers grazed up to four distinctive grazing strata. Digestible DM intake (DDM intake) was high at low levels of horizontal utilization of the top grazing stratum but DDM intake started to decline sharply when this stratum was removed in 0·92 of paddock area (i.e. equivalent to 0·08 of the pasture area remaining un-grazed). It was concluded that the proportion of un-grazed area of the pasture can be used as a grazing management strategy to control forage intake for sugarcane.
The Taipan galaxy survey (hereafter simply ‘Taipan’) is a multi-object spectroscopic survey starting in 2017 that will cover 2π steradians over the southern sky (δ ≲ 10°, |b| ≳ 10°), and obtain optical spectra for about two million galaxies out to z < 0.4. Taipan will use the newly refurbished 1.2-m UK Schmidt Telescope at Siding Spring Observatory with the new TAIPAN instrument, which includes an innovative ‘Starbugs’ positioning system capable of rapidly and simultaneously deploying up to 150 spectroscopic fibres (and up to 300 with a proposed upgrade) over the 6° diameter focal plane, and a purpose-built spectrograph operating in the range from 370 to 870 nm with resolving power R ≳ 2000. The main scientific goals of Taipan are (i) to measure the distance scale of the Universe (primarily governed by the local expansion rate, H0) to 1% precision, and the growth rate of structure to 5%; (ii) to make the most extensive map yet constructed of the total mass distribution and motions in the local Universe, using peculiar velocities based on improved Fundamental Plane distances, which will enable sensitive tests of gravitational physics; and (iii) to deliver a legacy sample of low-redshift galaxies as a unique laboratory for studying galaxy evolution as a function of dark matter halo and stellar mass and environment. The final survey, which will be completed within 5 yrs, will consist of a complete magnitude-limited sample (i ⩽ 17) of about 1.2 × 106 galaxies supplemented by an extension to higher redshifts and fainter magnitudes (i ⩽ 18.1) of a luminous red galaxy sample of about 0.8 × 106 galaxies. Observations and data processing will be carried out remotely and in a fully automated way, using a purpose-built automated ‘virtual observer’ software and an automated data reduction pipeline. The Taipan survey is deliberately designed to maximise its legacy value by complementing and enhancing current and planned surveys of the southern sky at wavelengths from the optical to the radio; it will become the primary redshift and optical spectroscopic reference catalogue for the local extragalactic Universe in the southern sky for the coming decade.
Pomegranate (Punica granatum), a polyphenol-rich fruit, has been suggested to reduce cardiovascular risk due to its antioxidant properties. Hypertension and obesity are the most preventable cardiovascular risk factors. Few studies on blood pressure and/or body-weight status have been conducted in human subjects. Previous investigations have tended to focus on pomegranate juice. The aim of the present study was to investigate the effect of pomegranate extract (PE) on blood pressure and anthropometric measures in adults with no symptomatic disease. A total of fifty-five participants enrolled in a randomised double-blinded placebo-controlled clinical trial where they were assigned to either PE capsules or placebo capsules for 8 weeks. Blood pressure, body weight, waist circumference, waist:hip ratio (WHR) and body composition (lean body mass, body fat) were measured at baseline, week 4 and week 8. Results showed a significant decrease in diastolic blood pressure after 8 weeks (by 2·79 (sd 5·32) mmHg; P < 0·05), while the decrease in systolic blood pressure did not reach statistical significance (2·57 (sd 7·4) mmHg; P > 0·05). Body fat percentage, lean body mass, waist circumference and WHR did not significantly differ between groups at the end of the intervention. Results suggest that PE may reduce blood pressure and possibly prevent hypertension in the normotensive population. Further large trials are required to elucidate this effect.
Schistosomiasis in China has been substantially reduced due to an effective control programme employing various measures including bovine and human chemotherapy, and the removal of bovines from endemic areas. To fulfil elimination targets, it will be necessary to identify other possible reservoir hosts for Schistosoma japonicum and include them in future control efforts. This study determined the infection prevalence of S. japonicum in rodents (0–9·21%), dogs (0–18·37%) and goats (6·9–46·4%) from the Dongting Lake area of Hunan province, using a combination of traditional coproparasitological techniques (miracidial hatching technique and Kato-Katz thick smear technique) and molecular methods [quantitative real-time PCR (qPCR) and droplet digital PCR (ddPCR)]. We found a much higher prevalence in goats than previously recorded in this setting. Cattle and water buffalo were also examined using the same procedures and all were found to be infected, emphasising the occurrence of active transmission. qPCR and ddPCR were much more sensitive than the coproparasitological procedures with both KK and MHT considerably underestimating the true prevalence in all animals surveyed. The high level of S. japonicum prevalence in goats indicates that they are likely important reservoirs in schistosomiasis transmission, necessitating their inclusion as targets of control, if the goal of elimination is to be achieved in China.
Terrestrial gastropods are problematical for radiocarbon (14C) measurement because they tend to incorporate carbon from ancient sources as a result of their dietary behavior. The 14C ecology of the pulmonate land snail, Helix melanostoma in Cyrenaica, northeastern Libya, was investigated as part of a wider study on the potential of using terrestrial mollusk shell for 14C dating of archaeological deposits. H. melanostoma was selected out of the species available in the region as it has the most predictable 14C ecology and also had a ubiquitous presence within the local archaeology. The ecological observations indicate that H. melanostoma has a very homogenous 14C ecology with consistent variations in F14C across sample sites controlled by availability of dietary vegetation. The majority of dated specimens from non-urbanized sample locations have only a small old-carbon effect, weighted mean of 476±48 14C yr, with between ~1% and 9% of dietary F14C from non-organic carbonate sources. Observed instabilities in the 14C ecology can all be attributed to the results of intense human activity not present before the Roman Period. Therefore, H. melanostoma and species with similar ecological behavior are suitable for 14C dating of archaeological and geological deposits with the use of a suitable offset.
We use cyclic charge-discharge experiments to evaluate the capacity retention rates of two quinone-bromide flow batteries (QBFBs). These aqueous QBFBs use a negative electrolyte containing either anthraquinone-2,7-disulfonic acid (AQDS) or anthraquinone-2-sulfonic acid (AQS) dissolved in sulfuric acid, and a positive electrolyte containing bromine and hydrobromic acid. We find that the AQS cell exhibits a significantly lower capacity retention rate than the AQDS cell. The observed AQS capacity fade is corroborated by NMR evidence that suggests the formation of hydroxylated products in the electrolyte in place of AQS. We further cycle the AQDS cell and observe a capacity fade rate extrapolating to 30% loss of active species after 5000 cycles. After about 180 cycles, bromine crossover leads to sufficient electrolyte imbalance to accelerate the capacity fade rate, indicating that the actual realization of long cycle life will require bromine rebalancing or a membrane less permeable than Nafion® to molecular bromine.
Catheter-associated urinary tract infections (CAUTIs) are among the most common hospital-acquired infections (HAIs). Reducing CAUTI rates has become a major focus of attention due to increasing public health concerns and reimbursement implications.
To implement and describe a multifaceted intervention to decrease CAUTIs in our ICUs with an emphasis on indications for obtaining a urine culture.
A project team composed of all critical care disciplines was assembled to address an institutional goal of decreasing CAUTIs. Interventions implemented between year 1 and year 2 included protocols recommended by the Centers for Disease Control and Prevention for placement, maintenance, and removal of catheters. Leaders from all critical care disciplines agreed to align routine culturing practice with American College of Critical Care Medicine (ACCCM) and Infectious Disease Society of America (IDSA) guidelines for evaluating a fever in a critically ill patient. Surveillance data for CAUTI and hospital-acquired bloodstream infection (HABSI) were recorded prospectively according to National Healthcare Safety Network (NHSN) protocols. Device utilization ratios (DURs), rates of CAUTI, HABSI, and urine cultures were calculated and compared.
The CAUTI rate decreased from 3.0 per 1,000 catheter days in 2013 to 1.9 in 2014. The DUR was 0.7 in 2013 and 0.68 in 2014. The HABSI rates per 1,000 patient days decreased from 2.8 in 2013 to 2.4 in 2014.
Effectively reducing ICU CAUTI rates requires a multifaceted and collaborative approach; stewardship of culturing was a key and safe component of our successful reduction efforts.
We describe a versatile infrared camera/spectrograph, IRIS, designed and constructed at the Anglo-Australian Observatory for use on the Anglo-Australian Telescope. A variety of optical configurations can be selected under remote control to provide several direct image scales and a few low-resolution spectroscopic formats. Two cross-dispersed transmission echelles are of novel design, as is the use of a modified Bowen-Burch system to provide a fast f/ratio in the widest-field option. The drive electronics includes a choice of readout schemes for versatility, and continuous display when the array is not taking data, to facilitate field acquisition and focusing.
The linearity of the detector has been studied in detail. Although outwardly good, slight nonlinearities prevent removal of fixed-pattern noise from the data without application of a cubic linearising function.
Specific control and data-reduction software has been written. We describe also a scanning mode developed for spectroscopic imaging.
The transition to the diverse and complex biosphere of the Ediacaran and early Paleozoic is the culmination of a complex history of tectonic, climate, and geochemical development. Although much of this rise occurred in the middle and late intervals of the Neoproterozoic Era (1000–541 million years ago [Ma]), the foundation for many of these developments was laid much earlier, during the latest Mesoproterozic Stenian Period (1200–1000 Ma) and early Neoproterozoic Tonian Period (1000–720 Ma). Concurrent with the development of complex ecosystems, changes in the composition, configuration, and tectonic interaction between continental plates have been proposed as major shapers of both climate and biogeochemical cycling, but there is little support in the geologic record for overriding tectonic controls. Biogeochemical evidence, however, suggests that an expansion of marine oxygen concentrations may have stabilized nutrient cycles and created more stable environmental conditions under which complex, eukaryotic life could gain a foothold and flourish. The interaction of tectonic, biogeochemical, and climate processes, as described in this paper, resulted in the establishment of habitable environments that fostered the Ediacaran and early Phanerozoic radiations of animal life and the emergence of complex, modern-style ecosystems.
Reintroductions are used to re-establish populations of species within their indigenous range, but their outcomes are variable. A key decision when developing a reintroduction strategy is whether to include a temporary period of confinement prior to release. Pre-release confinement is primarily used for the purpose of quarantine or as a delayed-release tactic to influence the performance or behaviour of founders post-release. A common difference between these approaches is that quarantine tends to be conducted in ex situ captivity, whereas delayed releases tend to involve in situ confinement at the release site. Although these practices are commonly viewed independently, it may be possible for a single confinement period to be used for both purposes. We tested whether temporarily holding wild eastern bettongs Bettongia gaimardi in ex situ captivity for 95–345 days prior to release (delayed release) influenced their body mass, pouch occupancy or survival during the first 1.5 years post-release, compared to founders released without confinement (immediate release). Our results suggest that exposing founders to captivity did not alter their body mass or performance post-release, despite being heavier and having fewer pouch young when released. We conclude that, for this species, ex situ captivity does not represent a tactical opportunity to improve post-release performance but can be used for quarantine without affecting the probability of establishment.
Public discourse suggests a lack of consensus in the United States regarding the environmental impacts of shale gas development. Newly available shale gas has reduced the cost of electricity and heating and replaced coal, but public fears about the environment threaten to curtail those gains. We designed the first survey-based analysis of the views of government, industry, academic, and nongovernmental experts to identify their priorities for regulation and voluntary action among 264 routine and 14 accidental environmental risk “pathways.” We find that nongovernmental experts select many more problems but that there is considerable agreement on the most important ones, which can guide research, policies, and practices so that shale gas benefits continue and environmental impacts are limited.