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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 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.
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.
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
The multi-object spectroscopic facility FOCAP at the Anglo-Australian Telescope has been used to obtain spectra centred at the Ca II IR triplet of 14 stars in the field of the Sextans dwarf spheroidal (dSph) galaxy. This satellite of our own Galaxy was recently discovered by Irwin et al. (1990) from APM measures of UK Schmidt Telescope photographic plates.
The first QSO with a redshift z > 4 was found using a combination of UK Schmidt Telescope (UKST) plates and the APM automatic plate measuring machine (Warren et al. 1987a). By continuing to make use of UKST survey plates plus the APM facility we have added substantially to the number of known QSOs with z > 4. A brief description of the general survey technique is presented together with a preliminary discussion of some of the results obtained so far.
We present the results from the state-of-the-art wide-field survey of the M81 galaxy group that we are conducting with Hyper Suprime-Cam on Subaru Telescope. Our photometry reaches about 2 mag below the tip of the red giant branch (RGB) and reveals the spatial distribution of both old and young stars over an area of 5°2 around the M81. The young main-sequence (MS) stars closely follow the HI distribution and can be found in a stellar stream between M81 and NGC 3077 and in numerous outlying stellar associations. Our survey also reveals for the first time the very extended (>2 × R25) halos of RGB stars around M81, M82, and NGC 3077, as well as faint tidal streams that link these systems. The gravitational interactions between M81, M82 and NGC 3077 galaxies induced star formation in tidally stripped gas, and also significantly perturbed the older stellar components leading to disturbed halo morphologies.
Trypanosomes and Leishmania are vector-borne parasites associated with high morbidity and mortality. Trypanosoma lewisi, putatively introduced with black rats and fleas, has been implicated in the extinction of two native rodents on Christmas Island (CI) and native trypanosomes are hypothesized to have caused decline in Australian marsupial populations on the mainland. This study investigated the distribution and prevalence of Trypanosoma spp. and Leishmania spp. in two introduced pests (cats and black rats) for three Australian locations. Molecular screening (PCR) on spleen tissue was performed on cats from CI (n = 35), Dirk Hartog Island (DHI; n = 23) and southwest Western Australia (swWA) (n = 58), and black rats from CI only (n = 46). Despite the continued presence of the intermediate and mechanical hosts of T. lewisi, there was no evidence of trypanosome or Leishmania infection in cats or rats from CI. Trypanosomes were not identified in cats from DHI or swWA. These findings suggest T. lewisi is no longer present on CI and endemic Trypanosoma spp. do not infect cats or rats in these locations.
Field stars provide important constraints for the late stages of stars' angular momentum evolution. We measured rotation periods ranging from 0.1 to 150 days for approximately 450 mid-to-late M dwarfs using photometry from the MEarth transiting planet survey. We use parallaxes, proper motions, and radial velocities to calculate galactic kinematics for these solar neighborhood M dwarfs. The velocity dispersions increase towards longer rotation periods, indicating that there is a relationship between rotation and age for these stars.
Trypanosomes are blood-borne parasites that can cause severe disease in both humans and animals, yet little is known of the pathogenicity and life-cycles of trypanosomes in native Australian mammals. Trypanosoma copemani is known to be infective to a variety of Australian marsupials and has recently been shown to be potentially zoonotic as it is resistant to normal human serum. In the present study, in vivo and in vitro examination of blood and cultures from Australian marsupials was conducted using light microscopy, immunofluorescence, scanning electron microscopy and fluorescence in situ hybridization. Promastigote, sphaeromastigote and amastigote life-cycle stages were detected in vivo and in vitro. Novel trypanosome-like stages were also detected both in vivo and in vitro representing an oval stage, an extremely thin stage, an adherent stage and a tiny round stage. The tiny round and adherent stages appeared to adhere to erythrocytes causing potential haematological damage with clinical effects similar to haemolytic anaemia. The present study shows for the first time that trypomastigotes are not the only life-cycle stages circulating within the blood stream of trypanosome infected Australian native marsupials and provides insights into possible pathogenic mechanisms of this potentially zoonotic trypanosome species.
The paper describes a method of representing damage on a wing due to multiple warhead fragments, and investigates two of the key variables: fragment impact density and hole diameter. The aerodynamic effects of the damage were quantified by wind-tunnel tests on a two-dimensional wing at a Reynolds number of 5 × 105. The wing was of hollow construction with leading and trailing-edge spars. In all of the cases tested, simulated fragment damage resulted in significant lift losses, drag increases and pitching moment changes. Increasing fragment density or hole size resulted in greater effects. To a first order approximation, both lift and drag increments at a given incidence were related to the percentage wing area removed. Surface flow visualisation showed that low fragment densities and small damage sizes resulted in a complex flow structure on the surface of the wing. This was made up of boundary-layer growth between the damage holes, attached wakes from the forward damage holes and separated surface flow over the rear of the wing. For these cases, individual hole patterns showed similar flow mechanisms to those seen for larger scale gunfire damage cases. Increased fragment density and hole size resulted in upper surface flow separation at the first row of holes. Behind this separation, the flow was attached and consisted of the combined wakes from the forward damage holes. Investigations into the influence of internal model structure indicated that trends in coefficient changes were similar for both hollow and solid wings. However, the magnitudes of the effects were found to be smaller for hollow wings than for solid wings.
The success of natural resource management depends on monitoring, assessment and enforcement. In support of these efforts, reference points (RPs) are often viewed as critical values of management-relevant indicators. This paper considers RPs from the standpoint of objective-driven decision making in dynamic resource systems, guided by principles of structured decision making (SDM) and adaptive resource management (AM). During the development of natural resource policy, RPs have been variously treated as either ‘targets’ or ‘triggers’. Under a SDM/AM paradigm, target RPs correspond approximately to value-based objectives, which may in turn be either of fundamental interest to stakeholders or intermediaries to other central objectives. By contrast, trigger RPs correspond to decision rules that are presumed to lead to desirable outcomes (such as the programme targets). Casting RPs as triggers or targets within a SDM framework is helpful towards clarifying why (or whether) a particular metric is appropriate. Further, the benefits of a SDM/AM process include elucidation of underlying untested assumptions that may reveal alternative metrics for use as RPs. Likewise, a structured decision-analytic framework may also reveal that failure to achieve management goals is not because the metrics are wrong, but because the decision-making process in which they are embedded is insufficiently robust to uncertainty, is not efficiently directed at producing a resource objective, or is incapable of adaptation to new knowledge.
Spectroscopic observations of transiting exoplanets have provided the first indications of their atmospheric structure and composition. Optimal estimation retrievals have been successfully applied to solar system planets to determine the temperature, composition and aerosol properties of their atmospheres, and have recently been applied to exoplanets. We show the effectiveness of the technique when combined with simulated observations from the proposed space telescope EChO, and also discuss the difficulty of constraining a complex system with sparse data and large uncertainties, using the super-Earth GJ 1214b as an example.