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Clinician-patient communication is a major factor in influencing outcomes of healthcare. Complexity increases if an individual has multiple health needs requiring support of different clinicians or agencies.
To develop and evidence a simple dynamic computerised tool to capture and communicate outcomes of intervention or alteration in clinical need in patients with multiple chronic health needs.
A MS Excel algorithm was designed for swift capture of clinical information discussed in an appointment using pre-designed set of evidenced based domains. An instant personalized single screen visual is produced to facilitate information sharing and decision-making. The display is responsive to compare changes across time. A prototype was conceptually tested in an epilepsy clinic for people with Intellectual disability (ID) due to the unique challenges posed in this population.
Evidence across 300 patients with ID and epilepsy showed the tool works by enhancing reflective communication, compliance and therapeutic relationship. Medication and appointment compliance was 95% and patient satisfaction over 90%.
To discuss all influencing health factors in a consultation is a communication challenge esp. if the patient has multiple health needs. A picture equals 1000 words and helps address the cognitive complexity of verbal information. The radar offers an evidenced based common framework to host care plans of different health conditions. It provides individualised easy view person centred care plans to allow patients to gain insight on how the different conditions impact on their overall well being and be active participants. The tool will be practically demonstrated.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
This paper analyses a series of high-quality continuous records from southeastern Africa to study the spatiotemporal patterning of Holocene hydroclimatic anomalies in the region. Results indicate dominant frequencies of variability at millennial time scales, and a series of anomalies broadly common to all records. Of particular interest, data from the southern Cape coast exhibit periods of wetter/drier conditions that are out of phase with the sites less than 150 km away in the adjacent interior, but in phase with sites in tropical regions over 1000 km to the northeast. To explain such spatial patterns and gradients, we propose that the Agulhas Current may be a critical vector by which tropical climatic signals are propagated along the littoral zone, exerting a dominant, highly localized influence on near-coastal environmental conditions. Limitations in the data available do not allow for a detailed examination of the climatic dynamics related to these phenomena, but this paper highlights a series of avenues for future research to clarify the spatial extent and stability of the patterns observed.
The study objective was to determine the prevalence of Staphylococcus aureus colonisation in the nares and oropharynx of healthy persons and identify any risk factors associated with such S. aureus colonisation. In total 263 participants (177 adults and 86 minors) comprising 95 families were enrolled in a year-long prospective cohort study from one urban and one rural county in eastern Iowa, USA, through local newspaper advertisements and email lists and through the Keokuk Rural Health Study. Potential risk factors including demographic factors, medical history, farming and healthcare exposure were assessed. Among the participants, 25.4% of adults and 36.1% minors carried S. aureus in their nares and 37.9% of adults carried it in their oropharynx. The overall prevalence was 44.1% among adults and 36.1% for minors. Having at least one positive environmental site for S. aureus in the family home was associated with colonisation (prevalence ratio: 1.34, 95% CI: 1.07–1.66). The sensitivity of the oropharyngeal cultures was greater than that of the nares cultures (86.1% compared with 58.2%, respectively). In conclusion, the nares and oropharynx are both important colonisation sites for healthy community members and the presence of S. aureus in the home environment is associated with an increased probability of colonisation.
DNA barcode analysis of specimens belonging to the genus Histeromerus Wesmael, 1838 (Hymenoptera: Braconidae) reveals the presence of two species in North America. One is identified as H. canadensis Ashmead, 1891, which is widely recorded in North America, while the other is H. mystacinus Wesmael, 1838, a species formerly known only from the western Palaearctic.
We report the results of Long Baseline Array observations made in 2001 of ten southern sources proposed by Mattox et al. as counterparts to EGRET >100 MeV gamma-ray sources. Source structures are compared with published data where available and possible superluminal motions identified in several cases. The associations are examined in the light of Fermi observations, indicating that the confirmed counterparts tend to have radio properties consistent with other identifications, including flat radio spectral index, high brightness temperature, greater radio variability, and higher core dominance.
We present results from a multiwavelength study of the blazar PKS 1954–388 at radio, UV, X-ray, and gamma-ray energies. A RadioAstron observation at 1.66 GHz in June 2012 resulted in the detection of interferometric fringes on baselines of 6.2 Earth-diameters. This suggests a source frame brightness temperature of greater than 2 × 1012 K, well in excess of both equipartition and inverse Compton limits and implying the existence of Doppler boosting in the core. An 8.4-GHz TANAMI VLBI image, made less than a month after the RadioAstron observations, is consistent with a previously reported superluminal motion for a jet component. Flux density monitoring with the Australia Telescope Compact Array confirms previous evidence for long-term variability that increases with observing frequency. A search for more rapid variability revealed no evidence for significant day-scale flux density variation. The ATCA light-curve reveals a strong radio flare beginning in late 2013, which peaks higher, and earlier, at higher frequencies. Comparison with the Fermi gamma-ray light-curve indicates this followed ~ 9 months after the start of a prolonged gamma-ray high-state—a radio lag comparable to that seen in other blazars. The multiwavelength data are combined to derive a Spectral Energy Distribution, which is fitted by a one-zone synchrotron-self-Compton (SSC) model with the addition of external Compton (EC) emission.
This chapter provides a perspective on vegetation changes (as a proxy for overall terrestrial ecosystem changes) within southern Africa’s summer and winter rainfall zones. While climate is a major determinant on southern African ecosystems, topography, geology and fire also play critical roles in ecosystem pattern and processes. Late Quaternary climate changes impacted on southern African ecosystems but did not result in wholesale migration of these biomes. Instead, the palaeoenvironmental record reveals that community dynamics within biomes or at their ecotonal boundaries changed as individual species were favoured or disadvantaged by changing conditions (e.g. climate, fire regimes and/or human impacts) over time.
Boiling is the most common method of household water treatment in developing countries; however, it is not always effectively practised. We conducted a randomized controlled trial among 210 households to assess the effectiveness of water pasteurization and safe-storage interventions in reducing Escherichia coli contamination of household drinking water in a water-boiling population in rural Peru. Households were randomized to receive either a safe-storage container or a safe-storage container plus water pasteurization indicator or to a control group. During a 13-week follow-up period, households that received a safe-storage container and water pasteurization indicator did not have a significantly different prevalence of stored drinking-water contamination relative to the control group [prevalence ratio (PR) 1·18, 95% confidence interval (CI) 0·92–1·52]. Similarly, receipt of a safe-storage container alone had no effect on prevalence of contamination (PR 1·02, 95% CI 0·79–1·31). Although use of water pasteurization indicators and locally available storage containers did not increase the safety of household drinking water in this study, future research could illuminate factors that facilitate the effective use of these interventions to improve water quality and reduce the risk of waterborne disease in populations that boil drinking water.
Significant gaps in immunity to polio, measles, and rubella may exist in adults in Cambodia and threaten vaccine-preventable disease (VPD) elimination and control goals, despite high childhood vaccination coverage. We conducted a nationwide serological survey during November–December 2012 of 2154 women aged 15–39 years to assess immunity to polio, measles, and rubella and to estimate congenital rubella syndrome (CRS) incidence. Measles and rubella antibodies were detected by IgG ELISA and polio antibodies by microneutralization testing. Age-structured catalytic models were fitted to rubella serological data to predict CRS cases. Overall, 29·8% of women lacked immunity to at least one poliovirus (PV); seroprevalence to PV1, PV2 and PV3 was 85·9%, 93·4% and 83·3%, respectively. Rubella and measles antibody seroprevalence was 73·3% and 95·9%, respectively. In the 15–19 years age group, 48·2% [95% confidence interval (CI) 42·4–54·1] were susceptible to either PV1 or PV3, and 40·3% (95% CI 33·0–47·5) to rubella virus. Based on rubella antibody seroprevalence, we estimate that >600 infants are born with CRS in Cambodia annually. Significant numbers of Cambodian women are still susceptible to polio and rubella, especially those aged 15–19 years, emphasizing the need to include adults in VPD surveillance and a potential role for vaccination strategies targeted at adults.
Cameroon has experienced recurrent cholera epidemics with high mortality rates. In September 2009, epidemic cholera was detected in the Far North region of Cameroon and the reported case-fatality rate was 12%. We conducted village-, healthcare facility- and community-level surveys to investigate reasons for excess cholera mortality. Results of this investigation suggest that cholera patients who died were less likely to seek care, receive rehydration therapy and antibiotics at a healthcare facility, and tended to live further from healthcare facilities. Furthermore, use of oral rehydration salts at home was very low in both decedents and survivors. Despite the many challenges inherent to delivering care in Cameroon, practical measures could be taken to reduce cholera mortality in this region, including the timely provision of treatment supplies, training of healthcare workers, establishment of rehydration centres, and promotion of household water treatment and enhanced handwashing with soap.
To investigate the impact of school garden-enhanced nutrition education (NE) on children’s fruit and vegetable consumption, vegetable preferences, fruit and vegetable knowledge and quality of school life.
Quasi-experimental 10-week intervention with nutrition education and garden (NE&G), NE only and control groups. Fruit and vegetable knowledge, vegetable preferences (willingness to taste and taste ratings), fruit and vegetable consumption (24 h recall × 2) and quality of school life (QoSL) were measured at baseline and 4-month follow-up.
Two primary schools in the Hunter Region, New South Wales, Australia.
A total of 127 students in Grades 5 and 6 (11–12 years old; 54 % boys).
Relative to controls, significant between-group differences were found for NE&G and NE students for overall willingness to taste vegetables (P < 0·001) and overall taste ratings of vegetables (P < 0·001). A treatment effect was found for the NE&G group for: ability to identify vegetables (P < 0·001); willingness to taste capsicum (P = 0·04), broccoli (P = 0·01), tomato (P < 0·001) and pea (P = 0·02); and student preference to eat broccoli (P < 0·001) and pea (P < 0·001) as a snack. No group-by-time differences were found for vegetable intake (P = 0·22), fruit intake (P = 0·23) or QoSL (P = 0·98).
School gardens can impact positively on primary-school students’ willingness to taste vegetables and their vegetable taste ratings, but given the complexity of dietary behaviour change, more comprehensive strategies are required to increase vegetable intake.
Safe drinking water and hygiene are essential to reducing Kenya's diarrhoeal disease burden. A school-based safe water and hygiene intervention in Kenya was evaluated to assess its impact on students' knowledge and parents' adoption of safe water and hygiene practices. We surveyed 390 students from nine schools and their parents at baseline and conducted a final evaluation of 363 students and their parents. From baseline to final evaluation, improvement was seen in students' knowledge of correct water treatment procedure (21–65%, P<0·01) and knowing when to wash their hands. At final evaluation, 14% of parents reported currently treating their water, compared with 6% at baseline (P<0·01). From 2004 to 2005, school absenteeism in the September–November term decreased in nine project schools by 35% and increased in nine neighbouring comparison schools by 5%. This novel programme shows promise for reducing school absenteeism and promoting water and hygiene interventions in the home.
Silicon carbide PIN diodes have been fabricated using a direct write laser doping and metallization technique. Trimethyaluminum (TMA) and nitrogen are precursors used to laser dope p-type and n-type regions, respectively, and μ4.3 mm p-type doped junction and 4 mm ntype doped junction are fabricated in semi-insulating 6H-SiC wafers. Rutherford backscattering studies show that no amorphization occurred during the laser doping process. A planar edge termination is fabricated by laser metallization in argon ambient to form a high resistivity layer. With this termination, the leakage current of the PIN diodes can be suppressed effectively compared to that of diodes without edge termination. The performance of the diodes can also be tailored by shrinking the active area of the diode and by conventional annealing.
In an attempt to investigate differences between the most widely discussed hypotheses of early tetrapod relationships, we assembled a new data matrix including 90 taxa coded for 319 cranial and postcranial characters. We have incorporated, where possible, original observations of numerous taxa spread throughout the major tetrapod clades. A stem-based (total-group) definition of Tetrapoda is preferred over apomorphy- and node-based (crown-group) definitions. This definition is operational, since it is based on a formal character analysis. A PAUP* search using a recently implemented version of the parsimony ratchet method yields 64 shortest trees. Differences between these trees concern: (1) the internal relationships of aïstopods, the three selected species of which form a trichotomy; (2) the internal relationships of embolomeres, with Archeria crassidisca and Pholiderpeton scutigerum collapsed in a trichotomy with a clade formed by Anthracosaurus russelli and Pholiderpeton attheyi; (3) the internal relationships of derived dissorophoids, with four amphibamid species forming an unresolved node with a clade consisting of micromelerpetontids and branchiosaurids and a clade consisting of albanerpetontids plus basal crown-group lissamphibians; (4) the position of albenerpetontids and Eocaecilia micropoda, which form an unresolved node with a trichotomy subtending Karaurus sharovi, Valdotriton gracilis and Triadobatrachus massinoti; (5) the branching pattern of derived diplocaulid nectrideans, with Batrachiderpeton reticulatum and Diceratosaurus brevirostris collapsed in a trichotomy with a clade formed by Diplocaulus magnicornis and Diploceraspis burkei. The results of the original parsimony run – as well as those retrieved from several other treatments of the data set (e.g. exclusion of postcranial and lower jaw data; character reweighting; reverse weighting) – indicate a deep split of early tetrapods between lissamphibian- and amniote-related taxa. Colosteids, Crassigyrinus, Whatcheeria and baphetids are progressively more crownward stem-tetrapods. Caerorhachis, embolomeres, gephyrostegids, Solenodonsaurus and seymouriamorphs are progressively more crownward stem-amniotes. Eucritta is basal to temnospondyls, with crown-lissamphibians nested within dissorophoids. Westlothiana is basal to Lepospondyli, but evidence for the monophyletic status of the latter is weak. Westlothiana and Lepospondyli form the sister group to diadectomorphs and crown-group amniotes. Tuditanomorph and microbrachomorph microsaurs are successively more closely related to a clade including proximodistally: (1) lysorophids; (2) Acherontiscus as sister taxon to adelospondyls; (3) scincosaurids plus diplocaulids; (4) urocordylids plus aïstopods. A data set employing cranial characters only places microsaurs on the amniote stem, but forces remaining lepospondyls to appear as sister group to colosteids on the tetrapod stem in several trees. This arrangement is not significantly worse than the tree topology obtained from the analysis of the complete data set. The pattern of sister group relationships in the crownward part of the temnospondyl-lissamphibian tree re-emphasizes the important role of dissorophoids in the lissamphibian origin debate. However, no specific dissorophoid can be identified as the immediate sister taxon to crown-group lissamphibians. The branching sequence of various stem-group amniotes reveals a coherent set of internested character-state changes related to the acquisition of progressively more terrestrial habits in several Permo-Carboniferous forms.
Laser direct-write (LDW) is used for in-situ metallization in single crystal 4H- and 6H-SiC wafers without metal deposition. Nanosecond-pulsed Nd:YAG (λ= 1064 and 532 nm) and excimer (λ = 193, 248 and 351 nm) lasers are utilized to create metal-like conductive phases in both n-type and p-type SiC wafers. Frequency-doubled Nd:YAG irradiation(Ephoton < Eg) induces a carbon rich conductive phase due to thermal decomposition of SiC. However, pulsed excimer laser irradiation (Ephoton > Eg) produces a Si- rich conductive phases due to carbon photo ablation. The Schottky barrier heights (SBH) between the laser-metallized layer and the original n-type SiC (ND = 1018 cm-3) is determined to be 0.8 eV and 1.0 eV by the current-voltage and capacitance-voltage measurements at room temperature, respectively. Linear transmission line method pattern is directly fabricated in n-type doped (ND=1018cm-3) SiC substrate by pulsed laser irradiation allowing to extract the specific contact resistance (rc)of the laser fabricated metal-like tracks (rc= 0.04-0.12 Ωcm2).The specific contact resistance is unchanged after annealing up to 3 hrs at 950°C.
Highly conductive tracks are generated in low-doped epilayers on 4H-SiC wafers using a laserdirect write technique. The current-voltage characteristics are measured to study the effect of the applied voltage on the electric resistance and the surface contact of the irradiated tracks. The effect of multiple irradiations on the electronic properties of the fabricated tracks was investigated and compared with the effect of the conventional annealing process. A laser doping process was used to achieve n-type as well as p-type impurity doping in the substrate. The electronic properties of the doped tracks are measured and compared with those of the untreated wafers. Microstructural observation and surface analysis of the irradiated tracks are studied. Laser fabrication of rectifying contact on SiC substrates is demonstrated.
Based on parent and teacher ratings of primary school children on a scale comprising the 18
DSM-IV AD/HD symptoms, this study used confirmatory factor analysis to compare three
models: all items in one factor; inattention in one and hyperactivity and impulsivity items in
a separate factor; and inattention, hyperactivity, and impulsivity items in three separate
factors. It also examined the prevalence rates of the three AD/HD Types, and gender and age differences. Results supported both the two- and three-factor models, with the three-factor model only slightly better than the two-factor model. Based on parent-teacher
agreement, the prevalence rates were 1.6, 0.2 and 0.6 % for the Inattentive, Hyperactive-
Impulsive, and Combined Types, respectively. Overall, the male to female ratio was 5[ratio ]1, and boys were rated higher than girls by both parents and teachers. Age differences were minimal. The implications of the findings in relation to some of the assumptions made in DSM-IV for AD/HD are discussed.
A novel water quality intervention that consists of point-of-use
water disinfection, safe storage
and community education was field tested in Bolivia. A total of 127 households
periurban communities were randomized into intervention and control groups,
the intervention was distributed. Monthly water quality testing and weekly
surveillance were conducted. Over a 5-month period, intervention households
had 44% fewer
diarrhoea episodes than control households (P=0·002).
Infants <1 year old (P=0·05) and
children 5–14 years old (P=0·01) in intervention
households had significantly less diarrhoea
than control children. Campylobacter was less commonly isolated from intervention
control patients (P=0·02). Stored water in intervention
households was less contaminated with
Escherichia coli than stored water in control households (P<0·0001).
exhibited less E. coli contamination of stored water and less
diarrhoea than control households.
This promising new strategy may have broad applicability for waterborne