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We sought to assess the presence and reporting quality of peer-reviewed literature concerning the accuracy, precision, and reliability of home monitoring technologies for vital signs and glucose determinations in older adult populations.
A narrative literature review was undertaken searching the databases Medline, Embase, and Compendex. Peer-reviewed publications with keywords related to vital signs, monitoring devices and technologies, independent living, and older adults were searched. Publications between the years 2012 and 2018 were included. Two reviewers independently conducted title and abstract screening, and four reviewers independently undertook full-text screening and data extraction with all disagreements resolved through discussion and consensus.
Two hundred nine articles were included. Our review showed limited assessment and low-quality reporting of evidence concerning the accuracy, precision, and reliability of home monitoring technologies. Of 209 articles describing a relevant device, only 45 percent (n = 95) provided a citation or some evidence to support their validation claim. Of forty-eight articles that described the use of a comparator device, 65 percent (n = 31) used low-quality statistical methods, 23 percent (n = 11) used moderate-quality statistical methods, and only 12 percent (n = 6) used high-quality statistical methods.
Our review found that current validity claims were based on low-quality assessments that do not provide the necessary confidence needed by clinicians for medical decision-making purposes. This narrative review highlights the need for standardized health technology reporting to increase health practitioner confidence in these devices, support the appropriate adoption of such devices within the healthcare system, and improve health outcomes.
To assess whether disparities in energy consumption and insufficient energy intake in India have changed over time across socio-economic status (SES).
This cross-sectional, population-based survey study examines the relationship between several SES indicators (i.e. wealth, education, caste, occupation) and energy consumption in India at two time points almost 20 years apart. Household food intake in the last 30 d was assessed in 1993–94 and in 2011–12. Average dietary energy intake per person in the household (e.g. kilocalories) and whether the household consumed less than 80 % of the recommended energy intake (i.e. insufficient energy intake) were calculated. Linear and relative risk regression models were used to estimate the relationship between SES and average energy consumed per day per person and the relative risk of consuming an insufficient amount of energy.
Rural and urban areas across India.
A nationally representative sample of households.
Among rural households, there was a positive association between SES and energy intake across all four SES indicators during both survey years. Similar results were seen for energy insufficiency vis-à-vis recommended energy intake levels. Among urban households, wealth was associated with energy intake and insufficiency at both time points, but there was no educational patterning of energy insufficiency in 2011–12.
Results suggest little overall change in the SES patterning of energy consumption and percentage of households with insufficient energy intake from 1993–94 to 2011–12 in India. Policies in India need to improve energy intake among low-SES households, particularly in rural areas.
To explore recent mothers’ views of the health visiting antenatal contact in England.
English health visitors are mandated to be in contact with all women in the third trimester of pregnancy. The aim of this antenatal contact is to assess the needs of the family before the birth and support preparation for parenthood. Recent data show that this contact is provided fragmentarily and not always face-to-face. More information on how women view this contact could inform service provision.
Twenty-nine mothers with a baby less than 1 year old were recruited via social media and word of mouth. Having had antenatal contact with a health visitor was not a requirement to participate in the study. Women took part in face-to-face or phone interviews and all recordings were transcribed verbatim. Data were analysed using systematic thematic analysis.
Eleven women had contact with a health visitor during pregnancy: nine through a home visit, one via a letter and one via a phone call. The remaining 18 women were asked about what they would have wanted from an antenatal contact. Three themes were identified: relationship building, information provision, and mode and time of contact. Some participants who had experienced a home visit reported building rapport with their health visitor before the postnatal period, but not everyone had this experience. Women reported requesting and receiving information about the health visiting service and the role of the health visitor. Finally, women suggested different modes of contact, suggesting a letter or that the information about health visiting could be provided by a midwife. A few women preferred a home visit. These study findings show women were unclear regarding the aim of the health visitor antenatal contact. As such, the contact is unlikely to reach its full potential in supporting parents-to-be.
South-East Asia’s bird trade is of global conservation concern as it has massively depleted wild populations of many species. Parrots (Order Psittaciformes) are especially vulnerable because they are the most heavily traded group of birds globally under the Convention on International Trade in Endangered Species (CITES) appendices. Singapore’s involvement in the global pet bird trade as a transhipment hub is well documented, particularly for parrots. Yet, much less is known about the links between its domestic and international trade. We attempt to quantify this relationship by comparing bird trade data on the CITES database with past market surveys of pet shops, complemented with semi-structured interviews with 30 parrot owners in Singapore. We report a decline in total imports and exports of CITES-listed birds in Singapore from 2005 to 2016, consistent with global trends after the European Union trade ban on wild bird imports. However, parrots continue to make up the majority of total imports; and there was a yearly increase in the percentage of parrot imports out of total imports. In addition, we report a difference in imports and exports of 54,207 CITES I, II and III listed birds into Singapore i.e. birds imported but not re-exported. A substantial proportion of these birds were possibly channelled into the domestic pet trade or used as breeding stock. Interviews with parrot owners confirmed the growing demand and popularity of parrots and particularly of larger species. We conclude that the domestic demand for parrots may have been previously underestimated, and make recommendations to manage Singapore’s international and domestic pet bird trade such as implementing a licensing and records system to track the movement of birds.
Guaiac stool testing has been routinely used as a method to detect gastrointestinal complications in infants with critical congenital heart disease (CHD); however, the sensitivity and specificity have not been established.
A retrospective chart review was performed investigating the presence of heme-positive stools and subsequent gastrointestinal complications as well as time to goal caloric intake and radiograph exposure.
The presence of heme-positive stools was not a statistically significant factor in patients with critical CHD that experienced gastrointestinal complications. Additionally, patients with heme-positive stools did undergo more abdominal X-rays than those with heme-negative stools.
The routine use of guaiac stool testing in infants with critical CHD is not a predictor of possible gastrointestinal complications and leads to more radiograph exposure for the patient. Close clinical monitoring can be used to evaluate feeding tolerance in infants with critical CHD.
Quantum dots (QDs) are increasingly employed in biologic imaging applications; however, anecdotal reports suggest difficulties in QD bioconjugation. Further, the stability of commercial QDs during bioconjugation has not been systematically evaluated. Thus, we examined fluorescence losses resulting from aggregation and declining photoluminescence quantum yield (QY) for commercial CdSe/ZnS QD products from four different vendors. QDs were most stable in the aqueous media in which they were supplied. The largest QY declines were observed during centrifugal filtration, whereas the largest declines in colloidal stability occurred in 2-(N-morpholino)ethanesulfonic acid (MES) buffer. These results enable optimization of bioconjugation protocols.
Hospice nurses frequently encounter patients and families under tremendous emotional distress, yet the communication techniques they use in emotionally charged situations have rarely been investigated. In this study, researchers sought to examine hospice nurses’ use of validation communication techniques, which have been shown in prior research to be effective in supporting individuals experiencing emotional distress.
Researchers performed a directed content analysis of audiorecordings of 65 hospice nurses’ home visits by identifying instances when nurses used validation communication techniques and rating the level of complexity of those techniques.
All nurses used validation communication techniques at least once during their home visits. Use of lower level (i.e., more basic) techniques was more common than use of higher level (i.e., more complex) techniques.
Significance of Results
Although hospice nurses appear to use basic validation techniques naturally, benefit may be found in the use of higher level techniques, which have been shown to result in improved clinical outcomes in other settings.
Early institutional rearing is associated with increased risk for subsequent peer relationship difficulties, but the underlying mechanisms have not been identified. Friendship characteristics, social behaviors with peers, normed assessments of social problems, and social cue use were assessed in 142 children (mean age = 10.06, SD = 2.02; range 7–13 years), of whom 67 were previously institutionalized (PI), and 75 were raised by their biological families. Anxiety and attention-deficit/hyperactivity disorder (ADHD) symptoms, often elevated among PI children, were examined as potential mediators of PI status and baseline social functioning and longitudinal follow-ups (2 and 4 years later). Twenty-seven percent of PI children fell above the Child Behavior Checklist Social Problems cutoff. An examination of specific social behaviors with peers indicated that PI and comparison children did not differ in empathic concern or peer social approach, though parents were more likely to endorse aggression/overarousal as a reason that PI children might struggle with friendships. Comparison children outperformed PI children in computerized testing of social cue use learning. Finally, across these measures, social difficulties exhibited in the PI group were mediated by ADHD symptoms with predicted social problems assessed 4 years later. These findings show that, when PI children struggle with friendships, mechanisms involving attention and behavior regulation are likely contributors.
In cases of non-fatal self-harm, suicide notes are a major risk factor for repeated self-harm and suicide. Suicide notes can now be left on new media services, emails or text messages, as well as on paper.
In a group of people who had harmed themselves, we aimed to compare new media note-leavers with paper note-leavers and characterise these groups demographically and by risk factors.
Clinical notes of patients who presented with non-fatal self-harm to two London emergency departments were anonymously searched for mentions of new media use. These were categorised and risk factors were compared for those who had left a new media note, a paper note, or no note to establish differences in risk of note-leaving.
New media note-leaving was associated with younger age and substance use; both risk factors for repeated self-harm. However, suicidal intent remained highest in paper note-leavers.
Paper note-leavers remain at greatest risk, however new media note leaving is still correlated with risk factors related to repeated self-harm and suicide. Clinicians should enquire about new media use during emergency department assessments of self-harm.
To fully understand the attractiveness bias, we propose that contextual factors or affordances should be integrated into the mating-based evolutionary account of Maestripieri et al. We review examples highlighting the role of contextual factors in the perception of attractiveness and in attractiveness bias. These suggest contextual factors differentially afford the development of preference for attractive others into observed habits of mind.
We use high-resolution Keck, VLT, or Hubble Space Telescope spectra of background quasars to examine the kinematic properties of the multiphase, metal-enriched circumgalactic medium in the outskirts of galaxies at 0.08 < zgal < 1.0, focusing on the low-ionization Mgii and high-ionization Ovi doublets. The absorption kinematics of low-ionization gas in the circumgalactic medium depend strongly on the star formation activity and the location about the host galaxy, where the largest velocity dispersions are associated with blue, face-on galaxies probed along the minor axis. Conversely, high-ionization gas kinematics are independent of galaxy star formation activity and orientation.
Asian populations have a higher percentage body fat (%BF) and are at higher risk for CVD and related complications at a given BMI compared with those of European descent. We explored whether %BF was disproportionately elevated in rural Bangladeshi women with low BMI. Height, weight, mid-upper arm circumference, triceps and subscapular skinfolds and bioelectrical impedance analysis (BIA) were measured in 1555 women at 3 months postpartum. %BF was assessed by skinfolds and by BIA. BMI was calculated in adults and BMI Z-scores were calculated for females <20 years old. Receiver operating characteristic (ROC) curves found the BMI and BMI Z-score cut-offs that optimally classified women as having moderately excessive adipose tissue (defined as >30 % body fat). Linear regressions estimated the association between BMI and BMI Z-score (among adolescents) and %BF. Mean BMI was 19·2 (sd 2·2) kg/m2, and mean %BF was calculated as 23·7 (sd 4·8) % by skinfolds and 23·3 (sd 4·9) % by BIA. ROC analyses indicated that a BMI value of approximately 21 kg/m2 optimised sensitivity (83·6 %) and specificity (84·2 %) for classifying subjects with >30 % body fat according to BIA among adults. This BMI level is substantially lower than the WHO recommended standard cut-off point of BMI ≥ 25 kg/m2. The equivalent cut-off among adolescents was a BMI Z-score of –0·36, with a sensitivity of 81·3 % and specificity of 80·9 %. These findings suggest that Bangladeshi women exhibit excess adipose tissue at substantially lower BMI compared with non-South Asian populations. This is important for the identification and prevention of obesity-related metabolic diseases.
By the time of the rise of Islam in the early seventh century, Christian writers had already developed a complex methodology of historical writing, one that was not merely concerned with preserving the history of past events, but which viewed contemporary and past events through the lens of the biblical narrative of history, from creation to the ultimate end as prophesied in the eschatological books of the Bible. In this model, the history of the world could be traced from creation to follow the story of God’s revelation of himself to humankind through the prophets, through inspired Scripture and, most importantly, through Christ.
By the middle of the eighth century, a new genre of Christian writing had developed among those Christians living within the Islamic empire, that of apologetics intended to defend Christianity against attacks from Muslims. Although the Islamic empire had come into existence a century earlier, a series of changes took place in the mid eighth century, including the rise of the Abbasid caliphal dynasty and the stabilization of the empires border with Byzantium, which led to more stable internal politics. In this new atmosphere, Christian authors began to consider, for the first time, the theological ramifications of an empire that was ruled by Muslims, but which still had a majority Christian population. The purpose of this essay is to enter into the ongoing scholarly discourse surrounding the genre of Christian apologetics produced under Islam in the eighth and ninth centuries. There are two competing perspectives on studying these works. One argues for them as historical sources authentically representing an ongoing dialogue between Christians and Muslims during a period commonly known as the Golden Age of Islam. The other argues that these texts are literary creations; at its most extreme, this school of thought asserts that these texts are purely fictional, creating a world of Christian rhetorical superiority in the face of mass conversion from Christianity to Islam.
Crop and weed competition studies rarely determine how plant-to-plant interactions alter the structure and physiology of crop roots. Soybean has the ability to detect neighboring weeds and to alter growth patterns including the allocation of resources to root growth. In this study, we hypothesized that low red : far red light ratio (R : FR) reflected from aboveground vegetative tissue of neighboring weeds would alter soybean root morphology and reduce root biomass and nodule number. All experiments were conducted under controlled conditions in which resources of light, water, and nutrients were nonlimiting. Low R : FR reflected from aboveground neighboring weeds reduced soybean seedling root length, surface area, and volume, including the number of nodules per plant. An accumulation of H2O2, an increase in malondialdehyde (MDA) content, a reduction in flavonoid content, and a decrease in 1,1-diphenyl-2-picrylhydrazyl (DPPH)–radicle scavenging activity were observed. The reduction in flavonoid content was accompanied by a decrease in the transcription of GmIFS and GmN93 and an increase in transcript levels of several antioxidant genes. These molecular and physiological changes may have a physiological cost to the soybean plant, which may limit the plant's ability to respond to subsequent abiotic and biotic stresses that will occur under field conditions.
This study investigated pain coping profiles using the Coping Strategies Questionnaire-24 (CSQ-24) in a sample of 171 workers’ compensation clients with chronic musculoskeletal pain from Canada. Cluster analysis identified three distinct coping profiles: mixed coping, catastrophising, and positive coping. Multivariate analysis of variance (MANOVA) results revealed that the positive coping group had lower levels of activity interference and depression as well as higher levels of quality of life than the mixed coping and catastrophising groups. Study findings indicate clients with chronic musculoskeletal pain can be categorised according to pain coping strategies, and pain coping strategies used are related to rehabilitation outcomes. The implications of these pain coping profiles for rehabilitation counselling practice are discussed.
We have previously reported on a simple desktop method for producing high quality reduced graphene oxide sheets (RGO) which involved dispersing graphene oxide in an ethanol-water solvent and reducing it with sodium borohydride. Metal salts can also be potent reducing agents. Here we show that when these salts are incorporated into the reduction process, metalized graphene sheets can be formed. Metallic salts were used to form Au, Pt, and AuPt nanoplatelets incorporated into the graphene structure. The nature of these metalized graphene platelets was then examined using FTIR, TEM, and SEM/EDAX. Raman spectroscopy of metalized graphene samples show peak shifts and increased D/G ratios over pure graphene, indicating an increased number of defects in the material and suggesting an attachment of metal atoms to the graphene surface. By using a minimum of metal while maximizing the surface contact area of the graphene sheet, these nanoparticle-RGO composites have potential for use in energy-producing devices and/or as catalysts.
Nasal swab culture is the standard method for identifying methicillin-resistant Staphylococcus aureus (MRSA) carriers. However, this method is known to miss a substantial portion of those carrying MRSA elsewhere. We hypothesized that the additional use of a sponge to collect skin culture samples would significantly improve the sensitivity of MRSA detection.
Hospitalized patients with recent MRSA infection were enrolled and underwent MRSA screening of the forehead, nostrils, pharynx, axilla, and groin with separate swabs and the forehead, axilla, and groin with separate sponges. Staphylococcal cassette chromosome mec (SCCmec) typing was conducted by polymerase chain reaction (PCR).
A total of 105 MRSA patients were included in the study.
At least 1 specimen from 56.2% of the patients grew MRSA. Among patients with at least 1 positive specimen, the detection sensitivities were 79.7% for the swabs and 64.4% for the sponges. Notably, 86.4% were detected by a combination of sponges and nasal swab, and 72.9% were detected by a combination of pharyngeal and nasal swabs, whereas only 50.9% were detected by nasal swab alone (P<0.0001 and P=0.0003, respectively). Most isolates had SCCmec type II (59.9%) and IV (35.7%). No correlation was observed between the SCCmec types and collection sites.
Screening using a sponge significantly improves MRSA detection when used in addition to screening with the standard nasal swab.