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.
The use of electronic cigarettes (e-cigarettes) in smokers with mental health conditions (MHC) is not well understood.
This study aims to compare e-cigarette users and non-users among veteran smokers with MHC to characterize differences in smoking behavior, motivation to quit, psychological distress, primary psychiatric diagnosis, and other factors.
Baseline survey data were used from a randomized smoking cessation trial enrolling smokers with MHC from four Veterans Health Administration hospitals. Participants were categorized as current, former (having ever tried an e-cigarette), or never e-cigarette users. Pearson's χ2 and ANOVA Type-3 F-tests were used to test the bivariate associations between e-cigarette use and variables measured.
Among 1,836 participants, mean age was 58 years (STD ± 12.5), 87% were male, 15% were current e-cigarette users (n = 275), and 27% were former users (n = 503). Sixty-five percent of e-cigarette users reported ‘wanting to quit smoking’ as a primary reason. Mean readiness to quit smoking (1–10) was 7.2, 6.8, and 6.4 for current, former, and never e-cigarette users, respectively (P = 0.0002). Sixty-three percent of current and former users and 55% of never-users reported some mental distress on Kessler-6 scale (P = 0.0003, OR = 1.4, 95% CI 1.1–1.7). A primary psychiatric diagnosis of alcohol or substance use disorder was recorded for 50% of current or former users and 60% of never-users (P = 0.0003, OR = 0.69, 95% CI 0.56–0.84).
E-cigarette users were more ready to quit and most often reported using e-cigarettes to assist with quitting. E-cigarette users had more psychological distress and were less likely to have substance use disorders as their primary psychiatric diagnosis.
In preparation for a multisite antibiotic stewardship intervention, we assessed knowledge and attitudes toward management of asymptomatic bacteriuria (ASB) plus teamwork and safety climate among providers, nurses, and clinical nurse assistants (CNAs).
Prospective surveys during January–June 2018.
All acute and long-term care units of 4 Veterans’ Affairs facilities.
The survey instrument included 2 previously tested subcomponents: the Kicking CAUTI survey (ASB knowledge and attitudes) and the Safety Attitudes Questionnaire (SAQ).
A total of 534 surveys were completed, with an overall response rate of 65%. Cognitive biases impacting management of ASB were identified. For example, providers presented with a case scenario of an asymptomatic patient with a positive urine culture were more likely to give antibiotics if the organism was resistant to antibiotics. Additionally, more than 80% of both nurses and CNAs indicated that foul smell is an appropriate indication for a urine culture. We found significant interprofessional differences in teamwork and safety climate (defined as attitudes about issues relevant to patient safety), with CNAs having highest scores and resident physicians having the lowest scores on self-reported perceptions of teamwork and safety climates (P < .001). Among providers, higher safety-climate scores were significantly associated with appropriate risk perceptions related to ASB, whereas social norms concerning ASB management were correlated with higher teamwork climate ratings.
Our survey revealed substantial misunderstanding regarding management of ASB among providers, nurses, and CNAs. Educating and empowering these professionals to discourage unnecessary urine culturing and inappropriate antibiotic use will be key components of antibiotic stewardship efforts.
To compare and validate neurocognitive tests in the Harmonized Cognitive Assessment Protocol (HCAP) for the China Health and Retirement Longitudinal Study (CHARLS), and to identify appropriate tests to be administered in future waves of CHARLS.
We recruited 825 individuals from the CHARLS sample and 766 subjects from hospitals in six provinces and cities in China. All participants were administered the HCAP-neurocognitive tests, and their informants were interviewed regarding the respondents’ functional status. Trained clinicians administered the Clinical Dementia Rating scale (CDR) to assess the respondents’ cognitive status independently.
The testing protocol took an average of 58 minutes to complete. Refusal rates for tests of general cognition, episodic memory, and language were less than 10%. All neurocognitive test scores significantly correlated with the CDR global score (correlation coefficients ranged from 0.139 to 0.641). The Mini-Mental State Examination (MMSE), the Health and Retirement Study (HRS) - telephone interview for cognitive status (TICS), community screening instrument for dementia (CSI-D) for respondent, episodic memory and language tests each accounted for more than 20% of the variance in global CDR score (p < 0.001) in bivariate tests. In the CHARLS subsample, age and education were associated with neuropsychological performance across most cognitive domains, and with functional status.
A brief set of the CHARLS-HCAP neurocognitive tests are feasible and valid to be used in the CHARLS sample and hospital samples. It could be applied in the future waves of the CHARLS study, and it allows estimating the prevalence of dementia in China through the population-based CHARLS.
Sepsis – syndrome of infection complicated by organ dysfunction – is responsible for over 750 000 hospitalisations and 200 000 deaths in the USA annually. Despite potential nutritional benefits, the association of diet and sepsis is unknown. Therefore, we sought to determine the association between adherence to a Mediterranean-style diet (Med-style diet) and long-term risk of sepsis in the REasons for Geographic Differences in Stroke (REGARDS) cohort. We analysed data from REGARDS, a population-based cohort of 30 239 community-dwelling adults age ≥45 years. We determined dietary patterns from a baseline FFQ. We defined Med-style diet as a high consumption of fruit, vegetables, legumes, fish, cereal and low consumption of meat, dairy products, fat and alcohol categorising participants into Med-style diet tertiles (low: 0–3, moderate: 4–5, high: 6–9). We defined sepsis events as hospital admission for serious infection and at least two systematic inflammatory response syndrome criteria. We used Cox proportional hazard models to determine the association between Med-style diet tertiles and first sepsis events, adjusting for socio-demographics, lifestyle factors, and co-morbidities. We included 21 256 participants with complete dietary data. Dietary patterns were: low Med-style diet 32·0 %, moderate Med-style diet 42·1 % and high Med-style diet 26·0 %. There were 1109 (5·2 %) first sepsis events. High Med-style diet was independently associated with sepsis risk; low Med-style diet referent, moderate Med-style diet adjusted hazard ratio (HR) 0·93 (95 % CI 0·81, 1·08), high Med-style diet adjusted HR=0·74 (95 % CI 0·61, 0·88). High Med-style diet adherence is associated with lower risk of sepsis. Dietary modification may potentially provide an option for reducing sepsis risk.
To determine whether probiotic prophylaxes reduce the odds of Clostridium difficile infection (CDI) in adults and children.
Individual participant data (IPD) meta-analysis of randomized controlled trials (RCTs), adjusting for risk factors.
We searched 6 databases and 11 grey literature sources from inception to April 2016. We identified 32 RCTs (n=8,713); among them, 18 RCTs provided IPD (n=6,851 participants) comparing probiotic prophylaxis to placebo or no treatment (standard care). One reviewer prepared the IPD, and 2 reviewers extracted data, rated study quality, and graded evidence quality.
Probiotics reduced CDI odds in the unadjusted model (n=6,645; odds ratio [OR] 0.37; 95% confidence interval [CI], 0.25–0.55) and the adjusted model (n=5,074; OR, 0.35; 95% CI, 0.23–0.55). Using 2 or more antibiotics increased the odds of CDI (OR, 2.20; 95% CI, 1.11–4.37), whereas age, sex, hospitalization status, and high-risk antibiotic exposure did not. Adjusted subgroup analyses suggested that, compared to no probiotics, multispecies probiotics were more beneficial than single-species probiotics, as was using probiotics in clinical settings where the CDI risk is ≥5%. Of 18 studies, 14 reported adverse events. In 11 of these 14 studies, the adverse events were retained in the adjusted model. Odds for serious adverse events were similar for both groups in the unadjusted analyses (n=4,990; OR, 1.06; 95% CI, 0.89–1.26) and adjusted analyses (n=4,718; OR, 1.06; 95% CI, 0.89–1.28). Missing outcome data for CDI ranged from 0% to 25.8%. Our analyses were robust to a sensitivity analysis for missingness.
Moderate quality (ie, certainty) evidence suggests that probiotic prophylaxis may be a useful and safe CDI prevention strategy, particularly among participants taking 2 or more antibiotics and in hospital settings where the risk of CDI is ≥5%.
The relationship between hospital antibiotic use and antibiotic resistance is poorly understood. We evaluated the association between antibiotic utilization and resistance in academic and community hospitals in Ontario, Canada.
We conducted a multicenter observational ecological study of 37 hospitals in 2014. Hospital antibiotic purchasing data were used as an indicator of antibiotic use, whereas antibiotic resistance data were extracted from hospital indexes of resistance. Multivariate regression was performed, with antibiotic susceptibility as the primary outcome, antibiotic consumption as the main predictor, and additional covariates of interest (ie, hospital type, laboratory standards, and patient days).
With resistance data representing more than 90,000 isolates, we found the increased antibiotic consumption in defined daily doses per 1,000 patient days (DDDs/1,000 PD) was associated with decreased antibiotic susceptibility for Pseudomonas aeruginosa (−0.162% per DDD/1,000 PD; P=.119). However, increased antibiotic consumption predicted increased antibiotic susceptibility significantly for Escherichia coli (0.173% per DDD/1,000 PD; P=.005), Klebsiella spp (0.124% per DDD/1,000 PD; P=.004), Enterobacter spp (0.194% per DDD/1,000 PD; P=.003), and Enterococcus spp (0.309% per DDD/1,000 PD; P=.001), and nonsignificantly for Staphylococcus aureus (0.012% per DDD/1,000 PD; P=.878). Hospital type (P=.797) and laboratory standard (P=.394) did not significantly predict antibiotic susceptibility, while increased hospital patient days generally predicted increased organism susceptibility (0.728% per 10,000 PD; P<.001).
We found that hospital-specific antibiotic usage was generally associated with increased, rather than decreased hospital antibiotic susceptibility. These findings may be explained by community origins for many hospital-diagnosed infections and practitioners choosing agents based on local antibiotic resistance patterns.
We derive mass changes of the Greenland ice sheet (GIS) for 2003–07 from ICESat laser altimetry and compare them with results for 1992–2002 from ERS radar and airborne laser altimetry. The GIS continued to grow inland and thin at the margins during 2003–07, but surface melting and accelerated flow significantly increased the marginal thinning compared with the 1990s. The net balance changed from a small loss of 7 ± 3 Gt a−1 in the 1990s to 171 ± 4 Gt a−1 for 2003–07, contributing 0.5 mm a−1 to recent global sea-level rise. We divide the derived mass changes into two components: (1) from changes in melting and ice dynamics and (2) from changes in precipitation and accumulation rate. We use our firn compaction model to calculate the elevation changes driven by changes in both temperature and accumulation rate and to calculate the appropriate density to convert the accumulation-driven changes to mass changes. Increased losses from melting and ice dynamics (17–206 Gt a−1) are over seven times larger than increased gains from precipitation (10–35 Gt a−1) during a warming period of ∼2 K (10 a)−1 over the GIS. Above 2000 m elevation, the rate of gain decreased from 44 to 28 Gt a−1, while below 2000 m the rate of loss increased from 51 to 198 Gt a−1. Enhanced thinning below the equilibrium line on outlet glaciers indicates that increased melting has a significant impact on outlet glaciers, as well as accelerating ice flow. Increased thinning at higher elevations appears to be induced by dynamic coupling to thinning at the margins on decadal timescales.
We introduce the idea that the electronic band structure of a charge density wave system may mimic that of graphene. In that case, a class of materials quite different from graphene might be opened up to exploit graphene’s remarkable properties. For such materials, their dynamical rather than static properties are crucial. The charge density wave system requires a wave geometry simply related to graphene and self-consistency among the electrons which requires the net Coulomb and phonon-mediated parts of the electron–electron interactions to be attractive. Our model leads to an analytical expression for the total energy in terms of the effective electron mass µ, the electron density ρ0, and the strength
of the net electron–electron interaction. We examine the limitations set upon
by self-consistency, stability, and the approximation in the electronic state calculation and find them to be mutually compatible.
The current study used data from two longitudinal samples to test whether self-regulation, depressive symptoms, and aggression/antisociality were mediators in the relation between a polygenic score indexing serotonin (5-HT) functioning and alcohol use in adolescence. The results from an independent genome-wide association study of 5-hydroxyindoleacetic acid in the cerebrospinal fluid were used to create 5-HT polygenic risk scores. Adolescents and/or parents reported on adolescents’ self-regulation (Time 1), depressive symptoms (Time 2), aggression/antisociality (Time 2), and alcohol use (Time 3). The results showed that 5-HT polygenic risk did not predict self-regulation. However, adolescents with higher levels of 5-HT polygenic risk showed greater depression and aggression/antisociality. Adolescents’ aggression/antisociality mediated the relation between 5-HT polygenic risk and later alcohol use. Deficits in self-regulation also predicted depression and aggression/antisociality, and indirectly predicted alcohol use through aggression/antisociality. Pathways to alcohol use were especially salient for males from families with low parental education in one of the two samples. The results provide insights into the longitudinal mechanisms underlying the relation between 5-HT functioning and alcohol use (i.e., earlier aggression/antisociality). There was no evidence that genetically based variation in 5-HT functioning predisposed individuals to deficits in self-regulation. Genetically based variation in 5-HT functioning and self-regulation might be separate, transdiagnostic risk factors for several types of psychopathology.
The interaction between flow inertia and elasticity in high-Reynolds-number, axisymmetric and near-critical swirling flows of an incompressible and viscoelastic fluid in an open finite-length straight circular pipe is studied at the limit of low elasticity. The stresses of the viscoelastic fluid are described by the generalized Giesekus constitutive model. This model helps to focus the analysis on low fluid elastic effects with shear thinning of the viscosity. The application of the Giesekus model to columnar streamwise vortices is first investigated. Then, a nonlinear small-disturbance analysis is developed from the governing equations of motion. It reveals the complicated interactions between flow inertia, swirl and fluid rheology. An effective Reynolds number that links between steady states of swirling flows of a viscoelastic fluid and those of a Newtonian fluid is revealed. The effects of the fluid viscosity, relaxation time, retardation time and mobility parameter on the flow development in the pipe and on the critical swirl for the appearance of vortex breakdown are explored. It is found that in vortex flows with either an axial jet or an axial wake profile, increasing the shear thinning by decreasing the ratio of the viscoelastic characteristic times from one (with fixed values of the Weissenberg number and the mobility parameter) increases the critical swirl ratio for breakdown. Increasing the fluid elasticity by increasing the Weissenberg number from zero (with a fixed ratio of the viscoelastic characteristic times and a fixed value of the mobility parameter) or increasing the fluid mobility parameter from zero (with fixed values of the Weissenberg number and the ratio of viscoelastic times) causes a similar effect. The results may explain the trend of changes in the appearance of breakdown zones as a function of swirl level that were observed in the experiments by Stokes et al. (J. Fluid Mech., vol. 429, 2001, pp. 67–115), where Boger fluids were used. This work extends for the first time the theory of vortex breakdown to include effects of non-Newtonian fluids.
Several Crab-type supernova remnants appear to have very bright non-thermal X-ray cores just around the pulsar or expected pulsar. This X-ray brightness is often not matched by a corresponding increase in radio emission. The best example of this phenomenon is in N157B in the LMC. G21.5−0.9 and possibly 3C 58 also show it while the Crab Nebula and 0540−69.3 do not. Some method to enhance the higher energy particles must be present in these objects.
The reconstruction of Holocene environmental changes in lakes on the plateau region of southwest China provides an understanding of how these ecosystems may respond to climate change. Fossil diatom assemblages were investigated from an 11,000-year lake sediment core from a deep, alpine lake (Lugu Hu) in southwest China, an area strongly influenced by the southwest (or the Indian) summer monsoon. Changes in diatom assemblage composition, notably the abundance of the two dominant planktonic species, Cyclotella rhomboideo-elliptica and Cyclostephanos dubius, reflect the effects of climate variability on nutrient dynamics, mediated via thermal stratification (internal nutrient cycling) and catchment-vegetation processes. Statistical analyses of the climateediatom interactions highlight the strong effect of changing orbitally-induced solar radiation during the Holocene, presumably via its effect on the lake’s thermal budget. In a partial redundancy analysis, climate (solar insolation) and proxies reflecting catchment process (pollen percentages, C/N ratio) were the most important drivers of diatom ecological change, showing the strong effects of climateecatchmentevegetation interactions on lake functioning. This diatom record reflects long-term ontogeny of the lake-catchment ecosystem and suggests that climatic changes (both temperature and precipitation) impact lake ecology indirectly through shifts in thermal stratification and catchment nutrient exports.
Consistent with neural reuse theory, empirical tests of the related “scaffolding” principle of abstract concept development show that higher-level concepts “reuse” and are built upon fundamental motives such as survival, safety, and consumption. This produces mutual influence between the two levels, with far-ranging impacts from consumer behavior to political attitudes.
The public abattoir emerged as an institution across the industrialized world in the mid-nineteenth century to centralize and control animal killing and meat processing, activities that had traditionally taken place in private slaughterhouses. The modern idea of the abattoir, however, is more than a place where animals are killed for human consumption. Designed to optimize a disassembling process that efficiently took apart the livestock into small pieces, the modern abattoir is one of the earliest building types where the production line was incorporated into the spatial layout. Modern abattoirs also separated livestock from people, and production from consumption, into special places removed from public view.
This paper is concerned with the production of a public abattoir in 1930s colonial Shanghai. The Shanghai Municipal Abattoir, completed in 1933, was deliberately designed as a ‘machine for killing’, which applied production-line principles to the efficient slaughter of animals. The result of this functionalism was an extraordinary series of multi-storey concrete structures, dictated by the bloody business of slaughtering animals and processing their carcasses, set behind an art deco façade. In this paper we seek to tell the story of the production of a building that has previously been little researched, with most of the archival material in Shanghai Municipal Archives (SMA) and the limited published material available only in Mandarin.
The ~ 108−109 old neutron stars in the Galaxy may be undergoing low luminosity accretion from the interstellar medium (Ostriker et al. 1970; Shvartsman 1971). It was first recognized by Shvartsman (1971) that the accretion induced radiation from the stellar surface can heat the infalling material, which in turn inhibits further accretion. This preheating instability has been studied in detail in the high luminosity regime where equilibrium ionization and heating holds (e.g., Buff & McCray 1974; Ostriker et al. 1976; Cowie et al. 1978). In the low luminosity regime, however, dynamical timescales are typically much shorter than atomic timescales so the accretion flow dynamics is strongly coupled to non-equilibrium (NEQ) atomic processes (cf. Blaes et al. 1995).
A record of late Paleozoic foraminiferal diversity, origination and extinction frequencies, and provincialism at million-year temporal resolution and species-level taxonomic resolution has been achieved by analyzing composite standard databases. Foraminiferal species diversity increased throughout Mississippian and Pennsylvanian time leading up to its peak at the Pennsylvanian/Permian boundary. Foraminifers then experienced a steep decline in diversity during the Early Permian. Frequencies of origination and extinction broadly tracked changes in global diversity. From Late Mississippian time onward, patterns in total foraminiferal diversity were dominated by fusulinoideans. There is no clear relationship between rates of foraminiferal evolution and the alternating glacial and nonglacial intervals that characterized the late Paleozoic ice age. Rather, high rates of origination and extinction might reflect instability of neritic environments as a consequence of high-frequency, high-amplitude base-level fluctuations (cyclothemic deposition). Further, the advent of algal symbiosis in fusulinoideans was a physiologic innovation that promoted diversification as these symbiont-bearing taxa experimented with morphologic adaptations for partitioning the low-nutrient environments to which they were specialized. Growth to large size and delayed maturation in fusulinoideans might have been enabled by the late Paleozoic hyperoxic atmosphere and the widespread development of oligotrophic, carbonate platform and shelf environments. The late Paleozoic history of foraminiferal diversification was influenced also by closure of the Rheic Ocean beginning in Late Mississippian time. Foraminiferal associations on opposite sides of Pangea exhibited relatively high similarity prior to the closure, but then similarity decreased steadily after destruction of the subequatorial marine corridor. Arctic-Eurasian and North American associations were nearly isolated from one another throughout the main burst of fusulinoidean diversification, so that parallel lineages developed independently in the two regions, resulting in many instances of convergence.
Glyphosate-resistant (GR) horseweed has become an especially problematic weed in different crop production systems across the United States and the world. In this field study, we used a nondestructive measurement system to analyze the pollen production, deposition, and dispersion of a Tennessee glyphosate resistant (TNR) horseweed biotype in Knoxville, TN during the 2013 pollination season. We observed that the pollination season of TNR horseweed lasted about 2 mo (54 d). About 78.93% of horseweed pollen was released between 9:00 A.M. and 7:00 P.M. during each sampling day and the release peak was at about 1:30 P.M. The seasonal release of pollen grains was estimated to be 5.11 million grains plant−1. The release rate data indicated that the integrated horizontal flux density and deposition flux density contributed to 78.17% and 21.83% of the release rate, respectively. We also found that pollen concentration decreased with distance from the source field; the average pollen concentration decreased to 50.69% at a distance of 16 m from the source plot. This is the first result of a systematic, direct examination of the release rate (emission and deposition), release pattern (daily and seasonal), and dispersion pattern of GR horseweed pollen.