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This volume contains nine survey articles based on plenary lectures given at the 28th British Combinatorial Conference, hosted online by Durham University in July 2021. This biennial conference is a well-established international event, attracting speakers from around the world. Written by some of the foremost researchers in the field, these surveys provide up-to-date overviews of several areas of contemporary interest in combinatorics. Topics discussed include maximal subgroups of finite simple groups, Hasse–Weil type theorems and relevant classes of polynomial functions, the partition complex, the graph isomorphism problem, and Borel combinatorics. Representing a snapshot of current developments in combinatorics, this book will be of interest to researchers and graduate students in mathematics and theoretical computer science.
To prioritise and refine a set of evidence-informed statements into advice messages to promote vegetable liking in early childhood, and to determine applicability for dissemination of advice to relevant audiences.
A nominal group technique (NGT) workshop and a Delphi survey were conducted to prioritise and achieve consensus (≥70% agreement) on 30 evidence-informed maternal (perinatal and lactation stage), infant (complementary feeding stage) and early years (family diet stage) vegetable-related advice messages. Messages were validated via triangulation analysis against the strength of evidence from an Umbrella review of strategies to increase children’s vegetable liking, and gaps in advice from a Desktop review of vegetable feeding advice.
A purposeful sample of key stakeholders (NGT workshop, n=8 experts; Delphi survey, n=23 end-users).
Participant consensus identified the most highly ranked priority messages associated with the strategies of: ‘in-utero exposure’ (perinatal and lactation, n=56 points); and ‘vegetable variety’ (complementary feeding, n=97 points; family diet, n=139 points). Triangulation revealed two strategies (‘repeated exposure’ and ‘variety’) and their associated advice messages suitable for policy and practice, 12 for research and four for food industry.
Supported by national and state feeding guideline documents and resources, the advice messages relating to ‘repeated exposure’ and ‘variety’ to increase vegetable liking can be communicated to families and caregivers by healthcare practitioners. The food industry provides a vehicle for advice promotion and product development. Further research, where stronger evidence is needed, could further inform strategies for policy and practice, and food industry application.
To investigate the perceived effects of the coronavirus disease (COVID-19) pandemic lockdown measures on food availability, accessibility, dietary practices and strategies used by participants to cope with these measures.
We conducted a cross-sectional multi-country online survey between May and July 2020. We used a study-specific questionnaire mainly based on the adaptation of questions to assess food security and coping strategies from the World Food Programme’s ‘Emergency Food Security Assessment’ and ‘The Coping Strategy Index’.
The questionnaire was hosted online using Google Forms and shared using social media platforms.
A total of 1075 adult participants from eighty-two countries completed the questionnaire.
As a prelude to COVID-19 lockdowns, 62·7 % of the participants reported to have stockpiled food, mainly cereals (59·5 % of the respondents) and legumes (48·8 %). An increase in the prices of staples, such as cereals and legumes, was widely reported. Price increases have been identified as an obstacle to food acquisition by 32·7 % of participants. Participants reported having lesser variety (50·4 %), quality (30·2 %) and quantity (39·2 %) of foods, with disparities across regions. Vulnerable groups were reported to be facing some struggle to acquire adequate food, especially people with chronic diseases (20·2 %), the elderly (17·3 %) and children (14·5 %). To cope with the situation, participants mostly relied on less preferred foods (49 %), reduced portion sizes (30 %) and/or reduced the number of meals (25·7 %).
The COVID-19 pandemic negatively impacted food accessibility and availability, altered dietary practices and worsened the food insecurity situation, particularly in the most fragile regions.
Radiotherapy is a mainstay of cancer therapy for a wide variety of anatomical areas. An unfortunate side effect of treatment can be radiation damage to the skin which can be a painful and debilitating problem. Previous experience from the experimental use of Flamigel® in two large-scale clinical studies on affected skin has proven sufficiently positive for the addition of a new product in the Flamigel® family (now commercially available in the UK as Flamigel RT®, Flen Health UK). The aim of this investigation is to evaluate the use of this new product to study how effective it is in the prevention and/or treatment of radiation-induced skin damage.
Materials and methods:
A survey was conducted among radiotherapy specialist teams in dedicated UK radiotherapy centres between 1 January 2017 and 31 October 2017. This report is of a preliminary evaluation conducted by UK-based specialists on 108 patients undergoing radiotherapy. The scoring system for skin reactions of the ‘Radiation Therapy Oncology Group’ was used.
Results show that the use of Flamigel® has the potential to soothe (p = 0·0001), reduce pain (p = 0·0001) and reduce pruritus (p = 0·004). The product met the expectations of the clinicians involved (p < 0·0001) of whom most were happy to continue use or to recommend its use to colleagues (p < 0·0001).
Flamigel® is an effective treatment in the management of radiation-induced skin reactions. Erythema was unchanged through the study period (p = 0·42). No adverse reactions were reported after the use of Flamigel from twice to six times a day.
This study compared the level of education and tests from multiple cognitive domains as proxies for cognitive reserve.
The participants were educationally, ethnically, and cognitively diverse older adults enrolled in a longitudinal aging study. We examined independent and interactive effects of education, baseline cognitive scores, and MRI measures of cortical gray matter change on longitudinal cognitive change.
Baseline episodic memory was related to cognitive decline independent of brain and demographic variables and moderated (weakened) the impact of gray matter change. Education moderated (strengthened) the gray matter change effect. Non-memory cognitive measures did not incrementally explain cognitive decline or moderate gray matter change effects.
Episodic memory showed strong construct validity as a measure of cognitive reserve. Education effects on cognitive decline were dependent upon the rate of atrophy, indicating education effectively measures cognitive reserve only when atrophy rate is low. Results indicate that episodic memory has clinical utility as a predictor of future cognitive decline and better represents the neural basis of cognitive reserve than other cognitive abilities or static proxies like education.
The goal of this study was to assess the utility of participatory needs assessment processes for continuous improvement of developing clinical and translational research (CTR) networks. Our approach expanded on evaluation strategies for CTR networks, centers, and institutes, which often survey stakeholders to identify infrastructure or resource needs, using the case example of the Great Plains IDeA-CTR Network. Our 4-stage approach (i.e., pre-assessment, data collection, implementation of needs assessment derived actions, monitoring of action plan) included a member survey (n = 357) and five subsequent small group sessions (n = 75 participants) to better characterize needs identified in the survey and to provide actionable recommendations. This participatory, mixed-methods needs assessment and strategic action planning process yielded 11 inter-related recommendations. These recommendations were presented to the CTR steering committee as inputs to develop detailed, prioritized action plans. Preliminary evaluation shows progress towards improved program capacity and effectiveness of the network to respond to member needs. The participatory, mixed-methods needs assessment and strategic planning process allowed a wide range of stakeholders to contribute to the development of actionable recommendations for network improvement, in line with the principles of team science.
Electron blocks are typically composed of a low melting point alloy (LMPA), which is poured into an insert frame containing a manually placed Styrofoam aperture negative used to define the desired field shape. Current implementations of the block fabrication process involve numerous steps which are subjective and prone to user error. Occasionally, bowing of the sides of the insert frame is observed, resulting in premature frame decommissioning. Recent works have investigated the feasibility of utilising 3D printing technology to replace the conventional electron block fabrication workflow; however, these approaches involved long print times, were not compatible with commonly used cadmium-free LMPAs, and did not address the problem of insert frame bowing. In this work, we sought to develop a new 3D printing technique that would remedy these issues.
Materials and Methods:
Electron cutout negatives and alignment jigs were printed using Acrylonitrile Butadiene Styrene, which does not warp at the high temperatures associated with molten cadmium-free alloys. The accuracy of the field shape produced by electron blocks fabricated using the 3D printed negatives was assessed using Gafchromic film and beam profiler measurements. As a proof-of-concept, electron blocks with off-axis apertures, as well as complex multi-aperture blocks to be used for passive electron beam intensity modulation, were also created.
Film and profiler measurements of field size were in excellent agreement with the values calculated using the Eclipse treatment planning system, showing less than a 1% difference in line profile full-width at half-maximum. The multi-aperture electron blocks produced fields with intensity modulation ≤3.2% of the theoretically predicted value. Use of the 3D printed alignment jig – which has contours designed to match those of the insert frame – was found to reduce the amount of frame bowing by factors of 1.8 and 2.1 in the lateral and superior–inferior directions, respectively.
The 3D printed ABS negatives generated with our technique maintain their spatial accuracy even at the higher temperatures associated with cadmium-free LMPA. The negatives typically take between 1 and 2 hours to print and have a material cost of approximately $2 per patient.
Adolescent diet, physical activity and nutritional status are generally known to be sub-optimal. This is an introduction to a special issue of papers devoted to exploring factors affecting diet and physical activity in adolescents, including food insecure and vulnerable groups.
Eight settings including urban, peri-urban and rural across sites from five different low- and middle-income countries.
Focus groups with adolescents and caregivers carried out by trained researchers.
Our results show that adolescents, even in poor settings, know about healthy diet and lifestyles. They want to have energy, feel happy, look good and live longer, but their desire for autonomy, a need to ‘belong’ in their peer group, plus vulnerability to marketing exploiting their aspirations, leads them to make unhealthy choices. They describe significant gender, culture and context-specific barriers. For example, urban adolescents had easy access to energy dense, unhealthy foods bought outside the home, whereas junk foods were only beginning to permeate rural sites. Among adolescents in Indian sites, pressure to excel in exams meant that academic studies were squeezing out physical activity time.
Interventions to improve adolescents’ diets and physical activity levels must therefore address structural and environmental issues and influences in their homes and schools, since it is clear that their food and activity choices are the product of an interacting complex of factors. In the next phase of work, the Transforming Adolescent Lives through Nutrition consortium will employ groups of adolescents, caregivers and local stakeholders in each site to develop interventions to improve adolescent nutritional status.
Elective surgical patients routinely bathe with chlorhexidine gluconate (CHG) at home days prior to their procedures. However, the impact of home CHG bathing on surgical site CHG concentration is unclear. We examined 3 different methods of applying CHG and hypothesized that different application methods would impact resulting CHG skin concentration.
Infants struggle to understand familiar words spoken in unfamiliar accents. Here, we examine whether accent exposure facilitates accent-specific adaptation. Two types of pre-exposure were examined: video-based (i.e., listening to pre-recorded stories; Experiment 1) and live interaction (reading books with an experimenter; Experiments 2 and 3). After video-based exposure, Canadian English-learning 15- to 18-month-olds failed to recognize familiar words spoken in an unfamiliar accent. However, after face-to-face interaction with a Mandarin-accented talker, infants showed enhanced recognition for words produced in Mandarin English compared to Australian English. Infants with live exposure to an Australian talker were not similarly facilitated, perhaps due to the lower vocabulary scores of the infants assigned to the Australian exposure condition. Thus, live exposure can facilitate accent adaptation, but this ability is fragile in young infants and is likely influenced by vocabulary size and the specific mapping between the speaker and the listener's phonological system.
In this chapter, we review the literature on leadership and emotion. Progress in understanding the junction of these two ideas has been steady but slow. To address this concern, at the conclusion of this chapter, we briefly discuss two theoretical obstacles that, in our view, have slowed progress. However, we begin with the larger substance of our chapter, which focuses on leaders’ affect at three levels of analysis – the overall climate, the work team, and, finally, the leader himself or herself. We show that leader emotion can be important at all three levels of analysis. At the highest level of analysis, leaders create emotional climate through personnel practices, by rewarding (or punishing) culturally appropriate emotion displays, and by their treatment of individual employees. Moving to teams and dyads, we will see that emotions can influence followers through contagion or emotional correspondence. Finally, looking within the leader, our review underscores how emotional intelligence is crucial for effective leadership.
Seismic-reflection surveys of the Isle Royale sub-basin, central Lake Superior, reveal two large end moraines and associated glacial sediments deposited during the last cycle of the Laurentide Ice Sheet in the basin. The Isle Royale moraines directly overlie bedrock and are cored with dense, acoustically massive till intercalated down-ice with acoustically stratified outwash. Till and outwash are overlain by glacial varves, a lower red unit and an upper gray unit.
The maximum extent of late Younger Dryas-age readvance into the western Lake Superior basin is uncertain, but it was probably controlled by both ice dynamics and climate. Our data indicate that during retreat from the maximum, the ice paused just long enough to construct the outer of the two moraines, >100 m high, and then retreated to the inner moraine, during which time most of the lower glacial-lacustrine sequence (red varves) was deposited. Retreat from the inner moraine coincided with a marked flux of icebergs at the calving margin and a change to gray varves. Rapid retreat may be related to both an influx of meltwater from Glacial Lake Agassiz about 10,500 cal yr BP and retreat of the calving margin down an adverse slope into the Isle Royale sub-basin.
Southeastern Appalachian Ohio has more than double the national average of diabetes and a critical shortage of healthcare providers. Paradoxically, there is limited research focused on primary care providers’ experiences treating people with diabetes in this region. This study explored providers’ perceived barriers to and facilitators for treating patients with diabetes in southeastern Appalachian Ohio.
We conducted in-depth interviews with healthcare providers who treat people with diabetes in rural southeastern Ohio. Interviews were transcribed, coded, and analyzed via content and thematic analyses using NVivo 12 software (QSR International, Chadstone, VIC, Australia).
Qualitative analysis revealed four themes: (1) patients’ diabetes fatalism and helplessness: providers recounted story after story of patients believing that their diabetes was inevitable and that they were helpless to prevent or delay diabetes complications. (2) Comorbid psychosocial issues: providers described high rates of depression, anxiety, incest, abuse, and post-traumatic stress disorder among people with diabetes in this region. (3) Inter-connected social determinants interfering with diabetes care: providers identified major barriers including lack of access to providers, lack of access to transportation, food insecurity, housing insecurity, and financial insecurity. (4) Providers’ cultural understanding and recommendations: providers emphasized the importance of understanding of the values central to Appalachian culture and gave culturally attuned clinical suggestions for how to use these values when working with this population.
Evidence-based interventions tailored to Appalachian culture and training designed to increase the cultural competency and cultural humility of primary care providers may be effective approaches to reduce barriers to diabetes care in Appalachian Ohio.
We examined whether change in added sugar intake is associated with change in δ13C, a novel sugar biomarker, in thirty-nine children aged 5–10 years selected from a Colorado (USA) prospective cohort of children at increased risk for type 1 diabetes. Reported added sugar intake via FFQ and δ13C in erythrocytes were measured at two time points a median of 2 years apart. Change in added sugar intake was associated with change in the δ13C biomarker, where for every 1-g increase in added sugar intake between the two time points, there was an increase in δ13C of 0⋅0082 (P = 0⋅0053), independent of change in HbA1c and δ15N. The δ13C biomarker may be used as a measure of compliance in an intervention study of children under the age of 10 years who are at increased risk for type 1 diabetes, in which the goal was to reduce dietary sugar intake.
The prodromal phase of schizophrenia is the time interval preceding a first psychotic episode. It begins with the appearance of nonspecific symptoms. It ends with the outbreak of an episode meeting the diagnostic criteria for schizophrenia. This phase is considered a key period in the prognosis of the disease because it provides access to early diagnosis.
Identify the symptoms of the prodromal phase of schizophrenia and point out the duration of their development in a sample of Tunisian patients.
Detect the specifities of prodromal phase in Tunisia.
15 schizophrenia patients with illness duration of less than 3 years were included. All patients were in clinical remission from at least 3 months (PANNS and BPRS). Exclusion criteria were any history of other psychiatric or neurological disorders and alcohol or drug abuse. Prodromal symptoms were assessed with the scale of prodromal symptoms (SOPS) developed by Mc Glashan. It is a heteroquestionnaire for patients and their parents.
The mean duration of prodromal phase was about 2 years with extremes ranging from 6 months to 4 years.
The most severe prodromal symptoms were suspiciousness/ persecutory ideas, social isolation, dysphoric mood and impaired tolerance to normal stress
The most frequent prodromal symptoms were impaired tolerance to normal stress, dysphoric mood, sleep disturbance, social isolation and suspiciousness/ persecutory ideas.
We have not found any difference between male and female.
The prodromal symptoms of schizophrenia found in the Tunisian socio cultural context are similar to those found in other countries.
Research has suggested that schizophrenia involves significant deficits in executive functioning. Yet, the literature has little studied patients with a recent onset of first episode of schizophrenia. Besides, only few studies have focused on symptom-free intervals. Furthermore, previous studies have included patients under polymedication of antipsychotics without any restriction on other psychotropes.
To investigate executive functions in remitted patients with recent onset of first episode of schizophrenia receiving only a monotherapy of antipsychotics.
Executive dysfunction in schizophrenia is not a consequence of the long term course of the disease, of the relapses, of the symptoms or of the polymedication.
25 schizophrenic outpatients with less than 3 years of illness duration and only one psychotic episode were included. All patients received a monotherapy of antipsychotics and none had an antidepressant, mood stabilizer, hypnotics or benzodiazepines. 25 healthy participants were matched according to age and educational level.
Patients were assessed by the Positive and Negative Syndrome Scale. Executive functions were assessed by the Davidson et al. computerized battery designed to manipulate inhibition and cognitive flexibility vary demands on these abilities.
Compared to healthy controls, remitted schizophrenia patients have shown significant differences in the percentage of correct responses and in the reaction time. This indicates a disorder in inhibition and in cognitive flexibility.
Our results reinforce the findings that the executive dysfunction in schizophrenia stands for itself and that it cannot be explained by relapses, duration of the disease and impact of medication or symptoms.
Schizophrenia is a serious mental illness that carries a significant burden for families providing care.
The ADHES carers' survey canvassed opinions of families/friends of patients with schizophrenia across Europe.
To ascertain carer attitudes towards schizophrenia, its treatment and treatment adherence.
The survey was conducted from January-April 2011 in 16 European countries, comprising 10 questions relating to the respondents' understanding of schizophrenia, attitudes towards schizophrenia treatments, and perception of the family's/friend's role in supporting patients with schizophrenia.
Results were obtained from 138 respondents. 76% of carers recognized the importance of medication to help patients get better, improve their quality of life (77%) and relationships (74%). 67% of carers responded that they believed schizophrenia treatment damages patients' general health. Two-thirds of the carers reported that treatment adherence was a burden for the patient and over a third of carers indicated that it was a daily struggle to get patients to take their medication. 50% of carers considered the benefits offered by long-acting injectable antipsychotics as very/quite important and thus, could provide a valuable tool in improving treatment adherence. 92% of carers agreed on the importance of family support to boost treatment adherence with education/information deemed important for families and patients alike.
Carers recognize the issues they face in caring for patients with schizophrenia and their role in improving partial/non-adherence to medication, especially to avoid suboptimal treatment outcomes. The important role of family carers should be considered by healthcare professionals when treating patients with schizophrenia.
Patients with medically unexplained physical symptoms (MUPS) may present frequently to hospital settings and receive potentially unnecessary investigations and treatments.
A sample of 49 patients was drawn and their handwritten and electronic clinical records were examined in detail to extricate all MUPS-related secondary care activity within six months of the MUPS presentation (emergency department, inpatient stays, outpatient appointments, and all associated investigations, procedures and medications).
We aimed to assess the frequency and type of MUPS presentations to clinical services and estimate the associated direct healthcare costs.
This study was undertaken at Waitemata District Health Board (WDHB), the largest DHB in New Zealand. All patients with a diagnosed presentation of MUPS in 2013 were identified using the WDHB clinical coding system. Their clinical records were screened to select all patients who matched the study inclusion and exclusion criteria. Standardised national costing methodology was used to calculate the associated healthcare costs.
Forty-five percent of patients presented to hospital settings at least twice over the one-year timeframe. The most common diagnoses were non-epileptic seizures (31%) and hyperventilation syndrome (30%). The total cost for the sample was NZ$179, 271 (mean NZ$3659). Costs were most significant in the areas of inpatient admissions and emergency care.
MUPS can result in frequent presentations to hospital settings. The costs incurred are substantial and comparable to the costs of chronic medical conditions with identifiable pathology. Improving the recognition and management of MUPS has the potential to offer more appropriate and cost-effective healthcare nationally and internationally.
Disclosure of interest
The authors have not supplied their declaration of competing interest.