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Emergency psychiatric care, unplanned hospital admissions, and inpatient health care are the costliest forms of mental health care. According to Statistics Canada (2018), almost 18% (5.3 million) of Canadians reported needing mental health support. However, just above half of this figure (56.2%) have reported their needs were fully met. To further expand capacity and access to mental health care in the province, Nova Scotia Health has launched a novel mental health initiative, the Rapid Access, and Stabilization Program (RASP).
Objectives
This study evaluates the effectiveness and impact of the RASP on high-cost health services utilization (e.g. ED visits, mobile crisis visits, and inpatient treatments) and related costs. It also assesses healthcare partners’ (e.g. healthcare providers, policymakers, community leaders) perceptions and patient experiences and satisfaction with the program and identifies sociodemographic characteristics, psychological conditions, recovery, well-being, and risk measures in the assisted population.
Methods
This is a hypothesis-driven program evaluation study that employs a mixed methods approach. A within-subject comparison will examine health services utilization data from patients attending RASP, one year before and one year after their psychiatry assessment at the program. A controlled between-subject comparison will use historical data from a control population will examine whether possible changes in high-cost health services utilization are associated with the intervention (RASP). The primary analysis involves extracting secondary data from provincial information systems, electronic medical records, and regular self-reported clinical assessments. Additionally, a qualitative sub-study will examine patient experience and satisfaction, and examine health care partners’ impressions.
Results
The results for the primary, secondary, and qualitative outcome measures to be available within 6 months of study completion. We expect that RASP evaluation findings will demonstrate a minimum 10% reduction in high-cost health services utilization and corresponding 10% cost savings, and also a reduction in the wait times for patient consultations with psychiatrists to less than 30 calendar days. In addition, we anticipate that patients, healthcare providers, and healthcare partners would express high levels of satisfaction with the new service.
Conclusions
This study will demonstrate the results of the Mental Health and Addictions Program (MHAP) efforts to provide stepped-care, particularly community-based support, to individuals with mental illnesses. Results will provide new insights into a novel community-based approach to mental health service delivery and contribute to knowledge on how to implement mental health programs across varying contexts.
The recent wildfires in Canada provide a clear illustration of the significant and lasting damage they inflict on the well-being of individuals and communities. Evaluating the occurrence and factors associated with post-traumatic stress disorder (PTSD) and low resilience is valuable for policymakers in public health.
Objectives
The study aimed to assess the prevalence and predictors of low resilience and likely PTSD among subscribers of Text4Hope, an e-mental health program that delivered daily supportive messages to residents of Nova Scotia (NS) and Alberta (AB) during the recent wildfires.
Methods
Data collection was through a self-administered online survey completed by residents of the affected regions of NS and AB from May 14 to June 23, 2023. Data were analyzed using Statistical Package for the Social Sciences.
Results
Out of 298 respondents, the prevalence of low resilience and likely PTSD in our sample were 52.0% and 39.3% respectively. Unemployed respondents were about 3 times more likely to experience both low resilience and PTSD symptoms compared to those employed. Respondents with a history of mental health diagnosis were about 4 times more likely to experience likely PTSD compared to those with no history of mental health diagnosis.
Conclusions
This research demonstrated that the likelihood of PTSD was predicted by both unemployment and a history of mental health diagnosis, with unemployment also being linked to low resilience during the wildfire. These results provide valuable insights for designing clinical interventions and developing psychosocial support programs tailored for vulnerable populations.
The current study evaluated cultural values and family processes that may moderate associations between daily racial-ethnic discrimination and distress among Mexican-origin youth. Integrating micro-time (daily diary) and macro-time (longitudinal survey) research design features, we examined familism, family cohesion, and ethnic-racial socialization from youth-, mother-, and father- reports as potential buffers of daily associations between youth racial-ethnic discrimination and youth distress (negative affect and anger). The analytic sample, drawn from the Seguimos Avanzando study, included 317 Mexican-origin adolescents (Mage = 13.5 years) and their parents, recruited from the Midwestern United States. Results indicated that youth-reported familism and family cohesion significantly buffered daily associations between youth racial-ethnic discrimination and youth distress. In contrast, parent-reported familism and family cohesion and some aspects of ethnic-racial socialization exacerbated the discrimination to distress link. The implications of these results are discussed to inform efforts supporting the healthy development of Mexican-origin youth and their families.
Despite several treatment strategies for treatment-resistant depression (TRD) exist, including the use of repetitive transcranial magnetic stimulation (rTMS), new therapeutic options are being introduced. Text4Support is a form of cognitive behavior therapy that allows patients with depression to receive daily supportive text messages that seek to correct or alter negative thought patterns through positive reinforcement. Text4Support is deemed a useful augmentation treatment strategy for patients with TRD. It is however currently unknown if adding the Text4Support intervention will enhance patients with TRD’s response to rTMS treatments
Objectives
This study aims to assess the initial comparative clinical effectiveness of rTMS when used with and without the Text4Support program as an innovative patient-centered intervention for the management of participants diagnosed with TRD.
Methods
This study is a multicentered prospective, parallel-design, two-arm, rater-blinded randomized controlled pilot trial. In total, 200 participants diagnosed with TRD will be randomized to one of two treatment arms (rTMS alone and rTMS with Text4Support). Participants in each arm will be made to complete evaluation measures at baseline, 1,3, and 6 months. The primary outcome measure will be the mean change to scores on the Hamilton Depression Rating Scale. Patient service utilization data and clinician-rated measures will also be used to gauge patient progress. Patient data will be analyzed with descriptive statistics, repeated measures, and correlational analyses.
Results
The result of the study is expected to be available 18 months after the start of recruitment. We hypothesize that participants enrolled in the rTMS plus Text4Support intervention will achieve superior outcomes compared with participants enrolled in the rTMS treatment alone.
Conclusions
The concomitant application of the combination of these two treatment techniques has not been investigated previously. Therefore, we hope that this project will provide a concrete base of data to evaluate the practical application and efficacy of using a novel combination of these two treatment modalities.
Emergency medical (EM) response systems require extensive coordination, particularly during mass casualty incidents (MCIs). The recognition of preparedness gaps and contextual priorities to MCI response capacity in low- and middle-income countries (LMICs) can be better understood through the components of EM reponse systems. This study aims to delineate essential components and provide a framework for effective emergency medical response to MCIs.
Methods:
A scoping review was conducted using 4 databases. Title and abstract screening was followed by full-text review. Thematic analysis was conducted to identify themes pertaining to the essential components and integration of EM response systems.
Results:
Of 20,456 screened citations, 181 articles were included in the analysis. Seven major and 40 sub-themes emerged from the content analysis as the essential components and supportive elements of MCI medical response. The essential components of MCI response were integrated into a framework demonstrating interrelated connections between essential and supportive elements.
Conclusions:
Definitions of essential components of EM response to MCIs vary considerably. Most literature pertaining to MCI response originates from high income countries with far fewer reports from LMICs. Integration of essential components is needed in different geopolitical and economic contexts to ensure an effective MCI emergency medical response.
Neuropsychiatric symptoms (NPS) are common, disabling and burdensome core-features of dementia, with important diagnostic and prognostic value. However, their measurement remains challenging. The Neuropsychiatric Inventory (NPI) is the most widely used NPS measure. Nevertheless, it is also time-consuming and impractical in most clinical settings. Therefore, the Abe’s BPSD score (ABS) has been proposed as a brief score to facilitate the NPS assessment.
Objectives
To explore the concurrent validity of the Portuguese ABS by comparing the 10 ABS items with the relevant NPI-12 domains.
Methods
A cross-sectional study was conducted with outpatients attending a gerontopsychiatric consultation. Patients were included if they were ≥65 years and had a reliable caregiver. NPS frequency rates (number of patients with a symptom) were estimated with ABS and NPI-12, and an agreement analysis was undertaken by calculating kappa-coefficients (k) and the respective 95% confidence interval [95%CI] between ABS items and relevant NPI-12 domains.
Results
Overall, 107 patients were included. Kappa-values ranged from 0.277 to 1.000. Higher agreement was recorded for the ABS items eating/toilet problems (k=1.000), day–night reversal (k=0.976[0.925-1.000]) and depressive/gloomy mood (k=0.957[0.899-1.000]), with the NPI-12 appetite/eating abnormalities, night-time behavioural disturbances and dysphoria domains, respectively. The ABS item violent force recorded the lowest agreement (k=0.277[0.104-0.45]) with the NPI-12 agitation/aggression domain.
Conclusions
This exploratory analysis demonstrates good levels of agreement between most ABS items and relevant NPI-12 domains. Data add to the evidence that both measures capture a comparable broad spectrum of psychopathology, supporting the ABS use in clinical routine. Support: FCT(PD/BD/114555/2016), and National Funds through FCT-within CINTESIS, R&D Unit (ref.UIDB/4255/2020).
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.
Design:
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’.
Setting:
The questionnaire was hosted online using Google Forms and shared using social media platforms.
Participants:
A total of 1075 adult participants from eighty-two countries completed the questionnaire.
Results:
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 %).
Conclusions:
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.
Pharyngocutaneous fistula is a troublesome complication. Recently, synthetic materials such as fibrin sealant have been used as a secondary measure to treat fistula. This work assessed whether the primary use of fibrin sealant can reduce the rate of fistula.
Method
A retrospective review of 50 cases from 2 centres was completed. Tisseel was an adjunct to primary closure in all cases.
Results
In the first centre, 3 out of 34 cases developed pharyngocutaneous fistula (fistula rate of 9 per cent). All three were salvage cases. In the second centre, 0 out of 16 cases developed a fistula.
Conclusion
The incidence of pharyngocutaneous fistula post-radiation and post-chemoradiotherapy in laryngectomy cases has been quoted as 23 per cent and 34 per cent respectively. This study represents the first patient series on the use of fibrin sealant as an adjunct in primary closure following laryngectomy. The results are promising, encouraging the use of Tisseel as an adjunct to meticulous closure.
Barramundi (Lates calcarifer) are a highly valued aquaculture species, and, as obligate carnivores, they have a demonstrated preference for dietary protein over lipid or starch to fuel energetic growth demands. In order to investigate how carnivorous fish regulate nutritional cues, we examined the metabolic effects of feeding two isoenergetic diets that contained different proportions of digestible protein or starch energy. Fish fed a high proportion of dietary starch energy had a higher proportion of liver SFA, but showed no change in plasma glucose levels, and few changes in the expression of genes regulating key hepatic metabolic pathways. Decreased activation of the mammalian target of rapamycin growth signalling cascade was consistent with decreased growth performance values. The fractional synthetic rate (lipogenesis), measured by TAG 2H-enrichment using 2H NMR, was significantly higher in barramundi fed with the starch diet compared with the protein diet (0·6 (se 0·1) v. 0·4 (se 0·1) % per d, respectively). Hepatic TAG-bound glycerol synthetic rates were much higher than other closely related fish such as sea bass, but were not significantly different (starch, 2·8 (se 0·3) v. protein, 3·4 (se 0·3) % per d), highlighting the role of glycerol as a metabolic intermediary and high TAG-FA cycling in barramundi. Overall, dietary starch significantly increased hepatic TAG through increased lipogenesis. Compared with other fish, barramundi possess a unique mechanism to metabolise dietary carbohydrates and this knowledge may define ways to improve performance of advanced formulated feeds.
To understand the production factors that affect conclusive parameters of sow herd performance can improve the use of the resources and profitability of farm. The objective of this study was to identify associations and quantify the effects of a set of factors related to piglet weight at weaning (PWW), kilograms of piglets weaned per sow per year (kgPWSY) and sow feed conversion (SFC). Data from 150 farms were collected, for a total study population of 135 168 sows, including gilt replacement, breeding (mating), gestation and farrowing/lactation phases. A questionnaire focusing on reproductive performance, management, facilities, feeding, health and biosafety was administered. Multiple linear regression models were used to assess associations among factors with each of the three dependent variables. Increased duration of lactation was positively associated with PWW, kgPWSY and SFC. The increase in the number of live born pigs per litter was positively associated with kgPWSY and with SFC. Farms with higher PWW had farrowing room humidifiers, did not surgically castrate male piglets and used quaternary ammonia compounds for farrowing room disinfection. Farms with higher kgPWSY used lined ceilings in farrowing rooms and winter feeds with higher CP percentages in gestation; they also had more farrowings per sow per year. Sow feed conversion was worse in farms with partly slatted floors during gestation, in farms feeding lactating sows six times a day or ad libitum and farms with a higher sow-handler ratio. This study indicates that farms can increase PWW and kgPWSY and improve the SFC by changing one or more management, biosafety and feeding practices or facilities as well as by focusing on improving several performance parameters, particularly increasing the duration of lactation and the number of live born pigs per litter.
This chapter explores sustainability reporting regimes in six African countries representing sub-regions of the continent – Egypt, Equatorial Guinea, Kenya, Nigeria, Botswana and South Africa. It reveals that Africa is catching up on sustainability reporting as each jurisdiction is found to have a sustainability reporting regime with an identified regulatory model(s). However, the conflicting nature of sustainability reporting standards calls for a broader reform strategy or policy harmonisation. It thus argues that the African Peer Review Mechanism, Regional Economic Communities, and new African Continental Free Trade Area present opportunities for sustainability reporting policy harmonisation in Africa. It is further argued that African regimes should jettison self-regulatory sustainability reporting models and opt for sanctions-based models or hybrid models combining mandatory and voluntary approaches. It observes, however, that the future of sustainability reporting in Africa lies in integrated reporting with its impact not just on corporate performance but also on strong sustainability.
Use of pneumococcal conjugate vaccines has caused emergence of non-vaccine serotypes. No Brazilian data specifically about serotype 19A are available. We aimed to evaluate the frequency of occurrence, susceptibility profile and molecular epidemiology of serotype 19A before and after vaccine introduction in Brazil. Pneumococcal identification was performed by the conventional method. Strain serotype was determined by multiplex polymerase chain reaction (PCR) and/or Quellung reaction. Resistance was determined by Etest® and PCR was performed to determine the presence of macrolide resistance genes, ermB and/or mefA. Pneumococci were typed by Multilocus Sequence Typing. Thirty-eight serotype 19A Streptococcus pneumoniae were recovered, mostly from invasive diseases. Prevalence of serotype 19A increased following vaccination (from 3.5% before vaccination to 8.1% after, p = 0.04196). Non-susceptibility increased to most antimicrobials after vaccine introduction and was associated with clonal complex (CC)320. MLST showed nine different STs, which were grouped in one main CC: CC320 (63.9%). During the post-vaccination era, the frequency of this serotype increased significantly from 1.2% in 2011 to 18.5% in 2014 (p = 0.00001), with a concomitant decrease in the genetic variability: ST320 consistently predominated after vaccine-introduction (61.1%). Overall, our results showed a post-PCV10 increase in the frequency of serotype 19A. This was accompanied by a selection of CC320 and antimicrobial resistance.
Brazil today has a legal market that allows for foreign lawyers and foreign firms, but existing regulations are restrictive. Foreign lawyers cannot practice domestic law or litigation, nor can Brazilian‐licensed lawyers working for foreign firms or partnering with foreign lawyers. This was not always the case, however. Until 1963, there was little regulation of the legal profession. Beginning in 1913, elite US lawyers traveled to Brazil, with some even becoming prominent domestic practitioners. They partnered with local elite lawyers (who maintained their domestic privileges) and served as key brokers for US businesses seeking market entry. Drawing on the elite theory literature, and on ethnographies, interview data, and over 1,000 pages of rare Portuguese and English archival sources, this study's thesis is that sophisticated US and Brazilian legal elites capitalized on the lack of regulation to advance their financial interests, and in the process transformed Brazil's corporate legal sector.
Tungsten (W) was select for an extensive use in nuclear fusion devices due to its low neutron activation, high melting point and sputtering threshold as well as low hydrogen inventory. Nevertheless, W is brittle at low and moderate temperatures, which results in abnormal thermal stress, component fracture and extra erosion under reactor operation due to inherent thermal cycling events. An attractive way to solve these problems involves the addition of other refractory metals in the W matrix and tantalum (Ta) is a natural candidate. It has a high ductility, toughness and radiation resistance relative to those of W and transmutes to W by high-energy neutron irradiation. Recently, IST proposed the production of W-Ta composite by mechanical synthesis.
The composite should reveal the individual properties of the pristine phases as long as the interdiffusion between the components is significantly avoided during the consolidation/sintering route of the final material. Sintering operations at temperatures higher than 1300ºC lead to significant improvements in the final densification and thermal conductivity of the composites, which is crucial for fusion applications. However, W and Ta interdiffusion can be relevant above 1300ºC, mainly due to diffusion of W into Ta, and the aim of the present work is to control the mechanism.
W-Taf composites presenting 10 and 20 at.% of Ta where produced by alloying W powders and Ta fibres with a planetary ball milling route (MA) and by consolidating the mixture with spark plasma sintering (SPS) in the 1300-1600ºC temperature range. The final densifications remain fairly constant in both composites after sintering at different temperatures (83 to 87%) and the elemental interdiffusion remained low at 1300ºC. Nevertheless, the diffusivity of W in Ta became significant at 1600ºC, leading to the formation of a solid solution zone with a stoichiometry close to W16Ta84. The mechanism was followed by scanning electron and energy-dispersive X-ray spectroscopies (SEM/EDS; Figures 1 and 2, Table 1). Fabrication routes yielding high densifications and low interdiffusion are currently under investigation.
The work has been supported by the Contract of Association between Euratom and IST and by the Fund. Ciência e a Tecnologia contracts PTDC/CTM/100163/2008, Pest-OE/SADG/LA0010/2011 and PEST-OE/CTM-UI0084/2011.
The high melting point, high sputtering threshold and low tritium inventory rendered W as a potentially suitable material in fusion devices. The major problem associated with presently available tungsten grades as structural materials is its brittleness at lower temperatures. This is further worsened by irradiation embrittlement. A strategy for ductility improvement is producing a composite, with the brittle W matrix being reinforced by short fibres of tantalum. As Ta is more ductile than W it can therefore divert or stop cracks propagating in the W matrix. In the present research Ta short fibres and powder were used as reinforcement component for W by alloying Ta short fibres or powder in a W powder matrix. The composites were subsequently irradiated with deuterium to assess the retention of this hydrogenic species in the materials.
The irradiated composites, with Ta contents of 10 or 20 at%, were produced from pure elemental powders (W-Ta powder composites), and pure W powder and Ta fibre (W-Ta fibre composites) with 100 μm in diameter by low energy ball milling in argon atmosphere. These materials were consolidated via spark plasma sintering (SPS) in the temperature 1200 to 1600 ºC range. Pure W and Ta plates (controls) and W-Ta composites were irradiated with He+ ions (optional pre-implantation step) and D+ ion beams at room temperature with fluences in the 1020-1021 at/m2 range. Blistering and deuterium retention in W and Ta plates and in W-Ta composites were studied with scanning electron microscopy (SEM), X-ray diffraction and thermal desorption analysis. The deuterium concentration was evaluated trough nuclear reaction analysis (NRA) using 0.75 to 2.1 MeV 3He+ beam and the D(3He,p)α reaction.
The investigations showed that deuterium irradiation induced microstructural modifications producing blistering in Ta plates as well as in W-Ta composites (Figure 1). These effects increased substantially in the Ta and W-Ta materials with the He pre-implantation step, while blisters have not been observed in the W plates either for D+ or He+ plus D+ implantation. Higher deuterium retention was observed by thermal desorption for the composites than for the W plates. Moreover the present study revealed that D+ trapping in the composites is dependent on the microstructure with higher retention observed for fibers than for powder.
This work has been performed under the Contract of Association between EURATOM and Instituto Superior Tecnico. Financial support was also received from the Fundação para a Ciência Tecnologia (FCT) grants with references PTDC/CTM/100163/2008, Pest-OE/SADG/LA0010/2011 and PEST-OE/CTM-UI0084/2011. The authors wish to acknowledge Jorge Rocha the implantation in W-Ta samples.
In this work we present an experimental study where energetic ions were produced in an underdense 2.5 × 1019 cm−3 plasma created by a 50 fs Ti:Sapphire laser with 5 TWs of power. The plasma comprises 95% He and 5% N2 gases. Ionization-induced trapping of nitrogen K-shell electrons in the laser-induced wakefield generates an electron beam with a mean energy of 40 MeV and ~1 nC of charge. Some of the helium ions at the wake–vacuum interface are accelerated with a measured minimum ion energy of He1+ ions of 1.2 MeV and He2+ ions of 4 MeV. The physics of the interaction is studied with 2D particle-in-cell simulations. These reveal the formation of an ion filament on the axis of the plasma due to space charge attraction of the wakefield-accelerated high-charge electron bunch. Some of these high-energy electrons escape the plasma to form a sheath at the plasma–vacuum boundary that accelerates some of the ions in the filament in the forward direction. Electrons with energy less than the sheath potential cannot escape and return to the plasma boundary in a vortex-like motion. This in turn produces a time-varying azimuthal magnetic field, which generates a longitudinal electric field at the interface that further accelerates and collimates the ions.
The objective of this study was to test the hypothesis that equine growth hormone (eGH), in combination with insulin growth factor-I (IGF-I), influences positively in vitro nuclear and cytoplasmic maturation of equine oocytes. Cumulus–oocyte complexes were recovered from follicles that were < 25 mm in diameter, characterized by morphology and were allocated randomly as follow: (a) control (no additives); (b) 400 ng/ml eGH; (c) 200 ng/ml IGF-I; (d) eGH + IGF-I; and (e) eGH + IGF-I + 400 ng/ml anti-IGF-I antibody. Oocytes were matured for 30 h at 38.5°C in air with 5% CO2 and then stained with 10 μg/ml propidium iodide (PI) to evaluate nuclear status and 10 μg/ml Lens culinaris agglutinin-fluorescein complex (FITC-LCA) to assess cortical granule migration by confocal microscopy. The proportion of immature oocytes that developed to the metaphase II (MII) stage in the eGH + IGF-I group (15 of 45) was greater than in the groups that were treated only with IGF-I (7 of 36, p = 0.03). Oocytes that reached MII in the control group (20 of 56; 35.7%) showed a tendency to be different when compared with eGH + IGF-I group (15 of 45; 33.3%, p = 0.08). The treated group that contained anti-IGF-I (15 of 33; 45.4%) decreased the number of oocytes reaching any stage of development when compared with eGH (47 of 72; 65.3%) and eGH + IGF-I (33 of 45; 73.3%) groups (p = 0.05) when data from MI and MII were combined. We concluded that the addition of eGH to in vitro maturation (IVM) medium influenced the in vitro nuclear and cytoplasmic maturation of equine oocytes. The use of GH and IGF-I in vitro may represent a potential alternative for IVM of equine oocytes.