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Mental stress is associated with higher mortality, but it remains controversial whether the association is causal or a consequence of a higher physical disease burden in those with a high mental stress load. Understanding causality is important when developing targeted interventions. We aimed to estimate the effect of mental stress on mortality by performing a ‘natural’ experiment using spousal bereavement as a disease-independent mental stressor.
We followed a population-based matched cohort, including all individuals in Denmark bereaved in 1997–2014, for 17 years. Prospectively recorded register data were obtained for civil and vital status, 39 mental and physical diagnoses, and socioeconomic factors.
In total, 389 316 bereaved individuals were identified and 137 247 died during follow-up. Bereaved individuals had higher all-cause mortality than non-bereaved references in the entire study period. The relative mortality in the bereaved individuals was highest shortly after the loss (adjusted hazard ratio (aHR), first month: 2.50, 95% confidence interval (CI) 2.37–2.63; aHR, 6–12 months: 1.38, 95% CI 1.34–1.42). The excess mortality rate associated with bereavement rose with increasing number of physical diseases (1.33 v. 7.00 excess death per 1000 person-months for individuals with 0 v. ⩾3 physical conditions during the first month) and was exacerbated by the presence of mental illness. The excess mortality among bereaved individuals was primarily due to death from natural causes.
Bereavement was associated with increased short-term and long-term mortality, even after adjustment for morbidities, which suggests that mental stress may play a causal role in excess mortality.
Excessive body fat, mainly abdominal fat, is associated with higher cardiovascular risk. However, a fat localisation measurement that would be more indicative of risk in adolescents has not yet been established.
This study was conducted in order to evaluate the correlation between body fat location measurements and cardiovascular disease risk factors in female adolescents.
Materials and methods:
A total of 113 girls – 38 eutrophic according to their body mass index but with a high percentage of body fat, 40 eutrophic with adequate body fat, and 35 with excessive weight – were evaluated using 15 anthropometrical measurements and 10 cardiovascular risk factors.
The central skinfold was the best measurement for predicting variables such as glycaemia and high-density lipoprotein; waist circumference for insulin and homeostasis model assessment; coronal diameter for total cholesterol and low-density lipoprotein; sagittal abdominal diameter for triglycerides and leptin; hip circumference for blood pressure; and the central/peripheral skinfold ratio for homocysteine. The correlation between the measurements and the number of risk factors showed that waist circumference and the waist/stature ratio produced the best results.
The results suggest that the body fat distribution in adolescents is relevant in the development of cardiovascular risk factors. Simple measurements such as waist circumference and the waist/stature ratio were the best predictors of a risk of disease and they should therefore be associated with the body mass index in clinical practice in order to identify those adolescents at higher risk.
A fire-mediated recruitment bottleneck provides a possible explanation for the coexistence of trees and grasses in mesic savannas. The key element of this hypothesis is that saplings are particularly vulnerable to fire because they are small enough to be top-killed by grass fires, but unlike juveniles, they take several years to recover their original size. This limits the number of recruits into the adult size classes. Thus savanna vegetation may be maintained by a feedback whereby fire restricts the density of adult trees and allows a grass layer to develop, which provides fuel for subsequent fires. Here, we use results from a landscape-scale fire experiment in tropical Australia, to explore the possible existence of a recruitment bottleneck. This experiment compared tree recruitment and survival over 4 y under regimes of no fire, annual early and annual late dry-season fire. Stem mortality decreased with increasing stem height in the fire treatments but not in the unburnt treatment. Tree recruitment was 76–84% lower in the fire treatments than the unburnt treatment. Such fire-induced stem loss of saplings and reduced recruitment to the canopy layer in this eucalypt savanna are consistent with the predictions of the fire-mediated recruitment bottleneck hypothesis.
We report a case of a patient who presented with otalgia and facial nerve palsy secondary to an aspergilloma of the middle ear.
A 72-year-old, diabetic man presented to the ENT department with a history of worsening right-sided otalgia, aural discharge and hearing loss, associated with a right-sided facial weakness. This was assumed to be secondary to malignant otitis externa, and treatment was commenced. Imaging showed soft tissue within the middle ear and no bony erosion. Surgical exploration and biopsy revealed an aspergilloma of the middle ear. The pre- and post-operative management, as well as treatment strategies, are discussed.
To our knowledge, this is the first documented case of an aspergilloma of the middle ear with associated facial palsy. Readers are asked to consider this rare diagnosis in patients with suspected malignant otitis externa not responding to standard treatment.
We describe aspects of the life history of Erynnis propertius (Scudder and Burgess) (Lepidoptera: Hesperiidae) by examining several populations over multiple years. We focused on peripheral populations of this species because they are isolated, are threatened by habitat loss, and may play an important role in driving poleward range expansion under increasing regional temperature. Our findings show that the annual larval growth rate does not vary directly with temperature, adult flight phenology and the timing of key resources respond to average daytime temperatures in spring, and population-density patterns among sites are robust over years across a broad region near the species' northern range limit. In addition, we provide descriptions of all larval instars for this species. This fundamental information about the biology, timing, and abundance of this species will facilitate further experimental study and improved assessment of its conservation status.
The Macarthur-Bates Communicative Development Inventories (CDI) have been used widely to document early communicative development. The paper reports on a large community sample of 1,447 children recruited from low, middle and high socioeconomic (SES) areas across metropolitan Melbourne, Australia. Regression analyses were conducted to determine the extent to which communicative behaviours reported at 0 ; 8 and 1 ; 0 predicted vocabulary development at 1 ; 0 and 2 ; 0. In support of previous findings with smaller, often less representative samples, gesture and object use at 1 ; 0 were better predictors of 2 ; 0 vocabulary than were gesture and object use at 0 ; 8. At 1 ; 0, children from the lower SES groups were reported to understand more words than children from the higher SES groups, but there were no SES differences for words produced at 1 ; 0 or 2 ; 0. The findings add to our understanding of the variability in the development of early communicative behaviours.
To investigate the use of a new technique to close persistent tympanic membrane perforations under general anaesthesia, in patients in whom this has previously been considered impractical.
Twenty patients aged 50 years and over were recruited. All had a persistent, symptomatic tympanic membrane perforation in at least one ear. Pre-operatively, an audiogram was performed and the tympanic membrane was assessed in order to establish the site and size of the perforation. Under general anaesthesia, the edges of the perforation were freshened and a sheet of Epifilm, trimmed to a size roughly 2 mm larger in diameter than the perforation, was tucked through the perforation. The ear was dressed appropriately. Patients were seen two weeks post-operatively in the out-patients department and reassessed.
The study was based at Poole General Hospital, a District General Hospital.
Twenty patients were recruited from the out-patients clinics of Poole Hospital ENT department.
Main outcome measures:
(1) closure of the perforation, as a percentage of the original size; (2) improvement of hearing, as an average across all frequencies, expressed in dB hearing level; and (3) presence or absence of discharge.
Five patients were operated upon and assessed six weeks post-operatively. The Epifilm had dissolved but the perforations remained the same size in all five patients. There were no other adverse effects. Pure tone audiometry at this stage was redundant. The study was subsequently aborted.
The authors conclude that repair of tympanic membrane perforations with hyaluronic acid ester films is not to be recommended.
This paper examines the bases of opposition to immigrant minorities in Western Europe, focusing on The Netherlands. The specific aim of this study is to test the validity of predictions derived from two theories—realistic conflict, which emphasizes considerations of economic well-being, and social identity, which emphasizes considerations of identity based on group membership. The larger aim of this study is to investigate the interplay of predisposing factors and situational triggers in evoking political responses. The analysis is based on a series of three experiments embedded in a public opinion survey carried out in The Netherlands (n=2007) in 1997–98. The experiments, combined with parallel individual-level measures, allow measurement of the comparative impact of both dispositionally based and situationally triggered threats to economic well-being and to national identity at work. The results show, first, that considerations of national identity dominate those of economic advantage in evoking exclusionary reactions to immigrant minorities and, second, that the effect of situational triggers is to mobilize support for exclusionary policies above and beyond the core constituency already predisposed to support them.
Two questions have dominated the modern study of politics. How do
political systems become democratic? And how, supposing they have managed to become democratic, do they manage to remain so? As yet, there is no agreement on the answer to the first question. For a generation, however, there has been consensus on a core part of the answer to the second. In democratic polities, political elites have come to consensus in support of democratic rights, and in times of political stress
this elite consensus has served as a bulwark protecting citizens' liberties.
The origin and course of the carotid arterial sysem in the superior mediastinum and neck are remarkably constant. Although variations are rare, they can have important implications in certain clinical problems. In this report, a patient underwent free jejunal graft repair of a cervical oesophageal stricture caused by radiotherapy for a post-cricoid carcinoma. The common carotid artery on the side of the surgical approach was found to cross the midline to the other side of the neck, and created difficulties both with the procedure and future management. This has not been previously reported.
While language, articulation and reading problems have been well documented in young twins, it is not clear how extensive such problems can be or how early in childhood they become evident. At the age of 30 months, twin boys in the La Trobe Twin Study were 8 months behind matched singletons and twin girls on expressive language and 6 months behind on verbal comprehension. They were also 5 months behind on symbolic play and this delay was closely related to language. “Secret” language characterised most of the twin boys but not the girls and the relation of this to articulation delays is discussed. To examine if exposure to other children helps the twin boys, 38-53 month old twins and singletons were matched on the Columbia Mental Maturity Scale at the time of starting preschool. The twin boys had more articulation problems and all twins scored much lower on a Sociability questionnaire completed by the teacher. After 8 months at preschool, all children had advanced in Sociability, but the twins remained just as far behind with poor Sociability relating to poor articulation. The role of intervention programs is discussed.