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This study identified factors affecting seniors’ ability to self-manage their health following an Emergency Department (ED) visit. Surveys (n = 380) completed by older adults and their caregivers in the ED assessed their understanding of information provided. Interviews (n = 51) completed with a participant subsample up to four weeks post-ED visit examined self-management factors. Perceived understanding of the information (“Yes, definitely”) received in the ED was greater at the time of the visit (91%) than at follow-up (71%). Patients reported self-management was influenced by communication with ED staff, understanding of post-discharge expectations and the health condition(s), caregiver availability, and various external factors. Caregivers also identified support for caregivers and patient resistance to recommendations. Senior-friendly strategies (e.g., recommendations in writing, confirmed understanding of recommendations), particularly those related to identifying those at risk and needing greater transitional supports, and greater access to and integration with community supports could enhance post-ED self-management.
To compare stimulation parameters of peri-modiolar and anti-modiolar electrode arrays using two surgical approaches.
Impedance, stimulation thresholds, comfortably loud current levels, electrically evoked compound action potential thresholds and electrically evoked stapedial reflex thresholds were compared between 2 arrays implanted in the same child at 5 time points: surgery, activation/day 1, week 1, and months 1 and 3. The peri-modiolar array was implanted via cochleostomy in all children (n = 64), while the anti-modiolar array was inserted via a cochleostomy in 43 children and via the round window in 21 children.
The anti-modiolar array had significantly lower impedance, but required higher current levels to elicit thresholds, comfort, electrically evoked compound action potential thresholds and electrically evoked stapedial reflex thresholds than the peri-modiolar array across all time points, particularly in basal electrodes (p < 0.05). The prevalence of open electrodes was similar in anti-modiolar (n = 5) and peri-modiolar (n = 3) arrays.
Significant but clinically acceptable differences in stimulation parameters between peri-modiolar and anti-modiolar arrays persisted four months after surgery in children using bilateral cochlear implants. The surgical approach used to insert the anti-modiolar array had no overall effect on outcomes.
Lack of coordination between screening studies for common mental disorders in primary care and community epidemiological samples impedes progress in clinical epidemiology. Short screening scales based on the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI), the diagnostic interview used in community epidemiological surveys throughout the world, were developed to address this problem.
Expert reviews and cognitive interviews generated CIDI screening scale (CIDI-SC) item pools for 30-day DSM-IV-TR major depressive episode (MDE), generalized anxiety disorder (GAD), panic disorder (PD) and bipolar disorder (BPD). These items were administered to 3058 unselected patients in 29 US primary care offices. Blinded SCID clinical reinterviews were administered to 206 of these patients, oversampling screened positives.
Stepwise regression selected optimal screening items to predict clinical diagnoses. Excellent concordance [area under the receiver operating characteristic curve (AUC)] was found between continuous CIDI-SC and DSM-IV/SCID diagnoses of 30-day MDE (0.93), GAD (0.88), PD (0.90) and BPD (0.97), with only 9–38 questions needed to administer all scales. CIDI-SC versus SCID prevalence differences are insignificant at the optimal CIDI-SC diagnostic thresholds (χ21 = 0.0–2.9, p = 0.09–0.94). Individual-level diagnostic concordance at these thresholds is substantial (AUC 0.81–0.86, sensitivity 68.0–80.2%, specificity 90.1–98.8%). Likelihood ratio positive (LR+) exceeds 10 and LR− is 0.1 or less at informative thresholds for all diagnoses.
CIDI-SC operating characteristics are equivalent (MDE, GAD) or superior (PD, BPD) to those of the best alternative screening scales. CIDI-SC results can be compared directly to general population CIDI survey results or used to target and streamline second-stage CIDIs.
We investigated verb generation in children with spina bifida meningomyelocele (SBM; n = 55) and in typically developing controls (n = 32). Participants completed 6 blocks (40 trials each) of a task requiring them to produce a semantically related verb in response to a target noun and an additional 40 trials on which they were simply required to read target nouns aloud. After controlling for reading response time, groups did not differ significantly in verb generation response time or learning. Children with SBM produced more non-verb errors than controls and tended to repeat their mistakes over blocks. Verb generation performance was associated with brain volume measures in participants with SBM. Congenital cerebellar dysmorphology is associated with impaired performance in verb generation accuracy, although not with increased response times to produce verbs.(JINS, 2008, 14, 181–191.)
In education, a popular model employed to represent the learning process is typically portrayed as a four-stage process signified by a cycle in a two-dimensional circular path. This cycle can be repeated by revisiting topics at increasing levels of sophistication in order to produce what is known as a spiral curriculum.
In this presentation, a variation of Kolb's two-dimensional learning cycle model is offered that represents the learning cycle as if it were a three-dimensional spiral or helix, with successive turns associated with increases in Bloom's Taxonomic level. This representation is explored and developed, with a specific example from a chemical engineering course offered in Industrial Electrochemistry. This more comprehensive concept-centered model for the learning cycle explicitly includes higher order thinking skills to promote creative thinking, through the application of concepts and can be used to develop more effective curricula and course instruction. Specifically, our sample class consists of four teams, each of which is responsible for becoming expert in the concepts associated with an area of science and another of application. Transfer of content is student driven while topics are explored. Students teaching each other allows for synergistic enhanced motivation to explore, with concurrent ultimate improvement in the retention of core concepts by the entire course population.
Learning and performance on a ballistic task were investigated in
children with spina bifida meningomyelocele (SBM), with either upper level
spinal lesions (n = 21) or lower level spinal lesions (n
= 81), and in typically developing controls (n = 35).
Participants completed three phases (20 trials each) of an elbow
goniometer task that required a ballistic arm movement to move a cursor to
one of two target positions on a screen, including (1) an initial
learning phase, (2) an adaptation phase with a gain
change such that recalibration of the ballistic arm movement was required,
and (3) a learning reactivation phase under the original gain
condition. Initial error rate, asymptotic error rate, and learning rate
did not differ significantly between the SBM and control groups. Relative
to controls, the SBM group had reduced volumes in the cerebellar
hemispheres and pericallosal gray matter (the region including the basal
ganglia), although only the pericallosal gray matter was significantly
correlated with motor adaptation. Congenital cerebellar dysmorphology is
associated with preserved motor skill learning on voluntary, nonreflexive
tasks in children with SBM, in whom the relative roles of the cerebellum
and basal ganglia may differ from those in the adult brain.
(JINS, 2006, 12, 598–608.)
We have rated eye color on a 3-point scale (1 = blue/grey, 2 = hazel/green, 3 = brown) in 502 twin families and carried out a 5–10 cM genome scan (400–757 markers). We analyzed eye color as a threshold trait and performed multipoint sib pair linkage analysis using variance components analysis in Mx. A lod of 19.2 was found at the marker D15S1002, less than 1 cM from OCA2, which has been previously implicated in eye color variation. We estimate that 74% of variance in eye color liability is due to this QTL and a further 18% due to polygenic effects. However, a large shoulder on this peak suggests that other loci affecting eye color may be telomeric of OCA2 and inflating the QTL estimate. No other peaks reached genome-wide significance, although lods > 2 were seen on 5p and 14q and lods >1 were additionally seen on chromosomes 2, 3, 6, 7, 8, 9, 17 and 18. Most of these secondary peaks were reduced or eliminated when we repeated the scan as a two locus analysis with the 15q linkage included, although this does not necessarily exclude them as false positives. We also estimated the interaction between the 15q QTL and the other marker locus but there was only minor evidence for additive [.dotmath] additive epistasis. Elaborating the analysis to the full two-locus model including non-additive main effects and interactions did not strengthen the evidence for epistasis. We conclude that most variation in eye color in Europeans is due to polymorphism in OCA2 but that there may be modifiers at several other loci.
Nutrient intake, digestibility and live-weight changes were compared for groups of grazing cattle on two Swiss Alpine pastures in different regions (R1 and R2; both >1500 m above sea level) during 2 years (1997 and 1998). The R1 site was an improved pasture, while R2 was an unimproved pasture of poor nutritional quality. Replicated over 2 years, R1 groups comprised four Scottish Highland suckler cows together with their calves and four Brown Swiss dairy cows (17·8 kg/day milk) kept at high stocking rates (approx. 7 cows/ha) in short rotations (intensive management system). R2 groups comprised four Highland cows with calves managed at low density (approx. 0·4 cows/ha) and set-stocked (extensive management system). Grazing seasons lasted 77 days at R1 and 127 days at R2. Intake, digestibility and faecal excretion were estimated by the slow-release alkane indicator method. Average dry matter intakes in kg/day and g/kg W0·75/day (in parentheses) were 17·4 (151) for dairy cows at R1 and, significantly lower, 12·7 (133) and 11·1 (111) for beef cows at R1 and R2, respectively. Herbage dry-matter intake of calves was 1·2 kg/day at both locations. Calf weight gains measured over 77 days (0·69 kg/day) were similar at the two sites and thereafter declined only slightly at R2. The N content of the herbage selected was similar in the two regions, but in other respects the herbage at R2 was of significantly poorer nutritive quality as indicated by the lower digestibility of organic matter and neutral detergent fibre at R2 compared with R1. Through feed selection, nutrient intake by beef cows was sufficient to gain weight. In contrast, dairy cows at R1 lost on average more than 50 kg of weight. Calculations were made and discussed regarding N utilization and urinary N loss, and measured faecal N and mineral excretion to allow a quantitative assessment of nutrient returns to the sward. We conclude that Highland beef cattle make poorer use of improved Alpine pasture than dairy cows though they utilize pastures of poor nutritive quality under extensive management without loss of productivity.
Susceptibility to coeliac disease involves HLA and non-HLA-linked genes. The CTLA4/CD28 gene region encodes immune regulatory T-cell surface molecules and is a strong candidate as a susceptibility locus. We evaluated CTLA4/CD28 in coeliac disease by genetic linkage and association and combined our findings with published studies through a meta-analysis. 116 multiplex families were genotyped across CTLA4/CD28 using eight markers. The contribution of CTLA4/CD28 to coeliac disease was assessed by non-parametric linkage and association analyses. Seven studies were identified that had evaluated the relationship between CTLA4/CD28 and coeliac disease and a pooled analysis of data undertaken. In our study there was evidence for a relationship between variation in the CTLA4/CD28 region and coeliac disease by linkage and association analyses. However, the findings did not attain formal statistical significance (p = 0·004 and 0·039, respectively). Pooling findings with published results showed significant evidence for linkage (504 families) and association (940 families): p values, 0·0001 and 0·0014 at D2S2214, respectively, and 0·0008 and 0·0006 at D2S116, respectively. These findings suggest that variation in the CD28/CTLA4 gene region is a determinant of coeliac disease susceptibility. Dissecting the sequence variation underlying this relationship will depend on further analyses utilising denser sets of markers.
The effect of 16 d intake of 300 mg carotenoids/kg diet (β-carotene (βC), bixin (BX), lycopene (LY), lutein (LU), canthaxanthin (CX) or astaxanthin (AX)) on xenobiotic metabolizing enzymes in the liver, lung, kidney and small intestine of male Wistar rats was assessed. A control group received the basal diet (AIN-76) without carotenoids and a positive control group for enzyme induction received 3-methylcholanthrene (3-MC) at 666 mg/kg diet. Cytochrome P450 activity was assessed using the substrates ethoxyresorufin for P450 1A1, methoxyresorufin for P450 1A2, pentoxyresorufin for P450 2B1/2 and benzyloxyresorufin for P450 types 1A1/2, 2B1/2 and 3A. Glutathione-S-transferase (EC 126.96.36.199) and reduced glutathione status were assessed. Carotenoid uptake by the tissues was also determined. 3-MC and the carotenoids BX, CX and AX led to significant increases compared with control in liver, lung and kidney ethoxyresorufin-O-deethylation. Methoxyresorufin-O-demethylation activity was significantly increased in liver and lung by BX, CX and AX but only CX and AX significantly increased activity in kidney. Pentoxyresorufin-O-depentylation and benzyloxyresorufin-O-dearylation increased in liver of 3-MC-, BX-, CX- and AX-treated rats, but to a much lesser degree than for the other two substrates. Benzyloxyresorufin-O-dearylation in lung was significantly decreased by all carotenoids. Activities of any of the measured enzymes in the small intestine were undetectable in all treatment groups except the 3-MC group. Glutathione status was unaffected by any of the treatments. This is the first study identifying the carotenoids BX, CX and AX as inducers of rat lung and kidney xenobiotic metabolizing enzymes.
A complex case of congenital heart disease is presented which features isomerism of the left atrial appendages combined with bronchoatrial discordance and an anteriorly placed non-interrupted inferior caval vein draining to the left-sided atrium. This combination of anomalies has, as far as we are aware, not been described before. It emphasizes the importance of direct confirmation of atrial arrangement by atrial angiography or transesophageal echocardiography.
The basic issues involved in the growth by molecular beam epitaxy (MBE) of
vertical-cavity surface-emitting lasers (VCSELs) are discussed. Successful
VCSEL optical information processing applications demonstrated to date are
discussed, including two-dimensional arrays, holographic memory retrieval,
optical addressing, wavelength division multiplexing, and tunable VCSEL
As the first part of a program to investigate the thermal emission of dust at millimeter wavelengths, we present maps of the continuum emission from radio-bright HII regions. These maps have been made with a filled aperture telescope, the NRAO 12-m telescope at Kitt Peak, with a HPBW of 70 arc seconds at 3.5 mm. We used a switched dual-beam technique and a restoration algorithm developed by Emerson et al. (1979 Astron. Ap. 76, 92). We compare these maps with maps made at centimeter wavelengths.
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