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To examine factors that influence decision-making, preferences, and plans related to advance care planning (ACP) and end-of-life care among persons with dementia and their caregivers, and examine how these may differ by race.
13 geographically dispersed Alzheimer’s Disease Centers across the United States.
431 racially diverse caregivers of persons with dementia.
Survey on “Care Planning for Individuals with Dementia.”
The respondents were knowledgeable about dementia and hospice care, indicated the person with dementia would want comfort care at the end stage of illness, and reported high levels of both legal ACP (e.g., living will; 87%) and informal ACP discussions (79%) for the person with dementia. However, notable racial differences were present. Relative to white persons with dementia, African American persons with dementia were reported to have a lower preference for comfort care (81% vs. 58%) and lower rates of completion of legal ACP (89% vs. 73%). Racial differences in ACP and care preferences were also reflected in geographic differences. Additionally, African American study partners had a lower level of knowledge about dementia and reported a greater influence of religious/spiritual beliefs on the desired types of medical treatments. Notably, all respondents indicated that more information about the stages of dementia and end-of-life health care options would be helpful.
Educational programs may be useful in reducing racial differences in attitudes towards ACP. These programs could focus on the clinical course of dementia and issues related to end-of-life care, including the importance of ACP.
Shiga toxin-producing Escherichia coli (STEC) infection can cause serious illness including haemolytic uraemic syndrome. The role of socio-economic status (SES) in differential clinical presentation and exposure to potential risk factors amongst STEC cases has not previously been reported in England. We conducted an observational study using a dataset of all STEC cases identified in England, 2010–2015. Odds ratios for clinical characteristics of cases and foodborne, waterborne and environmental risk factors were estimated using logistic regression, stratified by SES, adjusting for baseline demographic factors. Incidence was higher in the highest SES group compared to the lowest (RR 1.54, 95% CI 1.19–2.00). Odds of Accident and Emergency attendance (OR 1.35, 95% CI 1.10–1.75) and hospitalisation (OR 1.71, 95% CI 1.36–2.15) because of illness were higher in the most disadvantaged compared to the least, suggesting potential lower ascertainment of milder cases or delayed care-seeking behaviour in disadvantaged groups. Advantaged individuals were significantly more likely to report salad/fruit/vegetable/herb consumption (OR 1.59, 95% CI 1.16–2.17), non-UK or UK travel (OR 1.76, 95% CI 1.40–2.27; OR 1.85, 95% CI 1.35–2.56) and environmental exposures (walking in a paddock, OR 1.82, 95% CI 1.22–2.70; soil contact, OR 1.52, 95% CI 2.13–1.09) suggesting other unmeasured risks, such as person-to-person transmission, could be more important in the most disadvantaged group.
Since 2008 England's anti-stigma programme Time to Change has lobbied media outlets about stigmatising coverage and worked with them to promote accurate and non-stigmatising coverage. While this may have an impact on coverage and hence attitudes, it is also possible that coverage can change in response to improving attitudes, through the creation of a market demand for less stigmatising coverage. This study evaluates English newspaper coverage of mental health topics between 2008 and 2016.
Articles covering mental health in 27 newspapers were retrieved using keyword searches on two randomly chosen days each month in 2008–2016, excluding 2012 and 2015 due to restricted resources. Content analysis used a structured coding framework. Univariate logistic regression models were used to estimate the odds of each hypothesised element occurring in 2016 compared with 2008 and Wald tests to assess the overall statistical significance of the year variable as the predictor.
The sample retrieved almost doubled between 2008 (n = 882) and 2016 (n = 1738). We found a significant increase in the proportion of anti-stigmatising articles (odds ratio (OR) 2.26 (95% confidence interval (CI) 1.86–2.74)) and a significant decrease in stigmatising articles (OR 0.62 (95% CI 0.51–0.75)). Reports on all diagnoses except for schizophrenia were more often anti-stigmatising than stigmatising.
This is the first clear evidence of improvement in coverage since the start of Time to Change. However, coverage of schizophrenia may be less affected by this positive shift than that of other diagnoses. The increase in the level of coverage identified in 2016 requires further investigation, as it may also influence public conceptualisation of what constitutes mental illness, attitudes to mental illness in general and/or specific diagnoses. While most anti-stigma programmes are not diagnosis specific, we suggest their evaluation would benefit from a diagnosis specific approach to allow fuller interpretation of their effects. This could include media analysis driven by hypotheses based on diagnoses to ascertain whether variations by diagnosis over time occur both in the nature and in the proportion of coverage.
Circulating 25-hydroxy vitamin D (25(OH)D) is related to decreased rates of gastrointestinal and ear infections in school-age children. Vitamin D-binding protein (DBP) transports 25(OH)D and exerts immunological functions; however, it is unknown whether DBP is associated with infectious morbidity in children. We quantified plasma DBP concentrations in 540 school-age children at the time of recruitment into a cohort study in Bogotá, Colombia and obtained daily information on infectious morbidity symptoms and doctor visits during the school year. We compared the incidence rates of gastrointestinal and respiratory symptoms across quartiles of DBP concentration by estimating adjusted incidence rate ratios (IRRs) with 95% confidence interval (CI). We also estimated the per cent of the associations between DBP and morbidity that were mediated through 25(OH)D using a counterfactual frame. Mean ± s.d. DBP concentration was 2650 ± 1145 nmol/l. DBP was inversely associated with the rates of diarrhoea with vomiting (IRR for quartiles 2–4 vs. 1 = 0.48; 95% CI 0.25–0.92; P = 0.03) and earache/ear discharge with fever (IRR for quartiles 2–4 vs. 1 = 0.29; 95% CI 0.12–0.71; P = 0.006). The DBP–morbidity associations were not mediated through 25(OH)D. We conclude that plasma DBP predicts lower incidence of gastrointestinal and ear infections in school-age children independent of 25(OH)D.
Neck dissection is associated with post-operative shoulder dysfunction in a substantial number of patients, affecting quality of life and return to work. There is no current UK national practice regarding physiotherapy after neck dissection.
Nine regional centres were surveyed to determine their standard physiotherapy practice pre- and post-neck dissection, and to determine pre-emptive physiotherapy for any patients.
Eighty-nine per cent of centres never arranged any pre-emptive physiotherapy for any patients. Thirty-three per cent of centres offered routine in-patient physiotherapy after surgery. No centres offered out-patient physiotherapy for all patients regardless of symptoms. Seventy-eight per cent offered physiotherapy for patients with any symptoms, with 11 per cent offering physiotherapy for those with severe dysfunction only. Eleven per cent of centres never offered physiotherapy for any dysfunction.
The provision of physiotherapy is most commonly reactive rather than proactive, and usually driven by patient request. There is little evidence of pre-arranged physiotherapy for patients to treat or prevent shoulder dysfunction in the UK.
Arachidonic acid (ARA) and DHA, supplied primarily from the mother, are required for early development of the central nervous system. Thus, variations in maternal ARA or DHA status may modify neurocognitive development. We investigated the relationship between maternal ARA and DHA status in early (11·7 weeks) or late (34·5 weeks) pregnancy on neurocognitive function at the age of 4 years or 6–7 years in 724 mother–child pairs from the Southampton Women’s Survey cohort. Plasma phosphatidylcholine fatty acid composition was measured in early and late pregnancy. ARA concentration in early pregnancy predicted 13 % of the variation in ARA concentration in late pregnancy (β=0·36, P<0·001). DHA concentration in early pregnancy predicted 21 % of the variation in DHA concentration in late pregnancy (β=0·46, P<0·001). Children’s cognitive function at the age of 4 years was assessed by the Wechsler Preschool and Primary Scale of Intelligence and at the age of 6–7 years by the Wechsler Abbreviated Scale of Intelligence. Executive function at the age of 6–7 years was assessed using elements of the Cambridge Neuropsychological Test Automated Battery. Neither DHA nor ARA concentrations in early or late pregnancy were associated significantly with neurocognitive function in children at the age of 4 years or the age of 6–7 years. These findings suggest that ARA and DHA status during pregnancy in the range found in this cohort are unlikely to have major influences on neurocognitive function in healthy children.
Due to the interlocking nature of the ovine cervix semen deposition during cervical insemination takes place at the external cervical os resulting in commercially unacceptable conception rates when using frozen/thawed semen. During natural mating it is not known whether the cervix plays a pro-active role in the transport of semen into the uterine lumen. Endogenous and seminal prostaglandins and coitally-released oxytocin may contribute to the stimulation of the cervix and enhance the capture and movement of semen through the cervical canal. Electromyographical studies showed spontaneous motility of the ovine cervix and uterus with the greatest activity recorded during the periovulatory period (Garcia-Villar et al., 1982). Recent advances in fibre-optics and video technology allowed us to make direct observations and time-sequence recordings of cervical activity in fully conscious ewes under minimal restraint. The aim of the study was to observe and record for the first time the response of the external os cervix before and immediately after ram stimulation both with and without intromission, during artificial deposition of semen and after administration of exogenous oxytocin.
Extrapolate (EX-ante Tool for RAnking POLicy AlTErnatives) is a decision support tool to assess the impact of policy measures on different target groups. It is designed to serve as a “filter” that, given the broad characteristics of the population, allows the user to sift through different policy measures to assess ex ante the broad potential impacts of these before deciding to look at particular policy options in more detail. Extrapolate models, in a very simple way, the impact of changes on constraints facing potential beneficiary groups, and how these may affect outcomes and their livelihood status. Extrapolate now makes use of mapping facilities from another decision-support tool, PRIMAS (Poverty Reduction Intervention Mapping in Agricultural Systems), that allows the user to match characteristics of particular technological options and constraints with the spatial characteristics of particular target groups in the landscape.
In previous studies (Mylne et al, 1992; McKelvey et al, 1997)) we have shown that the recovery of sheep embryos via the cervix can be facilitated by combining topical application of prostaglandin E2 (PGE2) to the external os cervix with systemic oestradiol treatment (E2) to dilate the cervix. The combined PGE2 and E2 treatment did not inhibit early embryo development (McEvoy et al, 1996) but conceptus viability was not determined. The objective of the present study was to test the viability of embryos recovered transcervically following dilation of the cervix with exogenous hormones and provide quantative data on their subsequent ability to establish normal pregnancies.
The livestock sector is one of the fastest growing subsectors of the agricultural economy and, while it makes a major contribution to global food supply and economic development, it also consumes significant amounts of natural resources and alters the environment. In order to improve our understanding of the global environmental impact of livestock supply chains, the Food and Agriculture Organization of the United Nations has developed the Global Livestock Environmental Assessment Model (GLEAM). The purpose of this paper is to provide a review of GLEAM. Specifically, it explains the model architecture, methods and functionality, that is the types of analysis that the model can perform. The model focuses primarily on the quantification of greenhouse gases emissions arising from the production of the 11 main livestock commodities. The model inputs and outputs are managed and produced as raster data sets, with spatial resolution of 0.05 decimal degrees. The Global Livestock Environmental Assessment Model v1.0 consists of five distinct modules: (a) the Herd Module; (b) the Manure Module; (c) the Feed Module; (d) the System Module; (e) the Allocation Module. In terms of the modelling approach, GLEAM has several advantages. For example spatial information on livestock distributions and crops yields enables rations to be derived that reflect the local availability of feed resources in developing countries. The Global Livestock Environmental Assessment Model also contains a herd model that enables livestock statistics to be disaggregated and variation in livestock performance and management to be captured. Priorities for future development of GLEAM include: improving data quality and the methods used to perform emissions calculations; extending the scope of the model to include selected additional environmental impacts and to enable predictive modelling; and improving the utility of GLEAM output.
Observations made with the Infrared Astronomical Satellite (IRAS) showed the existence of a set of K stars with excess emission at 60 μ. The brightest star in the group is δ And (K3 III). Spectra of δ And have been obtained with the International Ultraviolet Explorer (IUE) in both the long and short wavelength regions. These spectra show several features unusual in a K giant as cool as δ And, in particular, emission from CIV, MgII h and k lines with blue wings stronger than the red and MgII absorption blue shifted to up to 300 km s−1. Overall δ And is similar to the known hybrid bright giant α TrA (K4 II). We have discovered the first ‘hybrid’ giant star. The IRAS observations are interpreted in terms of a cool (∼100 K) dust cloud surrounding δ And - a spectroscopic binary system- and a third component at 1200 A.U.
The net mass budget is estimated for the western part of the Ross Ice Shelf drainage system. The area of the system is (1.75±0.26) × 106 km.2, and the drainage periphery extends along the eastern flank of the Trans-Antarctic Mountains between lat. 77° 58′ S., long. 164° 37′ E. and lat. 85° 27′ S., long. 147°50′ discharge is estimated from vertical cross-sections and corresponding ice-movement data for eight outlet glaciers. Free-air gravity anomalies, corrected for the effect of terrain above the glacier surface, are used to determine cross-sections of valleys by comparison with theoretical gravity profiles for several two-dimensional valley models. These data provide a basis for estimating the rate of ice discharge from the plateau, which is compared with the estimated rate of net accumulation at the surface, to determine the net budget of the ice sheet in the region. Representative mean rates of ice discharge measured in different types of glaciers are approximately 0.25 × 1015 g. km.−1 yr.−1 in outlet glaciers with large basins, and 0.05 × 1015 g. km.−1 yr.−1 in outlet glaciers with small basins. Taking into account the snowshcd area and the rate of accumulation, the rate of ice discharge in cirque and piedmont glaciers is estimated at about 0.02 × 1015 g. km.−1 yr.−1 The difference ((48±29) × 1015 g. yr.−1) between mass input ((96±25) × 1015 g. yr.−1) and mass output ((48±15) × 1015 g. yr.−1) is large enough relative to the estimated standard error to indicate a probable positive net budget.
Control of glyphosate-resistant (GR) horseweed in soybean with glyphosate (900 g ai ha−1) plus saflufenacil (25 gaiha−1) has been variable. The objective of this research was to determine the effect of GR horseweed height, density, and time of day (TOD) at application on saflufenacil plus glyphosate efficacy in soybean. All experiments were completed six times during a 2 yr period (2014, 2015) in fields previously confirmed with GR horseweed. Applications from 0900 to 2100 hours provided optimal control of GR horseweed 8 WAA. Soybean yield paralleled GR horseweed control with the highest yield of 3000kgha−1 at 1500 hours, and the lowest yield of 2400kgha−1 at 0600 hours. The height and density of GR horseweed at application had minimal effect on saflufenacil efficacy. Saflufenacil provided>99% control of GR horseweed when applied to small plants and low densities; however, control decreased to 95% when>25 cm tall, and to 96% in densities>800 plants m−2 at 6 WAA due to some plant regrowth. TOD of application had a greater influence on GR horseweed control with saflufenacil than height or density. To optimize control of GR horseweed, saflufenacil should be applied during daytime hours to small plants at low densities. Optimizing GR horseweed control minimizes weed seed return and weed interference.
The control of glyphosate-resistant (GR) horseweed (Conyza canadensis) in soybean has been variable with glyphosate plus saflufenacil. The objective of this research was to determine the biologically effective rate (BER) of saflufenacil, saflufenacil mixed with glyphosate, and metribuzin mixed with saflufenacil and glyphosate applied preplant (PP) for the control of GR horseweed in no-till soybean; a study was conducted to determine each of the three treatments. For each study, seven field sites infested with GR horseweed were used over a 2-yr period (2014, 2015). Saflufenacil alone at 25 and 36 g ai ha–1 provided 90 and 95% control of GR Horseweed 8 wk after application, while the BER to achieve 98% control was outside of the treatment range tested. The saflufenacil plus glyphosate (900 g ai ha–1) BER experiment found less saflufenacil was required as 25, 34, and 47 g ha–1 provided 90, 95, and 98% control of GR horseweed respectively. The metribuzin BER experiment found 61, 261, and 572 g ha–1 was required to provide 90, 95 and 98% control of GR horseweed, respectively, mixed with saflufenacil (25 g ha–1) and glyphosate (900 g ha–1). The addition of metribuzin with the recommended rate of saflufenacil (25 g ha–1) plus glyphosate improved control and a second effective herbicide mode of action for the control of GR horseweed. The use of a threeway herbicide mixture can be an effective weed management strategy to control GR horseweed in soybean.
Laboratory tasks to delineate anxiety disorder features are used to refine classification and inform our understanding of etiological mechanisms. The present study examines laboratory measures of response inhibition, specifically the inhibition of a pre-potent motor response, in clinical anxiety. Data on associations between anxiety and response inhibition remain inconsistent, perhaps because of dissociable effects of clinical anxiety and experimentally manipulated state anxiety. Few studies directly assess the independent and interacting effects of these two anxiety types (state v. disorder) on response inhibition. The current study accomplished this goal, by manipulating state anxiety in healthy and clinically anxious individuals while they complete a response inhibition task.
The study employs the threat-of-shock paradigm, one of the best-established manipulations for robustly increasing state anxiety. Participants included 82 adults (41 healthy; 41 patients with an anxiety disorder). A go/nogo task with highly frequent go trials was administered during alternating periods of safety and shock threat. Signal detection theory was used to quantify response bias and signal-detection sensitivity.
There were independent effects of anxiety and clinical anxiety on response inhibition. In both groups, heightened anxiety facilitated response inhibition, leading to reduced nogo commission errors. Compared with the healthy group, clinical anxiety was associated with excessive response inhibition and increased go omission errors in both the safe and threat conditions.
Response inhibition and its impact on go omission errors appear to be a promising behavioral marker of clinical anxiety. These results have implications for a dimensional view of clinical anxiety.
Current calibration methods for single and replicate 14C dates are compared. Various forms of tabular and graphic output are discussed. Results from all the methods show reasonable agreement but further methodological development and improvements in computer output are required. Comparison of existing techniques for a series of non-contemporaneous dates showed less agreement amongst participants on this issue. We recommend that calibrated dates should be presented as a combination of graphs and ranges, in preference to mean and standard deviation.
This study aimed to determine whether age at introduction of solid foods was associated with feeding difficulties at 3 years of age. The present study was carried out using data from the Southampton Women’s Survey (SWS). Women enrolled in the SWS who subsequently became pregnant were followed-up during pregnancy and postpartum, and the offspring have been studied through childhood. Maternal socio-demographic and anthropometric data and child anthropometric and feeding data were collected through interviews and self-administered questionnaires. When the children were 3 years of age, mothers/carers rated six potential child feeding difficulty questions on a four-point Likert scale, including one general question and five specific feeding difficulty questions. Age at introduction of solids as a predictor of feeding difficulties was examined in 2389 mother–child pairs, adjusting for child (age last breast fed, sex, gestation) and maternal characteristics (parity, pre-pregnancy BMI, age, education, employment, parenting difficulties, diet quality). The majority of mothers/carers (61 %) reported some feeding difficulties (general feeding difficulty question) at 3 years of age, specifically with their child eating enough food (61 %), eating the right food (66 %) and being choosy with food (74 %). Children who were introduced to solids ≥6 months had a lower risk of feeding difficulties (RR 0·73; 95 % CI 0·59, 0·91, P=0·004) than children who were introduced to solids between 4 and 6 months. No other significant associations were found. There were few associations between feeding difficulties in relation to age at introduction of solid foods. However, general feeding difficulties were less common among infants introduced to solid foods ≥6 months of age.
I describe a project to survey ∼ 13 square degrees of the sky at 15μm and 90μm with the Infrared Space Observatory (ISO). The European Large Area ISO Survey (ELAIS) is a collaboration involving 19 European institutes (in addition to the authors and others at their institutes the following people and others their institutes are involved I. Gonzalez-Serrano, E. Kontizas, K. Mandolesi, J. Masegosa, K. Mattila, H. Norgaard-Nielsen, I. Perez-Fournon, M. Ward) and is the largest open time project being undertaken by ISO. We expect to detect at least 1000 extra-galactic objects and a similar number of Galactic sources.