To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
This study reports the effects of a high-fat (HF) diet on the iron (Fe) status of growing rats over 8 weeks. Tissue Fe levels were analysed by atomic absorption spectrophotometry, and whole-body adiposity was measured by dual-energy X-ray absorptiometry. Histopathology and morphometry of adipose tissue were performed. Liver homogenates were used for measuring ferroportin (Fpn)-1 protein levels by immunoblotting, and transcript levels were used for Fe genes measured by real-time PCR. Tissue Fe pools were fit to a compartmental biokinetic model in which Fe was assessed using 14 compartments and 27 transfer constants (kj,i from tissue “i” to tissue “j”) adapted from the International Commission on Radiological Protection (ICRP) 69. Ten kj,i were calculated from the experimental data using nonlinear regression, and 17 were estimated by allometry according to the formula kj,i = a · Mb. Validation of the model was carried out by comparing predicted and analysed Fe pool sizes in red blood cells (RBCs), the liver and the spleen. Body adiposity was negatively associated with serum Fe levels and positively associated with liver Fe stores. An inferred increase in Fe transfer from bone marrow to the liver paralleled higher hepatic Fe concentrations and ferritin heavy-chain mRNA levels in the HF diet-fed animals, suggesting that liver Fe accumulation occurred at least in part due to a favoured liver RBC uptake. If this feeding condition were to be prolonged, impaired Fe decompartmentalization may occur, ultimately resulting in dysmetabolic Fe overload.
Tranexamic acid (TXA) is an antifibrinolytic agent shown to reduce morbidity and mortality in hemorrhagic shock. It has potential use in prehospital and wilderness medicine; however, in these environments, TXA is likely to be exposed to fluctuating and extreme temperatures. If TXA degrades under these conditions, this may reduce antifibrinolytic effects.
This study sought to determine if repetitive temperature derangement causes degradation of TXA.
Experimental samples underwent either seven days of freeze/thaw or heating cycles and then were analyzed via mass spectrometry for degradation of TXA. An internal standard was used for comparison between experimental samples and controls. These samples were compared to room temperature controls to determine if fluctuating extreme temperatures cause degradation of TXA.
The coefficient of variability of ratios of TXA to internal standard within each group (room temperature, freeze, and heated) was less than five percent. An independent t-test was performed on freeze/thaw versus control samples (t = 2.77; P = .17) and heated versus control samples (t = 2.77; P = .722) demonstrating no difference between the groups.
These results suggest that TXA remains stable despite repeated exposure to extreme temperatures and does not significantly degrade. These findings support the stability of TXA and its use in extreme environments.
Secondary plant compounds have shown bioactivity against multi-drug resistant Haemonchus contortus in small ruminants. This study screened 51 strains of birdsfoot trefoil (BFT, Lotus corniculatus) crude aqueous extracts (BFT-AqE) for anti-parasitic activity in vitro against egg hatching, and of those 51 strains, 13 were selected for further testing of motility of first (L1) and third stage (L3) larvae, and exsheathment of L3. Proanthocyanidin content ranged between 1.4 and 63.8 mg PAC g−1 powder across the 51 BFT strains. When tested against egg hatching, 21 of the 51 aqueous extracts had an EC50 of 1–2 mg powder mL−1, 70% of the strains were >90% efficacious at 6 mg powder mL−1 and 11 of the strains were 100% efficacious at 3 mg powder mL−1 BFT-AqE. Across the 13 strains tested against L3, efficacy ranged from 0 to 75% exsheathment inhibition, and 17 to 92% L3 motility inhibition at a concentration of 25 mg powder mL−1 BFT-AqE. There was no correlation between the PAC content of BFT powders and the anti-parasitic activity of aqueous extracts, therefore other secondary compounds may have contributed to the observed anti-parasitic effects. Further testing of BFT using bioactivity-driven fractionation and screening of BFT populations for the identified anti-parasitic compounds is needed.
National policies target healthcare-associated infections using medical claims and National Healthcare Safety Network surveillance data. We found low concordance between the 2 data sources in rates and rankings for surgical site infection following colon surgery in 155 hospitals, underscoring the limitations in evaluating hospital quality by claims data.
Parenting, Eating and Activity for Child Health (PEACH) is a multi-component lifestyle intervention for families with overweight and obese children. PEACH was translated from an efficacious randomised-controlled trial (RCT) and delivered at scale as PEACH Queensland (QLD) in Queensland, Australia. The aim of this study is to explore pre–post changes in parenting, and child-level eating, activity and anthropometry, in the PEACH QLD service delivery project. PEACH QLD enrolled 926 overweight/obese children (817 families). Pre-programme evaluation was completed for 752 children and paired pre–post-programme evaluation data were available for 388 children. At baseline, children with pre–post-programme data were (mean) 8·8 years old, and at follow-up were 9·3 years old, with mean time between pre–post-programme measures of 0·46 years. Outcomes reflected each domain of the PEACH programme: parenting, eating behaviour of the child and activity behaviours (means reported). Parents reported improvements in parenting self-efficacy (3·6 to 3·7, P=0·001). Children had improved eating behaviours: eating more daily serves of vegetables (2·0 to 2·6, P=0·001) and fewer non-milk sweetened beverages (0·9 to 0·6, P=0·001) and discretionary foods (2·2 to 1·5, P=0·001). Children spent more time in moderate-to-vigorous physical activity (86 to 105 min/d, P=0·001) and less time in sedentary screen-based behaviours (190 to 148 min/d, P=0·001). Consequently, there were significant improvements in mean BMIz (−0·112; P<0·001) and weight status (healthy weight/overweight/obese/morbidly obese prevalence from 0/22/33/45 % to 2/27/34/37 %, P<0·001). When delivered at scale, PEACH remains an effective family-based, multi-component, lifestyle weight management programme for overweight and obese children whose families engage in the programme.
Migration has been reported to be associated with higher prevalence of mental disorders and suicidal behaviour.
To examine the prevalence of emotional and behavioural difficulties, suicidal ideation and suicide attempts among migrant adolescents and their non-migrant peers.
A school-based survey was completed by 11 057 European adolescents as part of the Saving and Empowering Young Lives in Europe (SEYLE) study.
A previous suicide attempt was reported by 386 (3.6%) adolescents. Compared with non-migrants, first-generation migrants had an elevated prevalence of suicide attempts (odds ratio (OR) 2.08; 95% CI 1.32–3.26; P=0.001 for European migrants and OR 1.86; 95% CI 1.06–3.27; P=0.031 for non-European migrants) and significantly higher levels of peer difficulties. Highest levels of conduct and hyperactivity problems were found among migrants of non-European origin.
Appropriate mental health services and school-based supports are required to meet the complex needs of migrant adolescents.
To examine dietary Na and K intake at eating occasions in Australian adults and identify the contribution of major food sources to Na and K at different eating occasions.
Secondary analysis of 24 h recall diet data from the Australian Health Survey (2011–2013).
Nationally representative survey in Australia.
Male and female Australians aged 18–84 years (n 7818).
Dinner contributed the greatest proportion to total daily Na intake (33 %) and K intake (35 %). Na density was highest at lunch (380 mg/MJ) and K density highest at between-meal time eating occasions (401 mg/MJ). Between-meal time eating occasions provided 20 % of daily Na intake and 26 % of daily K intake. The major food group sources of Na were different at meal times (breads and mixed dishes) compared with between-meal times (cakes, muffins, scones, cake-type desserts). The top food group sources of K at meal times were potatoes and unprocessed meat products and dishes.
Foods which contributed to Na and K intake differed according to eating occasion. Major food sources of Na were bread and processed foods. Major food sources of K were potatoes and meat products and dishes. Public health messages that emphasise meal-based advice and diet patterns high in vegetables, fruits and unprocessed foods may also aid reduction in dietary Na intake and increase in dietary K intake.
The scholarly dissemination of innovative medical education practices helps broaden the reach of this type of work, allowing scholarship to have an impact beyond a single institution. There is little guidance in the literature for those seeking to publish program evaluation studies and innovation papers. This study aims to derive a set of evidence-based features of high-quality reports on innovations in emergency medicine (EM) education.
We conducted a scoping review and thematic analysis to determine quality markers for medical education innovation reports, with a focus on EM. A search of MEDLINE, EMBASE, ERIC, and Google Scholar was augmented by a hand search of relevant publication guidelines, guidelines for authors, and website submission portals from medical education and EM journals. Study investigators reviewed the selected articles, and a thematic analysis was conducted.
Our search strategy identified 14 relevant articles from which 34 quality markers were extracted. These markers were grouped into seven important themes: goals and need for innovation, preparation, innovation development, innovation implementation, evaluation of innovation, evidence of reflective practice, and reporting and dissemination. In addition, multiple outlets for the publication of EM education innovations were identified and compiled.
The publication and dissemination of innovations are critical for the EM education community and the training of health professionals. We anticipate that our list of innovation report quality markers will be used by EM education innovators to support the dissemination of novel educational practices.
A key skill for successful clinician educators is the effective dissemination of scholarly innovations and research. Although there are many ways to disseminate scholarship, the most accepted and rewarded form of educational scholarship is publication in peer-reviewed journals.
This paper provides direction for emergency medicine (EM) educators interested in publishing their scholarship via traditional peer-reviewed avenues. It builds upon four literature reviews that aggregated recommendations for writing and publishing high-quality quantitative and qualitative research, innovations, and reviews. Based on the findings from these literature reviews, the recommendations were prioritized for importance and relevance to novice clinician educators by a broad community of medical educators.
The top items from the expert vetting process were presented to the 2016 Canadian Association of Emergency Physicians (CAEP) Academic Symposium Consensus Conference on Education Scholarship. This community of EM educators identified the highest yield recommendations for junior medical education scholars. This manuscript elaborates upon the top recommendations identified through this consensus-building process.
Anxiety and depression symptoms change over the lifespan and older adults use different terms to describe their mental health, contributing to under identification of anxiety and depression in older adults. To date, research has not examined these differences in younger and older samples with comorbid anxiety and depression.
One hundred and seven treatment-seeking participants (47 older, 60% female, and 60 younger, 50% female) with anxiety and mood disorders completed the Anxiety Disorders Interview Schedule and a symptom checklist to examine differences in symptom severity, symptom profiles and terms used to describe anxiety and mood.
The findings indicated several key differences between the presentation and description of anxiety and depression in younger and older adults. Older adults with Social Phobia reported fearing a narrower range of social situations and less distress and interference. Older adults with Generalized Anxiety Disorder (GAD) reported less worry about interpersonal relationships and work/school than younger adults, however, there were no differences between age groups for behavioral symptoms endorsed. Further older adults reported phobia of lifts/small spaces more frequently than younger adults. Depressed older depressed adults also reported more anhedonia compared to younger adults, but no differences in terms of reported sadness were found. Finally, older and younger adults differed in their descriptions of symptoms with older adults describing anxiety as feeling stressed and tense, while younger adults described anxiety as feeling anxious, worried or nervous.
Clinicians need to assess symptoms broadly to avoid missing the presence of anxiety and mood disorders especially in older adults.
The Geriatric Anxiety Inventory is a 20-item geriatric-specific measure of anxiety severity. While studies suggest good internal consistency and convergent validity, divergent validity from measures of depression are weak. Clinical cutoffs have been developed that vary across studies due to the small clinical samples used. A six-item short form (GAI-SF) has been developed, and while this scale is promising, the research assessing the psychometrics of this scale is limited.
This study examined the psychometric properties of GAI and GAI-SF in a large sample of 197 clinical geriatric participants with a comorbid anxiety and unipolar mood disorder, and a non-clinical control sample (N = 59).
The internal consistency and convergent validity with other measures of anxiety was adequate for GAI and GAI-SF. Divergent validity from depressive symptoms was good in the clinical sample but weak in the total and non-clinical samples. Divergent validity from cognitive functioning was good in all samples. The one-factor structure was replicated for both measures. Receiver Operating Characteristic analyses indicated that the GAI is more accurate at identifying clinical status than the GAI-SF, although the sensitivity and specificity for the recommended cutoffs was adequate for both measures.
Both GAI and GAI-SF show good psychometric properties for identifying geriatric anxiety. The GAI-SF may be a useful alternative screening measure for identifying anxiety in older adults.
The central Mesa Verde and the northern Rio Grande regions housed two of the densest populations of prehispanic Pueblo peoples in the North American Southwest. We plot incidence of violent trauma on human bone through time in each region. Such violence peaked in the mid-A.D. 1100s in the central Mesa Verde, and in general was higher through time there than in the northern Rio Grande region. In the central Mesa Verde, but not in the northern Rio Grande, there is a tendency for violence to be greater in periods of low potential maize produccción per capita and high variance in maize produccción, though these structural tendencies were on occasion overridden by historical factors such as the expansion and demise of the Chacoan polity and the regional depopulation. Violence generally declined through time in the northern Rio Grande until the arrival of the Spanish, even as populations increased. We propose that this decline was due to the combination of increased social span of polities, the importance of inter-Pueblo sodalities, the nature of religious practice, “gentle commerce,“ and increased adherence to a set of nonviolent norms.
Shared values, public trust in an agency, and attitudes can influence support for successful conservation initiatives. To understand these relationships, this paper examines the role of social trust as a partial mediator between salient values similarity and attitudes toward wolves in south-western Alberta, Canada. Rural residents in this area face increasing wolf depredation on livestock. Data were obtained from a mail questionnaire (n = 566 respondents, response rate = 70%) sent to rural residents in three municipal districts in south-western Alberta. Attitudes were predicted to directly influence behavioural intention to support or oppose wolf management. Most respondents held slightly similar values as the management agency and minimally trusted the agency to effectively manage wolves. As predicted, social trust in the agency served as a partial mediator between salient value similarity and attitudes toward wolves. Salient value similarity was also a strong predictor of attitudes toward wolves. Attitudes toward wolves predicted behavioural support. Thus, social trust of the management agency can influence attitudes and management preferences concerning a species. When dealing with human-wildlife conflict, social trust should be examined to understand the context of the problem.
If many consider the United States to be a Christian nation, how does this affect individuals who are American citizens but not Christian? We test two major hypotheses: (1) Americans consider Christians to be more fully American than non-Christians. We examine whether Americans explicitly and implicitly connect being Christian with being a true American; and (2) Christian Americans are more likely to be patriotic and set exclusive boundaries on the national group than non-Christian Americans. Among non-Christians, however, those who want to be fully accepted as American will be more patriotic and set more exclusive boundaries to emulate prototypical Americans than non-Christians who place less emphasis on national group membership. We test these hypotheses using data from a survey and from an Implicit Association Test. We find that Americans in general associate being Christian with being a true American. For Christians, this is true both explicitly and implicitly. For non-Christians, only the implicit measure uncovers an association. We also found that non-Christians exhibit significantly more pro-national group behaviors when they desire being prototypical than when they do not.
In this work, experiments using a pendulum apparatus were conducted for two particles engaged in oblique, wetted collisions over a range of impact angles, impact velocities, coating thicknesses, liquid viscosities, particle materials, and particle radii. From previous studies on normal or head-on collisions, the two particles bounce apart if the Stokes number (a ratio of particle inertia to viscous forces) exceeds a critical value, whereas they stick together if the Stokes number is below this critical value. However, for oblique collisions, an additional outcome is observed at moderate Stokes numbers and impact angles, in which the spheres initially stick together, rotate as a doublet, and then separate due to centrifugal forces. We refer to this outcome as ‘stick–rotate–separate’. For subcritical Stokes numbers exhibiting this new outcome, the experimental results for the apparent coefficient of normal restitution and angle of rotation from impact to separation show only weak dependence on the fluid viscosity and thickness and the dry restitution coefficient, whereas they both decrease with increasing particle radius. These results are in contrast with those for supercritical Stokes numbers in which the spheres bounce upon impact. An accompanying theory based on lubrication forces, the glass transition of the liquid layer, and solid deformation and rebound agrees well with experimental results and gives insight into the observed trends.