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Non-adherence of medication still is a major problem among patients suffering from bipolar disorders.
Previous studies focused mainly on possible side-effects, attitudes and subjective well-being. Most scales concerning this issue have been developed by psychiatric experts and based on their knowledge not on the patients points of view.
The purpose of this study was to find out what kind of drug effects the patients themselves want.
2 focus-groups with 13 patients and In-depth interviews with 15 mania patients were conducted to collect information about subjective burden and symptoms of the illness. Content analyses of the transcriptions were performed and the results were used to develop a first draft of the questionnaire.
The final German test version consists of 32 items and is called “The Subjective Mania Scale”. The study of content-validity showed that all SMS items were considered to be important by more than 50% of the sample. Test-retest reliability and sensitivity to change were evaluated. All SMS-items showed a significant change between time-point 1 and 3.
The SMS-rating scale is a feasible, reliable and valid instrument for clinical trials among mania patients.
The elimination of unwanted catch in mixed species fisheries is technically challenging given the complexity of fish behaviour within nets. Most approaches to date have employed technologies that modify the nets themselves or use physical sorting grids within the gear. There is currently increasing interest in the use of artificial light to either deter fish from entering the net, or to enhance their escapement from within the net. Here, we evaluated the differences in catch retained in a standard otter trawl, relative to the same gear fitted with a square mesh panel, or a square mesh panel fitted with LEDs. We found that the selectivity of the gear differed depending on water depth. When using a square mesh panel in shallow depths of 29–40 m the unwanted bycatch of whiting and haddock was reduced by 86% and 58% respectively. In deep, darker water (45–95 m), no change in catch was observed in the square-mesh panel treatment, however when LEDs were added to the square-mesh panel, haddock and flatfish catches were reduced by 47% and 25% respectively. These findings demonstrate the potential to improve the performance of bycatch reduction devices through the addition of light devices to enhance selectivity. The results also highlight species-specific and site-specific differences in the performance of bycatch reduction devices, and hence a more adaptive approach to reduce bycatch is probably required to maximize performance.
Premenstrual dysphoric disorder (PMDD) is a new Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 diagnosis characterized by the cyclical emergence of emotional and physical symptoms in the luteal phase of the menstrual cycle, with symptom remission in the follicular phase. Converging evidence highlights the possibility of distinct subtypes of PMDD with unique pathophysiologies, but temporal subgroups have yet to be explored in a systematic way.
In the current work, we use group-based trajectory modeling to identify unique trajectory subgroups of core emotional and total PMDD symptoms across the perimenstrual frame (days −14 to +9, where day 0 is menstrual onset) in a sample of 74 individuals prospectively diagnosed with DSM-5 PMDD.
For the total daily symptom score, the best-fitting model was comprised of three groups: a group demonstrating moderate symptoms only in the premenstrual week (65%), a group demonstrating severe symptoms across the full 2 weeks of the luteal phase (17.5%), and a group demonstrating severe symptoms in the premenstrual week that were slow to resolve in the follicular phase (17.5%).
These trajectory groups are discussed in the context of the latest work on the pathophysiology of PMDD. Experimental work is needed to test for the presence of possible pathophysiologic differences in trajectory groups, and whether unique treatment approaches are needed.
This study examines the impacts of two types of advertising content—healthy eating and anti-obesity advertising—on the demand for healthy and unhealthy food and beverage items. We show that differentiating consumers by weight is crucial in fully understanding the effects of advertising content on food and beverage demand. We find that among overweight individuals, anti-obesity advertisements are more effective than healthy eating advertisements at reducing the demand for unhealthy items and increasing the demand for healthy items. Furthermore, the magnitude of this effect increases with BMI. We discuss possible explanations and policy implications based on our results.
New therapeutic strategies have been established in chronic wound healing procedures, such as the use of platelet-rich plasma (PRP). There is currently still uncertainty about the effectiveness, cost-effectiveness and real safety of PRP in promoting chronic wound healing and what specific types of chronic wounds can benefit most from its use.
We conducted a systematic review of available scientific literature on the effectiveness, safety and cost-effectiveness of PRP compared to placebo, standard care or alternative topical therapies for the treatment of chronic wounds in adults. Overall effect size was estimated through a meta-analysis. A cost-effectiveness analysis was conducted using a Markov model which simulates the costs and health outcomes of individuals for a 5-year horizon, from the perspective of the Spanish National Health Service (NHS) for the PRP versus standard treatment in patients with diabetic foot ulcers. The effectiveness measure was quality-adjusted life years (QALYs). We ran extensive sensitivity analyses, including a probabilistic sensitivity analysis.
Sixteen RCTs and four observational studies were included for the effectiveness and safety meta-analysis. The primary outcome was the proportion of chronic wounds completely healed: 143 patients out of 334 (42.8 percent) were cured in the standard treatment arm and 251 patients out of 375 (66.9 percent) in the PRP arm, relative risk (RR) 1.68 (95% CI: 1.22–2.31). It was unclear whether there was a difference in the risk of infection (RR 0.53, 95% CI: 0.10–2.71) or adverse events (RR 1.05, 95% CI: 0.29–3.88) between PRP and standard care. Three studies were considered for the cost-effectiveness analysis. In the base case analysis, PRP led to higher QALYs and healthcare costs with an estimated incremental cost-effectiveness ratio (ICER) of EUR 41,767 (USD 48,323)/QALY.
PRP treatment is more expensive and more effective than standard treatment. The estimated ICER is above the acceptability threshold in Spain.
The US National Center for Health Statistics (NCHS) defines fetal death as “death prior to the complete expulsion or extraction from the mother of a product of human conception, irrespective of the duration of pregnancy and which is not an induced termination of pregnancy.” This definition is subcategorized by the gestational age at which the demise occurred: embryonic death at ≤ 12+6 weeks, early fetal death at 13–19+6 weeks’ gestation, intermediate fetal death at 20–27+6 weeks’ gestation, and late fetal death at ≥28 weeks’ gestation. The NCHS recommends reporting fetal deaths at ≥ 20 weeks’ gestation or, should the gestational age be unknown, a fetal weight of ≥ 350 grams, which represents the 50th percentile of weight at 20 weeks. Excluded from the definition of fetal death and associated statistics are losses due to induction after previable premature rupture of membranes or terminations/inductions for lethal fetal anomalies.
Uma M. Reddy, Pregnancy & Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health & Human Development, Bethesda, MD, USA,
Jennifer Kaiser, Department of Obstetrics & Gynecology, University of Utah Hospital, Salt Lake City, UT, USA
The US National Center for Health Statistics (NCHS) defines fetal death as “death prior to the complete expulsion or extraction from the mother of a product of human conception, irrespective of the duration of pregnancy and which is not an induced termination of pregnancy.” This definition is subcategorized by the gestational age at which the demise occurred: embryonic death at ≥ 12+6 weeks, early fetal death at 13–19+6 weeks’ gestation, intermediate fetal death at 20–27+6 weeks’ gestation, and late fetal death at ≥28 weeks’ gestation. The NCHS recommends reporting fetal deaths at ≥20 weeks’ gestation or, should the gestational age be unknown, a fetal weight of ≥ 350 grams, which represents the 50th percentile of weight at 20 weeks. Excluded from the definition of fetal death and associated statistics are losses due to induction after previable premature rupture of membranes or terminations/inductions for lethal fetal anomalies.
Though many terms have come to represent fetal death among parent groups, researchers, and medical professionals, stillbirth is widely accepted among lay populations, and has been adopted by the American College of Obstetricians and Gynecologists (ACOG) and research groups to define fetal deaths ≥ 20 weeks’ gestation.
Other countries may use definitions and categorizations that are slightly different to these.
Worldwide, stillbirth at ≥ 28 weeks’ gestation complicates approximately 3.2 million pregnancies annually, with 98% occurring in low- and middle-income countries. India, Pakistan, China, Nigeria, and Bangladesh have the five highest rates of stillbirth. In the US, an estimated 26,000 stillbirths occur annually, or one in 160 pregnancies. The overall stillbirth rate in the US was unchanged between 2006 and 2012: 6.05 per 1000 births. The early stillbirth rate per 1000 births (20–27 weeks) in 2006 (3.10 per 1000 births) and 2012 (3.11 per 1000 births) as well as the late stillbirth rate (≥ 28 weeks) (2.96 per 1000 births in 2012 and 2.97 per 1000 births in 2006) were each unchanged. Compared to other developed countries, the stillbirth rate in the United States is among the highest.
Exposure to threat-related early life stress (ELS) has been related to vulnerability for stress-related disorders in adulthood, putatively via disrupted corticolimbic circuits involved in stress response and regulation. However, previous research on ELS has not examined both the intrinsic strength and flexibility of corticolimbic circuits, which may be particularly important for adaptive stress responding, or associations between these dimensions of corticolimbic dysfunction and acute stress response in adulthood.
Seventy unmedicated women varying in history of threat-related ELS completed a functional magnetic resonance imaging scan to evaluate voxelwise static (overall) and dynamic (variability over a series of sliding windows) resting-state functional connectivity (RSFC) of bilateral amygdala. In a separate session and subset of participants (n = 42), measures of salivary cortisol and affect were collected during a social-evaluative stress challenge.
Higher severity of threat-related ELS was related to more strongly negative static RSFC between amygdala and left dorsolateral prefrontal cortex (DLPFC), and elevated dynamic RSFC between amygdala and rostral anterior cingulate cortex (rACC). Static amygdala-DLPFC antagonism mediated the relationship between higher severity of threat-related ELS and blunted cortisol response to stress, but increased dynamic amygdala-rACC connectivity weakened this mediated effect and was related to more positive post-stress mood.
Threat-related ELS was associated with RSFC within lateral corticolimbic circuits, which in turn was related to blunted physiological response to acute stress. Notably, increased flexibility between the amygdala and rACC compensated for this static disruption, suggesting that more dynamic medial corticolimbic circuits might be key to restoring healthy stress response.
Ashley Smith lived and died at a confluence of legal sanctions and correctional policy, norms, decisions, and indifference. This article approaches her incarceration primarily through a particular articulation of legal pluralism. Martha-Marie Kleinhans and Roderick A. Macdonald argue legal subjects should be understood as creating law in relationship with laws/norms. The Correctional Service of Canada (CSC) treated Smith as an excluded legal subject through practices of isolation, but the correctional norms evolving in relationship with her resultant distress simultaneously indicate CSC treated Smith as if she were effectively a law-producer, capable of changing policy. However, treating her as a source of norm-creation assumes equality/power Smith did not have. The story leading to Smith’s death in custody illustrates two primary themes regarding the production of law/norms. First, the legal subject within a critical legal pluralism should be widened to encompass those who act within/against (and are acted upon by) legal/normative systems characterized by extreme power disparities. Drawing on Martha Fineman’s vulnerability analysis, I argue such legal subjects should be understood/treated as vulnerable, implicating an enlarged role for institutions. Second, I follow the broad dictates of a critical legal pluralism to demonstrate how the reciprocally constitutive (though unequal) relationship between the legal subject and legal/normative orders manifested in Smith’s incarceration and attendant changes to correctional norms.
In this study, we isolate and analyse a new set of microsatellite loci for Cattleya walkeriana. Twenty-two primer pairs were screened for C. walkeriana (n = 32) and assessed for their transferability to Cattleya loddigesii (n = 12) and Cattleya nobilior (n = 06). All loci amplified for C. walkeriana; however, for C. loddigesii and C. nobilior, four and five primers, respectively, did not present amplification. The polymorphic loci presented between 2 and 13 alleles per locus for both C. walkeriana and C. loddigesii, with respective averages of 5.1 and 4.2. For C. nobilior, we found between two and five alleles per locus, with an average of 2.6. For C. walkeriana, observed heterozygosity varied from 0.100 to 0.966, whereas expected heterozygosity ranged from 0.097 to 0.900. The observed and expected heterozygosity for C. loddigesii and C. nobilior were also estimated. We found no significant linkage disequilibrium between any pair of loci, and evidence of null alleles at four loci (Cw16, Cw24, Cw30 and Cw31) for C. walkeriana. The combined power to exclude the first parent and combined non-exclusion probability of identity were 0.999 and 2.3 × 10−20, respectively. These new loci can be used in studies of germplasm resources, and assessments of genotypic and genetic diversity and population structure, thus improving the accuracy of such analyses and their applicability in the conservation and protection of these endangered species.
Catheter-associated urinary tract infections (CAUTIs) are among the most common hospital-acquired infections (HAIs). Reducing CAUTI rates has become a major focus of attention due to increasing public health concerns and reimbursement implications.
To implement and describe a multifaceted intervention to decrease CAUTIs in our ICUs with an emphasis on indications for obtaining a urine culture.
A project team composed of all critical care disciplines was assembled to address an institutional goal of decreasing CAUTIs. Interventions implemented between year 1 and year 2 included protocols recommended by the Centers for Disease Control and Prevention for placement, maintenance, and removal of catheters. Leaders from all critical care disciplines agreed to align routine culturing practice with American College of Critical Care Medicine (ACCCM) and Infectious Disease Society of America (IDSA) guidelines for evaluating a fever in a critically ill patient. Surveillance data for CAUTI and hospital-acquired bloodstream infection (HABSI) were recorded prospectively according to National Healthcare Safety Network (NHSN) protocols. Device utilization ratios (DURs), rates of CAUTI, HABSI, and urine cultures were calculated and compared.
The CAUTI rate decreased from 3.0 per 1,000 catheter days in 2013 to 1.9 in 2014. The DUR was 0.7 in 2013 and 0.68 in 2014. The HABSI rates per 1,000 patient days decreased from 2.8 in 2013 to 2.4 in 2014.
Effectively reducing ICU CAUTI rates requires a multifaceted and collaborative approach; stewardship of culturing was a key and safe component of our successful reduction efforts.
A new site with Lateglacial palaeosols covered by 0.8 - 2.4 m thick aeolian sands is presented. The buried soils were subjected to multidisciplinary analyses (pedology, micromorphology, geochronology, dendrology, palynology, macrofossils). The buried soil cover comprises a catena from relatively dry (’Nano’-Podzol, Arenosol) via moist (Histic Gleysol, Gleysol) to wet conditions (Histosol). Dry soils are similar to the so-called Usselo soil, as described from sites in NW Europe and central Poland. The buried soil surface covers ca. 3.4 km2. Pollen analyses date this surface into the late Allerød. Due to a possible contamination by younger carbon, radiocarbon dates are too young. OSL dates indicate that the covering by aeolian sands most probably occurred during the Younger Dryas. Botanical analyses enables the reconstruction of a vegetation pattern typical for the late Allerød. Large wooden remains of pine and birch were recorded.
The current study examines the impact of a nutrition rating system on consumers’ food purchases in supermarkets.
Aggregate sales data for 102 categories of food (over 60 000 brands) on a weekly basis for 2005–2007 from a supermarket chain of over 150 stores are analysed. Change in weekly sales of nutritious and less nutritious foods, after the introduction of a nutrition rating system on store shelves, is calculated, controlling for seasonality and time trends in sales.
One hundred and sixty-eight supermarket stores in the north-east USA, from January 2005 to December 2007.
Consumers purchasing goods at the supermarket chain during the study period.
After the introduction of the nutrition ratings, overall weekly food sales declined by an average of 3637 units per category (95 % CI –5961, –1313; P<0·01). Sales of less nutritious foods fell by 8·31 % (95 % CI –13·50, –2·80 %; P=0·004), while sales of nutritious foods did not change significantly (P=0·21); as a result, the percentage of food purchases rated as nutritious rose by 1·39 % (95 % CI 0·58, 2·20 %; P<0·01). The decrease in sales of less nutritious foods was greatest in the categories of canned meat and fish, soda pop, bakery and canned vegetables.
The introduction of the nutrition ratings led shoppers to buy a more nutritious mix of products. Interestingly, it did so by reducing purchases of less nutritious foods rather than by increasing purchases of nutritious foods. In evaluating nutrition information systems, researchers should focus on the entire market basket, not just sales of nutritious foods.
Farm-to-hospital (FTH) programs can potentially improve the economy of local communities and preserve the environment. Research on adoption of farm-to-hospital (FTH) programs is extremely limited in the agricultural and applied economics literature. Using data from our 2012 regional FTH program survey of hospital food-service directors in the Northeastern United States and from the U.S. Department of Agriculture, this study estimates a logit model to determine factors that influence a hospital's decision to adopt an FTH program. The empirical results indicate that specific hospital characteristics and agricultural factors significantly influence a hospital's decision to adopt.
Village chickens have been kept for millennia under patronage of smallholder farmers. Our study was intended at dissecting the signature of artificial selection and ecological variation on morphological structures of Ethiopian village chickens. This report was based on visual traits of 798 chickens and a concise one-to-one interview of 399 farmers for their preferences on chicken morphology. Significant population-specific differences in morphological counts were commonly found for rare morphological variants. Most of them were frequently seen in Jarso chickens, while some of them unique to Jarso chickens. This might be explained by the effect of location-specific evolutionary forces and differences in their breeding histories. The high within population variation in the frequency of morphological counts was observed among these panmictic chicken populations largely evolved under uncontrolled mating. Single comb was not (less) preferred by majority of the farmers (93.8 percent); it was thus present at a low frequency (26.7 percent). Farmers have shown high preference for yellow shank (42.3 percent), which was then frequently observed (61.1 percent). The reported reasons for morphological likeness were visual appeal, market demand and cultural and religious values. The absence of significant variation in preferences for chicken morphology among communities between the two study sites was attributed to their multifunctional needs.
The IntCal09 and Marine09 radiocarbon calibration curves have been revised utilizing newly available and updated data sets from 14C measurements on tree rings, plant macrofossils, speleothems, corals, and foraminifera. The calibration curves were derived from the data using the random walk model (RWM) used to generate IntCal09 and Marine09, which has been revised to account for additional uncertainties and error structures. The new curves were ratified at the 21st International Radiocarbon conference in July 2012 and are available as Supplemental Material at www.radiocarbon.org. The database can be accessed at http://intcal.qub.ac.uk/intcal13/.
High-quality data from appropriate archives are needed for the continuing improvement of radiocarbon calibration curves. We discuss here the basic assumptions behind 14C dating that necessitate calibration and the relative strengths and weaknesses of archives from which calibration data are obtained. We also highlight the procedures, problems, and uncertainties involved in determining atmospheric and surface ocean 14C/12C in these archives, including a discussion of the various methods used to derive an independent absolute timescale and uncertainty. The types of data required for the current IntCal database and calibration curve model are tabulated with examples.