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Preterm birth before 37 weeks gestation affects 10–15% of all births, with nearly 15 million babies born preterm every year . Prematurity is the leading cause of neonatal mortality, accounting for in excess of 75% of perinatal deaths . Infants born preterm are at high risk of both short- and long-term neurological morbidity, including developmental delay, cognitive problems, hearing loss, visual impairment, behavioral problems, and cerebral palsy . The impact of these sequelae is high, with 27.9% (IQR [interquartile range] 18.6–46.6) of preterm neonates suffering from at least one, and 8.1% (IQR 3.7–10.2) suffering multiple morbidities . Despite improvements in perinatal care the incidence of preterm birth has changed little in decades. In contrast, improvements in neonatal care mean nearly 90% of all babies born less than 28 weeks in high-income countries survive, including babies born as early as 23 weeks’ gestation . Despite this improvement in survival, babies born at extreme preterm gestations are at the highest risk of neurological injury, with rates of cerebral palsy and severe disability in these survivors remaining static .
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.
Improving access to tuberculosis (TB) care and ensuring early diagnosis are two major aims of the WHO End TB strategy and the Collaborative TB Strategy for England. This study describes risk factors associated with diagnostic delay among TB cases in England. We conducted a retrospective cohort study of TB cases notified to the Enhanced TB Surveillance System in England between 2012 and 2015. Diagnostic delay was defined as more than 4 months between symptom onset and treatment start date. Multivariable logistic regression was used to identify demographic and clinical factors associated with diagnostic delay. Between 2012 and 2015, 22 422 TB cases were notified in England and included in the study. A third (7612) of TB cases had a diagnostic delay of more than 4 months. Being female, aged 45 years and older, residing outside of London and having extra-pulmonary TB disease were significantly associated with a diagnostic delay in the multivariable model (aOR = 1.2, 1.2, 1.2, 1.3, 1.8, respectively). This study identifies demographic and clinical factors associated with diagnostic delay, which will inform targeted interventions to improve access to care and early diagnosis among these groups, with the ultimate aim of helping reduce transmission and improve treatment outcomes for TB cases in England.
Recreational saltwater anglers from the mid-Atlantic through the Gulf of Mexico commonly target red drum. Due to concerns about overharvesting within South Carolina coupled with regional management actions, South Carolina explored the technical feasibility of stocking hatchery-produced juvenile red drum as a technique to augment the abundance of South Carolina stock. In order to assess a continued program, in 2005 a mail survey was used to collect data for estimating the economic benefits with the contingent valuation method. The theoretical validity of willingness to pay was assessed by comparison to the value of a change in red drum fishing trips that would result from the program. Benefits were compared to estimated, explicit stocking costs. We illustrate how a certainty recode approach can be used in sensitivity analysis. The net present values (NPVs) for the stocking program are positive suggesting that the program would have been economically efficient relative to no program.
This systematic overview reports findings from systematic reviews of randomized controlled trials of pharmacological and non-pharmacological interventions for behavioural and psychological symptoms of dementia (BPSD).
The Cochrane Database of Systematic Reviews, DARE, Medline, EMBASE, and PsycINFO were searched to September 2015.
Fifteen systematic reviews of eighteen different interventions were included. A significant improvement in BPSD was seen with: functional analysis-based interventions (GRADE quality of evidence moderate; standardized mean difference (SMD) −0.10, 95%CI −0.20 to 0.00), music therapy (low; SMD −0.49, 95%CI −0.82 to −0.17), analgesics (low; SMD −0.24, 95%CI −0.47 to −0.01), donepezil (high; SMD −0.15 95% CI −0.29 to −0.01), galantamine (high; SMD −0.15, 95%CI −0.28 to −0.03), and antipsychotics (high; SMD −0.13, 95%CI −0.21 to −0.06). The estimate of effect size for most interventions was small.
Although some pharmacological interventions had a slightly larger effect size, current evidence suggests functional analysis-based interventions should be used as first line management of BPSD whenever possible due to the lack of associated adverse events. Music therapy may also be beneficial, but further research is required as the quality of evidence to support its use is low. Cholinesterase inhibitors donepezil and galantamine should be trialled for the management of BPSD where non-pharmacological treatments have failed. Low-quality evidence suggests that assessment of pain should be conducted and a stepped analgesic approach trialled when appropriate. Antipsychotics have proven effectiveness but should be avoided where possible due to the high risk of serious adverse events and availability of safer alternatives.
This study aimed to critically review our criteria for elective admission to the paediatric intensive care unit following adenotonsillectomy for obstructive sleep apnoea.
Materials and methods:
We reviewed 122 children electively admitted between 1997 and 2011. During this time, our criteria for admission evolved.
In these 122 children, the respiratory disturbance index during rapid eye movement sleep ranged from 6 to 159 (mean, 83). Forty-one per cent of the children had a recognised co-morbidity. Nine children required extra intervention, i.e. in addition to re-positioning and/or supplemental oxygen. One child was an unplanned re-admission after discharge from the paediatric intensive care unit. Over the same period, five children required unplanned transfers into the paediatric intensive care unit following adenotonsillectomy for sleep-disordered breathing.
Based upon these results, we describe our current criteria for elective admission to the paediatric intensive care unit following adenotonsillectomy for severe obstructive sleep apnoea.
Ageing is associated with weight loss and subsequently poor health outcomes. The present study assessed agreement between two field methods, bioelectrical impedance spectroscopy (BIS) and corrected arm muscle area (CAMA) for assessment of body composition against dual-energy X-ray absorptiometry (DXA), the reference technique. Agreement between two predictive equations estimating skeletal muscle mass (SMM) from BIS against SMM from DXA was also determined. Assessments occurred at baseline < 14 d post-surgery (n 79), and at 6 months (6M; n 75) and 12 months (12M; n 63) in community-living older adults after surgical treatment for hip fracture. The 95 % limits of agreement (LOA) between BIS and DXA, CAMA and DXA and the equations and DXA were assessed using Bland–Altman analyses. Mean bias and LOA for fat-free mass (FFM) between BIS and DXA were: baseline, 0·7 ( − 10·9, 12·4) kg; 6M, − 0·5 ( − 20·7, 19·8) kg; 12M, 0·1 ( − 8·7, 8·9) kg and for SMM between CAMA and DXA were: baseline, 0·3 ( − 11·7, 12·3) kg; 6M, 1·3 ( − 4·5, 7·1) kg; 12M, 0·9 ( − 5·4, 7·2) kg. Equivalent data for predictive equations against DXA were: equation 1: baseline, 15·1 ( − 9·5, 20·6) kg; 6M, 17·1 ( − 12·0, 22·2) kg; 12M, 17·5 ( − 13·0, 22·0) kg; equation 2: baseline, 12·6 ( − 7·3, 19·9) kg; 6M, 14·4 ( − 9·7, 19·1) kg; 12M, 14·8 ( − 10·7, 18·9) kg. Proportional bias (BIS: β = − 0·337, P< 0·001; CAMA: β = − 0·294, P< 0·001) was present at baseline but not at 6M or 12M. Clinicians should be cautious in using these field methods to predict FFM and SMM, particularly in the acute care setting. New predictive equations would be beneficial.
Background: Paranoid delusions are a common and difficult-to-manage feature of Alzheimer's disease (AD). We investigated the neuroanatomical correlates of paranoid delusions in a cohort of AD patients, using magnetic resonance imaging (MRI) to measure regional volume and regional cortical thickness.
Methods: 113 participants with probable AD were assessed for severity of disease, cognitive and functional impairment. Presence and type of delusions were assessed using the Neuropsychiatric Inventory (NPI). Structural MRI images were acquired on a 1.5T scanner, and were analyzed using an automated analysis pipeline.
Results: Paranoid delusions were experienced by 23 (20.4%) of the participants. Female participants with paranoid delusions showed reduced cortical thickness in left medial orbitofrontal and left superior temporal regions, independently of cognitive decline. Male participants with delusions did not show any significant differences compared to males without delusions. An exploratory whole brain analysis of non-hypothesized regions showed reduced cortical thickness in the left insula for female participants only.
Conclusion: Frontotemporal atrophy is associated with paranoid delusions in females with AD. Evidence of sex differences in the neuroanatomical correlates of delusions as well as differences in regional involvement in different types of delusions may be informative in guiding management and treatment of delusions in AD.
Jugular foramen schwannomas are rare skull base tumours which typically have a variable clinical presentation. Glossopharyngeal syncope syndrome is an unusual clinical presentation; in the following case report, it was the sole presentation of an extracranial jugular foramen tumour.
The presentation of a patient with glossopharyngeal neuralgia syncope syndrome is reviewed and the pathophysiology, clinical features and treatment discussed.
A 45-year-old woman presented with unilateral throat pain, bradycardia and hypotension leading to episodes of impaired consciousness when lying on her left side or turning her head to the left. Imaging detected a left-sided extracranial jugular foramen schwannoma. The tumour was excised, and the patient had no more syncopal attacks.
Glossopharyngeal neuralgia syncope syndrome can be the sole presentation of a jugular foramen schwannoma. Although this syndrome may be treated with anti-dysrhythmic drugs, cardiac pacing or nerve section, in the presented patient excision of the jugular foramen schwannoma was successful in preventing further episodes of syncope.
Vulnerability is a concept that captures the dynamic interactions between complex human systems and complex environmental systems. Thus, a vulnerability assessment that produces a static view of human–environment interactions (i.e., by examining one place at one time) will likely provide only limited – and potentially misleading – insight into how the coupled system works. Of course, such static pictures are common in this research domain because it is challenging to establish the temporal evolution of vulnerability (i.e., one place or many places over time). Especially in the context of having limited resources to conduct a vulnerability assessment, a solution to this challenge is to ignore variations over time in favor of examining variations over geographic space (i.e., many places at one time; see Mendelsohn et al. 1994; Carbone 1995; Polsky 2004). We argue that executing a many-places-at-one-time approach requires that all the places adopt a common research protocol; to our knowledge such a networked vulnerability assessment has yet to be reported in the literature. In this chapter, we report results from our effort to examine vulnerabilities – using a rapidly executable and commonly executed methodology – in four distinct study sites in the United States.
As explained in Chapter 1, the HERO project sought to develop infrastructure for studying and monitoring human–environment interactions at individual sites and to enable cross-site comparisons and generalizations. To test how well these concepts and tools work in practice, the project addressed the question, “How does land-use change influence vulnerability to droughts and floods?
As described in preceding chapters, one of the overarching HERO research activities was to establish a set of methodological protocols for vulnerability assessments. Within the methodological research plan were two principal activities, as introduced in Chapter 8: the development and testing of a Rapid Vulnerability Assessment methodology, and the development and testing of an Vulnerability Assessment Evaluation methodology, designed to validate, or assess the accuracy, of our work. Chapter 9 summarized our efforts on the former task; this chapter presents the results of the latter task. Accordingly, at the end of this chapter, we will be in a position to posit some synthetic conclusions about vulnerability in and across the four HERO sites.
Accuracy assessments are difficult to conduct in many research domains, but they are particularly challenging in the domain of vulnerability because the multidimensional nature of this concept makes it difficult for an individual researcher to observe and measure the principal variable of interest. The multi-site context, where the number of places and researchers is larger, amplifies this challenge. Clearly, then, conducting vulnerability research in a networked environment will present particular challenges to validating the research. In this light, a methodology for validating – or what we term evaluating – our research findings is needed.
Methods and data
There are two datasets involved in the application of our Vulnerability Assessment Evaluation methodology: the reference dataset and the validation dataset.
Austrochlamys heardensis (Fleming) is recorded from a boulder of Late Pliocene (3.62–2.5 Ma) volcaniclastic sandstone dredged 70 km east-north-east of Heard Island, the third record of the species. The collection is much larger than the original described by Fleming and includes left valves which are described for the first time. The species is compared with A. anderssoni (Hennig) from Cockburn Island and ‘Chlamys’ mawsoni Fletcher from Îles Kerguelen. The source rock accumulated in fully marine, highly current-affected conditions. The collection is dominated by right valves, possibly because left valves are more susceptible to breakage and the effects of current winnowing. The locality may have subsided some 500 m since deposition. It lies immediately north of a straight, north-east–south-west trending lineament which may mark a major tectonic feature with left-lateral displacement of approximately 50 km, and provides a natural boundary within the Central Province of Kerguelen Plateau.
Genetic selection has increased pig lean tissue growth rate, the most extreme animals comprising the ‘sire’ lines of breeding stock. However such improvement has not been without cost in other areas of production. Sire line sows are characterised by smaller litters with poorer pre-weaning growth rates than dam line sows of the same breed. The aim of this experiment was to determine whether reduced pre-weaning growth rate of sire line piglets was due to poor lactation performance of the sow or reduced vitality of sire line piglets.
The Menzies Range in the southern Prince Charles Mountains, Antarctica, records at least four intervals of Cenozoic terrestrial glacigene sedimentation, and two periods of glacial erosion. The oldest Cenozoic strata, here named the Pardoe Formation, are >240 m thick, and consist of variable diamicts with subordinate sandstones and minor laminated lacustrine siltstones. The Pardoe Formation overlies a rugged erosion surface cut into Precambrian basement. Two subsequent Cenozoic sequences are here named informally the Trail diamicts and the younger Amphitheatre diamicts. The latter infilled the lower regions of an extremely rugged erosion surface, many components of which still dominate the present topography. The palaeodrainage of this erosion surface is markedly discordant with that of the older erosion surface underlying the Pardoe Formation. These three depositional events and the two associated erosion surfaces record warmer climates and increased snow accumulation under conditions of temperate wet-based glaciation. During the excavation of the sub-Amphitheatre diamict erosion surface, the East Antarctic ice sheet was either absent, further inland or the height of its surface relative to the Menzies Range was considerably lower than at present. The fourth and youngest depositional episode, recorded by a veneer of boulder gravel distributed along the northern flank of the Menzies Range, is from dry-based glacier ice, and assumed to be <2.6 Myr.
Elevated levels of coagulation factor VII activity (FVIIc) are associated with increased risk of CHD. FVIIc is strongly determined by two polymorphisms (R353Q and 0/10 base pairs (bp)) and plasma triacylglycerol (TAG) concentrations. The Q and 10 bp polymorphisms show strong linkage disequilibrium and have been associated with lower levels of fasting FVII, but there has been little investigation of the effect of these genotypes on the postprandial FVII metabolism. The present study demonstrated that fasting activated factor VII (FVIIa) and factor VII antigen (FVIIag) levels were significantly lower in the heterozygotes carrying the Q and 10 bp alleles (n 12), than in the R/0 bp homozygotes (n 12) (43·0 (SE 4·8) v. 23·9 (SE 6·5) mU/ml and 85·7 (SE 5·4) v. 71·6 (SE 7·5) % respectively). During postprandial lipaemia there was a significant increase in FVIIa in R/0 bp homozygotes but not in the heterozygotes carrying the Q and 10 bp alleles. The proportion of FVIIa (FVIIa : FVIIag) increased in the homozygotes but not in the heterozygotes (2·04 (SE 0·35) v. 1·20 (SE 0·26) respectively). Therefore possession of the relatively common Q and 10 bp alleles is not associated with postprandial activation of FVII, which may in turn have a protective effect against CHD.
Bracken (Pteridium aquilinum (L.) Kuhn) and heather
(Calluna vulgaris (L.) Hull) are important upland species
which often grow in close proximity in the UK. The effects of factorial
treatments of elevated atmospheric CO2
(539 μmol mol−1 as opposed to ambient atmospheric
CO2 concentrations of 355 μmol mol−1), added
(50 kg N ha−1 as NH4NO3) and added
(20 kg P ha−1 as NaH2PO4) on the
performance of these two species were
studied under controlled environmental conditions using container-grown
Plants grown and measured at
high CO2 had higher rates of net photosynthesis than those grown
measured in ambient CO2 . This increase
was greater in heather than in bracken and resulted in a large stimulation
growth in the former. In bracken there
was no significant change in plant size or phenology. The increase in biomass
of heather in high CO2 was greatest
in the absence of added nutrients and lowest when both N and P were supplied.
The growth and photosynthesis
of both plants responded positively to the supply of P alone or P with
both CO2 atmospheres), but there was
little response to N alone. The implications of these findings for bracken
and heather growing in the field under
conditions of an elevated CO2 atmosphere and greater nutrient
availability are discussed.