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Selenium (Se) is an essential element for human health. However, our knowledge of the prevalence of Se deficiency is less than for other micronutrients of public health concern such as iodine, iron and zinc, especially in sub-Saharan Africa (SSA). Studies of food systems in SSA, in particular in Malawi, have revealed that human Se deficiency risks are widespread and influenced strongly by geography. Direct evidence of Se deficiency risks includes nationally representative data of Se concentrations in blood plasma and urine as population biomarkers of Se status. Long-range geospatial variation in Se deficiency risks has been linked to soil characteristics and their effects on the Se concentration of food crops. Selenium deficiency risks are also linked to socio-economic status including access to animal source foods. This review highlights the need for geospatially-resolved data on the movement of Se and other micronutrients in food systems which span agriculture–nutrition–health disciplinary domains (defined as a GeoNutrition approach). Given that similar drivers of deficiency risks for Se, and other micronutrients, are likely to occur in other countries in SSA and elsewhere, micronutrient surveillance programmes should be designed accordingly.
Stressful experiences affect biological stress systems, such as the hypothalamic–pituitary–adrenal (HPA) axis. Life stress can potentially alter regulation of the HPA axis and has been associated with poorer physical and mental health. Little, however, is known about the relative influence of stressors that are encountered at different developmental periods on acute stress reactions in adulthood. In this study, we explored three models of the influence of stress exposure on cortisol reactivity to a modified version of the Trier Social Stress Test (TSST) by leveraging 37 years of longitudinal data in a high-risk birth cohort (N = 112). The cumulative stress model suggests that accumulated stress across the lifespan leads to dysregulated reactivity, whereas the biological embedding model implicates early childhood as a critical period. The sensitization model assumes that dysregulation should only occur when stress is high in both early childhood and concurrently. All of the models predicted altered reactivity, but do not anticipate its exact form. We found support for both cumulative and biological embedding effects. However, when pitted against each other, early life stress predicted more blunted cortisol responses at age 37 over and above cumulative life stress. Additional analyses revealed that stress exposure in middle childhood also predicted more blunted cortisol reactivity.
Clozapine is the most effective antipsychotic medication, but it has the highest propensity for metabolic side effects. A clozapine clinic was established within an early intervention for psychosis service to facilitate the timely commencement of clozapine and to manage the associated adverse effects. This study describes the changes in the weight, body mass index (BMI), waist circumference and blood pressure after 6 months in young people commenced on clozapine.
This was a prospective cohort study of all young people, aged 15–24 years, commenced on clozapine within an early intervention service in Melbourne, Australia, between 01.04.2016 and 30.06.2018. Continuous data were analyzed with paired t-test and categorical with Wilcoxon signed-rank test.
Twenty-six young people received 6 months of treatment with clozapine, of whom the mean age was 19.8 years (s.d. ±3.1) and 66.7% were male. After 6 months, the mean weight gain was 5.1 kg (s.d. ±10.1 kg) and over half (53.8%) gained clinically significant weight. The proportion of young people classified as either overweight or obese rose from 69.2% to 88.5% (p = 0.006). The proportion of young people with a waist circumference above the recommended parameters increased from 57.9% to 78.9% (p = 0.008). Hypertension was present in 30%, and after 6 months, 45% had hypertension (p = 0.64). Metformin was prescribed to 34.6%, typically to those with the greatest and most rapid weight gain.
Among young people with treatment resistant psychosis, clozapine is associated with significant metabolic side effects in the early stages of commencement. More interventions aimed at attenuating this weight gain are needed.
Automated manufacturing of thermoplastic composites has found increased interest in aerospace applications over the past three decades because of its great potential in low-cost, high rate, repeatable production of high performance composite structures. Experimental validation is a key element in the development of structures made using this emerging technology. In this work, a
mm variable-stiffness unitised integrated-stiffener out-of-autoclave thermoplastic composite wingbox is tested for a combined shear-bending-torsion induced buckling load. The wingbox is manufactured by in-situ consolidation using a laser-assisted automated tape placement technique. It is made and tested as a demonstrator section located at 85% of the wing semi-span of a B-737/A320 sized aircraft. A bespoke in-house test rig and two aluminium dummy wingboxes are also designed and manufactured for testing the wingbox assembly which spans more than 3m. Prior to testing, the wingbox assembly and the test rig were analysed using a high fidelity finite element method to minimise the failure risk due to the applied load case. The experimental test results of the wingbox are also compared with the predictions made by a numerical study performed by nonlinear finite element analysis showing less than 5% difference in load-displacement behaviour and buckling load and full agreement in predicting the buckling mode shape.
Indicators are necessary to monitor national progress toward commitments made to the Convention on Biological Diversity (CBD), but countries often struggle to mobilize quantitative indicators for many biodiversity targets. Assessing the extent to which countries are using measurable indicators from global and national sources by surveying 5th National Reports to the CBD, we found that nationally generated indicators were used 11 times more frequently than global indicators and only one-fifth of indicators matched those recommended by the CBD, suggesting that countries and indicator experts should work more closely to agree upon measurable, scalable, fit-for-purpose indicators for the next generation of CBD targets.
The fluid–structure interactions (FSI) of compliant lifting surfaces is complicated by free-surface and multiphase flows such as cavitation and ventilation. This paper describes the dynamic FSI response of a flexible surface-piercing hydrofoil in dry, wetted, ventilating and cavitating conditions. Experimental modal analysis is used to quantify the resonant frequencies and damping ratios of the fluid–structure system in each flow regime. The generalized hydrodynamic stiffness, fluid damping and fluid added mass are also determined as ratios to the corresponding structural modal forces. Added mass increases with increasing partial immersion of the hydrofoil and decreases in the presence of gaseous cavities. In particular, modal frequencies were observed to increase significantly in fully ventilated flow compared to fully wetted flow. The modal frequencies varied non-monotonically with speed in fully wetted flow. Gaseous cavities reduced the modal added mass and reduced the fluid disturbing force. Modal damping increases non-monotonically with increasing immersion depth. Forward speed causes the fluid damping force to increase with an approximately quadratic functional behaviour, consistent with a series expansion of the Morison equation, although damping identification became increasingly difficult at high flow speeds. The results indicate that fluid damping is greater than the associated structural damping in a quiescent liquid, and increasingly so with increasing immersion, suggesting viscous dissipation as a dominant mechanism. A preliminary investigation of modal vibration as a means of controlling the size and stability of ventilated cavities indicates that low-order modes encourage the formation of ventilation, while higher-order modes encourage the washout and elimination of ventilation.
Management of volunteer glyphosate-resistant (GR) corn may be problematic in soybean resistant to glyphosate and 2,4-D or dicamba, as auxinic herbicides often antagonize graminicide efficacy. Field and greenhouse trials were conducted using mixtures of 2,4-D or dicamba in combination with glyphosate and clethodim-A (formulated without an adjuvant) or clethodim-SM (adjuvant-inclusive formulation) to determine the effect on volunteer GR corn control. Neither auxinic herbicide reduced clethodim efficacy, regardless of clethodim rate or formulation in field trials. However, the addition of glyphosate to these mixtures at the 35 g ai ha−1 clethodim dose reduced control from clethodim-A and clethodim-SM by 62% to 75% and 27% to 47%, respectively. Increasing the clethodim dose to 105 g ha−1 or greater in combination with glyphosate and either auxinic herbicide generally restored clethodim efficacy (74% to 98% control); in one site-year, the addition of glyphosate plus dicamba to clethodim-A at 140 g ha−1 still reduced control by 34%. In greenhouse experiments, clethodim-A efficacy was reduced by 17% and 28% when applied with glyphosate plus 420 and 1,680 g ae ha−1 2,4-D, respectively, in the absence of crop oil concentrate (COC). Increasing the dose of dicamba in a similar mixture had a negligible effect. Irrespective of auxinic herbicide dose, the inclusion of COC to clethodim-A mixtures with glyphosate plus 2,4-D or dicamba resulted in ≥ 90% control. These results specify an enhanced risk of reduced clethodim efficacy on volunteer GR corn when glyphosate is added to mixtures containing 2,4-D or dicamba. To optimize control from these mixtures, clethodim should be applied at ≥ 105 g ha−1 and should include an activator adjuvant in the form of COC and/or an adjuvant-inclusive clethodim formulation. This recommendation contrasts with several labels of clethodim that do not require COC when applied with adjuvant-loaded glyphosate products.
Compliant lift-generating surfaces have widespread applications as marine propellers, hydrofoils and control surfaces, and the fluid–structure interactions (FSI) of such systems have important effects upon their performance and stability. Multi-phase flows like cavitation and ventilation alter the hydrodynamic and hydroelastic behaviours of lifting surfaces in ways that are not yet completely understood. This paper describes experiments on one rigid and two flexible variants of a vertical surface-piercing hydrofoil in wetted, ventilating and cavitating conditions. Tests were conducted in a towing tank and a free-surface cavitation channel. This work, which is Part 1 of a two-part series, examines the passive, or flow-induced, fluid–structure interactions of the hydrofoils. Four characteristic flow regimes are described: fully wetted, partially ventilated, partially cavitating and fully ventilated. Hydroelastic coupling is shown to increase the hydrodynamic lift and yawing moments across all four flow regimes by augmenting the effective angle of attack. The effective angle of attack, which was derived using a beam model to account for the effect of spanwise twisting deflections, effectively collapses the hydrodynamic load coefficients for the three hydrofoils. A generalized cavitation parameter, using the effective angle of attack, is used to collapse the lift and moment coefficients for all trials at a single immersed aspect ratio, smoothly bridging the four distinct flow regimes. None of the hydrofoils approached the static divergence condition, which occurs when the hydrodynamic stiffness negates the structural stiffness, but theory and experiments both show that ventilation increases the divergence speed by reducing the hydrodynamic twisting moment about the elastic axis. Coherent vortex shedding from the blunt trailing edge of the hydrofoil causes vortex-induced vibration at an approximately constant Strouhal number of 0.275 (based on the trailing edge thickness), and leads to amplified response at lock-in, when the vortex-shedding frequency approaches one of the resonant modal frequencies of the coupled fluid–structure system.
Evidence on whether nutritional supplementation affects physical activity (PA) during early childhood is limited. We examined the long-term effects of lipid-based nutrient supplements (LNS) on total PA, moderate-to-vigorous PA (MVPA) and sedentary behaviour (SB) of children at 4–6 years using an accelerometer for 1 week. Their mothers were enrolled in the International Lipid-based Nutrient Supplement-DYAD randomised controlled trial in Ghana, assigned to daily LNS or multiple micronutrients (MMN) during pregnancy through 6 months postpartum or Fe and folic acid (IFA) during pregnancy and placebo for 6 months postpartum. From 6 to 18 months, children in the LNS group received LNS; the other two groups received no supplements. Analysis was done with intention to treat comparing two groups: LNS v. non-LNS (MMN+ IFA). Of the sub-sample of 375 children fitted with accelerometers, 353 provided sufficient data. Median vector magnitude (VM) count was 1374 (interquartile range (IQR) 309), and percentages of time in MVPA and SB were 4·8 (IQR 2) and 31 (IQR 8) %, respectively. The LNS group (n 129) had lower VM (difference in mean −73 (95 % CI −20, −126), P = 0·007) and spent more time in SB (LNS v. non-LNS: 32·3 v. 30·5 %, P = 0·020) than the non-LNS group (n 224) but did not differ in MVPA (4·4 v. 4·7 %, P = 0·198). Contrary to expectations, provision of LNS in early life slightly reduced the total PA and increased the time in SB but did not affect time in MVPA. Given reduced social-emotional difficulties in the LNS group previously reported, including hyperactivity, one possible explanation is less restless movement in the LNS group.
The use of cover crops in soybean production systems has increased in recent years. There are many questions surrounding cover crops—specifically about benefits to crop production and most effective herbicides for spring termination. No studies evaluating cover crop termination have been conducted across a wide geographic area, to our knowledge. Therefore, field experiments were conducted in 2016 and 2017 in Arkansas, Indiana, Mississippi, Missouri, and Wisconsin for spring termination of regionally specific cover crops. Glyphosate-, glufosinate-, and paraquat-containing treatments were applied between April 15 and April 29 in 2016 and April 10 and April 20 in 2017. Visible control of cover crops was determined 28 days after treatment. Glyphosate-containing herbicide treatments were more effective than paraquat- and glufosinate-containing treatments, providing 71% to 97% control across all site years. Specifically, glyphosate at 1.12 kg ha−1 applied alone or with 2,4-D at 0.56 kg ha−1, saflufenacil at 0.025 kg ha−1, or clethodim at 0.56 kg ha−1 provided the most effective control on all grass cover crop species. Glyphosate-, paraquat-, or glufosinate-containing treatments were generally most effective on broadleaf cover crop species when applied with 2,4-D or dicamba. Results from this research indicate that proper herbicide selection is crucial to successfully terminate cover crops in the spring.
We derive the surface and basal radar reflectance and backscatter coefficients of the southern McMurdo Ice Shelf (SMIS) and part of the nearby Ross Ice Shelf (RIS), Antarctica, from radar statistical reconnaissance using a 60-MHZ airborne survey. The surface coefficients are further inverted in terms of snow density and roughness, providing a spatial distribution of the processes contributing to the surface boundary conditions. We disentangle the basal coefficients from surface transmission losses, and we provide the basal coherent content, an indicator of the boundary geometric disorder that is also self-corrected from englacial attenuation. The basal radar properties exhibit sharp gradients along specific iso-depths, suggesting an abrupt modification of the ice composition and geometric structure. We interpret this behavior as locations where the pressure-melting point is reached, outlining fields of freezing and melting ice. Basal steps are observed at both SMIS and RIS, suggesting a common geometric expression of widespread basal processes. This technique offers a simultaneous view of both the surface and basal boundary conditions to help investigate the ice-shelf stability, while its application to airborne data significantly improves coverage of the difficult-to-observe ice–ocean boundary. It also provides constraints on thermohaline circulation in ice shelves cavities, which are analogs for ice-covered ocean worlds.
We aimed to identify factors (child diet, physical activity; maternal BMI) associated with body composition of Ghanaian pre-school children.
Longitudinal analysis of the International Lipid-Based Nutrient Supplements (iLiNS)-DYAD-Ghana randomized trial, which enrolled 1320 pregnant women at ≤20 weeks’ gestation and followed them and their infants until 6 and 18 months postpartum, respectively. At follow-up, child age 4–6 years, we collected data on body composition (by 2H dilution), physical activity and diet, extracted dietary patterns using factor analysis, and examined the association of children’s percentage body fat with maternal and child factors by regression analysis.
Eastern Region, Ghana.
Children 4–6 years of age.
The analysis included 889 children with percentage body fat and dietary data at follow-up. We identified two major dietary patterns, a snacking and a cooked foods pattern. Percentage body fat was positively associated (standardized β (se)) with maternal BMI at follow-up (0·10 (0·03); P = 0·003) and negatively associated with physical activity (−0·15 (0·05); P = 0·003, unadjusted for child gender), but not associated with the snacking (0·06 (0·03); P = 0·103) or cooked foods (−0·05 (0·07); P = 0·474) pattern. Boys were more active than girls (1470 v. 1314 mean vector magnitude counts/min; P < 0·0001) and had lower percentage body fat (13·8 v. 16·9 %; P < 0·0001).
In this population, maternal overweight and child physical activity, especially among girls, may be key factors for addressing child overweight/obesity. We did not demonstrate a relationship between the dietary patterns and body fatness, which may be related to limitations of the dietary data available.
Clostridioides difficile infection (CDI) remains a significant public health concern, resulting in excess morbidity, mortality, and costs. Additional insight into the burden of CDI in adults aged <65 years is needed.
A 6-year retrospective cohort study was conducted using data extracted from United States Veterans Health Administration electronic medical records.
Patients aged 18–64 years on January 1, 2011, were followed until incident CDI, death, loss-to-follow-up, or December 31, 2016. CDI was identified by a diagnosis code accompanied by metronidazole, vancomycin, or fidaxomicin therapy, or positive laboratory test. The clinical setting of CDI onset was defined according to 2017 SHEA-IDSA guidelines.
Of 1,073,900 patients, 10,534 had a CDI during follow-up. The overall incidence rate was 177 CDIs per 100,000 person years, rising steadily from 164 per 100,000 person years in 2011 to 189 per 100,000 person years in 2016. Those with a CDI were slightly older (55 vs 51 years) and sicker, with a higher baseline Charlson comorbidity index score (1.4 vs 0.5) than those without an infection. Nearly half (48%) of all incident CDIs were community associated, and this proportion rose from 41% in 2011 to 56% in 2016.
The findings from this large retrospective study indicate that CDI incidence, driven primarily by increasing community-associated infection, is rising among young and middle-aged adult Veterans with high service-related disability. The increasing burden of community associated CDI in this vulnerable population warrants attention. Future studies quantifying the economic and societal burden of CDI will inform decisions surrounding prevention strategies.
To assess whether disparities in energy consumption and insufficient energy intake in India have changed over time across socio-economic status (SES).
This cross-sectional, population-based survey study examines the relationship between several SES indicators (i.e. wealth, education, caste, occupation) and energy consumption in India at two time points almost 20 years apart. Household food intake in the last 30 d was assessed in 1993–94 and in 2011–12. Average dietary energy intake per person in the household (e.g. kilocalories) and whether the household consumed less than 80 % of the recommended energy intake (i.e. insufficient energy intake) were calculated. Linear and relative risk regression models were used to estimate the relationship between SES and average energy consumed per day per person and the relative risk of consuming an insufficient amount of energy.
Rural and urban areas across India.
A nationally representative sample of households.
Among rural households, there was a positive association between SES and energy intake across all four SES indicators during both survey years. Similar results were seen for energy insufficiency vis-à-vis recommended energy intake levels. Among urban households, wealth was associated with energy intake and insufficiency at both time points, but there was no educational patterning of energy insufficiency in 2011–12.
Results suggest little overall change in the SES patterning of energy consumption and percentage of households with insufficient energy intake from 1993–94 to 2011–12 in India. Policies in India need to improve energy intake among low-SES households, particularly in rural areas.
Shiga toxin-producing Escherichia coli (STEC) infections are a significant public health issue, with foodborne transmission causing >1 million illnesses worldwide each year. We conducted a systematic review and meta-analysis (PROSPERO registry # CRD42017074239), to determine the relative association of different food types with sporadic illnesses caused by STEC. Searches were conducted from 01 August to 30 September 2017, using bibliographic and grey literature databases, websites and expert consultation. We identified 22 case-control studies of sporadic STEC infection in humans, from 10 countries within four World Health Organization subregions, from 1985 to 2012. We extracted data from 21 studies, for 237 individual measures in 11 food categories and across three status types (raw or undercooked, not raw and unknown). Beef was the most significant food item associated with STEC illness in the Americas and Europe, but in the Western Pacific region, chicken was most significant. These findings were not significantly moderated by the raw or cooked status of the food item, nor the publication year of the study. Data from the African, South-East Asian and Eastern Mediterranean subregions were lacking and it is unclear whether our results are relevant to these regions.
Optimal transition from child to adult services involves continuity, joint care, planning meetings and information transfer; commissioners and service providers therefore need data on how many people require that service. Although attention-deficit hyperactivity disorder (ADHD) frequently persists into adulthood, evidence is limited on these transitions.
To estimate the national incidence of young people taking medication for ADHD that require and complete transition, and to describe the proportion that experienced optimal transition.
Surveillance over 12 months using the British Paediatric Surveillance Unit and Child and Adolescent Psychiatry Surveillance System, including baseline notification and follow-up questionnaires.
Questionnaire response was 79% at baseline and 82% at follow-up. For those aged 17–19, incident rate (range adjusted for non-response) of transition need was 202–511 per 100 000 people aged 17–19 per year, with successful transition of 38–96 per 100 000 people aged 17–19 per year. Eligible young people with ADHD were mostly male (77%) with a comorbid condition (62%). Half were referred to specialist adult ADHD and 25% to general adult mental health services; 64% had referral accepted but only 22% attended a first appointment. Only 6% met optimal transition criteria.
As inclusion criteria required participants to be on medication, these estimates represent the lower limit of the transition need. Two critical points were apparent: referral acceptance and first appointment attendance. The low rate of successful transition and limited guideline adherence indicates significant need for commissioners and service providers to improve service transition experiences.