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HIV-positive individuals are at significantly increased risk of depression. In low- and middle-income countries, depression is frequently under-detected, hampered by a lack of data regarding available screening tools. The 5-item World Health Organization Well-Being Index (WHO-5) is widely used to screen for depression, yet its validity in African adults with HIV has yet to be examined.
In this cross-sectional study, we enrolled HIV-positive adults presenting to an outpatient HIV clinic in Mwanza, Tanzania. Patients were administered the Patient Health Questionnaires (PHQ)-2/9 and WHO-5 questionnaires. The rate of positive screens was calculated. Fisher's exact test and Pearson's correlation coefficients between PHQ-2/9 and WHO-5 scores were calculated.
We enrolled 72 HIV-positive adults: rates of positive depression screen were 62.5%, 77.8%, and 47.2% according to PHQ-2, PHQ-9, and WHO-5, respectively. PHQ and WHO results for depression were significantly associated (Fisher's exact test: PHQ-2 v. WHO-5, p = 0.028; PHQ-9 v. WHO-5, p = 0.002). The level of correlation between PHQ and WHO results for depression was moderate (Pearson's correlation coefficient: PHQ-2 v. WHO-5 −0.3289; PHQ-9 v. WHO-5 −0.4463).Per Mantel–Haenszel analysis, screening results were significantly more concordant among patients in the following strata: men, age >40, Sukuma ethnicity, Christian, unmarried, self-employed, at least primary school education completed, and higher than the median income level.
WHO-5 scores correlated well with those of the PHQ-9, suggesting that the WHO-5 represents a valid screening tool. The concordance of PHQ-9 and WHO-5 results was poorer in marginalized socioeconomic groups. Positive depression screens were exceedingly common among HIV-positive Tanzanian adults according to all three questionnaires.
Movement disorders associated with exposure to antipsychotic drugs are common and stigmatising but underdiagnosed.
To develop and evaluate a new clinical procedure, the ScanMove instrument, for the screening of antipsychotic-associated movement disorders for use by mental health nurses.
Item selection and content validity assessment for the ScanMove instrument were conducted by a panel of neurologists, psychiatrists and a mental health nurse, who operationalised a 31-item screening procedure. Interrater reliability was measured on ratings for 30 patients with psychosis from ten mental health nurses evaluating video recordings of the procedure. Criterion and concurrent validity were tested comparing the ScanMove instrument-based rating of 13 mental health nurses for 635 community patients from mental health services with diagnostic judgement of a movement disorder neurologist based on the ScanMove instrument and a reference procedure comprising a selection of commonly used rating scales.
Interreliability analysis showed no systematic difference between raters in their prediction of any antipsychotic-associated movement disorders category. On criterion validity testing, the ScanMove instrument showed good sensitivity for parkinsonism (90%) and hyperkinesia (89%), but not for akathisia (38%), whereas specificity was low for parkinsonism and hyperkinesia, and moderate for akathisia.
The ScanMove instrument demonstrated good feasibility and interrater reliability, and acceptable sensitivity as a mental health nurse-administered screening tool for parkinsonism and hyperkinesia.
Objective: Neuronal ceroid-lipofuscinoses are a heterogeneous group of inherited disorders in which abnormal lipopigments form lysosomal inclusion bodies in neurons. Kufs disease is rare, and clinical symptoms include seizures, progressive cognitive impairment, and myoclonus. Most cases of Kufs disease are autosomal recessive; however, there have been a few case reports of an autosomal dominant form linked to mutations within the DNAJC5 gene. Methods: We describe a family with Kufs disease in which the proband and three of her four children presented with cognitive impairment, seizures, and myoclonus. Results: Genetic testing of all four children was positive for a c.346_348delCTC(p.L116del) mutation in the DNAJC5 gene. The proband brain had an abundance of neuronal lipofuscin in the cerebral cortex, striatum, amygdala, hippocampus, substantia nigra, and cerebellum. There were no amyloid plaques or neurofibrillary tangles. Immunohistochemistry demonstrated that the cholinergic neurons and cholinergic projection fibers were spared, but there was a profound loss of choline acetyltransferase within the caudate, putamen, and basal forebrain. This suggests a loss of choline acetyltransferase as opposed to a loss of the neurons. Conclusions: This report describes the clinical history of autosomal dominant Kufs disease, the genetic mutation within the DNAJC5 gene, and the neuropathological findings demonstrating depletion of choline acetyltransferase in the brain.
We report on analysis of meteorological data for the period 27 May–20 August 2004, from two automatic weather stations on McCall Glacier, Alaska, USA, aimed at studying the relationship between climate and ablation. One station is located on a mountain ridge and the other in the ablation area where we also analyzed the energy balance. The weather station on the glacier measured an average temperature of 5.3°C (at 2 m height above surface) and wind speed of 3.1 m s−1 (at 3 m height). A sonic height ranger and ablation stakes indicate a specific mass balance of –1.94 ± 0.09 m w.e between 15 June and 20 August. The specific mass balance calculated from the surface energy balance, –2.06 ± 0.18 m w.e., is in close correspondence to this. The latter is the sum of 0.12 m w.e. of snowfall, 0.003 m w.e. of deposition and –2.18 m w.e. of melt. Net radiation contributes 74% of the melt energy. Compared to ablation measurements in the early 1970s, summer ablation was large. This increase is explained by a combination of a relatively higher net radiation, a lower albedo and larger turbulent heat fluxes that led to more energy being available for melting. No single meteorological variable can be isolated as being the principal reason for the high ablation, however. The lower ice albedo (0.19) is possibly due to ash deposits from forest fires.
The present study evaluated the behaviour of the AusBeef model for beef production as part of a 2 × 2 study simulating performance on forage-based and concentrate-based diets from Oceania and North America for four methane (CH4)-relevant outputs of interest. Three sensitivity analysis methods, one local and two global, were conducted. Different patterns of sensitivity were observed between forage-based and concentrate-based diets, but patterns were consistent within diet types. For the local analysis, 36, 196, 47 and 8 out of 305 model parameters had normalized sensitivities of 0, >0, >0·01 and >0·1 across all diets and outputs, respectively. No parameters had a normalized local sensitivity >1 across all diets and outputs. However, daily CH4 production had the greatest number of parameters with normalized local sensitivities >1 for each individual diet. Parameters that were highly sensitive for global and local analyses across the range of diets and outputs examined included terms involved in microbial growth, volatile fatty acid (VFA) yields, maximum absorption rates and their inhibition due to pH effects and particle exit rates. Global sensitivity analysis I showed the high sensitivity of forage-based diets to lipid entering the rumen, which may be a result of the use of a feedlot-optimized model to represent high-forage diets and warrants further investigation. Global sensitivity analysis II showed that when all parameter values were simultaneously varied within ±10% of initial value, >96% of output values were within ±20% of the baseline, which decreased to >50% when parameter value boundaries were expanded to ±25% of their original values, giving a range for robustness of model outputs with regards to potential different ‘true’ parameter values. There were output-specific differences in sensitivity, where outputs that had greater maximum local sensitivities displayed greater degrees of non-linear interaction in global sensitivity analysis I and less variance in output values for global sensitivity analysis II. For outputs with less interaction, such as the acetate : propionate ratio and microbial protein production, the single most sensitive term in global sensitivity analysis I contributed more to the overall total-order sensitivity than for outputs with more interaction, with an average of 49, 33, 15 and 14% of total-order sensitivity for microbial protein production, acetate : propionate ratio, CH4 production and energy from absorbed VFAs, respectively. Future studies should include data collection for highly sensitive parameters reported in the present study to improve overall model accuracy.
Two observational programs which provide new information about particular LBVs through investigations of their immediate surroundings are described. (1) Digital spectral classification of OB supergiants in compact groups apparently associated with Radcliffe 127 and S Doradus has revealed several interesting objects and indicates which of them are likely to be generically related to the LBVs. (2) Velocity-resolved images of the Eta Carinae shell show qualitatively new features, which will contribute substantially to the interpretation of its complex spatial/kinematical structure.
The macular carotenoids lutein (L), zeaxanthin (Z) and meso-zeaxanthin (MZ) accumulate at the macula, where they are collectively referred to as macular pigment (MP). Augmentation of this pigment, typically achieved through diet and supplementation, enhances visual function and protects against progression of age-related macular degeneration. However, it is known that eggs are a rich dietary source of L and Z, in a highly bioavailable matrix. In this single-blind placebo-controlled study, L- and MZ-enriched eggs and control non-enriched eggs were fed to human subjects (mean age 41 and 35 years, respectively) over an 8-week period, and outcome measures included MP, visual function and serum concentrations of carotenoids and cholesterol. Serum carotenoid concentrations increased significantly in control and enriched egg groups, but to a significantly greater extent in the enriched egg group (P<0·001 for L, Z and MZ). There was no significant increase in MP in either study group post intervention, and we saw no significant improvement in visual performance in either group. Total cholesterol increased significantly in each group, but it did not exceed the upper limit of the normative range (6·5 mmol/l). Therefore, carotenoid-enriched eggs may represent an effective dietary source of L, Z and MZ, reflected in significantly raised serum concentrations of these carotenoids, and consequentially improved bioavailability for capture by target tissues. However, benefits in terms of MP augmentation and /or improved visual performance were not realised over the 8-week study period, and a study of greater duration will be required to address these questions.
Testing and estimating formal models of political behavior has not advanced as far as theoretical applications. One of the major literatures in formal theory is the spatial model of electoral competition which has its origins in the work of Black (1948) and Downs (1957). These models are used to make predictions about the policy positions candidates take in order to win elections. A lack of data on these candidate positions, especially challengers who never serve in Congress, has made direct testing of these models on congressional elections difficult.
Recently, researchers have begun to incorporate campaign finance into the standard Downsian model. These models of position-induced contributions examine the tradeoff that candidates make between choosing positions favorable to interest group contributors and positions favorable to voters. A major premise of these models is that interest group contributions are based on the policy positions of candidates. This has been borne out empirically in the case of incumbents, but not challengers.
To test key hypotheses of these models, we develop a simple spatial model of position-induced campaign contributions where the PAC's decision to contribute or abstain from each race is a function of the policy distance between the PAC and the candidates. We use data from political action committee contributions in order to estimate the locations of incumbents, challengers and PACs. Our model reliably estimates the spatial positions as well as correctly predicts nearly 74 percent of the contribution and abstention decisions of the PACs. Conditional upon making a contribution, we correctly predict the contribution in 94 percent of the cases. These results are strong evidence for position-induced campaign contributions. Furthermore, our estimates of candidate positions allow us to address issues of platform convergence between candidates.
The image of Sk −69° 202 was scanned and analyzed on eight (of 32 available) blue through near-infrared photographic plates obtained at the prime focus of the Cerro Tololo Inter-American Observatory 4-meter telescope during 1974–1983. Both intensity syntheses of the image and density differences were derived by means of reference stars from the same plates, including the similar nearby object Sk −69° 203. Several of the density differences are shown in Figure 1. The analysis shows that the 12m blue supergiant in Sk −69° 202 (Star 1) has two companions with V magnitudes, position angles, and separations 315°, 3″ (Star 2) and 115°, 1.″5 (Star 3), respectively. Both companions appear to be early-type stars; there is no evidence for a bright red star in the system. The two companions are responsible for the spectra observed by the International Ultraviolet Explorer following the decline of the SN in the far UV, so that Star 1 has disappeared and was probably the progenitor. The most likely interpretation is that it was a post-red supergiant evolving blueward in the HR diagram.
Gamma Ray Bursts (GRBs) have puzzled astronomers since their discovery more than 20 years ago. As no counterparts at wavelengths other than X- and γ-rays have yet been found the identification of the sources is still missing. Theoretical explanations range from colliding comets (1993) and merging neutron stars (1982) to more exotic objects, such as superconducting cosmic strings (1988). Data accumulated until now still do not discriminate between these models, although results from the BATSE (Burst and Transient Source Experiment) instrument aboard the Compton Gamma Ray Observatory (CGRO) strongly favor extragalactic models.
The Energetic Gamma Ray Experiment Telescope (EGRET) aboard CGRO has s ofar detected photons from 5 GRBs with its spark chamber. These are the highest energy γ-rays associated with GRBs to date. In this work we review previously published data and summarize the properties of these events. Elsewhere we present possible constraints from the data on the models proposed to explain GRBs.
The xanthophyll carotenoids lutein (L), zeaxanthin (Z) and meso-zeaxanthin (MZ) are found at the macula, the central part of the retina, where they are referred to as macular pigment (MP). MP is studied in human subjects because of its proven role in enhancing visual function and its putative role in protecting against age-related macular degeneration. These benefits are probably due to the antioxidant and short-wavelength filtering properties of MP. It is known that eggs are a dietary source of L and Z. This experiment was designed to measure the egg yolk carotenoid response to hen supplementation with L, Z and MZ. A total of forty hens were used in the trial and were divided into eight groups of five hens. Each group was supplemented (with about 140 mg active xanthophylls/kg feed) with one of the following oil-based carotenoid formulations for 6 weeks: unesterified L (group 1); L diacetate (group 2); unesterified Z (group 3); Z diacetate (group 4); unesterified MZ (group 5); MZ diacetate (group 6); L–MZ (1:1) diacetate mixture (group 7); L–MZ diacetate (1:3) mixture (group 8). Yolk carotenoid content was analysed weekly (in four randomly selected eggs) by HPLC. We found that hens supplemented with Z diacetate and MZ diacetate produced eggs with significantly greater carotenoid concentrations than their free form counterparts. This finding potentially represents the development of a novel food, suitable to increase MP and its constituent carotenoids in serum.
The ever increasing nexus between human rights and business and the accompanying vagueness of concepts such as a company's ‘sphere of responsibility’ for human rights can, and has, created anxiety amongst companies. Considerations of human rights traditionally take place in the context of a state-based system of global governance; however, the rise of the corporation as a powerful non-state actor in recent decades has seen increased interest in understanding the emerging relationship between human rights and business and what, if any, responsibility business should assume for protecting human rights. This article considers the role played by U.S. technology companies such as Yahoo, Google and Microsoft in working with the Chinese government to censor internet content and thus intrude on the human rights to freedom of expression and opinion and the right to privacy. It concludes by focusing on the practicalities of protection and how human rights responsibilities might be apportioned between states and business and if so, how, when and why such an obligation might ensue.
The recovery approach provides a key organising principle underlying mental health policy throughout the English speaking world with endorsement by agencies such as the World Health Organisation. In Ireland, personal recovery is one of the quality markers identified by users of mental health services and has become central to national mental health policy.
Aim and objective
The aim of this study was to explore the implications for mental health services and professional practice arising from a structured investigation of what personal recovery means for people using specialist mental health services and the extent to which services support their individual recovery.
Ten service user participants in a service initiative were assessed using a novel measure based on an empirically based conceptual framework of recovery. The INSPIRE determines the level of recovery promoting support received from mental health staff and the quality of the supportive relationship as perceived by individual service users.
A consistent pattern of beliefs about recovery in keeping with national guidelines and the international literature was apparent. All respondents indicated that support by other people was an important part of their recovery with high levels of support received from mental health professionals. There was less consistent endorsement of the quality of relationships with professionals and recovery-oriented practice as perceived by participants.
The findings are highly relevant to the development of recovery focused, clinically excellent services. Further work is needed to improve the process of translating recovery guidance into mental health practice.
Macular pigment (MP) is composed of lutein (L), zeaxanthin (Z) and meso-zeaxanthin (MZ). The present study reports on serum response to three different MP supplements in normal subjects (n 27) and in subjects with age-related macular degeneration (AMD) (n 27). Subjects were randomly assigned to: Group 1 (20 mg L and 2 mg Z), Group 2 (10 mg L, 2 mg Z and 10 mg MZ) or Group 3 (3 mg L, 2 mg Z and 17 mg MZ). Serum carotenoids were quantified at baseline, and at 4 and 8 weeks using HPLC. Response data for normal and AMD subjects were comparable and therefore combined for analysis. We report response as the average of the 4- and 8-week concentrations (saturation plateau). Serum L increased significantly in Group 1 (0·036 μmol/l per mg (269 %); P< 0·001) and Group 2 (0·079 μmol/l per mg (340 %); P< 0·001), with no significant change in Group 3 (0·006 μmol/l per mg (7 %); P= 0·466). Serum Z increased significantly in Group 1 (0·037 μmol/l per mg (69 %); P= 0·001) and Group 2 (0·015 μmol/l per mg (75 %); P< 0·001), with no significant change in Group 3 ( − 0·0002 μmol/l per mg ( − 6 %); P= 0·384). Serum MZ increased significantly in Group 1 (0·0094 μmol/l (absolute value); P= 0·015), Group 2 (0·005 μmol/l per mg; P< 0·001) and Group 3 (0·004 μmol/l per mg; P< 0·001). The formulation containing all three macular carotenoids (Group 2 supplement) was the most efficacious in terms of achieving the highest combined concentration of the three MP constituent carotenoids in serum, thereby potentially optimising the bioavailability of these compounds for capture by the target tissue (retina).