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Background: Quality of life (QOL) is of great importance in dementia. We examined QOL across types of dementia in patients presenting to a rural and remote memory clinic (RRMC). Methods: This analysis included 343 RRMC patients seen between 2004 and 2016. Patients were diagnosed with mild cognitive impairment (MCI, n=74), frontotemporal dementia (FTD, n=42), Alzheimer’s disease (AD, n=187), vascular dementia (VD, n=22), or Lewy Body dementia (DLB, n=18). Patients and caregivers completed questionnaires at their initial visit. Data collection included patient-rated patient QOL (QOL-PT), caregiver-rated patient QOL (QOL-CG), MMSE score, age, and other patient demographics. Statistical analysis assessed patient variables and differences in QOL across types of dementia using one-way ANOVA, χ2 tests, and t-tests. Results: QOL-PT did not differ by diagnosis, whereas QOL-CG did. QOL-CG was significantly higher in MCI (34.6±7.1) compared to FTD (30.9±5.2) and AD (31.7±5.9). QOL-PT and QOL-CG differed in certain dementia types. QOL-PT was significantly higher than QOL-CG in MCI (QOL-PT=37.3±5.0, QOL-CG=35.3±7.3), FTD (QOL-PT=37.2±6.1, QOL-CG=31.7±5.5), and AD (QOL-PT=37.0±9.7, QOL-CG=32.1±5.9). Conclusions: We found that QOL-PT does not differ across dementia types, QOL-CG is higher in MCI compared to FTD and AD, and patients rate their own QOL higher than their caregivers do in MCI, FTD, and AD.
Background: To determine whether there is a difference in the average annual rate of decline in Mini Mental Status Examination (MMSE) scores between those with Alzheimer’s disease, vascular dementia, frontotemporal dementia and dementia with Lewy bodies. Methods: We conducted a retrospective chart review of 225 consecutive patients with dementia who attended the Rural and Remote Memory Clinic in Saskatoon, Saskatchewan. The data collected included MMSE scores and demographic information. Statistical analysis with ANOVA compared the average the annual rate of decline in MMSE score between patients with different types of dementia. Results: There was no statistically significant difference in the rate of MMSE score decline between these groups. Patients with frontotemporal dementia and vascular dementia were referred to the clinic at younger ages than those with Alzheimer’s disease and dementia with Lewy bodies. Conclusions: The rate of decline in MMSE did not differ between these four types of dementia. Patients with frontotemporal dementia and vascular dementia often experience cognitive decline earlier in life than those with Alzheimer’s disease and dementia with Lewy bodies.
The ‘Portus Project’ investigates the social and economic contexts of the maritime port of Imperial Rome. This article presents the results of analysis of plant, animal and human remains from the site, and evaluates their significance for the reconstruction of the diets and geographic origins of its inhabitants between the second and sixth centuries AD. Integrating this evidence with other material from the recent excavations, including ceramic data, the authors identify clear diachronic shifts in imported foods and diet that relate to the commercial and political changes following the breakdown of Roman control of the Mediterranean.
Our principle objective was to examine the personal and professional impact of service user (SU) suicide on mental health professionals (MHPs). We also wished to explore putative demographic or clinical factors relating to SUs or MPHs that could influence the impact of SU suicide for MHPs and explore factors MHPs report as helpful in reducing distress following SU suicide.
A mixed-method questionnaire with quantitative and thematic analysis was utilised.
Quantitative data indicated SU suicide was associated with personal and professional distress with sadness (79.5%), shock (74.5%) and surprise (68.7%) particularly evident with these phenomena lasting less than a year for more than 90% of MHPs. MHPs also reported guilt, reduced self-confidence and a fear of negative publicity. Thematic analysis indicated that some MHPs had greater expertise when addressing SU suicidal ideation and in supporting colleagues after experiencing a SU suicide. Only 17.7% of MHPs were offered formal support following SU suicide.
SU suicide impacts MHPs personally and professionally in both a positive and negative fashion. A culture and clear pathway of formal support for MHPs to ascertain the most appropriate individualised support dependent on the distress they experience following SU suicide would be optimal.
Autistic spectrum disorder (ASD) is a neuro-developmental disability with multi-systemic impacts. Individuals with ASD without intellectual impairment (DSM-V) or Aspergers (DSM-IV) are often particularly vulnerable to mental health problems such as anxiety disorders including social phobia and generalised anxiety disorder, depressive disorders and psychosis. Adults with ASD without intellectual impairment suffer higher rates of physical and psychiatric morbidity, display a poorer ability to engage with treatment and have a lower chance of recovery compared with the general population. It is widely acknowledged that adults with suspected ASD without intellectual impairment and co-morbid mental health problems are often not best supported through adult mental health services and often require more tailored supports. This review seeks to (a) increase awareness in the area of undiagnosed cases of ASD without intellectual impairment in adult mental health settings and (b) highlights the importance of identifying this population more efficiently by referring to best practice guidelines. The value of future research to examine the benefit of having a team of specialist staff within adult mental health teams who have received ASD training and who are supported to work with the ‘core difficulties’ of ASD is discussed and a model for the same is proposed. It is proposed that a specialist team could form a ‘hub’ for the development of expertise in ASD, which when adequately resourced and funded could reach across an entire region, offering consultancy and diagnostic assessments and interventions.
The emergence of callous unemotional (CU) traits, and associated externalizing behaviors, is believed to reflect underlying dysfunction in the amygdala. Studies of adults with CU traits or psychopathy have linked characteristic patterns of amygdala dysfunction to reduced amygdala volume, but studies in youths have not thus far found evidence of similar amygdala volume reductions. The current study examined the association between CU traits and amygdala volume by modeling CU traits and externalizing behavior as independent continuous variables, and explored the relative contributions of callous, uncaring, and unemotional traits.
CU traits and externalizing behavior problems were assessed in 148 youths using the Inventory of Callous Unemotional Traits (ICU) and the Child Behavior Checklist (CBCL). For a subset of participants (n = 93), high-resolution T1-weighted images were collected and volume estimates for the amygdala were extracted.
Analyses revealed that CU traits were associated with increased externalizing behaviors and decreased bilateral amygdala volume. These results were driven by the callous and uncaring sub-factors of CU traits, with unemotional traits unrelated to either externalizing behaviors or amygdala volume. Results persisted after accounting for covariation between CU traits and externalizing behaviors. Bootstrap mediation analyses indicated that CU traits mediated the relationship between reduced amygdala volume and externalizing severity.
These findings provide evidence that callous-uncaring traits account for reduced amygdala volume among youths with conduct problems. These findings provide a framework for further investigation of abnormal amygdala development as a key causal pathway for the development of callous-uncaring traits and conduct problems.
Concentrate inclusion levels in dairy cow diets are often adjusted so that the milk yield responses remain economic. While changes in concentrate level on performance is well known, their impact on other biological parameters, including immune function, is less well understood. The objective of this study was to evaluate the effect of concentrate inclusion level in a grass silage-based mixed ration on immune function. Following calving 63 (45 multiparous and 18 primiparous) Holstein Friesian dairy cows were allocated to one of three isonitrogenous diets for the first 70 days of lactation. Diets comprised of a mixture of concentrates and grass silage, with concentrates comprising either a low (30%, LC), medium (50%, MC) or high (70%, HC) proportion of the diet on a dry matter (DM) basis. Daily DM intakes, milk yields and BW were recorded, along with weekly body condition score, milk composition and vaginal mucus scores. Blood biochemistry was measured using a chemistry analyzer, neutrophil phagocytic and oxidative burst assessed using commercial kits and flow cytometry, and interferon-γ production evaluated by ELISA after whole blood stimulation. Over the study period cows on HC had a higher total DM intake, milk yield, fat yield, protein yield, fat+protein yield, protein content, mean BW and mean daily energy balance, and a lower BW loss than cows on MC, whose respective values were higher than cows on LC. Cows on HC and MC had a lower serum non-esterified fatty acid concentration than cows on LC (0.37, 0.37 and 0.50 mmol/l, respectively, P=0.005, SED=0.032), while cows on HC had a lower serum β-hydroxybutyrate concentration than cows on MC and LC (0.42, 0.55 and 0.55 mmol/l, respectively, P=0.002, SED=0.03). Concentrate inclusion level had no effect on vaginal mucus scores. At week 3 postpartum, cows on HC tended to have a higher percentage of oxidative burst positive neutrophils than cows on LC (43.2% and 35.3%, respectively, P=0.078, SED=3.11), although at all other times concentrate inclusion level in the total mixed ration had no effect on neutrophil phagocytic or oxidative burst characteristics, or on interferon-γ production by pokeweed mitogen stimulated whole blood culture. This study demonstrates that for high yielding Holstein Friesian cows managed on a grass silage-based diet, concentrate inclusion levels in early lactation affects performance but has no effect on neutrophil or lymphocyte immune parameters.
Background: A will, power of attorney and advanced healthcare directive are critical to guide decision-making in people with cognitive decline. We identified characteristics that are associated with the existence of these documents in patients who presented to a rural and remote memory clinic (RRMC). Methods: 95 consecutive patients were included in this study. Patients and caregivers completed questionnaires on initial presentation to the RRMC and patients were asked if they have legal documents. Patients also completed neuropsychological testing. Statistical analysis (t-test and χ2 test) was performed to identify significant variables. Results: 70 patients had a will, 62 had a power of attorney and 21 had an advanced healthcare directive. Having a will was associated with good quality of life (p=0.001), living alone (p=0.034), poor verbal fluency (p=0.055) and European ethnicity (p=0.028). Factors associated with having a power of attorney included good quality of life (p=0.031), living alone (p=0.053) and poor verbal fluency (p=0.015). Old age (p=0.015), poor verbal fluency (p=0.023) and severity of cognitive and functional impairment (p=0.023) were associated with having an advanced healthcare directive. Conclusions: Our results indicate that poor quality of life, good verbal fluency, non-European ethnicity and living with others are associated with a lower likelihood of creating legal documents in patients with cognitive decline
There is currently a lack of research investigating the effectiveness of commercial broiler enrichments, and in particular the ability of these additions to create opportunities for positive welfare. One aim of this study was to investigate whether offering broiler chickens enrichments that have recently been found to be preferred leads to increased levels of activity. A second aim was to investigate the emotional effects of provision of these enrichments by assessing levels of fearfulness and play-like activity. Commercially housed broilers were assigned to treatment houses containing either: (1) platform perches, (2) platform perches+peat dust baths, (3) no enrichment (control). Activity levels and play behaviours in unenriched areas of the house were measured in weeks 3, 4 and 5. Levels of active behaviours, such as foraging and locomotion, were determined from video recordings of undisturbed birds in unenriched areas of the house. To stimulate play-like behaviours an observer walked through the birds, displacing them and creating a space. The broilers using the space were then filmed for 5 min and the occurrences of frolicking, sparring and food-running were recorded. Fearfulness of broilers in unenriched areas of the house, and also when using enrichments, was measured using observer avoidance tests in week 5. We found that creating space among the broilers was a successful method of stimulating play (largely sparring and frolicking), with play being observed in 93% of videos, however the presence of enrichments did not have an effect on the level of play recorded (P>0.05). There was also no treatment effect on activity levels of broilers in unenriched areas (P>0.05), however levels of overall activity decreased as broilers aged. Compared with the control, flight distances in unenriched areas were significantly lower in the perches+dust bath treatment (P=0.026), and were numerically lower in the perches treatment. This suggests a reduction in fearfulness with increased environmental complexity, and thus possible welfare benefits. It is suggested that further research should investigate whether increasing the level of provision of these enrichments leads to more marked improvements in welfare.
In vitro techniques have been developed to facilitate the measurement of nutritional variability amongst food. Many kinetic studies have utilized the modified Tilley and Terry technique, with long-term incubations carried out in Erlenmeyer flasks. These are inefficient in utilizing incubator space for large scale studies. However substitution of Erlenmeyer flasks with tubes as fermentation units leaves the system prone to ‘bridging’, the formation of dense mats of forage particles by entrapped gas, above the level of the media in a fermentation unit. The objective of experiment 1 was to establish an effective incubation technique to eliminate the random variation caused by bridging.
Provision of an appropriate dustbathing substrate may allow broiler chickens to satisfy a natural motivation and give them an opportunity to exercise. The main aim of this study was to evaluate the extent to which different substrates promote dustbathing behaviour in broilers. The trial was replicated over three production cycles in one commercial broiler house, with ~22 000 Ross broilers housed per cycle. The birds were provided with access to five experimental substrates from day 10 of the 6-week production cycle. The substrates included the following: (1) peat (P), (2) oat hulls (OH), (3) straw pellets (SP), (4) clean wood shavings (WS), and (5) litter control (C). The substrates were provided in 15 steel rings (1.1 m in diameter, three rings per substrate) dispersed throughout the house. The level of occupancy of the rings, behaviours performed in each substrate, and the effect of ring position (central or edge of house) were assessed in weeks 3, 4, 5 and 6 using scan sampling from video footage. Where substrates successfully promoted dustbathing, the length and components of the bouts (including number of vertical wing shakes and ground pecks) were also assessed. Results showed that birds used P significantly more than the remaining substrates for dustbathing (P<0.001). Oat hulls were the second most preferred substrate for dustbathing, with significantly more birds dustbathing in the OH compared with SP, WS and C (P<0.001). The least sitting inactive was also seen in the P and OH rings compared with the SP, WS and C (P<0.001). The highest levels of foraging were recorded in the P, OH and WS compared with SP and the C. Position of the rings did not affect the types of behaviours performed in any substrate, although overall more birds were counted in the central compared with edge rings (P=0.001). More detailed information on dustbathing behaviour was only recorded in the P and OH treatments, and there were no differences in the length of dustbathing bout, or components of the bout between them (P>0.05). The use of OH is likely to be more environmentally sustainable than that of P, and our results suggest that this substrate is relatively successful in promoting dustbathing. However, a preference was still observed for P and further work should investigate whether other suitable substrates could better reflect its qualities.
The increase in the prevalence of post weaning diarrhoea in pigs due to the progressive ban of antibiotic use has necessitated the use of alternative management and nutritional strategies (Le Bellego and Noblet, 2001). During immunological stress, amino acids are redistributed away from protein production towards tissues involved in inflammation and immune response. This can disturb normal body processes, which can in turn induce specific amino acid requirements. Threonine utilization by the gut is higher than that of any other amino acid because it is involved in the synthesis of intestinal mucin. Mucin plays a key role in the defence of the mucosa, however it is indigestible. Thus, when the positive effects of an antimicrobial growth promoter are removed, increased levels of dietary threonine may benefit piglets due to additional reserves of threonine being present to compensate for the portion of dietary threonine that becomes unavailable due to the increased synthesis of intestinal mucin. The objective of the experiment was to investigate the interaction between threonine level and avilamycin inclusion on piglet performance and diet digestibility post weaning.
Ammonia and volatile fatty acids are significant sources of pollution. In wheat, xylans predominate as the primary non-starch polysaccharide while in barley β-glucan predominates. β-glucans have also been shown to support the growth of lactobacilli and bifidobacteria. By increasing bacterial activity in the hindgut, the pattern of nitrogen excretion and VFA production may be augmented. Exogenous enzymes may increase nutrient digestibility by degrading the β-glucan. It is hypothesised that the addition of an exogenous enzyme mix to a barley-based diet would result in a benefit in terms of increased nutrient digestibility however; this benefit may be reduced by an associated increase in ammonia emissions.
Lameness is a significant problem leading to reduced dairy cow productivity and welfare. Housing and management factors are known to influence lameness levels in dairy cows (Haskell et al., 2006). Furthermore, lameness management strategies are also key factors affecting the incidence of lameness (e.g. early detection of lameness (Whay, 2002) and claw trimming (Manske et al., 2002)). It is likely that knowledge factors influence lameness management strategies (Mill and Ward, 1994). The current study aimed to gain a better understanding of the relationship between lameness knowledge levels and the incidence of lameness on-farm. This is part of a wider survey aimed at understanding how knowledge, attitude, perception, and management factors affect lameness levels on dairy farms.
Recent research suggests that the genetic makeup of a pig may contribute to the expression of tail biting (Breuer et al., 2002). To date there has been little investigation into the genetics of tail biting. A significant population of tail biters was found at a commercial pig breeding farm at which an experiment on the genetic basis of the expression of harmful social behaviour was being performed. As pedigree data for each pig on the farm were available, the opportunity was taken to investigate the heritability of tail biting by recording the perpetrators of clinical tail biting.
People with pancreatic cancer have poor survival, and management is challenging. Pancreatic cancer patients' perceptions of their care coordination and its association with their outcomes have not been well-studied. Our objective was to determine if perception of care coordination is associated with patient-reported outcomes or survival.
People with pancreatic cancer who were 1–8 months postdiagnosis (52 with completed resection and 58 with no resection) completed a patient-reported questionnaire that assessed their perceptions of care coordination, quality of life, anxiety, and depression using validated instruments. Mean scores for 15 care-coordination items were calculated and then ranked from highest (best experience) to lowest (worst experience). Associations between care-coordination scores (including communication and navigation domains) and patient-reported outcomes and survival were investigated using general linear regression and Cox regression, respectively. All analyses were stratified by whether or not the tumor had been resected.
In both groups, the highest-ranked care-coordination items were: knowing who was responsible for coordinating care, health professionals being informed about their history, and waiting times. The worst-ranked items related to: how often patients were asked about visits with other health professionals and how well they and their family were coping, knowing the symptoms they should monitor, having sufficient emotional help from staff, and access to additional specialist services. For people who had a resection, better communication and navigation scores were significantly associated with higher quality of life and less anxiety and depression. However, these associations were not statistically significant for those with no resection. Perception of cancer care coordination was not associated with survival in either group.
Significance of results:
Our results suggest that, while many core clinical aspects of care are perceived to be done well for pancreatic cancer patients, improvements in emotional support, referral to specialist services, and self-management education may improve patient-reported outcomes.
Resistance training (RT) and increased dietary protein are recommended to attenuate age-related muscle loss in the elderly. This study examined the effect of a lean red meat protein-enriched diet combined with progressive resistance training (RT+Meat) on health-related quality of life (HR-QoL) in elderly women. In this 4-month cluster randomised controlled trial, 100 women aged 60–90 years (mean 73 years) from self-care retirement villages participated in RT twice a week and were allocated either 160 g/d (cooked) lean red meat consumed across 2 meals/d, 6 d/week or ≥1 serving/d (25–30 g) carbohydrates (control group, CRT). HR-QoL (SF-36 Health Survey questionnaire), lower limb maximum muscle strength and lean tissue mass (LTM) (dual-energy X-ray absorptiometry) were assessed at baseline and 4 months. In all, ninety-one women (91 %) completed the study (RT+Meat (n 48); CRT (n 43)). Mean protein intake was greater in RT+Meat than CRT throughout the study (1·3 (sd 0·3) v. 1·1 (sd 0·3) g/kg per d, P<0·05). Exercise compliance (74 %) was not different between groups. After 4 months there was a significant net benefit in the RT+Meat compared with CRT group for overall HR-QoL and the physical component summary (PCS) score (P<0·01), but there were no changes in either group in the mental component summary (MCS) score. Changes in lower limb muscle strength, but not LTM, were positively associated with changes in overall HR-QoL (muscle strength, β: 2·2 (95 % CI 0·1, 4·3), P<0·05). In conclusion, a combination of RT and increased dietary protein led to greater net benefits in overall HR-QoL in elderly women compared with RT alone, which was because of greater improvements in PCS rather than MCS.