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Adults with congenital heart disease face psychological challenges although an understanding of depression vs. anxiety symptoms is unclear. We analyzed the prevalence of elevated symptoms of anxiety and depression and explored associations with demographic and medical factors as well as quality of life.
Adults with congenital heart disease enrolled from an outpatient clinic completed the Hospital Anxiety and Depression Scale and two measures of quality of life: the Linear Analogue Scale and the Satisfaction with Life Scale. Medical data were obtained by chart review.
Of 130 patients (median age = 32 years; 55% female), 55 (42%) had elevated anxiety symptoms and 16 (12%) had elevated depression symptoms on subscales of the Hospital Anxiety and Depression Scale. Most patients with elevated depression symptoms also had elevated anxiety symptoms (15/16; 94%). Of 56 patients with at least one elevated subscale, 37 (66%) were not receiving mental health treatment. Compared to patients with 0 or 1 elevated subscales, patients with elevations in both (n=15) were less likely to be studying or working (47% vs. 81%; p=0.016) and reported lower scores on the Linear Analogue Scale (60 vs. 81, p<0.001) and the Satisfaction with Life Scale (14 vs. 28, p<0.001).
Among adults with congenital heart disease, elevated anxiety symptoms are common and typically accompany elevated depressive symptoms. The combination is associated with unemployment and lower quality of life. Improved strategies to provide psychosocial care and support appropriate engagement in employment are required.
Protected areas are central to global efforts to prevent species extinctions, with many countries investing heavily in their establishment. Yet the designation of protected areas alone can only abate certain threats to biodiversity. Targeted management within protected areas is often required to achieve fully effective conservation within their boundaries. It remains unclear what combination of protected area designation and management is needed to remove the suite of processes that imperil species. Here, using Australia as a case study, we use a dataset on the pressures facing threatened species to determine the role of protected areas and management in conserving imperilled species. We found that protected areas that are not resourced for threat management could remove one or more threats to 1,185 (76%) species and all threats to very few (n = 51, 3%) species. In contrast, a protected area network that is adequately resourced to manage threatening processes within their boundary could remove one or more threats to almost all species (n = 1,551; c. 100%) and all threats to almost half (n = 740, 48%). However, 815 (52%) species face one or more threats that require coordinated conservation actions that protected areas alone could not remove. This research shows that investing in the continued expansion of Australia's protected area network without providing adequate funding for threat management within and beyond the existing protected area network will benefit few threatened species. These findings highlight that as the international community expands the global protected area network in accordance with the 2020 Strategic Plan for Biodiversity, a greater emphasis on the effectiveness of threat management is needed.
The Numeniini is a tribe of 13 wader species (Scolopacidae, Charadriiformes) of which seven are Near Threatened or globally threatened, including two Critically Endangered. To help inform conservation management and policy responses, we present the results of an expert assessment of the threats that members of this taxonomic group face across migratory flyways. Most threats are increasing in intensity, particularly in non-breeding areas, where habitat loss resulting from residential and commercial development, aquaculture, mining, transport, disturbance, problematic invasive species, pollution and climate change were regarded as having the greatest detrimental impact. Fewer threats (mining, disturbance, problematic native species and climate change) were identified as widely affecting breeding areas. Numeniini populations face the greatest number of non-breeding threats in the East Asian-Australasian Flyway, especially those associated with coastal reclamation; related threats were also identified across the Central and Atlantic Americas, and East Atlantic flyways. Threats on the breeding grounds were greatest in Central and Atlantic Americas, East Atlantic and West Asian flyways. Three priority actions were associated with monitoring and research: to monitor breeding population trends (which for species breeding in remote areas may best be achieved through surveys at key non-breeding sites), to deploy tracking technologies to identify migratory connectivity, and to monitor land-cover change across breeding and non-breeding areas. Two priority actions were focused on conservation and policy responses: to identify and effectively protect key non-breeding sites across all flyways (particularly in the East Asian- Australasian Flyway), and to implement successful conservation interventions at a sufficient scale across human-dominated landscapes for species’ recovery to be achieved. If implemented urgently, these measures in combination have the potential to alter the current population declines of many Numeniini species and provide a template for the conservation of other groups of threatened species.
Are wine alcohol labels accurate? If not, why? We explore the high and rising alcohol content of wine and examine incentives for false labeling, including the roles of climate, evolving consumer preferences, and expert ratings. We draw on international time-series data from a large number of countries that experienced different patterns of climate change and influences of policy and demand shifts. We find systematic patterns that suggest that rising wine alcohol content may be a nuisance by-product of producer responses to perceived market preferences for wines having more-intense flavours, possibly in conjunction with evolving climate. (JEL Classifications: D22, L15, L66, Q18, Q54).
Radical hypofractionated thoracic radiotherapy is the most commonly used radiotherapy schedule for inoperable non-small-cell lung cancer (NSCLC) in the United Kingdom, despite a lack of level I evidence to support its use.
To supplement existing published retrospective data with a mature data series and provide further evidence to support the use of this schedule in routine clinical practice.
Materials and methods
Retrospective analysis of all inoperable NSCLC cases treated with radical hypofractionated radiotherapy with or without induction chemotherapy in the North Wales Cancer Treatment Centre between 2001 and 2011.
Of the 222 patients, 209 (94%) received 55 Gy in 20 fractions (#) and 13 (6%) received 52·5 Gy in 20#. Induction chemotherapy was administered in 121 (55%) cases. The median survival of 28·6 months (95% confidence interval 24·2–32·5) is comparable with previously published survival outcomes for this patient group.
The growing body of evidence for this schedule, confirming survival outcomes comparable with internationally accepted results, is sufficient to support its future use in inoperable NSCLC.
Breeding trials for swede (Brassica napus var. napobrassica) in 2000–2010 showed that 0·85 of the incidence of brown heart (BH) in the trials was associated with genotypes that are progeny of Ag31, Or13 and Me77c. In order to investigate this and the effect of treatment with boron (B), established varieties and improved parent lines carrying male sterility (ms), and their F1 hybrids (test hybrids), were grown in a field trial in the UK in 2011 and subjected to four B treatments (0·00, 1·35, 1·80 and 2·70 kg B/ha). The results confirmed that BH incidence and severity was affected by genotype but could be ameliorated by B application. Genotype Ag31 was very susceptible while Or13 and Me77c were of intermediate susceptibility and the hybrids between susceptible parents were also sensitive. Genotypes Gr19 and Ly01 were highly resistant even in the absence of B application. Hybrids between resistant and susceptible lines were highly resistant. The use of ms had no influence on BH. Resistance to BH was a dominant trait: homozygous dominant (BHBH) or heterozygous (BHbh) genotypes confer this trait, while susceptibility is recessive (bhbh). Some quantitative variation existed, suggesting that resistance was not a single gene effect. There was a significant negative correlation (r=−0·632) between root B content and the severity of BH in susceptible genotypes. Severe BH was associated with 12–21·5 μg B/g of root dry weight at zero B applied. Moderate discolouration was associated with 19·5–24·8 μg B/g recorded at moderate B applied and only Ag31 showed BH at 2·70 kg B/ha. Resistant varieties had root contents of 23 μg B/g or more while susceptible varieties required a minimum of 31 μg B/g to offset BH.
The Millimetre Astronomy Legacy Team 90 GHz (MALT90) survey aims to characterise the physical and chemical evolution of high-mass star-forming clumps. Exploiting the unique broad frequency range and on-the-fly mapping capabilities of the Australia Telescope National Facility Mopra 22 m single-dish telescope1, MALT90 has obtained 3′ × 3′ maps towards ~2 000 dense molecular clumps identified in the ATLASGAL 870 μm Galactic plane survey. The clumps were selected to host the early stages of high-mass star formation and to span the complete range in their evolutionary states (from prestellar, to protostellar, and on to
regions and photodissociation regions). Because MALT90 mapped 16 lines simultaneously with excellent spatial (38 arcsec) and spectral (0.11 km s−1) resolution, the data reveal a wealth of information about the clumps’ morphologies, chemistry, and kinematics. In this paper we outline the survey strategy, observing mode, data reduction procedure, and highlight some early science results. All MALT90 raw and processed data products are available to the community. With its unprecedented large sample of clumps, MALT90 is the largest survey of its type ever conducted and an excellent resource for identifying interesting candidates for high-resolution studies with ALMA.
The purpose of the present study was to determine the effects of short-term supplementation with the free acid form of β-hydroxy-β-methylbutyrate (HMB-FA) on indices of muscle damage, protein breakdown, recovery and hormone status following a high-volume resistance training session in trained athletes. A total of twenty resistance-trained males were recruited to participate in a high-volume resistance training session centred on full squats, bench presses and dead lifts. Subjects were randomly assigned to receive either 3 g/d of HMB-FA or a placebo. Immediately before the exercise session and 48 h post-exercise, serum creatine kinase (CK), urinary 3-methylhistadine (3-MH), testosterone, cortisol and perceived recovery status (PRS) scale measurements were taken. The results showed that CK increased to a greater extent in the placebo (329 %) than in the HMB-FA group (104 %) (P= 0·004, d= 1·6). There was also a significant change for PRS, which decreased to a greater extent in the placebo (9·1 (sem 0·4) to 4·6 (sem 0·5)) than in the HMB-FA group (9·1 (sem 0·3) to 6·3 (sem 0·3)) (P= 0·005, d= − 0·48). Muscle protein breakdown, measured by 3-MH analysis, numerically decreased with HMB-FA supplementation and approached significance (P= 0·08, d= 0·12). There were no acute changes in plasma total or free testosterone, cortisol or C-reactive protein. In conclusion, these results suggest that an HMB-FA supplement given to trained athletes before exercise can blunt increases in muscle damage and prevent declines in perceived readiness to train following a high-volume, muscle-damaging resistance-training session.
The methanol multi-beam (MMB) survey has produced the largest and most complete catalogue of Galactic 6.7-GHz methanol masers to date. 6.7-GHz methanol masers are exclusively associated with high-mass star formation, and as such provide invaluable insight into the Galactic distribution and properties of high-mass star formation regions. I present the statistical properties of the MMB catalogue and, through the calculation of kinematic distances, investigate the resolution of distance ambiguities and explore the Galactic distribution.
The results of the first complete survey for 6668-MHz CH3OH and 6035-MHz excited-state OH masers in the Small and Large Magellanic Clouds are presented. A new 6668-MHz CH3OH maser in the Large Magellanic Cloud has been detected towards the star-forming region N 160a, together with a new 6035-MHz excited-state OH maser detected towards N 157a. We also re-observed the previously known 6668-MHz CH3OH masers and the single known 6035-MHz OH maser. Neither maser transition was detected above ~0.13 Jy in the Small Magellanic Cloud. All observations were initially made using the CH3OH Multibeam (MMB) survey receiver on the 64-m Parkes radio telescope as part of the overall MMB project. Accurate positions were measured with the Australia Telescope Compact Array (ATCA). In a comparison of the star formation maser populations in the Magellanic Clouds and our Galaxy, the LMC maser populations are demonstrated to be smaller than their Milky Way counterparts. CH3OH masers are under-abundant by a factor of ~50, whilst OH and H2O masers are a factor of ~10 less abundant than our Galaxy.
A new 7-beam methanol multibeam receiver is being used to survey the Galaxy for newly forming massive stars, that are pinpointed by strong methanol maser emission at 6.668 GHz. The receiver, jointly constructed by Jodrell Bank Observatory (JBO) and the Australia Telescope National Facility (ATNF), was successfully commissioned at Parkes in January 2006. The Parkes-Jodrell survey of the Milky Way for methanol masers is two orders of magnitude faster than previous systematic surveys using 30-m class dishes, and is the first systematic survey of the entire Galactic plane. The first 53 days of observations with the Parkes telescope have yielded 518 methanol sources, of which 218 are new discoveries. We present the survey methodology as well as preliminary results and analysis.
Thomas Spray, Heart, Lung and Heart Transplant Services, Children's Hospital of Philadelphia, PA, USA,
Stephanie M. P. Fuller, Heart, Lung and Heart Transplant Services, Children's Hospital of Philadelphia, PA, USA
Thoracic organ transplantation is an important treatment option in children with acquired or congenital cardiopulmonary disease. In recent years, there has been considerable improvement in early outcomes following thoracic organ transplantation in children and 1-year survival is similar now to that in adults. Approximately 250 pediatric heart transplants and 60 lung transplants are performed annually in the United States. Thoracic organ transplantation in neonates and infants has been limited by donor availability, and the number of thoracic organ transplants performed each year in children has plateaued. Complications such as acute and chronic rejection, graft coronary artery disease (CAD) or bronchiolitis obliterans, as well as those of immunosuppression, pose serious threats to the long-term success of thoracic organ transplantation in children. Despite these potential impediments, life expectancy and quality of life for patients following transplantation exceed that for patients with end-stage cardiopulmonary disease who are managed medically. This chapter focuses on the clinical aspects of heart and lung transplantation in infants and children including indications, preoperative evaluation, postoperative course and management, complications and long-term outcomes.
As published by the Registry for the International Society for Heart and Lung Transplantation (ISHLT) in the Seventh Official Report in May 2004, the number of pediatric heart transplants has remained relatively constant over the last 10 years (Fig. 67.1). The most common indication for heart transplantation in the neonatal population remains complex congenital heart disease for which no reasonable corrective or palliative surgical therapy is available.
A new 7-beam methanol multibeam receiver was successfully commissioned at Parkes Observatory in January 2006, and has begun surveying the Milky Way for newly forming massive stars, that are pinpointed by strong methanol maser emission at 6.7 GHz. The receiver was jointly constructed by Jodrell Bank Observatory and the Australia Telescope National Facility for use on the Parkes and Lovell Telescopes. The whole galactic plane is being surveyed within latitudes ±2°, with a velocity resolution of 0.1 km s−1 and a 5-σ sensitivity of ~0.7 Jy. Altogether 200 days of observing will be required.
PRD1 is a ds-DNA bacteriophage from the Tectiviridae family with an unusual structural feature: the viral genome is enclosed by a protein-rich membrane, which is in turn enclosed by an external icosahedral protein shell (capsid). Three-dimensional reconstructions from cryo-electron microscopy (cryo-EM) images have revealed the structure of the PRD1 capsid at moderate resolution (28 Å), while X-ray crystallographic studies have recently provided a high resolution (1.85 Å) picture of the major coat protein, P3. We have now combined these results from different imaging methods to obtain a more detailed understanding of the virion organization. The combination has been made in a cyclic process: a preliminary fitting of the atomic structure of P3 to each one of its independent positions in the cryo-EM maps of the capsids provided initial models that could be used to improve the reconstructions; the refined maps then served as a base frame for an optimized fit. This process allows us to study the viral particle structure at “quasi-atomic” resolution.
A new mechanism for space-charge field formation in photorefractive liquid crystal composites containing poly(2,5-bis(2′-ethylhexyloxy)-l,4-phenylenevinylene) (BEH-PPV) and the electron acceptor N,N′-dioctyl-1,4:5,8-naphthalenediimide, NI, is observed. Using asymmetric energy transfer (beam coupling) measurements that are diagnostic for the photorefractive effect, the direction of beam coupling as a function of grating fringe spacing inverts at a spacing of 5.5 μm. We show that the inversion is due to a change in the dominant mechanism for space-charge field formation. At small fringe spacings, the space-charge field is formed by ion diffusion in which the photogenerated anion is the more mobile species. At larger fringe spacings, the polarity of the space charge field inverts due to dominance of a charge transport mechanism in which photogenerated holes are the most mobile species due to hole migration along the BEH-PPV chains coupled with interchain hole hopping. Control experiments are presented, which use composites that can access only one of the two charge transport mechanisms. The results show that charge migration over long distances leading to enhanced photorefractive effects can be obtained using conjugated polymers dissolved in liquid crystals.
Current recommendations for energy requirements in the elderly are based on assumed levels of physical activity relative to BMR (1.5 x BMR). The main aim of the present study was to establish whether these recommendations might be applicable to a randomly-selected group of free-living elderly men (all over 75 years of age). BMR was measured by indirect calorimetry and total energy expenditure (TEE) by the doubly-labelled-water technique. Further aims included evaluating the applicability of a variety of BMR prediction equations and whether assessed quality of life reflected any measured indices of energy expenditure. The mean value for daily energy requirement was found to be 1.5 x BMR (89 J/kg per min) but with substantial inter-individual variation (SD 0-2 x BMR; 14 J/kg per min). The bias between measured TEE and TEE estimated (1.5 x BMR) from the various BMR predictions varied according to which equation was used (-10-+ 8% of the mean) with substantial 95 YO limits of agreement (28-30%of the mean). TEE and physical activity plus thermogenesis (TEE -BMR) were positively related to activities of daily living, but no relationships were apparent between these and perceived quality of life. It is concluded that, despite considerable inter-individual variability, national recommendations for energy requirements of elderly people are applicable to this randomly-selected group of free-living men over 75 years of age but that substantial variation exists when attempts are made to estimate TEE from measurements or predictions of BMR.
The fracture toughness of interface reinforced with dps-b-dpmma copolymer between immiscible polymers of PS and PMMA is tested by asymmetric double cantilever beam. The local deformation field at the interfacial crack tip is determined by the technique of SIEM. Normal and tangential crack opening displacements are calculated. A weak singularity is shown to exist near crack tip. Direct observation on the fracture process inside an environmental scanning electron microscope shows the large effect of mode mixity.