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A previously healthy 48-year-old female presented to the emergency department with a 2-week history of low back pain, progressive lower extremities weakness, and right leg numbness. There were no bowel or bladder dysfunction symptoms. Spine magnetic resonance imaging (MRI) showed an intradural cystic lesion dorsal to the spinal cord at the level of L1 measuring 1.6 × 2.1 × 4.1 cm, which was T1 hypointense and T2 hyperintense, with a small soft tissue component and no gadolinium enhancement (Figure 1). A small lipomatous component was also noted. There were no associated vertebral anomalies. The patient underwent a T12-L2 laminectomy and cyst resection, which was subtotal due to the cyst adherence to the conus medullaris. Histopathology showed characteristic features of a neurenteric cyst, with respiratory-type epithelium in the cyst wall (Figure 2). Eight months later, follow-up MRI showed no evidence of recurrence. The patient reported improved sensation in the lower extremities; however, there was some residual weakness predominantly in the proximal hip flexors bilaterally.
Intensified cover-cropping practices are increasingly viewed as a herbicide-resistance management tool but clear distinction between reactive and proactive resistance management performance targets is needed. We evaluated two proactive performance targets for integrating cover-cropping tactics, including (1) facilitation of reduced herbicide inputs and (2) reduced herbicide selection pressure. We conducted corn (Zea mays L.) and soybean [Glycine max (L.) Merr.] field experiments in Pennsylvania and Delaware using synthetic weed seedbanks of horseweed [Conyza canadensis (L.) Cronquist] and smooth pigweed (Amaranthus hybridus L.) to assess winter and summer annual population dynamics, respectively. The effect of alternative cover crops was evaluated across a range of herbicide inputs. Cover crop biomass production ranged from 2,000 to 8,500 kg ha−1 in corn and 3,000 to 5,500 kg ha−1 in soybean. Experimental results demonstrated that herbicide-based tactics were the primary drivers of total weed biomass production, with cover-cropping tactics providing an additive weed-suppression benefit. Substitution of cover crops for PRE or POST herbicide programs did not reduce total weed control levels or cash crop yields but did result in lower net returns due to higher input costs. Cover-cropping tactics significantly reduced C. canadensis populations in three of four cover crop treatments and decreased the number of large rosettes (>7.6-cm diameter) at the time of preplant herbicide exposure. Substitution of cover crops for PRE herbicides resulted in increased selection pressure on POST herbicides, but reduced the number of large individuals (>10 cm) at POST applications. Collectively, our findings suggest that cover crops can reduce the intensity of selection pressure on POST herbicides, but the magnitude of the effect varies based on weed life-history traits. Additional work is needed to describe proactive resistance management concepts and performance targets for integrating cover crops so producers can apply these concepts in site-specific, within-field management practices.
Previous research suggests recovery from cannabis-related deficits in verbal learning and memory functioning after periods of cannabis abstinence in adolescents. Here, we examine how cannabis cessation affects cognitive performance over 2 weeks of monitored abstinence compared to controls in adolescents and young adults.
Methods:
Seventy-four participants (35 cannabis users) aged 16–26 ceased all cannabis, alcohol, and other illicit substance consumption for a 2-week period; abstinence was monitored via weekly urinalysis, breath, and sweat patch testing. Starting at baseline, participants completed weekly abbreviated neuropsychological batteries. Measures included tests of attention, inhibition, verbal working memory, and learning. Repeated measures assessed within and between subject effects for time and group status, while controlling for past year alcohol and nicotine use.
Results:
Cannabis users showed increased performance compared to controls on sustained attention tasks after 2 weeks of cannabis use.
Conclusions:
Deficits in attention, but not verbal learning and memory, recovered after 2 weeks of monitored abstinence. This differs from previous literature, suggesting that other cognitive domains may show signs of recovery after periods of cannabis cessation in adolescents and young adults.
The comparative effectiveness of antidepressant medication and cognitive-behaviour therapy for the acute treatment of depression is contentious.
Objective:
To compare the acute outcomes of antidepressant medication, cognitive-behaviour therapy (CBT), and the combination of the two, in adult, depressed patients.
Methods:
Sixteen electronic databases together with reference lists were searched for randomised and other clinical trials that compared CBT, antidepressants, or their combination.
Results:
In the comparison between CBT and antidepressants, 8 studies met inclusion criteria. Five studies met the inclusion criteria for the second comparison between single therapy and combination therapy. In the antidepressant and CBT comparison, effect sizes favoured CBT over antidepressants with a significant advantage for CBT on some outcome measures. Combined treatment appeared more effective than antidepressants. However, combined treatment did not emerge more effective than CBT.
Conclusions:
Antidepressants may not be considered more efficacious than CBT for the acute treatment of depressed patients nor can combination therapy be regarded as more effective than CBT alone.
Major depressive disorder (MDD) affects at some point in their lives a tenth of the world's population with a higher incidence in females than males. Like all clinical disorders encountered in adult psychiatry, a diagnosis of MDD is symptom-based and has not been externally validated. Eye movement dysfunctions (EMDs) in the functional psychoses have been extensively reported and their potential as biomarkers highlighted but it is unclear whether there are patterns of EMDs specific to MDD. Abnormal EMs in bipolar affective cases have been observed during face and picture viewing, saccadic control and smooth pursuit tasks. However most studies reporting EMs in affective disorders, have not distinguished between unipolar/MDD and bipolar cases. to address this problem we have compared performance on a broad range of EM tests in patients meeting DSM-IV criteria for MDD with identical measures made in a large sample of bipolar, schizophrenia and undiagnosed individuals. Remarkably a network classifier was able to delineate controls and each patient group using EM performance measures with exceptional sensitivity (94%) and specificity (98%). What is more, probability of illness category was not associated with demographic, symptom, neuropsychological or medication variables. It therefore appears that a unique multivariate eye movement phenotype may be associated with MDD. If verified in further MDD cases these findings could be an enormous advance in helping to assess and/or diagnose individuals with symptoms of MDD or at risk of developing MDD.
The American Academy of Pediatrics (AAP) calls for the inclusion of office-based pediatricians in disaster preparedness and response efforts. However, there is little research about disaster preparedness and response on the part of pediatric practices. This study describes the readiness of pediatric practices to respond to disaster and delineates factors associated with increased preparedness.
Methods:
An AAP survey was distributed to members to assess the state of pediatric offices in readiness for disaster. Potential predictor variables used in chi-square analysis included community setting, primary employment setting, area of practice, and previous disaster experience.
Results:
Three-quarters (74%) of respondents reported some degree of disaster preparedness (measured by 6 indicators including written plans and maintaining stocks of supplies), and approximately half (54%) reported response experience (measured by 3 indicators, including volunteering to serve in disaster areas). Respondents who reported disaster preparation efforts were more likely to have signed up for disaster response efforts, and vice versa.
Conclusions:
These results contribute information about the state of pediatric physician offices and can aid in developing strategies for augmenting the inclusion of office-based pediatricians in community preparedness and response efforts.
Organic grain producers are interested in interseeding cover crops into corn (Zea mays L.) in regions that have a narrow growing season window for post-harvest establishment of cover crops. A field experiment was replicated across 2 years on three commercial organic farms in Pennsylvania to compare the effects of drill- and broadcast-interseeding to standard grower practices, which included post-harvest seeding cereal rye (Secale cereale L.) at the more southern location and winter fallow at the more northern locations. Drill- and broadcast-interseeding treatments occurred just after last cultivation and used a cover crop mixture of annual ryegrass [Lolium perenne L. ssp. multiflorum (Lam.) Husnot] + orchardgrass (Dactylis glomerata L.) + forage radish (Raphanus sativus L. ssp. longipinnatus). Higher mean fall cover crop biomass and forage radish abundance (% of total) was observed in drill-interseeding treatments compared with broadcast-interseeding. However, corn grain yield and weed suppression and N retention in late-fall and spring were similar among interseeding treatments, which suggests that broadcast-interseeding at last cultivation has the potential to produce similar production and conservation benefits at lower labor and equipment costs in organic systems. Post-harvest seeding cereal rye resulted in greater spring biomass production and N retention compared with interseeded cover crops at the southern location, whereas variable interseeding establishment success and dominance of winter-killed forage radish produced conditions that increased the likelihood of N loss at more northern locations. Additional research is needed to contrast conservation benefits and management tradeoffs between interseeding and post-harvest establishment methods.
Sub-acute ruminal acidosis (SARA) can reduce the production efficiency and impair the welfare of cattle, potentially in all production systems. The aim of this study was to characterise measurable postmortem observations from divergently managed intensive beef finishing farms with high rates of concentrate feeding. At the time of slaughter, we obtained samples from 19 to 20 animals on each of 6 beef finishing units (119 animals in total) with diverse feeding practices, which had been subjectively classified as being high risk (three farms) or low risk (three farms) for SARA on the basis of the proportions of barley, silage and straw in the ration. We measured the concentrations of histamine, lipopolysaccharide (LPS), lactate and other short-chain fatty acids (SCFAs) in ruminal fluid, LPS and SCFA in caecal fluid. We also took samples of the ventral blind sac of the rumen for histopathology, immunohistopathology and gene expression. Subjective assessments were made of the presence of lesions on the ruminal wall, the colour of the lining of the ruminal wall and the shape of the ruminal papillae. Almost all variables differed significantly and substantially among farms. Very few pathological changes were detected in any of the rumens examined. The animals on the high-risk diets had lower concentrations of SCFA and higher concentrations of lactate and LPS in the ruminal fluid. Higher LPS concentrations were found in the caecum than the rumen but were not related to the risk status of the farm. The diameters of the stratum granulosum, stratum corneum and of the vasculature of the papillae, and the expression of the gene TLR4 in the ruminal epithelium were all increased on the high-risk farms. The expression of IFN-γ and IL-1β and the counts of cluster of differentiation 3 positive and major histocompatibility complex class two positive cells were lower on the high-risk farms. High among-farm variation and the unbalanced design inherent in this type of study in the field prevented confident assignment of variation in the dependent variables to individual dietary components; however, the CP percentage of the total mixed ration DM was the factor that was most consistently associated with the variables of interest. Despite the strong effect of farm on the measured variables, there was wide inter-animal variation.
Organic grain producers are interested in reducing tillage to conserve soil and decrease labor and fuel costs. We examined agronomic and economic tradeoffs associated with alternative strategies for reducing tillage frequency and intensity in a cover crop–soybean (Glycine max L. Merr.) sequence within a corn (Zea mays L.)–soybean–spelt (Triticum spelta L.) organic cropping system experiment in Pennsylvania. Tillage-based soybean production preceded by a cover crop mixture of annual ryegrass (Lolium perenne L. ssp. multiflorum), orchardgrass (Dactylis glomerata L.) and forage radish (Raphanus sativus L.) interseeded into corn grain (Z. mays L.) was compared with reduced-tillage soybean production preceded by roller-crimped cereal rye (Secale cereale L.) that was sown after corn silage. Total aboveground weed biomass did not differ between soybean production strategies. Each strategy, however, was characterized by high inter-annual variability in weed abundance. Tillage-based soybean production marginally increased grain yield by 0.28 Mg ha−1 compared with reduced-tillage soybean. A path model of soybean yield indicated that soybean stand establishment and weed biomass were primary drivers of yield, but soybean production strategy had a measurable effect on yields due to factors other than within-season weed–crop competition. Cumulative tillage frequency and intensity were quantified for each cover crop—sequence using the Soil Tillage Intensity Rating (STIR) index. The reduced-tillage soybean sequence resulted in 50% less soil disturbance compared to tillage-based soybean sequence across study years. Finally, enterprise budget comparisons showed that the reduced-tillage soybean sequence resulted in lower input costs than the tillage-based soybean sequence but was approximately $114 ha−1 less profitable because of lower average yields.
How do views about national identity shape support for multiculturalism? In this paper, we argue that individuals who view national ingroup belonging as “achievable” are more likely to support multiculturalism than individuals who view belonging as “ascriptive.” Using data from the 1995, 2003, and 2013 International Social Survey Programme (ISSP) Nationality Identity survey waves across 35 advanced democracies, we find achievable national identities correspond with support for multicultural principles but not for programmatic aspects involving government intervention. Robust analyses reveal these patterns are specific to the content, rather than the strength, of one's national identity. Our findings underline the role of both national belonging and outgroup attitudes on building support for policies of inclusion—and therefore social solidarity—in diverse democracies.
A 73-year-old male with a history of chronic ataxia presented with transient facial droop to the Emergency Department. A CT angiogram and MRI with diffusion weighted imaging (DWI) were negative for stroke. However, incidental note was made of numerous giant arachnoid granulation pits in the posterior fossa predominantly involving the left occipital bone (Figure 1). These arachnoid pits demonstrated multiple foci of herniation of the adjacent cerebellar parenchyma into the pits with gliosis of the herniated parenchyma and focal encephalomalacia of the subjacent cerebellar parenchyma. Review of bone windows on a remote CT brain performed almost 13 years earlier confirmed this to be a longstanding abnormality (Figure 2). The patient’s physical exam was suggestive of cerebellar ataxia with left-sided dysmetria on finger to nose testing and a wide-based unsteady gait.
Placental weight is a valuable indicator of its function, predicting both pregnancy outcome and lifelong health. Population-based centile charts of weight-for-gestational-age and parity are useful for identifying extremes of placental weight but fail to consider maternal size. To address this deficit, a multiple regression model was fitted to derive coefficients for predicting normal placental weight using records from healthy pregnancies of nulliparous/multiparous women of differing height and weight (n = 107,170 deliveries, 37–43 weeks gestation). The difference between actual and predicted placental weight generated a z-score/individual centile for the entire cohort including women with pregnancy complications (n = 121,591). The association between maternal BMI and placental weight extremes defined by the new customised versus population-based standard was investigated by logistic regression, as was the association between low placental weight and pregnancy complications. Underweight women had a greater risk of low placental weight [<10thcentile, OR 1.84 (95% CI 1.66, 2.05)] and obese women had a greater risk of high placental weight [>90th centile, OR 1.98 (95% CI 1.88, 2.10)] using a population standard. After customisation, the risk of high placental weight in obese/morbidly obese women was attenuated [OR 1.17 (95% CI 1.09, 1.25)]/no longer significant, while their risk of low placental weight was 59%–129% higher (P < 0.001). The customised placental weight standard was more closely associated with stillbirth, hypertensive disease, placental abruption and neonatal death than the population standard. Our customised placental weight standard reveals higher risk of relative placental growth restriction leading to lower than expected birthweights in obese women, and a stronger association between low placental weight and pregnancy complications generally. Further, it provides an alternative tool for defining placental weight extremes with implications for the placental programming of chronic disease.
To assess the feasibility, reliability, and validity of the Pictorial Fit-Frail Scale (PFFS) among patients, caregivers, nurses, and geriatricians in an outpatient memory clinic.
Design:
Observational study.
Setting:
A Canadian referral-based outpatient memory clinic.
Participants:
Fifty-one consecutive patients and/or their caregivers, as well as attending nurses and geriatricians.
Measurements:
Participants (patients, caregivers, nurses, and geriatricians) were asked to complete the PFFS based on the patient’s current level of functioning. Time-to-complete and level of assistance required was recorded. Participants also completed a demographic survey and patients’ medical history (including the Mini-Mental State Examination [MMSE], and Comprehensive Geriatric Assessment [CGA]) was obtained via chart review.
Results:
Patient participants had a mean age of 77.3±10.1 years, and average MMSE of 22.0±7.0, and 53% were female. Participants were able to complete the PFFS with minimal assistance, and their average times to completion were 4:38±2:09, 3:11±1:16, 1:05±0:19, and 0:57±0:30 (mins:sec) for patients, caregivers, nurses, and geriatricians, respectively. Mean PFFS scores as rated by patients, caregivers, nurses, and geriatricians were 9.0±5.7, 13.1±6.6, 11.2±4.5, 11.9±5.9, respectively. Patients with low MMSE scores (0–24) took significantly longer to complete the scale and had higher PFFS scores. Inter-rater reliability between nurses and geriatricians was 0.74, but it was lower when assessments were done for patients with low MMSE scores (0.47, p<0.05). The correlation between PFFS and a Frailty Index based on the CGA was moderately high and statistically significant for caregivers, nurses, and geriatricians (r=0.66, r=0.59, r=0.64, respectively), but not patients.
Conclusions:
The PFFS is feasible, even among people with some slight cognitive impairment, though it may be less useful when patients with severe dementia administer it to themselves. Further, the PFFS may help inform clinicians about areas of concern as identified by patients, enabling them to contribute more to diagnostic and treatment decisions or helping with health tracking and care planning.
Background: As with other specialties, Royal College of Physicians and Surgeons of Canada (RCPSC) trainees in Neurosurgery have anecdotally had challenges securing full-time employment. This study presents the employment status, research pursuits, and fellowship choices of neurosurgery trainees in Canadian programs. Methods: RCPSC neurosurgery trainees (n = 143) who began their residency training between 1998 and 2008 were included in this study. Associations between year of residency completion, research pursuits, and fellowship choice with career outcomes were determined by Fisher’s exact test (p < 0.05, statistical significance). Results: In 2015, 60% and 26% of neurosurgery trainees had permanent positions in Canada and the USA, respectively. Underemployment, defined as locum and clinical associate positions, pursuit of multiple unrelated fellowships, unemployment, and career change to non-surgical career, was 12% in 2015. The proportion of neurosurgery trainees who had been underemployed at some point within 5 years since residency completion was 20%. Pursuit of in-folded research (MSc, PhD, or non-degree research greater than 1 year) was significantly associated with obtaining full employment (94% vs. 73%, p = 0.011). However, fellowship training was not significantly associated with obtaining full employment (78% vs. 75%, p = 1.000). Conclusions: Underemployment in neurosurgery has become a significant issue in Canada for various reasons. Pursuit of in-folded research, but not fellowship training, was associated with obtaining full employment.
Proactive integrated weed management (IWM) is critically needed in no-till production to reduce the intensity of selection pressure for herbicide-resistant weeds. Reducing the density of emerged weed populations and the number of larger individuals within the population at the time of herbicide application are two practical management objectives when integrating cover crops as a complementary tactic in herbicide-based production systems. We examined the following demographic questions related to the effects of alternative cover-cropping tactics following small grain harvest on preplant, burndown management of horseweed (Erigeron canadensis L.) in no-till commodity-grain production: (1) Do cover crops differentially affect E. canadensis density and size inequality at the time of herbicide exposure? (2) Which cover crop response traits are drivers of E. canadensis suppression at time of herbicide exposure? Interannual variation in growing conditions (study year) and intra-annual variation in soil fertility (low vs. high nitrogen) were the primary drivers of cover crop response traits and significantly affected E. canadensis density at the time of herbicide exposure. In comparison to the fallow control, cover crop treatments reduced E. canadensis density 52% to 86% at the time of a preplant, burndown application. Cereal rye (Secale cereale L.) alone or in combination with forage radish (Raphanus sativus L.) provided the most consistent E. canadensis suppression. Fall and spring cover crop biomass production was negatively correlated with E. canadensis density at the preplant burndown application timing. Our results also show that winter-hardy cover crops reduce the size inequality of E. canadensis populations at the time of herbicide exposure by reducing the number of large individuals within the population. Finally, we advocate for advancement in our understanding of complementarity between cover crop– and herbicide-based management tactics in no-till systems to facilitate development of proactive, herbicide-resistant management strategies.
The kinetics of silica polymerization was measured in silicic acid solutions containing a suite of 0.1 M amino acids, 0.1 M citric acid, 0.7 M NaCl, and 0.10 M NaCl (Control). Fitting a modified classical rate model to measurements of induction time (τ) at 20 °C for a series of supersaturated solutions, we estimate the thermodynamic barrier (ΔGc), interfacial free energy (γ), and kinetic barrier (Δagk) for silica nucleation. For 0.10 M NaCl solutions, γControl = 54.9 ± 1.6 mJ/m2 and ΔagkControl = 2.29 × 10−19 J/mol. These values are consistent with previous reports for amorphous and fused silica materials. To facilitate comparisons with the treatments, ΔagkControl is converted to a molar basis and used as a reference datum, such that ΔagkControl = 0.0 J/mol. The effects of salt and organic acids on nucleation rate have thermodynamic and kinetic origins, respectively. Faster nucleation rates measured in 0.7 M NaCl solutions arise from a lower interfacial free energy, such that γ0.7 M NaCl = 51.4 ± 1.7 mJ/m2. Organic acids increase rate through biomolecule-specific reductions in Δagk. Catalytic effects are greatest for lysine (Δagklysine = −1685 ± 315) and citric acid (Δagkcitric = −1690 ± 96 J/mol). Reductions in the kinetic barrier correlate with net positive charge of the amino acids and dissociation of the amine
$\left( {{K_{\alpha {\rm{ ‐ N}}{{\rm{H}}_3}^ {\bf{+}} }}} \right)$
group and thus the abundance of the conjugate base. Citric acid, lacking amine groups, promotes the greatest rate enhancement, thus demonstrating the role(s) of additional kinetic factors in promoting nucleation rate. Catalytic activity correlates with multiple physical and chemical properties of the organic acids.