To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
To sustainably improve cleaning of high-touch surfaces (HTSs) in acute-care hospitals using a multimodal approach to education, reduction of barriers to cleaning, and culture change for environmental services workers.
The study was conducted in 2 academic acute-care hospitals, 2 community hospitals, and an academic pediatric and women’s hospital.
Frontline environmental services workers.
A 5-module educational program, using principles of adult learning theory, was developed and presented to environmental services workers. Audience response system (ARS), videos, demonstrations, role playing, and graphics were used to illustrate concepts of and the rationale for infection prevention strategies. Topics included hand hygiene, isolation precautions, personal protective equipment (PPE), cleaning protocols, and strategies to overcome barriers. Program evaluation included ARS questions, written evaluations, and objective assessments of occupied patient room cleaning. Changes in hospital-onset C. difficile infection (CDI) and methicillin-resistant S. aureus (MRSA) bacteremia were evaluated.
On average, 357 environmental service workers participated in each module. Most (93%) rated the presentations as ‘excellent’ or ‘very good’ and agreed that they were useful (95%), reported that they were more comfortable donning/doffing PPE (91%) and performing hand hygiene (96%) and better understood the importance of disinfecting HTSs (96%) after the program. The frequency of cleaning individual HTSs in occupied rooms increased from 26% to 62% (P < .001) following the intervention. Improvement was sustained 1-year post intervention (P < .001). A significant decrease in CDI was associated with the program.
A novel program that addressed environmental services workers’ knowledge gaps, challenges, and barriers was well received and appeared to result in learning, behavior change, and sustained improvements in cleaning.
Background: Utilization of endovascular procedures in the perioperative management of patients undergoing transsphenoidal surgery is uncommon but plays a critical role in preventing and treating potentially life-threatening vascular complications. Methods: We performed a retrospective review of all patients over a 10-year period who underwent transsphenoidal surgery at two tertiary-care institutions and identified all pre-operative and post-operative endovascular procedures performed. Results: 18 perioperative endovascular procedures were performed including 9 pre- and 9 post-operative. Pre-operative procedures included balloon-test occlusion (n=4), aneurysm coiling (n=4), and parent artery occlusion (n=1). One aneurysm coiling was complicated by coil migration requiring coil retrieval with a snare device and one balloon-test occlusion was complicated by pituitary apoplexy. Pituitary apoplexy following balloon-test occlusion has not been reported and the potential pathophysiology is reviewed. Post-operative procedures included embolization for epistaxis (n=2) and embolization with or without parent artery sacrifice for carotid and anterior cerebral artery vascular injury (n=7). Arterial vascular injury was managed with coil embolization and/or with detachable balloons. Review of anatomical features predisposing to vascular injury are discussed. Conclusions: Patients undergoing transsphenoidal surgery should be managed with a multidisciplinary team ensuring that endovascular treatment options are made available during the perioperative period.
The archaeological site of Saruq al-Hadid, Dubai, United Arab Emirates, presents a long sequence of persistent temporary human occupation on the northern edge of the Rub’ al-Khali desert. The site is located in active dune fields, and evidence for human activity is stratified within a deep sequence of natural dune deposits that reflect complex taphonomic processes of deposition, erosion and reworking. This study presents the results of a program of radiocarbon (14C) and thermoluminescence dating on deposits from Saruq al-Hadid, allied with studies of material remains, which are amalgamated with the results of earlier absolute dating studies provide a robust chronology for the use of the site from the Bronze Age to the Islamic period. The results of the dating program allow the various expressions of human activity at the site—ranging from subsistence activities such as hunting and herding, to multi-community ritual activities and large scale metallurgical extraction—to be better situated chronologically, and thus in relation to current debates regarding the development of late prehistoric and early historic societies in southeastern Arabia.
Background: Glioblastoma (GBM) is the most common primary malignant brain tumour. Despite aggressive therapy, median survival is only 14 months. Death typically results from treatment failure and local recurrence. The GBM microenvironment is highly hypoxic, which correlates with treatment resistance. Cytoplasmic RNA stress granules (SGs) form in response to hypoxic stress and act as sights of mRNA triage, allowing preferential translation of pro-survival mRNA during stress. We hypothesize that SGs may play a role in hypoxia-induced resistance to therapy, and may be targetable by chemotherapeutics to improve outcomes. Methods: We screened 1280 approved compounds to identify drugs that inhibited formation or dissolution of SGs in U251 glioma cells. Raloxifene inhibited SG dissolution in a dose dependent manner. We treated cells with raloxifene and incubated them in hypoxia, and then measured rates of cell death using cell counting and Presto blue. Results: Cell death rates were synergistically higher in cells treated with the combination of raloxifene and hypoxia compared to either treatment alone. Conclusions: Raloxifene inhibits the dissolution of SGs in glioma cells, and combination treatment results in synergistic tumour cell death. Taken together, this provides evidence that inhibition of SG dissolution may be a viable target for future GBM chemotherapeutics.
Low energy and protein intakes have been associated with an increased risk of malnutrition in outpatients with chronic obstructive pulmonary disease (COPD). We aimed to assess the energy and protein intakes of hospitalised COPD patients according to nutritional risk status and requirements, and the relative contribution from meals, snacks, drinks and oral nutritional supplements (ONS), and to examine whether either energy or protein intake predicts outcomes. Subjects were COPD patients (n 99) admitted to Landspitali University Hospital in 1 year (March 2015–March 2016). Patients were screened for nutritional risk using a validated screening tool, and energy and protein intake for 3 d, 1–5 d after admission to the hospital, was estimated using a validated plate diagram sheet. The percentage of patients reaching energy and protein intake ≥75 % of requirements was on average 59 and 37 %, respectively. Malnourished patients consumed less at mealtimes and more from ONS than lower-risk patients, resulting in no difference in total energy and protein intakes between groups. No clear associations between energy or protein intake and outcomes were found, although the association between energy intake, as percentage of requirement, and mortality at 12 months of follow-up was of borderline significance (OR 0·12; 95 % CI 0·01, 1·15; P=0·066). Energy and protein intakes during hospitalisation in the study population failed to meet requirements. Further studies are needed on how to increase energy and protein intakes during hospitalisation and after discharge and to assess whether higher intake in relation to requirement of hospitalised COPD patients results in better outcomes.
Potentially fatal arrhythmias add to the mental health challenges of adolescence. This systematic review sought to summarise current knowledge regarding the mental health of adolescents and pre-adolescents diagnosed with inherited arrhythmia syndromes. Searches combining psychological problems with inherited cardiac arrhythmia diagnoses identified 16 studies with paediatric (<18 years) inherited arrhythmia patients. All studies were cross-sectional; 8/16 required an implantable cardioverter defibrillator. Methods were quantitative (n=11), qualitative (n=4), or mixed (n=1), with 14–100% of participants having an inherited arrhythmia syndrome. Mean/median age in 13/16 studies was 12–16 years. Patients and parents reported lower quality of life, particularly in relation to physical function, social relationships, restriction of peer activities, bodily pain, and mental and emotional health. Self-perceptions and behaviour were similar to healthy populations. Rates of anxiety and depression (15–33% of these patients) were not increased in these studies where patients were assessed 2+ years after diagnosis. Higher mental health risk occurred among patients who have a diagnosed sibling, those with cardiomyopathy, and those who report decreased quality of life. Mental health research among youth with inherited arrhythmias is extremely limited and of low quality. Data, primarily from patients 2–4 years after diagnosis or treatment with an implantable cardioverter defibrillator, indicate that quality of life may be decreased and 15–33% experience mental health issues. Future research is required to examine the mental health and quality of life of paediatric patients with inherited arrhythmia syndromes, whether or not they have an implantable cardioverter defibrillator, from time of diagnosis.
Irradiation of reactor pressure vessel (RPV) steels causes the formation of nanoscale microstructural features (termed radiation damage), which affect the mechanical properties of the vessel. A key tool for characterizing these nanoscale features is atom probe tomography (APT), due to its high spatial resolution and the ability to identify different chemical species in three dimensions. Microstructural observations using APT can underpin development of a mechanistic understanding of defect formation. However, with atom probe analyses there are currently multiple methods for analyzing the data. This can result in inconsistencies between results obtained from different researchers and unnecessary scatter when combining data from multiple sources. This makes interpretation of results more complex and calibration of radiation damage models challenging. In this work simulations of a range of different microstructures are used to directly compare different cluster analysis algorithms and identify their strengths and weaknesses.
Data on the physical properties of seasonal alpine snow have been collected from the Beartooth Mountains near Cooke City, Montana (elevation ≈3000 m) and the Bridger Range near Bozeman, Montana (elevation ≈2200 m). Systematic measurements of snow density, temperature, structure, ram and Canadian hardness, centrifugal tensile strength and shear strength measured with a shear box and several types of shear vanes are included. Test results were grouped according to gross snow types (cohesive fine-grained “winter” snow. depth hoar, new snow, etc.) and whether the snow was wet or dry. Then interrelations between the different test parameters were studied. A plot of ram number versus density for winter snow gave a log-linear relation similar to that suggested for polar snows. Both shear-vane and centrifugal-tensile results when plotted as a function of porosity are well described by the negative exponential relation suggested by Ballard and Feldt. Depth hoar and wet snow invariably have lower strength values at any given density. There is an excellent one-to-one agreement between values obtained with the shear vane and the shear box.
Several field experiments were performed to study the sources of error in making in-situ mechanical tests on snow without utilizing a pit wall. Statistical analysis of the results shows that the main factor contributing to the experimental scatter is lateral inhomogeneity in the snow cover. There was no significant difference between the results of different operators. The standard deviation of a group of strength tests is shown to be directly proportional to the mean value of the group. This indicates that a logarithmic transformation should be made in handling snow strength results in order to stabilize the variance. It is emphasized that the systematic relations between snow properties invariably become obscured when different snow “types” are indiscriminately grouped together.
Ice cores were obtained in January 1990 from the land-fast ice in McMurdo Sound for a study of variations in texture, fabric, sub-structure, composition and development. Two primary ice types were observed, congelation and platelet, with a minor amount of frazil ice. Congelation ice growth precedes platelet-ice accretion. Congelation-ice fabrics show frequent moderate to strong alignments, a phenomenon believed to be due to water-current control of selective ice-crystal growth. Platelet ice originates at the base of the congelation ice, initially as a porous latticework of tabular ice crystals which subsequently consolidate by congelation of the interstitial water. Interstitial congelation-ice fabrics generally have little or no alignment, indicating the reduced effect of currents within the platelet latticework prior to solidification. Platelet-crystal textures range from small, wavy-edged forms to large, blade-like forms. Platelet-crystal fabrics indicate that, in addition to being randomly oriented, the platelet latticeworks commonly include many crystals with their flat (0001) faces oriented both parallel and normal to the base of the overlying ice. Plate-width data suggest that the interstitial congelation ice-growth rates remain similar to those of the overlying congelation ice. This effective increase in growth rates probably happens because the latticework of accumulating platelets ahead of the freezing interface ensures that the water within the platelet layer is at the freezing point and less heat has to be removed from platelet-rich water than from platelet-free water for a given thickness of congelation ice to grow. The negative oceanic heat flux associated with platelet-ice formation in McMurdo Sound explains why McMurdo Sound fast ice is thicker than Ross Sea pack ice, and also why it reaches a greater thickness than Arctic fast ice grown in a similar polar marine climate. Plate widths in the McMurdo Sound congelation ice suggest, however, that it grows no faster than Arctic congelation ice.
Sixty-three ice cores were collected in the Bellingshausen and Amundsen Seas in August and September 1993 during a cruise of the R.V. Nathaniel B. Palmer. The structure and stable-isotopic composition (18O/16O) of the cores were investigated in order to understand the growth conditions and to identify the key growth processes, particularly the contribution of snow to sea-ice formation. The structure and isotopic composition of a set of 12 cores that was collected for the same purpose in the Bellingshausen Sea in March 1992 are reassessed. Frazil ice and congelation ice contribute 44% and 26%, respectively, to the composition of both the winter and summer ice-core sets, evidence that the relatively calm conditions that favour congelation-ice formation are neither as common nor as prolonged as the more turbulent conditions that favour frazil-ice growth and pancake-ice formation. Both frazil- and congelation-ice layers have an av erage thickness of 0.12 m in winter, evidence that congelation ice and pancake ice thicken primarily by dynamic processes. The thermodynamic development of the ice cover relies heavily on the formation of snow ice at the surface of floes after sea water has flooded the snow cover. Snow-ice layers have a mean thickness of 0.20 and 0.28 m in the winter and summer cores, respectively, and the contribution of snow ice to the winter (24%) and summer (16%) core sets exceeds most quantities that have been reported previously in other Antarctic pack-ice zones. The thickness and quantity of snow ice may be due to a combination of high snow-accumulation rates and snow loads, environmental conditions that favour a warm ice cover in which brine convection between the bottom and top of the ice introduces sea water to the snow/ice interface, and bottom melting losses being compensated by snow-ice formation. Layers of superimposed ice at the top of each of the summer cores make up 4.6% of the ice that was examined and they increase by a factor of 3 the quantity of snow entrained in the ice. The accumulation of superimposed ice is evidence that melting in the snow cover on Antarctic sea-ice floes ran reach an advanced stage and contribute a significant amount of snow to the total ice mass.
The objective of this study was to examine associations between trajectories of childhood neighbourhood social cohesion and adolescent mental health and behaviour.
This study used data from the National Longitudinal Survey of Children and Youth, a nationally representative sample of Canadian children. The sample included 5577 children aged 0–3 years in 1994–1995, prospectively followed until age 12–15 years. Parental perceived neighbourhood cohesion was assessed every 2 years. Latent growth class modelling was used to identify trajectories of neighbourhood cohesion. Mental health and behavioural outcomes were self-reported at age 12–15 years. Logistic regression was used to examine associations between neighbourhood cohesion trajectories and outcomes, adjusting for potential confounders.
Five distinct trajectories were identified: ‘stable low’ (4.2%); ‘moderate increasing’ (9.1%); ‘stable moderate’ (68.5%); ‘high falling’ (8.9%); and ‘stable high’ (9.3%). Relative to those living in stable moderately cohesive neighbourhoods, those in stable low cohesive neighbourhoods were more likely to experience symptoms of anxiety/depression [odds ratio (OR) = 1.73, 95% confidence interval (CI) 1.04–2.90] and engage in indirect aggression (OR = 1.62, 95% CI 1.07–2.45). Those with improvements in neighbourhood cohesion had significantly lower odds of hyperactivity (OR = 0.67, 95% CI 0.46–0.98) and indirect aggression (OR = 0.69, 95% CI 0.49–0.96). In contrast, those with a decline in neighbourhood cohesion had increased odds of hyperactivity (OR = 1.67, 95% CI 1.21–2.29). Those in highly cohesive neighbourhoods in early childhood were more likely to engage in prosocial behaviour (‘high falling’: OR = 1.93, 95% CI 1.38–2.69; ‘stable high’: OR = 1.89, 95% CI 1.35–2.63).
These results suggest that neighbourhood cohesion in childhood may have time-sensitive effects on several domains of adolescent mental health and behaviour.
1 spoken or written words that have no meaning or make no sense: he was talking absolute nonsense.
• [as exclamation] used to show strong disagreement: ‘Nonsense! No one can do that.’
• [as modifier] denoting verse or other writing intended to be amusing by virtue of its absurd or whimsical language: nonsense poetry.
2 foolish or unacceptable behavior: put a stop to that nonsense, will you?
Outrage arose when Representative Todd Akin of Missouri argued against making exceptions to the abortion restriction for rape victims on the grounds that due to a woman's physiology ‘legitimate rape’ was unlikely to result in pregnancy. Although thoroughly denounced, the claim that there is some feature of biology that prevents rapes from resulting in pregnancy has taken root in the political and popular imagination. This falsehood has proven so irrepressible that one reporter at Slate.com has written repeatedly about the ultimate source of this idea: a confabulated Nazi experiment. Discourse with these features– a ‘strange’ genealogy; bad reasoning; persistence despite, at best, specious proof; and exploitation for what are, to some minds, malicious purposes – has become increasingly common in political discourse, the press and even the arguments made by ordinary folk.
Such discourse is oft en criticized for its falsehood or its hurtfulness; these critiques – aimed at singular features of this discourse – tend to miss its pernicious potential.
Background and aims: For patients with a severe brain injury there is no objective physiotherapy assessment tool that is responsive to the incremental changes in motor recovery in the acute stage. The aims of this study were to identify the items of neuro-motor recovery and scoring criteria for the Acute Brain Injury Physiotherapy Assessment (ABIPA) and determine responsiveness to change and concurrent validity against accepted standard measures of consciousness and physical function in the severe brain injury population.
Method: The literature was searched and an expert consensus panel of experienced clinical physiotherapists informed item selection and developed practical assessment guidelines. The ABIPA was investigated for responsiveness to change and concurrent validity against the Glasgow Coma Scale (GCS), Clinical Outcome Variable Scale (COVS) and Motor Assessment Scale (MAS). Eleven patients (9 males; cohort 41 ± 18 years) with moderate/severe brain injury were recruited, and assessed on days 1, 3, 7 and then weekly until discharge.
Results: The ABIPA demonstrated good to excellent correlations overall with the GCS (rho > .76, p ≤ .001), COVS (rho > .82, p ≤ .001) and MAS (rho > 0.66, p ≤ .001). On day 3, the ABIPA showed the greatest responsiveness to change (standardised response means (SRM) > .83) compared to other measures (SRMs < .77). At discharge all tools demonstrated change in neuro-motor recovery.
Conclusions: The ABIPA is a promising tool for detecting incremental changes in neuro-motor recovery early after severe brain injury.
The aetiology of depression is multifactorial, with biological, cognitive and environmental factors across the life course influencing risk of a depressive episode. There is inconsistent evidence linking early life development and later depression. The aim of this study was to investigate relationships between low birthweight (LBW), infant neurodevelopment, and acute and chronic stress as components in pathways to depression in adulthood.
The sample included 4627 members of the National Survey of Health and Development (NSHD; the 1946 British birth cohort). Weight at birth, age of developmental milestones, economic deprivation in early childhood, acute stressors in childhood and adulthood, and socio-economic status (SES) in adulthood were assessed for their direct and indirect effects on adolescent (ages 13 and 15 years) and adult (ages 36, 43 and 53 years) measures of depressive symptoms in a structural equation modelling (SEM) framework. A structural equation model developed to incorporate all variables exhibited excellent model fit according to several indices.
The path of prediction from birthweight to age of developmental milestones to adolescent depression/anxiety to adult depression/anxiety was significant (p < 0.001). Notably, direct paths from birthweight (p = 0.25) and age of developmental milestones (p = 0.23) to adult depression were not significant. Childhood deprivation and stressors had important direct and indirect effects on depression. Stressors in adulthood were strongly associated with adult depression.
Depression in adulthood is influenced by an accumulation of stressors across the life course, including many that originate in the first years of life. Effects of early-life development on mental health appear by adolescence.
Several studies demonstrating that central line–associated bloodstream infections (CLABSIs) are preventable prompted a national initiative to reduce the incidence of these infections.
We conducted a collaborative cohort study to evaluate the impact of the national “On the CUSP: Stop BSI” program on CLABSI rates among participating adult intensive care units (ICUs). The program goal was to achieve a unit-level mean CLABSI rate of less than 1 case per 1,000 catheter-days using standardized definitions from the National Healthcare Safety Network. Multilevel Poisson regression modeling compared infection rates before, during, and up to 18 months after the intervention was implemented.
A total of 1,071 ICUs from 44 states, the District of Columbia, and Puerto Rico, reporting 27,153 ICU-months and 4,454,324 catheter-days of data, were included in the analysis. The overall mean CLABSI rate significantly decreased from 1.96 cases per 1,000 catheter-days at baseline to 1.15 at 16–18 months after implementation. CLABSI rates decreased during all observation periods compared with baseline, with adjusted incidence rate ratios steadily decreasing to 0.57 (95% confidence intervals, 0.50–0.65) at 16–18 months after implementation.
Coincident with the implementation of the national “On the CUSP: Stop BSI” program was a significant and sustained decrease in CLABSIs among a large and diverse cohort of ICUs, demonstrating an overall 43% decrease and suggesting the majority of ICUs in the United States can achieve additional reductions in CLABSI rates.
Studies on the prevalence of feather pecking in different commercial laying hen
systems and its welfare and economic impacts are reviewed in the following
paper. Current methods for controlling feather pecking include beak-trimming and
alterations to light regimes, but these methods have significant disadvantages
from the perspective of bird welfare. A substantial body of research has now
identified risk factors for feather pecking during both the rearing and laying
periods. It is argued that these findings can be translated into optimised
management practices that can prevent and control feather pecking whilst
simultaneously conferring welfare benefits. The genetic basis of feather pecking
is considered, and studies that suggest group selection techniques could produce
birds with a reduced tendency to feather peck in commercial flocks are
Discrimination against people with severe mental illness is an international problem. It is associated with reduced social contact and hinders recovery. This paper aims to evaluate if experienced or anticipated discrimination is associated with social capital, a known correlate of mental health.
Data from the annual viewpoint cross-sectional survey of people with severe mental illness (n = 1016) were analysed. Exploratory univariate analysis was used to identify correlates of social capital in the sample, which were then evaluated in linear regression models. Additional hypotheses were tested using t tests.
Experienced discrimination made a modest contribution to the explained variance of social capital. Experienced discrimination from friends and immediate family was associated with reduced access to social capital from these groups, but this was not found for wider family, neighbours or mental health staff. Experience of discrimination in finding or keeping a job was also associated with reduced access to social capital.
Further longitudinal research is needed to determine how resources within people's networks can help to build resilience, which reduces the harmful effect of discrimination on mental health.
In Guatemala prior to control initiatives, the main vectors of Trypanosoma cruzi, the causative agent of Chagas disease, were Rhodnius prolixus and Triatoma dimidiata. This study conducted in 2006 in the department of Chiquimula recorded a high level of T. dimidiata infestation and an absence of R. prolixus in all surveyed communities. In Guatemala, the presence of T. dimidiata as domestic, peridomestic and sylvatic populations results in control difficulties as houses are re-infested from the surrounding environment. Entomological surveys, the current method used to select houses in need of control efforts, are labour intensive and time consuming. A time- and cost-effective way to prioritize houses for evaluation and subsequent treatment is the stratification of houses based on the risk of triatomine infestation. In the present study, 17 anthropogenic risk factors were evaluated for associations with house infestation of T. dimidiata including: wall, floor and roof type. There was an increased likelihood of domestic infestation with T. dimidiata associated with the presence of dirt floors (18/29; OR 8.075, 95% CI 2.13–30.6), uncoated bajareque walls (12/17; OR 4.80, 95% CI 1.35–17.1) and triatomine-like faeces on walls (16/26; OR 3.89, 95% CI 1.19–12.7). These factors could be used to target control of T. dimidiata to communities with an increased risk of being infested.