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.
With the move into Gold Coast University Hospital, a new disaster plan was developed in 2017. To assess preparedness for the Commonwealth Games (April 2018), a number of mass casualty exercises were conducted, including a large multi-agency exercise with Queensland Police and Ambulance Services. During this preparation phase, senior clinicians from the perioperative area clarified their sub-plans and developed a novel model of periop response.
This study assesses this model of response and evaluates it within the context of periop disaster exercises.
The periop response model evolved through multi-disciplinary key stakeholder engagement into a defined model of surgical, anesthetic, and periop nursing responses with dedicated roles and parallel communication streams from ED to OR by the respective specialties. Throughout different disaster exercises, this model of response was tested, refined, and evaluated by formal post-exercise debriefs and group meetings.
Since May 2017, seven different mass casualty exercises with periop response were performed; firstly, a table-top (EmergoTrainSystem) format was used, which revealed communication and logistical deficiencies. After model refinement, further exercises were accomplished, all within the clinical environment, including movements of mock patients from ED to OR. These exercises generated improvements in communication, coordination, and logistics. Every exercise was also used to test more detailed information, communication, and organizational tasks of the various involved craft groups, such as notification, call-in lists, whiteboard structure, transport facilitation, and many more. Overall, our newly developed periop response model proved to be robust and successful, even with rotating personnel through different roles.
Apart from the success of the periop response model, other hospital areas (ICU, bed and ward management) became involved. With growing interest and staff turn-over a regular periop disaster response exercise program has now been established. This model of periop response has potential for use in other health systems.
Since its rediscovery in 1998, two major threats have been mentioned for the enigmatic Austral Rail Rallus antarcticus: cattle management by burning grass and rushes and predation by American mink Neovison vison. Added to the lack of a protocol to monitor this secretive bird, ever-growing threats make it necessary to study its global situation in depth to take accurate and urgent management decisions. We firstly studied how threats to the Austral Rail currently impact their occupancy and relative density (RD) at a wetland scale and habitat features associated with its presence at survey site scale inside wetlands in Santa Cruz province, Argentina. We additionally developed a monitoring protocol to detect the rail effectively and promptly by studying responses to playback with two different vocalisations at different times of the day and season. Both threats evaluated were negatively related to occupancy and RD of the Austral Rail, especially mink presence appearing to have an additive effect. We propose American mink control as crucial for Austral Rail conservation, while it would also be necessary to conserve a portion of wetlands exempt from burning and cattle presence. At survey sites, its presence was positively related with c.1–1.5 m tall rushes, whilst rails avoided low- density rush areas that resulted after management of rushes with fire to create pasture. To detect rails, both vocalisations can be confidently used at any time of the day and season. The poor knowledge about species ecology, mismanagement of vegetation in wetlands, expansion of American mink in Patagonia, construction on two dams in the Santa Cruz river basin, added to the already modified humidity conditions due to global climate change, force us to suggest that the Austral Rail should be considered as globally ‘Endangered’ (EN), to ensure the consideration of the species in management decisions.
Our objective was to determine the frequency of zika (ZIKV), chikungunya (CHIKV) and dengue (DENV) virus coinfection and describe the mortality cases that occurred during the epidemiologic surveillance of the ZIKV epidemic in Colombia. We analysed all cases of suspected ZIKV infection that were reported to the National Institute of Health (October 2015–December 2016). DENV, CHIKV and ZIKV RNA were detected in serum or tissue samples using polymerase chain reaction assay. Medical records of the fatal cases were reviewed. We identified that 23 871 samples were processed. The frequency of viral agents was 439 (1.84%) for DENV, 257 (1.07%) for CHIKV and 10118 (42.38%) for ZIKV. Thirty-four (0.14%) cases of coinfection were identified. The CHIKV–ZIKV coinfection was present in 28 cases (82.3%), DENV–CHIKV in three (8.8%) and DENV–ZIKV in three (8.8%). Seven (20.6%) coinfection cases were fatal (two DENV–CHIKV cases and five CHIKV–ZIKV cases). Two cases were foetal deaths and the others were related to neurological syndrome and sepsis. In conclusion, the frequency of arbovirus coinfection during epidemic of ZIKV was low, and CHIKV–ZIKV coinfection was the most common. Mortality was high among coinfection patients. The role of each virus in the mortality cases of coinfection warrants further studies.
Transparency is recognised to be a key underpinning of the work of health technology assessment (HTA) agencies, yet it has only recently become a subject of systematic inquiry. We contribute to this research field by considering the Polish Agency for Health Technology Assessment (AHTAPol). We situate the AHTAPol in a broader context by comparing it with the National Institute for Health and Care Excellence (NICE) in England. To this end, we analyse all 332 assessment reports, called verification analyses, that the AHTAPol issued from 2012 to 2015, and a stratified sample of 22 Evidence Review Group reports published by NICE in the same period. Overall, by increasingly presenting its key conclusions in assessment reports, the AHTAPol has reached the transparency standards set out by NICE in transparency of HTA outputs. The AHTAPol is more transparent than NICE in certain aspects of the HTA process, such as providing rationales for redacting assessment reports and providing summaries of expert opinions. Nevertheless, it is less transparent in other areas of the HTA process, such as including information on expert conflicts of interest. Our findings have important implications for understanding HTA in Poland and more broadly. We use them to formulate recommendations for policymakers.
The phenological development of crops from emergence to flowering time is largely controlled by temperature and photoperiod. Flowering time is a critical phenological stage for subsequent reproductive phase. Lotus tenuis management in grasslands, pastures and seed production systems is through defoliation and sowing date; however, yet little is known about their effects on flowering time. The data presented in this study were obtained from experiments conducted with L. tenuis during the years 1989 to 2016 under field conditions. Our objectives were to determine if flowering time (a) is affected by sowing date; (b) can be predicted through equations using temperature and photoperiod and (c) is affected by defoliation applied at vegetative stage. Two defoliation intensities were applied, low (LDI) crop height reduced by 54% compared to pre-defoliation crop height and high (HDI), crop height reduced by 75%. The rate of progress from seedling emergence to flowering time (inverse of time from emergence to first flowering, 1/f) was modulated by temperature, photoperiod and photothermal functions. When L. tenuis sowing was delayed from autumn to spring, time from seedling emergence to first flowering decreased from 260 to 100 days. 1/f was linearly related to average temperature (R²=0.75) and photoperiod (R²=0.85) and both variables (R²=0.92). Defoliation retarded flowering time. Flower and pod growth periods were shorter under defoliation than in control one. Defoliation did not cause abortion of flowers and pods. Flower production was fitted to quadratic function of photoperiod. Flowering peak was approximately within 15.2 h. The prediction of flowering time using thermal, photoperiod and photothermal models can provide information about crop management decisions, such as optimal environmental regimes for crop growth through sowing date.
Central-line bloodstream infection (CLABSI) increases hospital mortality. A cohort study was conducted in a Brazilian hospital to estimate the disability-adjusted life year (DALY) of CLABSI using modified World Health Organization (WHO) methodology. CLABSI DALY was 20.44 per 1,000 inpatients, most were the result of premature death (20.42 per 1,000 inpatients). DALY can be useful to guide and measure the impact of healthcare infection prevention.
The biological and genetic diversity of Neospora caninum is very limited because of availability of only a few viable isolates worldwide. This study describes the isolation and biological and molecular characterization of a new viable isolate of N. caninum (NC-SP1), from a cattle in Brazil. Approximately 400 g of brain from a naturally infected adult male cattle from an abattoir was fed to a 2-month-old dog. Neospora-like oocysts were observed on day 7 post-inoculation (PI) and the duration of oocyst shedding was 14 days. The DNA obtained from oocysts was characterized molecularly and the final sequence was 99% identical to homologous sequences of N. caninum available in GenBank®. For bioassay, gerbils (Meriones unguiculatus) were orally inoculated with 10 100 and 1000 oocysts; all gerbils remained clinically normal but developed N. caninum antibodies 14 days PI. Cell culture isolation was successful using the brain homogenate from one of the gerbils and tachyzoites were observed 24 days PI. Microsatellite genotyping revealed a unique genetic profile for this new reference isolate.
Studies have highlighted the role of early Executive Functioning (EF) interventions with regard to preventing behavioral and mental health problems. In this sense, interventions to promote EF have been developed and tested; however, in Latin America, evidence of early EF-related interventions is still limited. We developed a program for EF promotion in children and applied it to first-grade students. Sixty-eight six-year-old children and their five teachers were divided into an experimental group (EG) and a control group (CG). EG teachers administered the Intervention Program for Self-regulation and Executive Functions in a classroom context. The results of the ANCOVAs showed that children in the EG had significantly better performance in measures of cognitive flexibility (Trail Making Test for Preschoolers; p = .05), attention (Cancellation Attention Test – errors in the Part 3; p = .027), inhibition (Simon Task – interference score in the part 1; p = .008 and interference reaction time in the part 2; p = .010), and planning (CHEXI - planning scale; p = .041) than those in the CG. The results show that EF can be promoted using classroom intervention in public schools. These results expand previous findings for Latin America.
We report changes in guanaco Lama guanicoe density, recruitment, and social structure associated with increased access of poachers along an extensive network of hydrocarbon-exploration roads in northern Patagonia, and conservation measures taken in response. Mean guanaco densities declined 93–96% and mean group size declined from 9.8 to 5.0 guanacos per group at three sites surveyed during 1982–1983 and 2002–2007, whereas yearling proportions did not change significantly. Additional surveys during 2002–2007 suggest population declines and fragmentation have occurred over a wide area of intense hydrocarbon exploration and extraction. Guanaco densities in 2002–2007 showed a strong negative association with the density of access points along hydrocarbon-exploration roads and, to a lesser degree, with livestock densities. The increase in poaching in recent decades, resulting from increased access and an urban population that has appropriate vehicles, has probably been the main cause of the decline of the guanaco population, although overgrazing by livestock and decreased plant productivity may also be contributing factors. Closing of exploration roads with levees and ditches in 2006 and 2010 by a hydrocarbon company, under supervision by the local government and scientists, restricted access by unauthorized vehicles to a 220,000-ha area, including two of the sites where guanaco numbers collapsed. This action, in combination with increased ranger patrols, may allow guanaco recovery in the coming years.
Live-shearing of wild guanacos Lama guanicoe may affect their reproductive success and population resilience, and therefore it is important to assess the biological sustainability of obtaining their wool. We evaluated effects of capture and shearing on survival and reproduction, population parameters, daily movements, ranging behaviour and spatial distribution in sedentary and migratory populations. We assessed population variables by radio-telemetry and line-transect surveys before and after capture. We estimated high post-shearing survival rates in both populations and similar yearling production in shorn and non-shorn females in the migratory population. We did not find significant variations in density and population structure before and after shearing in the sedentary population, whereas in the migratory population density decreased and the population structure changed significantly after assembly of the capture structure, returning to pre-assembly levels 1 month later. The mean daily distance moved by radio-collared guanacos during the first 2 days after shearing was three times longer than during the following 30 days. There was a 25% decrease in the mean home-range size of shorn guanacos between the first and second month after shearing but this decline appeared to be associated with a seasonal change in movement, because a similar reduction occurred during the same period the following year, when the guanacos were not shorn. Live-shearing modified the spatial distribution pattern in the sedentary population but did not have a significant effect on the migratory population. Management of guanacos may contribute towards developing a biologically sustainable economic activity that promotes conservation of wildlife and habitats.
The assessment of facial expression is an important aspect of a clinical neurological examination, both as an indicator of a mood disorder and as a sign of neurological damage. To date, although studies have been conducted on certain psychosocial aspects of myasthenia, such as quality of life and anxiety, and on neuropsychological aspects such as memory, no studies have directly assessed facial emotion recognition accuracy. The aim of this study was to assess the facial emotion recognition accuracy (fear, surprise, sadness, happiness, anger, and disgust), empathy, and reaction time of patients with myasthenia. Thirty-five patients with myasthenia and 36 healthy controls were tested for their ability to differentiate emotional facial expressions. Participants were matched with respect to age, gender, and education level. Their ability to differentiate emotional facial expressions was evaluated using the computer-based program Feel Test. The data showed that myasthenic patients scored significantly lower (p < 0.05) than healthy controls in the total Feel score, fear, surprise, and higher reaction time. The findings suggest that the ability to recognize facial affect may be reduced in individuals with myasthenia.
Executive abilities have been suggested to show differential age-related changes. This study aimed to extend this evidence to a Brazilian sample, which was composed of 572 children and adolescents aged 6 to 14 years, assessed in tests of visual and auditory working memory, selective attention, inhibitory control, cognitive flexibility, attentional abilities, verbal fluency and planning. ANOVAs revealed significant age effect on performance in all tests, with a trend toward better performance with the progression of age, even in differential ways. Overall, the performance on simpler tests, such as the basic attention, increased with age progression until around 11 or 12 years, when performance becomes more stable. However, in more complex tasks, including working memory tasks, the performance showed a more continuous improvement. There was gender effect in two measures: visual working memory, in which boys outperformed girls, and verbal fluency, in which the girls outperformed boys. In general, the results of this Brazilian sample were similar to those reported by studies conducted in other countries, what suggests that Brazilian socio-cultural specificities, at least of the participants of this sample, were not sufficient to reveal a distinct pattern of progression.
Hordeum chilense Roem. et Schultz. is a diploid wild barley native to Chile and Argentina. The high crossability of this species with other members of the Triticeae tribe promoted the development of the new species × Tritordeum Ascherson et Graebner. Hexaploid tritordeum was developed from the hybrid derived from the cross between H. chilense (used as female parent) and durum wheat. The interest of H. chilense is based on the presence of traits potentially useful for wheat breeding, including high endosperm carotenoid content, septoria tritici blotch resistance and abiotic stress tolerance. Besides, the variability at cytoplasm level is also important in this species. The development of common wheat–H. chilense alloplasmic lines (nucleus from wheat and cytoplasm from H. chilense) results in fertile or male sterile genotypes, depending on the accession donating the cytoplasm. Furthermore, these alloplasmic lines constitute an ideal system for deepening our knowledge on nuclear–cytoplasm interactions. In conclusion, H. chilense is an interesting source of variability for wheat breeding.
Nanocrystalline ceria-zirconia samples doped with rare-earth (Gd, Pr, Sm, La) cations were prepared via modified Pechini route. Effect of their real structure and surface composition characterized by a combination of sophisticated physical methods (XRD, TEM +EDX, EXAFS, WAXS, UV-Vis, XPS, SIMS) on the mobility and reactivity of the lattice oxygen estimated by oxygen isotope exchange, H2, CH4 and CO TPR was analyzed. For the reaction of acetone autothermal reforming into syngas, catalytic activity correlates rather well with the oxygen mobility controlled by the type and content of a dopant
The cost of caring for people with intellectual disability currently
makes up a large proportion of healthcare spending in western Europe, and
may rise in line with the increasing numbers of people with intellectual
disability now living to old age.
To report service use and costs of older people with intellectual
disability and explore the influence of sociodemographic and
We collected data on receipt and costs of accommodation, health and
personal care, physical as well as mental illness, dementia, sensory
impairment and disability in a representative sample of adults with
intellectual disability aged 60 years and older (n =
The average weekly cost in GBP per older person was £790 (£41 080 per
year). Accommodation accounted for 74%. Overall costs were highest for
those living in congregate settings. Gender, intellectual disability
severity, hearing impairment, physical disorder and mental illness had
significant independent relationships with costs. Mental illness was
associated with an additional weekly cost of £202.
Older adults with intellectual disability comprise about 0.15–0.25% of
the population of England but consume up to 5% of the total personal care
budget. Interventions that meet needs and might prove to be
cost-effective should be sought.
Many South American hotspots of bird endemism are found in Polylepis dominated forests. Although the avifauna of Polylepis forests has been relatively well studied in the tropical Andes, little is known in Argentina. In this study, we characterize the Argentine avifauna of Polylepis australis forests along their entire latitudinal gradient of distribution and provide a first systematic bird list and their conservation status. Fieldwork was carried out from 1,500 to 2,800 m a.s.l. in three study sites: North (Jujuy province), Centre (Tucumán province) and South (Córdoba province); we surveyed 30 point counts per site. We recorded 543 individuals belonging to 50 bird species; two subspecies are endemic to the South site and four species are typical Polylepis forest birds of the North and Centre sites. We identified four species of conservation concern; one globally threatened and three declining at regional level. Bird richness and abundance decreased with latitude; and equitability showed an inverse pattern. Sorenson's similarity index ranged from 12% to 40% showing a large latitudinal turnover in avian communities. Disturbance-sensitive species were the most diverse group in the North site. Variations in species richness, evenness and guild composition may be a response to latitude, but also to differences in habitat complexity and food availability, which appear to be a consequence of forest degradation at the South site. We recommend: (1) the enlargement of Calilegua National Park to include the Polylepis australis belt to assure the conservation of many disturbance-sensitive species which could decline or disappear in degraded areas; (2) management of Quebrada del Condorito National Park to increase the forest structure complexity and therefore provide habitat for disturbance-sensitive species.
Dietary intake of long-chain n-3 PUFA has been reported to decrease several markers of lymphocyte activation and modulate monocyte susceptibility to apoptosis. However, most human studies examined the combined effect of DHA and EPA using relatively high daily amounts of n-3 PUFA. The present study investigated the effects of increasing doses of DHA added to the regular diet of human healthy volunteers on lymphocyte response to tetradecanoylphorbol acetate plus ionomycin activation, and on monocyte apoptosis induced by oxidized LDL. Eight subjects were supplemented with increasing daily doses of DHA (200, 400, 800, 1600 mg) in a TAG form containing DHA as the only PUFA, for 2 weeks each dose. DHA intake dose-dependently increased the proportion of DHA in mononuclear cell phospholipids, the augmentation being significant after 400 mg DHA/d. The tetradecanoylphorbol acetate plus ionomycin-stimulated IL-2 mRNA level started to increase after ingestion of 400 mg DHA/d, with a maximum after 800 mg intake, and was positively correlated (P < 0·003) with DHA enrichment in cell phospholipids. The treatment of monocytes by oxidized LDL before DHA supplementation drastically reduced mitochondrial membrane potential as compared with native LDL treatment. Oxidized LDL apoptotic effect was significantly attenuated after 400 mg DHA/d and the protective effect was maintained throughout the experiment, although to a lesser extent at higher doses. The present results show that supplementation of the human diet with low DHA dosages improves lymphocyte activability. It also increases monocyte resistance to oxidized LDL-induced apoptosis, which may be beneficial in the prevention of atherosclerosis.
We demonstrate a new sensitive biosensor for detection of vital fungal
spores of Aspergillus niger. The biosensor is based on silicon
microfabricated cantilever arrays operated in dynamic mode. The change in
resonance frequency of the sensor is a function of mass binding to the
cantilever surface. For specific A. niger spore immobilization on
the cantilever, each cantilever was individually coated with
anti-Aspergillus niger polyclonal antibodies. We demonstrate the
detection of single A. niger spores and their subsequent growth
on the functionalized cantilever surface by online measurements of
resonance frequency shifts. The new biosensor operating in humid air
allows quantitative and qualitative detection of A. niger spores
as well as detection of vital, functional spores in situ within
∼4 h. The detection limit of the sensor is 103 CFU
mL−1. Mass sensitivity of the cantilever sensor is
∼53 pg Hz−1.
Email your librarian or administrator to recommend adding this to your organisation's collection.