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 firstname.lastname@example.org
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.
Antipsychotic depot injections can improve adherence compared to tablets. However, depot prescribing practices differ amongst psychiatrists. Previously, some clinicians perceived an “image” problem for typical antipsychotic depots. This study investigated psychiatrists’ attitudes and knowledge concerning antipsychotic depots (typical and atypical) in an era when patient choice is a pertinent issue.
Cross-sectional postal survey of consultant psychiatrists working in NorthWest England. A pre-existing questionnaire on clinicians’ attitudes and knowledge regarding depots was updated.
The sample comprised 102 consultant psychiatrists (response rate 102/143, 71%). Their use of depots over the past 5 years had: decreased (50%), not changed (27%), increased (23%). In a forced-choice selection of factors that would persuade them to use depots more, the factor cited as most important was ‘having more atypicals available in long-acting depot form’ (43%). Most regarded depots as being associated with better compliance (89%) and reduced relapse rates (98%) compared to oral medication but only 62% agreed that depots can be used for those with first episode psychosis. A significant minority (33%) believed patients always prefer to have oral medication instead of a depot. 68% believed that patients taking medication of their own free choice is more likely for oral than depot.
During the last 5 years, overall depot prescribing rates have reduced. Most regarded depots as offering better adherence and reduced relapse rates but some remain concerned about the acceptability of depots to patients. These clinician concerns are important but, if extreme, could compromise medication choices offered to patients.
Previously, when only typical antipsychotic depot injections were available, some clinicians perceived depots as having an “image” problem despite them being associated with reduced rates of rehospitalisation when compared to tablets. This study investigated psychiatrists’ attitudes and knowledge concerning depots (typical and atypical) and whether they had changed over time.
Cross-sectional postal survey of consultant psychiatrists working in NorthWest England. A pre-existing questionnaire on clinicians’ attitudes and knowledge regarding depots was updated. Results were compared with a former sample (SouthEast England, 2001: N=143).
The sample comprised 102 consultant psychiatrists (response rate 71%). Depot use over the past 5 years had: decreased (50%), not changed (27%), increased (23%). Psychiatrists with decreased depot use had significantly lower scores for the side effects knowledge subscale than those who had unchanged or increased rates of depot use (mean 51.5% vs 54.8%, p=0.029). When compared to psychiatrists sampled five years previously, our current participants had more favourable patient-focussed attitudes (63.5% vs 60.4%, p=0.034); other subscales did not differ. Item-by-item analysis revealed specific changes over time including significantly less respondents regarding depots as: (i) compromising patient autonomy (mean 0.99 vs 1.28, p=0.036); being stigmatising (1.88 vs 2.42, p=0.002); being old fashioned (1.49 vs 2.04, p=0.002).
During the period that an atypical antipsychotic depot has been available, and depot prescribing rates have reduced, some attitudes have changed. These mainly encompass aspects regarding the patient rather than the depot injection and include reducing concerns about stigma and autonomy although concerns about patient acceptance continue.
Recent findings support sex-specific effects of PDYN polymorphisms on association with opioid addiction (Clarke et al. 2012). We have demonstrated that PDYN haplotypes, which include rs2281285, are associated with alcohol dependence and propensity to drink in negative emotional situations (negative craving) (Karpyak et al 2012). The rs2281285 variant may contribute to regulation of alternative PDYN mRNA transcription specific to brain area or physiological condition.
To investigate sex-specific effects of the PDYN rs2281285 variant on risk for alcohol dependence.
To examine the association of the PDYN rs2281285 variant with alcohol dependence in male and female subjects.
rs2281285 was genotyped in the investigation cohort of 816 (554 males) alcohol dependent subjects (DSM-IV-TR) and 1248 (603 males) non-alcoholic controls and in the replication cohort of 467 (347 males) alcohol dependent subjects and 431 (224 males) non-alcoholic controls. Logistic regression models were used to test for sex-specific associations after controlling for age.
As previously reported, significant association of the PDYN rs2281285 variant with alcohol dependence was found in the investigation (p = 0.008, odds ratio = 1.299), but not the replication cohort (0.223, OR = 0.118). However, sex-specific analyses revealed stronger association in males (p = 0.002, OR = 1.493) but not females (p = 0.684, OR = 1.066) in the investigation cohort, and a trend for association in males (p = 0.086, OR = 1.352) but not females (p = 0.808, OR = 0.947) in the replication cohort.
Our findings support association of PDYN rs2281285 variant with alcohol dependence in male but not female subjects. Future studies should investigate functional mechanisms of this effect.
Lack of trust toward medical research is a major barrier to research participation, particularly among some population groups. Valid measures of trust are needed to develop appropriate interventions. The study purpose was to compare two previously validated scales that measure trust in biomedical research – one developed by Hall et al. (H-TBR; 2006) and the other by Mainous et al. (M-TBR; 2006) – in relation to socio-demographic variables and attitudes toward research. Differences between Black and White respondents were explored.
Two nearly identical surveys – one with H-TBR and the other with M-TBR – were systematically administered to a convenience sample. Internal consistency reliability of each scale was assessed. Associations were computed between scores on each scale with attitudes toward biomedical research and demographic variables (i.e., gender, age, race, and socioeconomic status). The difference between White and Black respondents on each TBR score while controlling for age, education, and race was also investigated.
A total of 2020 participants completed the H-TBR survey; 1957 completed the M-TBR survey. Mean item scores for M-TBR were higher (F = 56.05, p < 0.001) among Whites than Blacks. Whites also had higher mean item scores than Blacks on H-TBR (F = 7.09, p < 0.001). Both scales showed a strong association with participants’ perceived barriers to research (ps < 0.001) and significant, positive correlations with interest in research participation (ps < 0.001). Age and household income were positive predictors of TBR scores, but the effects of education differed.
Both scales are internally consistent and show associations with attitudes toward research. Whites score higher than Blacks on both TBR scales, even while controlling for age and socioeconomic status.
To determine the scope, source, and mode of transmission of a multifacility outbreak of extensively drug-resistant (XDR) Acinetobacter baumannii.
SETTING AND PARTICIPANTS
Residents and patients in skilled nursing facilities, long-term acute-care hospital, and acute-care hospitals.
A case was defined as the incident isolate from clinical or surveillance cultures of XDR Acinetobacter baumannii resistant to imipenem or meropenem and nonsusceptible to all but 1 or 2 antibiotic classes in a patient in an Oregon healthcare facility during January 2012–December 2014. We queried clinical laboratories, reviewed medical records, oversaw patient and environmental surveillance surveys at 2 facilities, and recommended interventions. Pulsed-field gel electrophoresis (PFGE) and molecular analysis were performed.
We identified 21 cases, highly related by PFGE or healthcare facility exposure. Overall, 17 patients (81%) were admitted to either long-term acute-care hospital A (n=8), or skilled nursing facility A (n=8), or both (n=1) prior to XDR A. baumannii isolation. Interfacility communication of patient or resident XDR status was not performed during transfer between facilities. The rare plasmid-encoded carbapenemase gene blaOXA-237 was present in 16 outbreak isolates. Contact precautions, chlorhexidine baths, enhanced environmental cleaning, and interfacility communication were implemented for cases to halt transmission.
Interfacility transmission of XDR A. baumannii carrying the rare blaOXA-237 was facilitated by transfer of affected patients without communication to receiving facilities.
We present the initial results from a class I 44-GHz methanol maser follow-up survey, observed with the MOPRA telescope, towards 272 sources from the Methanol Multi-beam survey (MMB). Over half (∼60%) of the 6.7 GHz class II MMB maser sources are associated with a class I 44-GHz methanol maser at a greater than 5σ detection level. We find that class II MMB masers sources with an associated class I methanol maser have stronger peak fluxes compared to regions without an associated class I maser. Furthermore, as part of the MOPRA follow-up observations we simultaneously observed SiO emission which is a known tracer of shocks and outflows in massive star forming regions. The presence of SiO emission, and potentially outflows, is found to be strongly associated with the detection of class I maser emission in these regions.
Results are presented from our ongoing studies of Titan using ALMA during the period 2012-2015, including a confirmation of the previous detection of vinyl cyanide (C2H3CN), as well as the first spatial map for this species on Titan. Simultaneous mapping of HC3N, CH3CN and C2H5CN reveal characteristic abundance patterns for each species that provide insight into their individual photochemical lifetimes, and help inform our understanding of Titan’s unique, time-variable atmospheric chemistry and global circulation. A time-sequence of HC3N maps covering 38 months reveals a dramatic change in the distribution of this gas consistent with high-altitude photochemical production followed by advection towards the southern (winter) pole, combined with rapid loss in the north after Titan’s 2009 seasonal equinox. The 2015 C2H3CN and C2H5CN maps show abundance peaks in Titan’s southern hemisphere, similar to those observed for the short-lived HC3N molecule. The longer-lived CH3CN, on the other hand, remains more concentrated in the north.
Silicon carbide dust grains are ubiquitous in circumstellar envelopes around C-rich AGB stars. However, the main gas-phase precursors leading to the formation of SiC dust have not yet been identified. To date, only three molecules containing an Si–C bond have been identified to have significant abundances in C-rich AGB stars: SiC2, SiC, and Si2C. The ring molecule SiC2 has been observed in a handful of evolved stars, while SiC and Si2C have only been detected in the C-star envelope IRC +10216. We aim to study how widespread and abundant SiC2, SiC, and Si2C are in envelopes around C-rich AGB stars and whether or not these species play an active role as gas-phase precursors of silicon carbide dust in the ejecta of carbon stars.
A series of catalytic reactions has been performed in our laboratory using olivine-type silicates (OTS) and SiC as catalysts for the conversion of carbon-containing molecules (such as acetylene, CO and methanol) to small organic molecules (C2H4, C3H3, CH3O) and also polycyclic aromatic hydrocarbons (PAHs). Experimentally, small-to-medium-sized gas-phase compounds such as PAHs, reaction intermediates and hydrocarbon compounds were detected in situ using the time-of-light mass-spectrometry technique. Solid deposition on the catalyst surface was examined by high-resolution transmission electron microscopy and thermo-gravimetric analysis techniques. Our laboratory results show that the conversion of acetylene to PAHs, the CO disproportionation reaction for producing CO2 and carbon deposition (graphitic and carbon nanostructures), and also the transformation of methanol to hydrocarbon compounds can easily be achieved with OTS as a catalyst. Furthermore, the conversion of acetylene to PAHs could also be achieved by SiC as the catalyst. It is proposed that these catalytic reactions mimic similar chemical processes in circumstellar envelopes (CSEs).
This paper analyzes in detail the role of environmental and economic shocks in the migration of the 1930s. The 1940 US Census of Population asked every inhabitant where they lived five years earlier, a unique source for understanding migration flows and networks. Earlier research documented migrant origins and destinations, but we will show how short-term and annual weather conditions at sending locations in the 1930s explain those flows, and how they operated through agricultural success. Beyond demographic data, we use data about temperature and precipitation, plus data about agricultural production from the agricultural census. The widely known migration literature for the 1930s describes an era of relatively low migration, with much of the migration that did occur radiating outward from the Dust Bowl region and the cotton South. Our work about the complete United States will provide a fuller examination of migration in this socially and economically important era.
Recent commentary has suggested that performance management (PM) is fundamentally “broken,” with negative feelings from managers and employees toward the process at an all-time high (Pulakos, Hanson, Arad, & Moye, 2015; Pulakos & O'Leary, 2011). In response, some high-profile organizations have decided to eliminate performance ratings altogether as a solution to the growing disenchantment. Adler et al. (2016) offer arguments both in support of and against eliminating performance ratings in organizations. Although both sides of the debate in the focal article make some strong arguments both for and against utilizing performance ratings in organizations, we believe there continue to be misunderstandings, mischaracterizations, and misinformation with respect to some of the measurement issues in PM. We offer the following commentary not to persuade readers to adopt one particular side over another but as a call to critically reconsider and reevaluate some of the assumptions underlying measurement issues in PM and to dispel some of the pervasive beliefs throughout the performance rating literature.
To aid in preparation of military medic trainers for a possible new curriculum in teaching junctional tourniquet use, the investigators studied the time to control hemorrhage and blood volume lost in order to provide evidence for ease of use.
Models of junctional tourniquet could perform differentially by blood loss, time to hemostasis, and user preference.
In a laboratory experiment, 30 users controlled simulated hemorrhage from a manikin (Combat Ready Clamp [CRoC] Trainer) with three iterations each of three junctional tourniquets. There were 270 tests which included hemorrhage control (yes/no), time to hemostasis, and blood volume lost. Users also subjectively ranked tourniquet performance. Models included CRoC, Junctional Emergency Treatment Tool (JETT), and SAM Junctional Tourniquet (SJT). Time to hemostasis and total blood loss were log-transformed and analyzed using a mixed model analysis of variance (ANOVA) with the users represented as random effects and the tourniquet model used as the treatment effect. Preference scores were analyzed with ANOVA, and Tukey’s honest significant difference test was used for all post-hoc pairwise comparisons.
All tourniquet uses were 100% effective for hemorrhage control. For blood loss, CRoC and SJT performed best with least blood loss and were significantly better than JETT; in pairwise comparison, CRoC-JETT (P < .0001) and SJT-JETT (P = .0085) were statistically significant in their mean difference, while CRoC-SJT (P = .35) was not. For time to hemostasis in pairwise comparison, the CRoC had a significantly shorter time compared to JETT and SJT (P < .0001, both comparisons); SJT-JETT was also significant (P = .0087). In responding to the directive, “Rank the performance of the models from best to worst,” users did not prefer junctional tourniquet models differently (P > .5, all models).
The CRoC and SJT performed best in having least blood loss, CRoC performed best in having least time to hemostasis, and users did not differ in preference of model. Models of junctional tourniquet performed differentially by blood loss and time to hemostasis.
KraghJFJr, LunatiMP, KharodCU, CunninghamCW, BaileyJA, StockingerZT, CapAP, ChenJ, AdenJK3d, CancioLC. Assessment of Groin Application of Junctional Tourniquets in a Manikin Model. Prehosp Disaster Med. 2016;31(4):358–363.
Galactic cold clumps have been identified from the Planck data (Planck Collaboration, 2011a, 2011b, 2015) as 10 342 cold (7 - 19 K) sources that stand out against a warmer environment, with the Early Cold Cores as a subsample of 915 most reliable detections. There is CO emission associated with the Planck Cold Clumps (PCCs), which has been observed with ground-based radio telescopes at higher resolution (Wu et al. 2012, Liu et al. 2014). A subset of PCCs have also been observed with Herschel at higher resolution (Juvela et al. 2012).
A southern sub-sample of the PCCs has been observed with the Mopra 22-m telescope to study the molecular gas. The Mopra telescope has 3-mm, 7-mm and 12-mm bands, with broadband correlator configuration 8-GHz wide with 0.27-MHz channels, or multiple zoom bands 137-MHz wide with 33-KHz channels, within the 8 GHz.
During the 2013 southern winter season we observed 10 clumps. This included observations in the 3-mm band of 12CO, 13CO and C18O and lines around 89 GHz (e.g. HCN, HCO+ and HNC), in the 7-mm band (e.g. CS) and in the 12-mm band (e.g. NH3). These observations were heterogenous, with sources selected by LST in gaps between observations of other projects, and band chosen by weather (i.e. in conditions unsuitable for higher frequencies, lower frequency bands were observed). During the 2014 season we observed 34 positions in 22 clumps, with zoom mode observations of lines around 89 GHz. This was a more well-defined sample of sources.
The mapping of the CO lines shows good spatial correlation of the CO with the dust column density The CO isotoplogues show high optical depth in 12CO and 13CO. The lines of HCN, HCO+ and HNC are weak, but detected in many of the 2014 sample. We are modelling the line results to determine column densities, excitation temperatures and abundances, using tools such as radex (van der Tak et al. 2007).
The intensity ratios of HCO+/HCN and HNC/HCN (1-0) reveal the relative influence of star formation and active galactic nuclei (AGN) or black holes on the circum-nuclear gas of a galaxy, allowing the identification of X-ray dominated regions (XDRs) and Photon-dominated regions (PDRs). It is not always clear in the literature how this intensity ratio calculation has been, or should be performed. This paper discusses ratio calculation methods for interferometric data.
We present the first measurement of the anisotropy parameter β using 3D kinematic information outside of the solar neighborhood. Our sample consists of 13 Milky Way halo stars with measured proper motions and radial velocities in the line of sight of M31. Proper motions were measured using deep, multi-epoch HST imaging, and radial velocities were measured from Keck II/DEIMOS spectra. We measure β = −0.3−0.9+0.4, which is consistent with isotropy, and inconsistent with measurements in the solar neighborhood. We suggest that this may be the kinematic signature of a relatively early, massive accretion event, or perhaps several such events.
Massive stars are some of the most important objects in the Universe, shaping the evolution of galaxies, creating chemical elements, and hence shaping the evolution of the Universe. However, the processes by which they form, and how they shape their environment during their birth processes, are not well understood. We are using NH3 data from the “The H2O Southern Galactic Plane Survey” (HOPS) to define the positions of dense cores/clumps of gas in the southern Galactic plane that are likely to form stars. We did a comparative study with different methods for finding clumps and found Fellwalker to be the best for this dataset. We detected ~ 500 clumps with mean kinetic temperature ~ 20 K and virial mass ~ 680 solar masses.
This audit cycle looked at details of antidepressants given in general practitioners’ (GPs) referral letters to Primary Mental Health Care (PMHC). With adequate information when patients are referred, time spent in clarifying details could be put into better use by clinicians and prompt effective treatment would help to reduce the direct and indirect costs of depression.
To evaluate how effective our intervention was 7 months after a previous audit and identify areas that need improvement.
Audit of 33 referral letters of patients referred for depression from GPs to a PMHC service in Northern Ireland, followed by the intervention (feedback and pro forma) and re-audit after 7 months.
The April audit showed 100% documentation of current antidepressant treatment and dose, but showed poor documentation of previous antidepressant use (33%), dose or duration (15%) and the reason for stopping the treatment (3%). Following intervention, the re-audit showed 25% and 24% rise in documenting previous antidepressant used and maximum dose reached, respectively, and 20% rise in documenting the reason for stopping.
Our interventions made modest improvement in providing relevant data in referral letters. This study adds to the existing evidence that relying mainly on feedback as a method of implementing change is ineffective. Lack of enthusiasm for using the newly introduced pro forma suggests that mental health services should obtain more effective ways of engaging GPs in service development. Using a systematic approach, which includes identifying local barriers to change and providing a supportive environment are important before the next re-audit.
The Sunbelt’s social, cultural, and economic development from the 1940s through the 1970s foreshadowed the region’s emergence as a nationally dominant political force during the 1980s and beyond. From roughly 1945 until the close of the 1970s, the Sunbelt was transformed into an economically vibrant, culturally diverse, and bitterly contested battleground on which many of the most divisive and important political struggles of the postwar era were waged. The Sunbelt’s development also correlated with an important trend in American politics – one in which the nation’s political culture, over time, came to resemble and reflect the Sunbelt’s. Put another way, by the 1980s, the Sunbelt seemed to encapsulate the very essence of American politics, if not American history more broadly – sentimentally patriotic, nostalgic, and dedicated to middle-class expansion on the one hand, divisive, polarized, and passionately contested on the other. These were not necessarily new characteristics in the history of American politics, but so far as the twentieth century was concerned, it was the contested but predominantly conservative nature of the Sunbelt’s development that entrenched these characteristics at the forefront of the nation’s political stage. If the first three decades following the end of World War II were a story about the Sunbelt’s remarkable rise from obscurity (or nonexistence) to prominence and power, then the last two decades of the twentieth century were a story about how the rest of the United States came to see the Sunbelt not as an anomaly, but as a pacesetter and role model.
On January 30, 1968, a combined force of North Vietnamese and Viet Cong insurgents caught American troops in South Vietnam by surprise when they launched a massive and coordinated assault that became known as the Tet Offensive. Over the next several weeks, American forces rallied to repel the offensive and win a decisive military victory. That victory notwithstanding, the Tet Offensive was a fatal political defeat for Lyndon Johnson, whose administration had been promising for months that its communist opponents in Southeast Asia were crumbling and that the war in Vietnam would soon be won. The newly presented evidence of Tet suggesting otherwise, the Democratic Party’s already fading political consensus quickly evaporated.
These divisions became clearer on March 12 when Senator Eugene McCarthy of Minnesota, an antiwar candidate, came stunningly close to defeating Johnson in the Democratic Party’s New Hampshire primary. Four days later, Robert F. Kennedy – Johnson’s most hated and feared political foe – announced his candidacy for the Democratic Party’s presidential nomination. Unwilling to face the possible humiliation of failing to win renomination, Johnson shocked the country two weeks later when he announced that he would not seek a second term as president. Then, on April 4 – just four days after Johnson’s announcement – Martin Luther King Jr. was assassinated in Memphis, Tennessee, while visiting that city in support of striking sanitation workers. Race riots subsequently erupted in several cities, including Washington, D.C.; Chicago; and Kansas City. Kennedy almost single-handedly helped mitigate the eruption of further riots as a result of an impromptu speech given in Indianapolis on the night of King’s death. Over the next two months, RFK – essentially seizing a mythical torch surrendered by his assassinated brother five years earlier – emerged as the candidate of choice for many of the nation’s most impoverished and politically disaffected citizens, especially recently enfranchised minorities. For many on the Left, Kennedy was their greatest hope for a truly progressive shift in national politics.