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The prevalence of psychotic experiences (PEs) is higher in low-and-middle-income-countries (LAMIC) than in high-income countries (HIC). Here, we examine whether this effect is explicable by measurement bias.
A community sample from 13 countries (N = 7141) was used to examine the measurement invariance (MI) of a frequently used self-report measure of PEs, the Community Assessment of Psychic Experiences (CAPE), in LAMIC (n = 2472) and HIC (n = 4669). The CAPE measures positive (e.g. hallucinations), negative (e.g. avolition) and depressive symptoms. MI analyses were conducted with multiple-group confirmatory factor analyses.
MI analyses showed similarities in the structure and understanding of the CAPE factors between LAMIC and HIC. Partial scalar invariance was found, allowing for latent score comparisons. Residual invariance was not found, indicating that sum score comparisons are biased. A comparison of latent scores before and after MI adjustment showed both overestimation (e.g. avolition, d = 0.03 into d = −0.42) and underestimation (e.g. magical thinking, d = −0.03 into d = 0.33) of PE in LAMIC relative to HIC. After adjusting the CAPE for MI, participants from LAMIC reported significantly higher levels on most CAPE factors but a significantly lower level of avolition.
Previous studies using sum scores to compare differences across countries are likely to be biased. The direction of the bias involves both over- and underestimation of PEs in LAMIC compared to HIC. Nevertheless, the study confirms the basic finding that PEs are more frequent in LAMIC than in HIC.
The dairy cow model ‘Molly’ is a mixed discrete event-continuous system model that simulates feeding, metabolism and lactation of dairy cows. Decades of model development have resulted in a valuable tool in dairy science. Due to the deprecation of the ACSL (Advanced Continuous Simulation Language) programming language, Molly has been translated into C++. This paper describes the translation process and discusses the advantages of the new implementation, one of which is the ability to run Molly within RStudio, a popular integrated development environment (IDE) for data science.
Common mental disorders are highly prevalent among Syrian refugees. Problem Management Plus (PM+) is a brief, transdiagnostic, non-specialist helper delivered, psychological intervention targeting psychological distress. This single-blind pilot randomised controlled trial (RCT) on PM+ delivered by peer-refugees examined trial procedures in advance of a definitive RCT, evaluated PM+ 's acceptability and feasibility, and investigated its likely effectiveness and cost-effectiveness among Syrian refugees in the Netherlands.
Adult Syrian refugees (N = 60) with elevated psychological distress (Kessler Psychological Distress Scale (K10) score >15) and reduced pychosocial functioning (WHO Disability Assessment Schedule 2.0 (WHODAS) score >16) were randomised into PM+ in addition to care as usual (CAU) (PM+/CAU; n = 30) or CAU alone (n = 30). Primary outcomes were symptoms of depression and anxiety (Hopkins Symptom Checklist; HSCL-25) at 3-month follow-up. Secondary outcomes were pychosocial functioning (WHO Disability Assessment Schedule; WHODAS 2.0), symptoms of posttraumatic stress disorder (PTSD) (PTSD Checklist for DSM 5; PCL-5) and self-identified problems (Psychological Outcomes Profiles; PSYCHLOPS). Changes in service utilisation and time out of employment and/or adult education were estimated (adapted version of the Client Service Receipt Inventory; CSRI). Semi-structured interviews on the implementation of PM+ were conducted with stakeholders (i.e. six PM+ participants, five non-specialist helpers and five key informants).
Recruitment, randomization and blinding procedures were successful. PM+ was generally perceived positively by stakeholders, especially regarding the intervention strategies, accommodation of the intervention and the helpers. Two serious adverse events not attributable to the trial were reported. At 3-month follow-up, the HSCL-25 total score was significantly lower for the PM+/CAU group (n = 30) than CAU group (n = 30) (p = 0.004; d = 0.58). Significant differences in favour of PM+/CAU were also found for WHODAS psychosocial functioning (p = 0.009, d = 0.73), PCL-5 symptoms of PTSD (p = 0.006, d = 0.66) and PSYCHLOPS self-identified problems (p = 0.005, d = 0.81). There were no significant differences in mean health service costs (p = 0.191) and the mean costs of lost productive time (p = 0.141). This suggests PM+ may potentially be cost-effective with an incremental cost from a health system perspective of €5047 (95% CI €0–€19 773) per additional recovery achieved.
Trial procedures and PM+ delivered by non-specialist peer-refugee helpers seemed acceptable, feasible and safe. Analyses indicate that PM+ may be effective in improving mental health outcomes and psychosocial functioning, and potentially cost-effective. These results support the development of a definitive RCT with a larger sample of refugees and a longer follow-up period.
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: Neonatal hypoxic ischemic encephalopathy (HIE) is a clinical phenomenon, that often results from pre or perinatal reduced cerebral blood flow and/or hypoxemia. However, in some cases, neonates present with HIE without significant risk factors or have an unusual clinical course. With the advent of advanced genetic testing, we aimed to explore if such infants had genetic risk factors predisposing them to an HIE-phenotype. Methods: We reviewed 206 charts of infants meeting local protocol criteria for moderate to severe HIE at Level III NICU’s in Calgary, Alberta. Of these, 27 patients had genetic testing such as microarray, whole exome sequencing, or gene panels. Results: Six/twenty-seven patients had genetic mutations; two CDKL5 mutations (protein kinase), one CFTR mutation (cystic fibrosis), one PDH deficiency, one CYP21A2 mutation (congenital adrenal hyperplasia), and one ISY1 (VUS; pre-mRNA splicing). Two patients had noted difficult deliveries and four had minor complications, but all were out of keeping with the severity of presumed HIE. Conclusions: This preliminary study demonstrates a possible association between genetic co-morbidities and predisposition towards HIE in the context of a relatively uneventful pre/perinatal course. Earlier identification of genetic etiology, recognized by a discrepancy between risk factors and clinical presentation, could aid in treatment decisions and outcome prognostication.
In this study, we used an online survey to assess knowledge, attitudes, and practices related to environmental cleaning and other infection prevention strategies among environmental services workers (ESWs) at 5 hospitals. Our findings suggest that ESWs could benefit from additional education and feedback as well as new strategies to address workflow challenges.
The presence of 10 virulence genes was examined using polymerase chain reaction (PCR) in 365 European O157 and non-O157 Escherichia coli isolates associated with verotoxin production. Strain-specific PCR data were analysed using hierarchical clustering. The resulting dendrogram clearly separated O157 from non-O157 strains. The former clustered typical high-risk seropathotype (SPT) A strains from all regions, including Sweden and Spain, which were homogenous by Cramer's V statistic, and strains with less typical O157 features mostly from Hungary. The non-O157 strains divided into a high-risk SPTB harbouring O26, O111 and O103 strains, a group pathogenic to pigs, and a group with few virulence genes other than for verotoxin. The data demonstrate SPT designation and selected PCR separated verotoxigenic E. coli of high and low risk to humans; although more virulence genes or pulsed-field gel electrophoresis will need to be included to separate high-risk strains further for epidemiological tracing.
A key component of social work ethics is social justice and equitable access to resources. Increasingly, this includes access to technology. This study addresses issues related to the ‘digital divide’ by testing a peer tutor model (Technology and Aging Project, TAP2) to teach adults aged 60 and older how to use information and communication technologies (ICTs) such as email, the internet, online chat rooms and discussion groups, internet-based support groups, and voice technology and webcams. Participants from the control group of a previous programme, TAP1 (N=19) participated in a six-month computer training programme. Six participants who had successfully completed the TAP1 training were selected to be peer tutors. Data were collected from tutors and learners at baseline, three months, six months and nine months (three months after the end of training). The current study reports on learner outcomes only. Measures include computer, social support, and mental health-related outcomes. Learners reported a significant and consistent increase over time in their confidence completing certain computer-related tasks and their overall use of ICTs. Mental health and social support outcomes did not change. Overall, the peer tutor model appeared to be at least as effective as the previous staff-directed model.
Infections involving Salmonella enterica subsp. enterica serovars have serious animal and human health implications; causing gastroenteritis in humans and clinical symptoms, such as diarrhoea and abortion, in livestock. In this study an optical genetic mapping technique was used to screen 20 field isolate strains from four serovars implicated in disease outbreaks. The technique was able to distinguish between the serovars and the available sequenced strains and group them in agreement with similar data from microarrays and PFGE. The optical maps revealed variation in genome maps associated with antimicrobial resistance and prophage content in S. Typhimurium, and separated the S. Newport strains into two clear geographical lineages defined by the presence of prophage sequences. The technique was also able to detect novel insertions that may have had effects on the central metabolism of some strains. Overall optical mapping allowed a greater level of differentiation of genomic content and spatial information than more traditional typing methods.
The two methods for measuring the haemagglutinin content of an influenza virus suspension are the haemagglutinating (HA) and chick cell agglutinating (CCA) techniques and both measure the same biological activity. With the establishment of an international reference preparation for influenza virus haemagglutinin (type A), however, it seems logical to express the haemagglutinin content of influenza vaccines in international units. Accordingly a collaborative study was arranged in order to obtain agreement on the number of units to be assigned to a British reference preparation for influenza haemagglutinin. It was agreed that the preparation contains 190 i.u. per ampoule and 1 i.u. is contained in 0·0622 mg. of the dried material.
Fourier analysis is used to consider the characteristics of linear magnetosonic N waves propagating through a uniform background medium at rest, with constant uniform magnetic field В0. The disturbance is driven by an initial compressed and localized gas pressure perturbation, represented by a Dirac delta distribution. The solutions for the perturbed gas and magnetic field variables are expressed as second derivatives of appropriate wave potentials. The wave potentials split naturally into fast and slow magnetosonic components. The fast- and slow-mode wave potentials reduce to onedimensional integrals over the wave normal angle θ between the wave vector k and B0. Alternatively, the fast-mode wave potentials can be written as Abelian integrals over the slow-mode phase speed cs, whereas the slow-mode potentials reduce to Abelian integrals over the fast-mode phase speed cf. The structure of the integrals depends on the location of the observation point relative to the fast and slow magnetosonic eikonal or group velocity surfaces. Calculations of the time evolution of the magnetic field of the N wave show a family of magnetic field lines connecting the cusps of the slow magnetosonic group velocity surface, plus a further family of field lines not connected with the cusps. The wave disturbance is confined on and within the fast magnetosonic group velocity surface. The gas pressure perturbation shows singular N wave type disturbances on the fast- and slow-mode eikonal surfaces. The Green's function for the magneto-acoustic wave operator for a uniform background medium initially at rest is also obtained. Generalization of the N wave solutions for non-singular distributions of the initial gas pressure perturbation are also obtained.
Ba0.7Sr0.3TiO3 (BST) single and quadruple layer capacitors with Pt electrodes were fabricated together on polycrystalline alumina substrates with a SiO2-based multicomponent amorphous buffer layer (SiO2/Al2O3). This paper presents the results of the characterization of these capacitors, to demonstrate their suitability for application as decoupling (high value) capacitors and as components in tunable RF applications (e.g., phase shifters and filters). BST films of different compositions, (Ba0.7Sr0.3)TiO3 and (Ba0.5Sr0.5)TiO3, were grown by metal-organic decomposition (MOD) and RF magnetron reactive sputtering. The capacitance density of 90–140 nm thick BST films was in the range of 20 to 70 fF/μm 2. Parallel plate capacitors with areas from 16 μm2 to 2.25 mm2 were fabricated using photolithography and ion milling techniques. For large capacitors (0.125 to 2.25 mm2), capacitance and tanδ were measured at low frequencies (1 KHz - 1 MHz) using an LCR meter. Smaller capacitors (16 μm2 to 3600 μm2) were additionally characterized in the frequency range of 50 MHz - 20 GHz. In such case, capacitance, tanδ and equivalent series resistance (ESR) were extracted from two port scattering parameters obtained using a vector network analyzer (VNA). The relationship between dielectric loss, tunability and calculated figure of merit vs. BST composition and deposition temperature was outlined. In addition, loss and ESR at high frequencies was investigated. The typical achieved leakage current density of sputtered BST films for 2.25 mm2 capacitors fabricated on SiO2/Al2O3 was 7.3×10-9 A/cm2 at 300 kV/cm (65 fF/μm2), about 2 times lower than for (Ba0.7Sr0.3)TiO3 films deposited by MOD (1.4×10-8 A/cm2 at 300 kV/cm, 34.5 fF/μm2). Furthermore, the tunability of (Ba0.7Sr0.3)TiO3 deposited by both methods on SiO2/Al2O3 was ∼60% at 350 kV/cm.
Cost effective high volume manufacture (HVM) is a major challenge to the success of solid oxide fuel cells (SOFCs). More than fifteen processing methods have been reported in the literature many of which could be used in various combinations to create the desired product characteristics. Modeling tools are needed to aid in the selection of the appropriate process combination prior to making expensive investment decisions.
This paper describes the development of a multi-process cost model that permits the comparison of manufacturing cost for different processing combinations and various materials. Two specific processing methods are discussed, tape casting and screen printing.
The results are compared with data and experience from the fuel cell and electronic packaging industries. Initial comparisons show good agreement with this experience base. Sensitivity of manufacturing costs to SOFC performance requirements such as maximum power density and operation temperature is investigated.