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Trauma and dissociation may be important factors contributing to the experiences of distressing voice hearing. However, there is scant mention of how to target and treat such processes when working with people with psychosis. This case study reports on an initial attempt to work with dissociation and trauma memories in a person with voices. A single case approach was used, with standardized measures used before, during and after 24 sessions of cognitive therapy, and at 6-month follow-up. In addition, session-by-session measures tracked frequency and distress associated with voices and dissociation. The participant reported significant improvements in terms of reduced frequency and distress of dissociation, and voice hearing, as well as improvement in low mood at the end of treatment. At follow-up there were enduring benefits in terms of dissociation and trauma-related experiences, as well as broad recovery but not of change in voices. This case illustrated the potential benefit of targeting dissociation and exposure to trauma memories in producing general symptom improvement and specific reductions in dissociation and voice hearing at end of treatment.
The objective of this study was to investigate the impact of the most commonly cited factors that may have influenced infants’ gut microbiota profiles at one year of age: mode of delivery, breastfeeding duration and antibiotic exposure. Barcoded V3/V4 amplicons of bacterial 16S-rRNA gene were prepared from the stool samples of 52 healthy 1-year-old Australian children and sequenced using the Illumina MiSeq platform. Following the quality checks, the data were processed using the Quantitative Insights Into Microbial Ecology pipeline and analysed using the Calypso package for microbiome data analysis. The stool microbiota profiles of children still breastfed were significantly different from that of children weaned earlier (P<0.05), independent of the age of solid food introduction. Among children still breastfed, Veillonella spp. abundance was higher. Children no longer breastfed possessed a more ‘mature’ microbiota, with notable increases of Firmicutes. The microbiota profiles of the children could not be differentiated by delivery mode or antibiotic exposure. Further analysis based on children’s feeding patterns found children who were breastfed alongside solid food had significantly different microbiota profiles compared to that of children who were receiving both breastmilk and formula milk alongside solid food. This study provided evidence that breastfeeding continues to influence gut microbial community even at late infancy when these children are also consuming table foods. At this age, any impacts from mode of delivery or antibiotic exposure did not appear to be discernible imprints on the microbial community profiles of these healthy children.
Emergency physicians are using bolus-dose vasopressors to temporize hypotensive patients until more definitive blood pressure support can be established. Despite a paucity of clinical outcome data, emergency department applications are expanding into the prehospital setting. This series presents two cases of field expedient vasopressor use by emergency medicine providers for preflight stabilization during aeromedical evacuation to a hospital ship as part of the United States Navy disaster response in Puerto Rico. A critical approach and review of the literature are discussed.
Two critically ill patients were managed in an austere environment as a result of the devastation from Hurricane Maria (Yabucoa, Puerto Rico; 2017). They both exhibited signs of respiratory distress, hemodynamic instability, and distributive shock requiring definitive airway management and hemodynamic support prior to aeromedical evacuation.
The novel use of field expedient vasopressors prior to induction for rapid sequence intubation was successfully and safely employed in both cases. Both patients had multiple risk factors for peri-induction cardiac arrest given their presenting hemodynamics. Despite their illness severity, both patients were induced, transported, and ultimately admitted to the intensive care unit (ICU) in stable condition following administration of the field expedient vasopressors.
Field expedient vasopressors were safely and effectively employed in an austere field environment during a disaster response. This case series contributes to the growing body of literature of safe bolus-dose vasopressor use by emergency physicians to temporize hypotensive patients in resource-constrained situations.
HardwickJM, MurnanSD, Morrison-PonceDP, DevlinJJ. Field Expedient Vasopressors During Aeromedical Evacuation: A Case Series from the Puerto Rico Disaster Response. Prehosp Disaster Med. 2018;33(6):668–672.
Posttraumatic stress disorder (PTSD) and stress/trauma exposure are cross-sectionally associated with advanced DNA methylation age relative to chronological age. However, longitudinal inquiry and examination of associations between advanced DNA methylation age and a broader range of psychiatric disorders is lacking. The aim of this study was to examine if PTSD, depression, generalized anxiety, and alcohol-use disorders predicted acceleration of DNA methylation age over time (i.e. an increasing pace, or rate of advancement, of the epigenetic clock).
Genome-wide DNA methylation and a comprehensive set of psychiatric symptoms and diagnoses were assessed in 179 Iraq/Afghanistan war veterans who completed two assessments over the course of approximately 2 years. Two DNA methylation age indices (Horvath and Hannum), each a weighted index of an array of genome-wide DNA methylation probes, were quantified. The pace of the epigenetic clock was operationalized as change in DNA methylation age as a function of time between assessments.
Analyses revealed that alcohol-use disorders (p = 0.001) and PTSD avoidance and numbing symptoms (p = 0.02) at Time 1 were associated with an increasing pace of the epigenetic clock over time, per the Horvath (but not the Hannum) index of cellular aging.
This is the first study to suggest that posttraumatic psychopathology is longitudinally associated with a quickened pace of the epigenetic clock. Results raise the possibility that accelerated cellular aging is a common biological consequence of stress-related psychopathology, which carries implications for identifying mechanisms of stress-related cellular aging and developing interventions to slow its pace.
Hamiltonian extended magnetohydrodynamics (XMHD) is restricted to respect helical symmetry by reducing the Poisson bracket for the three-dimensional dynamics to a helically symmetric one, as an extension of the previous study for translationally symmetric XMHD (Kaltsas et al., Phys. Plasmas, vol. 24, 2017, 092504). Four families of Casimir invariants are obtained directly from the symmetric Poisson bracket and they are used to construct Energy–Casimir variational principles for deriving generalized XMHD equilibrium equations with arbitrary macroscopic flows. The system is then cast into the form of Grad–Shafranov–Bernoulli equilibrium equations. The axisymmetric and the translationally symmetric formulations can be retrieved as geometric reductions of the helically symmetric one. As special cases, the derivation of the corresponding equilibrium equations for incompressible plasmas is discussed and the helically symmetric equilibrium equations for the Hall MHD system are obtained upon neglecting electron inertia. An example of an incompressible double-Beltrami equilibrium is presented in connection with a magnetic configuration having non-planar helical magnetic axis.
Problems of particle dynamics involving unsteady Stokes flows in confined geometries are typically harder to solve than their steady counterparts. Approximation techniques are often the only resort. Felderhof (see e.g. J. Phys. Chem. B, vol. 109 (45), 2005, pp. 21406–21412; J. Fluid Mech., vol. 637, 2009, pp. 285–303) has developed a point-particle approximation framework to solve such problems, especially in the context of Brownian motion. Despite excellent agreement with past experiments, this framework produces unsteady drag coefficients that depend on particle density. This is inconsistent, since the problem can be formulated mathematically without any reference to the particle’s density. We address this inconsistency in our work. Upon implementing our modifications, the framework passes consistency checks that it previously failed. Further, it is not obvious that such an approximation should work for short-time-scale motion. We investigate its validity by deriving it from a general formalism based on integral equations through a series of systematic approximations. We also compare results from the point-particle framework against a calculation performed using the method of reflections, for the specific case of a sphere near a full-slip plane boundary. We find from our analysis that the reasons for the success of the point-particle approximation are subtle and have to do with the nature of the unsteady Oseen tensor. Finally, we provide numerical predictions for Brownian motion near a full-slip and a no-slip plane wall based on the point-particle approximation as used by Felderhof, our modified point-particle approximation and the method of reflections. We show that our modifications to Felderhof’s framework would become significant for systems of metallic nanoparticles in liquids.
The closely related actions of cortisol and leptin (Ahima & Flier, 2000) are involved with appetite, tissue growth and maturation, energy balance and weight deposition so that resistance to either may lead to obesity. In normal weight humans, plasma leptin and cortisol exhibit diurnal variation, peaking during darkness and late afternoon (respectively). In sheep, the literature consensus is that plasma cortisol levels are greatest during daylight. Ovine plasma leptin is also reported to vary in response to photoperiod-driven changes (Bocquier et al., 1998) and such as alterations in voluntary feed intake as daylength changes. Daily circadian patterns, however, are thought to be entrained by the time of daily feed presentation (Marie et al., 2001). The aim of the present study was to investigate the diurnal variation in ovine plasma leptin in unrestrained animals with ad-lib access to hay and water in relation to their plasma cortisol profile over the same period. Remote blood sampling was employed in order to reduce sampling stress that would affect the animals’ plasma physiology.
The first two catalogues produced from test observations made with the Carlsberg Automatic Transit Circle (CATC) at the Copenhagen University Observatory in the period 1981/83 have internal mean errors of 0″.21 in right ascension and 0″.22 in declination. In 1983 the CATC was moved to the international Observatorio del Roque de los Muchachos where it will begin a programme of differential and fundamental astrometry in 1984.
On this silver anniversary of the first published proposal for a search of the skies to seek communications over interstellar distances, I present a rather personal account of the origins of the proposal, and an appraisal of the new and hopeful status of the search worldwide.
Background: Internalized stigma is a significant difficulty for those who experience psychosis, but it has never been conceptualized using cognitive theory. Aims: The aim of this paper is to outline a cognitive model conceptualizing internalized stigma experienced by people who also experience psychosis. Method: Previous literature is reviewed, critiqued and synthesized to develop the model. It draws upon previous social cognitive models of internalized stigma and integrates cognitive behavioural theory and social mentality theory. Results: This paper identifies key cognitive, behavioural and emotional processes that contribute to the development and maintenance of internalized stigma, whilst also recognizing the central importance of cultural context in creating negative stereotypes of psychosis. Moreover, therapeutic strategies to alleviate internalized stigma are identified. A case example is explored and a formulation and brief intervention plan was developed in order to illustrate the model in practice. Conclusion: An integrative cognitive model is presented, which can be used to develop individualized case formulations, which can guide cognitive behavioural interventions targeting internalized stigma in those who experience psychosis. More research is required to examine the efficacy of such interventions. In addition, it is imperative to continue to research interventions that create change in stigma at a societal level.
Introduction: High-quality cardiopulmonary resuscitation (CPR) is essential for patient survival. Typically, CPR quality is only measured during the first 10 minutes of resuscitation. There is limited research examining the quality of CPR over the entire duration of resuscitation.Objective: To examine the quality of CPR over the entire duration of resuscitation and correlate the quality of CPR to patient survival. Methods: This was a retrospective observational study using data from the Toronto RescuNET Epistry-Cardiac Arrest database. We included consecutive, adult (>18) OHCA treated by EMS between January 1, 2014 and September 30, 2015. High-quality CPR was defined, in accordance with 2015 AHA Guidelines, as a chest compression rate of 100-120/min, depth of 5.0-6.0 cm and chest compression fraction (ccf) of >0.80. We further categorized high-quality resuscitation as meeting benchmarks >80% of the time, moderate-quality between 50-80% and low-quality meeting benchmarks <50% of the resuscitation. We used multivariable logistic regression to determine association between variables of interest, including CPR quality metrics, and survival to hospital discharge. Results: A total of 5,208 OHCA met our inclusion criteria with a survival rate of 8%. The median (IQR) duration of resuscitation was 23.0 min (15.0,32.7). Overall CPR quality was considered high-quality for ccf in 81% of resuscitation episodes, 41% for rate, and 7% for depth. The percentage of resuscitations meeting the quality benchmarks differed between survivors and non-survivors for both depth (15% vs 6%) and ccf (61% vs 83%) (P value <0.001). After controlling for Utstein variables maintaining a chest compression depth within recommendations for >80% showed a trend towards improved survival (OR 1.68, 95% CI 0.96, 2.92). Other variables associated with survival were public location, initial CPR by EMS providers or bystanders, witnessed cardiac arrest (EMS or bystander), and initial shockable rhythm. Increasing age and longer duration of resuscitation were associated with decreased survival. Conclusion: Overall, EMS providers were not able to maintain rate or depth within guideline recommendations for the majority of the duration of resuscitation. Maintaining chest compression depth for greater than 80% of the resuscitation showed a trend towards increased survival from OHCA.
Angiotensin-converting enzyme (ACE) inhibitors are important agents in blood pressure (BP) management. It was recently shown that the egg-protein hydrolysate NWT-03 inhibited ACE in Zucker diabetic fatty rats. We therefore designed a dose-finding study to assess the effects of 1, 2 and 5 g NWT-03 on daytime, 36-h, and night-time systolic and diastolic BP (SBP and DBP) in ninety-two generally healthy subjects with normal BP (n 29), high-normal BP (n 34) or mild hypertension (n 29). The study had a cross-over design with six treatment arms (1 g NWT-03 or placebo in period 1 and placebo or 1 g NWT-03 in period 2, 2 g NTW-03 or placebo in period 1 and placebo or 2 g NWT-03 in period 2, or 5 g NTW-03 or placebo in period 1 and placebo or 5 g NTW-03 in period 2). A comparable number of subjects from each BP class were included in each study arm. Duration of both treatments in each arm was 7 d, separated by 5-d wash-out periods. BP was measured with an ambulatory BP monitor before and after the treatments. In mild-hypertensive subjects, 2 g NWT-03 significantly decreased daytime SBP (7·9 mmHg; P=0·006), daytime DBP (4·2 mmHg; P=0·009), 36-h SBP (6·9 mmHg; P=0·015) and 36-h DBP (3·5 mmHg; P=0·035) compared with placebo subjects. In addition, in mild-hypertensive subjects, 5 g NWT-03 significantly decreased night-time SBP (14·8 mmHg; P=0·008) and night-time DBP (8·4 mmHg; P=0·020) compared with that in placebo subjects. To conclude, we found that 2 g NWT-03 lowered daytime and 36-h BP in subjects with mild hypertension, and 5 g NWT-03 lowered night-time BP in subjects with mild hypertension. As no dose–response relationship was evident, these results should be interpreted with care, and additional studies are needed.
As part of the Winter Weddell Sea Project 1986 (WWSP 86), a buoy, transmitting via TIROS-N satellites to Service Argos, was inserted into an ice floe in the southern Weddell Sea. Operational U.K. Meteorological Office numerical surface-pressure analyses, which utilized the buoy’s measured values of air pressure and temperature, are used to assess the impact of weather systems on pack-ice movement. The motion of the buoy is shown to be related closely to the position of the circumpolar trough and to the tracks of depressions crossing the area. The tracks of this and other buoys deployed during WWSP 86 are analysed, together with the known drifts of some ice-bound vessels, to establish the overall movement of sea ice in the central and western Weddell Sea. Using these data, the area of ice transported northward out of the Weddell Sea is determined. Roughly 60% of the winter sea-ice cover is discharged out of the area, and is replaced by new ice formation in coastal polynyas and by influx of new ice from the east. In summer, a further 30% is discharged northward out of the region, leaving 40% cover and by implication a 30% loss by melting.
Position data from an Argos-tracked buoy deployed in the southern Weddell Sea in the austral summer of 1986 are analysed to determine important time-scales of variation of sea-ice motion in the seasonal sea-ice zone. Quality control and pre-processing of raw buoy data are discussed. Processed position data are subjected to time- and frequency-domain analyses. These highlight the importance of diurnal and semi-diurnal periodicities in the buoy motion. These preferred periodicities are associated with tidal forcing rather than wind forcing or inertial oscillations. Periodograms of the longitudinal component of buoy motion indicate that the power of the 24 h tidal component drops dramatically around day 130 in 1986. The possible causes of this are discussed and it is concluded that internal resistance within the sea-ice field may have increased at that time.
Ice motion in the Weddell Sea is examined for the period 19 August (Day 232) to 12 October (Day 286) 1986 using the tracks of four Argos buoys deployed during the Winter Weddell Sea Project 1986 (WWSP 86). Two were SPRI/BAS buoys, launched in December 1985 and March 1986 in the south-east and north-west Weddell Sea. The others were part of a mesoscale array deployed in the Maud Rise area by H. Hoeber of the Meteorologisches Institut der Universität Hamburg, during the WWSP 86 cruise of FS Polarstern. The four buoys operated together for 44 d, comprising a basin-scale quadrilateral from which the differential kinematic parameters of divergence, vorticity, shear, and stretch were extracted, as well as the large-scale pattern of motion. It is found that most deformation episodes were associated with atmospheric forcing events.
The Vlasov–Maxwell equations possess a Hamiltonian structure expressed in terms of a Hamiltonian functional and a functional bracket. In the present paper, the transformation (‘lift’) of the Vlasov–Maxwell bracket induced by the dynamical reduction of single-particle dynamics is investigated when the reduction is carried out by Lie-transform perturbation methods. The ultimate goal of this work is to provide an explicit pathway to the Hamiltonian formulations for the guiding-centre and gyrokinetic Vlasov–Maxwell equations, which have found important applications in our understanding of turbulent magnetized plasmas. Here, it is shown that the general form of the reduced Vlasov–Maxwell equations possesses a Hamiltonian structure defined in terms of a reduced Hamiltonian functional and a reduced bracket that automatically satisfies the standard bracket properties.
Pathogenic animal trypanosomes affecting livestock have represented a major constraint to agricultural development in Africa for centuries, and their negative economic impact is increasing in South America and Asia. Chemotherapy and chemoprophylaxis represent the main means of control. However, research into new trypanocides has remained inadequate for decades, leading to a situation where the few compounds available are losing efficacy due to the emergence of drug-resistant parasites. In this review, we provide a comprehensive overview of the current options available for the treatment and prophylaxis of the animal trypanosomiases, with a special focus on the problem of resistance. The key issues surrounding the main economically important animal trypanosome species and the diseases they cause are also presented. As new investment becomes available to develop improved tools to control the animal trypanosomiases, we stress that efforts should be directed towards a better understanding of the biology of the relevant parasite species and strains, to identify new drug targets and interrogate resistance mechanisms.