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.
Neonates undergoing surgery for congenital heart disease are vulnerable to adverse events. Conventional quality improvement processes centring on mortality and significant morbidity leave a gap in the identification of systematic processes that, though not directly linked to an error, may still contribute to adverse outcomes. Implementation of a multidisciplinary “flight path” process for surgical patients may be used to identify modifiable threats and errors and generate action items, which may lead to quality improvement.
A retrospective review of our neonatal “flight path” initiative was performed. Within 72 hours of a cardiac surgery, a meeting of the multidisciplinary patient care team occurs. A “flight path” is generated, graphically illustrating the patient’s hospital course. Threats, errors, or unintended consequences are identified. Action items are generated, and a working group is formed to address the items. A patient’s flight path is updated weekly until discharge. The errors and action items are logged into a database, which is analysed quarterly to identify trends.
Thirty one patients underwent flight path review over a 1-year period; 22.5% (N = 7) of patients had an error-free “flight.” Eleven action items were generated – four from identified errors and seven from identified threats. Nine action items were completed.
Flight path reviews of congenital cardiac patients can be generated with few resources and aid in the detection of quality improvement opportunities. The regular multidisciplinary meetings that occur as a part of the flight path review process can promote inter-professional teamwork.
Risk for emotional and behavioural problems are known to be high among children of depressed mothers, but little is known about the impact of antenatal and postnatal depression on the physical health of the infant. Our one-year prospective follow-up study of 320 mothers and their infants in rural Rawalpindi, Pakistan, shows that infants of antenatally depressed mothers have poorer growth than controls. The relative risk for being underweight (weight-for-age z-score < -2SD) is 4.0 (95%CI 2.1-7.7) at 6 months and 2.6 (95% CI 1.7-4.1) at 12 months, while the risks for stunting (length-for-age z-score < –2SD) is 4.4 (95%CI 1.7-11.4) at 6 months and 2.5 (95% CI 1.6-4.0) at 12 months. Relative risk for ≥5 diarrhoeal episodes per year is 2.4 (95% CI 1.7-3.3). Chronic depression carries a greater risk for poor outcome than episodic depression. The associations remain significant after adjustment for confounders by multivariate analyses. It is concluded that preventive and treatment strategies for maternal depression could benefit not only the mother's well-being but also the infant's physical health and development.
The Pennsylvania Longitudinal Study of Parents and Children Twin Registry was developed to capture a representative sample of multiple births and their parents in the state of Pennsylvania. The registry has two main efforts. The first began in 2012 through recruitment of adolescents in Pennsylvania schools. The second effort began in January 2019 in partnership with the Pennsylvania Department of Health to capture the birth cohort of twins born from 2007 to 2017. Study recruitment, sample demographics, focus and measures are provided, as well as future directions.
Cephalopods are important prey in the diet of top predators, such as marine mammals and seabirds. However, detailed information on their trophic relationships in the Patagonian marine ecosystem is scarce, including those cephalopod species with commercial interest. The aims of this study were to evaluate the composition of the cephalopod component in the diet of Otaria byronia and determine the habitat use and trophic levels of their main cephalopod prey by measuring the stable isotopic signature of cephalopod beaks. Between May 2005 and February 2009, fresh faecal samples were collected from two sea lions rookeries in San Matias Gulf. Cephalopods occurred in 39.4% of the 1112 samples collected during the whole period of study. The dominant prey species was Octopus tehuelchus, which occurred in 45.8% of scats containing cephalopod remains, and represented 58.7% in terms of numerical abundance and 52.0% in mass of cephalopods consumed. The second species most consumed was the myopsid Doryteuthis gahi. The significant higher δ15N values of O. tehuelchus beaks in comparison with those of D. gahi showed that these two species have different trophic levels while occupying similar habitat (δ13C values) in neritic waters of the Patagonian shelf.
Cognitive impairment has been identified as an important aspect of major depressive disorder (MDD). We tested two theories regarding the association between MDD and cognitive functioning using data from longitudinal cohort studies. One theory, the cognitive reserve hypothesis, suggests that higher cognitive ability in childhood decreases risk of later MDD. The second, the scarring hypothesis, instead suggests that MDD leads to persistent cognitive deficits following disorder onset. We tested both theories in the Dunedin Study, a population-representative cohort followed from birth to midlife and assessed repeatedly for both cognitive functioning and psychopathology. We also used data from the Environmental Risk Longitudinal Twin Study to test whether childhood cognitive functioning predicts future MDD risk independent of family-wide and genetic risk using a discordant twin design. Contrary to both hypotheses, we found that childhood cognitive functioning did not predict future risk of MDD, nor did study members with a past history of MDD show evidence of greater cognitive decline unless MDD was accompanied by other comorbid psychiatric conditions. Our results thus suggest that low cognitive functioning is related to comorbidity, but is neither an antecedent nor an enduring consequence of MDD. Future research may benefit from considering cognitive deficits that occur during depressive episodes from a transdiagnostic perspective.
To determine whether living in a food swamp (≥4 corner stores within 0·40 km (0·25 miles) of home) or a food desert (generally, no supermarket or access to healthy foods) is associated with consumption of snacks/desserts or fruits/vegetables, and if neighbourhood-level socio-economic status (SES) confounds relationships.
Cross-sectional. Assessments included diet (Youth/Adolescent FFQ, skewed dietary variables normalized) and measured height/weight (BMI-for-age percentiles/Z-scores calculated). A geographic information system geocoded home addresses and mapped food deserts/food swamps. Associations examined using multiple linear regression (MLR) models adjusting for age and BMI-for-age Z-score.
Baltimore City, MD, USA.
Early adolescent girls (6th/7th grade, n 634; mean age 12·1 years; 90·7 % African American; 52·4 % overweight/obese), recruited from twenty-two urban, low-income schools.
Girls’ consumption of fruit, vegetables and snacks/desserts: 1·2, 1·7 and 3·4 servings/d, respectively. Girls’ food environment: 10·4 % food desert only, 19·1 % food swamp only, 16·1 % both food desert/swamp and 54·4 % neither food desert/swamp. Average median neighbourhood-level household income: $US 35 298. In MLR models, girls living in both food deserts/swamps consumed additional servings of snacks/desserts v. girls living in neither (β=0·13, P=0·029; 3·8 v. 3·2 servings/d). Specifically, girls living in food swamps consumed more snacks/desserts than girls who did not (β=0·16, P=0·003; 3·7 v. 3·1 servings/d), with no confounding effect of neighbourhood-level SES. No associations were identified with food deserts or consumption of fruits/vegetables.
Early adolescent girls living in food swamps consumed more snacks/desserts than girls not living in food swamps. Dietary interventions should consider the built environment/food access when addressing adolescent dietary behaviours.
The Darwin region in northern Australia has experienced rapid population growth in recent years, and with it, an increased incidence of melioidosis. Previous studies in Darwin have associated the environmental presence of Burkholderia pseudomallei, the causative agent of melioidosis, with anthropogenic land usage and proximity to animals. In our study, we estimated the occurrence of B. pseudomallei and Burkholderia spp. relatives in faecal matter of wildlife, livestock and domestic animals in the Darwin region. A total of 357 faecal samples were collected and bacteria isolated through culture and direct DNA extraction after enrichment in selective media. Identification of B. pseudomallei, B. ubonensis, and other Burkholderia spp. was carried out using TTS1, Bu550, and recA BUR3–BUR4 quantitative PCR assays, respectively. B. pseudomallei was detected in seven faecal samples from wallabies and a chicken. B. cepacia complex spp. and Pandoraea spp. were cultured from wallaby faecal samples, and B. cenocepacia and B. cepacia were also isolated from livestock animals. Various bacteria isolated in this study represent opportunistic human pathogens, raising the possibility that faecal shedding contributes to the expanding geographical distribution of not just B. pseudomallei but other Burkholderiaceae that can cause human disease.
We have assembled a new sample of some of the most FIR-luminous galaxies in the Universe and have imaged them in 1.1 mm dust emission and measured their redshifts 1 < z < 4 via CO emission lines using the 32-m Large Millimeter Telescope / Gran Telescopio Milimétrico (LMT/GTM). Our sample of 31 submm galaxies (SMGs), culled from the Planck and Herschel all-sky surveys, includes 14 of the 21 most luminous galaxies known, with LFIR > 1014L⊙ and SFR > 104M⊙/yr. These extreme inferred luminosities – and multiple / extended 1.1 mm images – imply that most or all are strongly gravitationally lensed, with typical magnification μ ~ 10 × . The gravitational lensing provides two significant benefits: (1) it boosts the S/N, and (2) it allows investigation of star formation and gas processes on sub-kpc scales.
To our knowledge, there are no universal screening tools for substance dependence that (1) were developed using a population-based sample, (2) estimate total risk briefly and inexpensively by incorporating a relatively small number of well-established risk factors, and (3) aggregate risk factors using a simple algorithm. We created a universal screening tool that incorporates these features to identify adolescents at risk for persistent substance dependence in adulthood.
Participants were members of a representative cohort of 1037 individuals born in Dunedin, New Zealand in 1972–1973 and followed prospectively to age 38 years, with 95% retention. We assessed a small set of childhood and adolescent risk factors: family history of substance dependence, childhood psychopathology (conduct disorder, depression), early exposure to substances, frequent substance use in adolescence, sex, and childhood socioeconomic status. We defined the outcome (persistent substance dependence in adulthood) as dependence on one or more of alcohol, tobacco, cannabis, or hard drugs at ⩾3 assessment ages: 21, 26, 32, and 38 years.
A cumulative risk index, a simple sum of nine childhood and adolescent risk factors, predicted persistent substance dependence in adulthood with considerable accuracy (AUC = 0.80).
A cumulative risk score can accurately predict which adolescents in the general population will develop persistent substance dependence in adulthood.
One of the most challenging aspects of understanding the flow of gas and water during testing in clay-rich low-permeability materials is the difficulty in visualizing localized flow. Whilst understanding has been increased using X-ray Computed-tomography (CT) scanning, synchrotron X-ray imaging and Nuclear Magnetic Resonance (NMR) imaging, real-time testing is problematic under realistic in situ conditions confining pressures, which require steel pressure vessels. These methods tend not to have the nano-metre scale resolution necessary for clay mineral visualization, and are generally not compatible with the long duration necessary to investigate flow in such materials. Therefore other methods are necessary to visualize flow paths during post-mortem analysis of test samples. Several methodologies have been established at the British Geological Survey (BGS), in order to visualize flow paths both directly and indirectly. These include: (1) the injection of fluorescein-stained water or deuterium oxide; (2) the introduction of nanoparticles that are transported by carrier gas; (3) the use of radiologically tagged gas; and (4) the development of apparatus for the direct visualization of clay. These methodologies have greatly increased our understanding of the transport of water and gas through intact and fractured clay-rich materials. The body of evidence for gas transport through the formation of dilatant pathways is now considerable. This study presents observations using a new apparatus to directly visualize the flow of gas in a kaolinite paste. The results presented provide an insight into the flow of gas in clay-rich rocks. The flow of gas through dilatant pathways has been shown in a number of argillaceous materials (Angeli et al., 2009; Autio et al., 2006; Cuss et al., 2014; Harrington et al., 2012). These pathways are pressure induced and an increase in gas pressure leads to the dilation of pathways. Once the gas breakthrough occurs, pressure decreases and pathways begin to close. This new approach is providing a unique insight into the complex processes involved during the onset, development and closure of these dilatant gas pathways.
Voters and political candidates increasingly use social networking sites (SNSs) such as Facebook. This study uses data from an online posttest-only experiment (N = 183) in analyzing how exposure to supportive or challenging user comments on a fictional candidate's Facebook page influenced participants’ perceptions of and willingness to vote for the candidate, as well as whether candidate replies to each type of user comments affected these outcomes. Participants who viewed a page with supportive comments and “likes” reported more favorable perceptions of and greater support for the candidate, relative to participants who viewed a page with challenging comments. Thus, the appearance of interactivity between a candidate and other users on the candidate's Facebook page can shape the responses of those viewing the page. However, exposure to candidate replies to either supportive or challenging comments did not lead to significantly more favorable perceptions or a greater likelihood of voting for the candidate.
We develop a polarimetry-based remote-sensing method for detecting and identifying life forms in distant worlds and distinguishing them from non-biological species. To achieve this we have designed and built a bio-polarimetric laboratory experiment BioPol for measuring optical polarized spectra of various biological and non-biological samples. Here we focus on biological pigments, which are common in plants and bacteria that employ them either for photosynthesis or for protection against reactive oxygen species. Photosynthesis, which provides organisms with the ability to use light as a source of energy, emerged early in the evolution of life on Earth. The ability to harvest such a significant energy resource could likely also develop on habited exoplanets. Thus, we investigate the detectability of biomolecules that can capture photons of particular wavelengths and contribute to storing their energy in chemical bonds. We have carried out laboratory spectropolarimetric measurements of a representative sample of plants containing various amounts of pigments such as chlorophyll, carotenoids and others. We have also measured a variety of non-biological samples (sands, rocks). Using our lab measurements, we have modelled intensity and polarized spectra of Earth-like planets having different surface coverage by photosynthetic organisms, deserted land and ocean, as well as clouds. Our results demonstrate that linearly polarized spectra provide very sensitive and rather unambiguous detection of photosynthetic pigments of various kinds. Our work paves the path towards analogous measurements of microorganisms and remote sensing of microbial ecology on the Earth and of extraterrestrial life on other planets and moons.
Continuum scattering by free electrons can be significant in early type stars, while in late type stars Rayleigh scattering by hydrogen atoms or molecules may be important. Computer programs used to construct models of stellar atmospheres generally treat the scattering of the continuum radiation as isotropic and unpolarized, but this scattering has a dipole angular dependence and will produce polarization. We review an accurate method for evaluating the polarization and limb darkening of the radiation from model stellar atmospheres. We use this method to obtain results for: (i) Late type stars, based on the MARCS code models (Gustafsson et al. 2008), and (ii) Early type stars, based on the NLTE code TLUSTY (Lanz and Hubeny 2003). These results are tabulated at http://www.astro.umd.edu/~jph/Stellar_Polarization.html While the net polarization vanishes for an unresolved spherical star, this symmetry is broken by rapid rotation or by the masking of part of the star by a binary companion or during the transit of an exoplanet. We give some numerical results for these last cases.
We describe two cases of infant botulism due to Clostridium butyricum producing botulinum type E neurotoxin (BoNT/E) and a previously unreported environmental source. The infants presented at age 11 days with poor feeding and lethargy, hypotonia, dilated pupils and absent reflexes. Faecal samples were positive for C. butyricum BoNT/E. The infants recovered after treatment including botulism immune globulin intravenous (BIG-IV). C. butyricum BoNT/E was isolated from water from tanks housing pet ‘yellow-bellied’ terrapins (Trachemys scripta scripta): in case A the terrapins were in the infant's home; in case B a relative fed the terrapin prior to holding and feeding the infant when both visited another relative. C. butyricum isolates from the infants and the respective terrapin tank waters were indistinguishable by molecular typing. Review of a case of C. butyricum BoNT/E botulism in the UK found that there was a pet terrapin where the infant was living. It is concluded that the C. butyricum-producing BoNT type E in these cases of infant botulism most likely originated from pet terrapins. These findings reinforce public health advice that reptiles, including terrapins, are not suitable pets for children aged <5 years, and highlight the importance of hand washing after handling these pets.
Childhood psychotic symptoms have been used as a subclinical phenotype of schizophrenia in etiological research and as a target for preventative interventions. However, recent studies have cast doubt on the specificity of these symptoms for schizophrenia, suggesting alternative outcomes such as anxiety and depression. Using a prospective longitudinal birth cohort we investigated whether childhood psychotic symptoms predicted a diagnosis of schizophrenia or other psychiatric disorders by 38 years of age.
Participants were drawn from a birth cohort of 1037 children from Dunedin, New Zealand, who were followed prospectively to 38 years of age (96% retention rate). Structured clinical interviews were administered at age 11 to assess psychotic symptoms and study members underwent psychiatric assessments at ages 18, 21, 26, 32 and 38 to obtain past-year DSM-III-R/IV diagnoses and self-reports of attempted suicides since adolescence.
Psychotic symptoms at age 11 predicted elevated rates of research diagnoses of schizophrenia and post-traumatic stress disorder (PTSD) and also suicide attempts by age 38, even when controlling for gender, social class and childhood psychopathology. No significant associations were found for persistent anxiety, persistent depression, mania or persistent substance dependence. Very few of the children presenting with age-11 psychotic symptoms were free from disorder by age 38.
Childhood psychotic symptoms were not specific to a diagnosis of schizophrenia in adulthood and thus future studies of early symptoms should be cautious in extrapolating findings only to this clinical disorder. However, these symptoms may be useful as a marker of adult mental health problems more broadly.
Understanding flow along fractures and faults is of importance to the performance assessment (PA) of a geological disposal facility (GDF) for radioactive waste. Flow can occur along pre-existing fractures in the host-rock or along fractures created during the construction of the GDF within the excavation damage zone (EDZ). The complex fracture network will have a range of orientations and will exist within a complex stress regime. Critical stress theory suggests that fractures close to localized shear failure are critically stressed and therefore most conductive to fluid flow. Analysis of fault geometry and stress conditions at Sellafield has revealed that no features were found to be, or even close to being, classified as critically stressed, despite some being conductive. In order to understand the underlying reasons why non-critically stressed fractures were conductive a series of laboratory experiments were performed. A bespoke angled shear rig (ASR) was built in order to study the relationship between fluid flow (water and gas) through a fracture surface as a function of normal load. Fluid flow reduced with an increase in normal load, as expected. During unloading considerable hysteresis was seen in flow and shear stress. Fracture flow was only partially recovered for water injection, whereas gas flow increased remarkably during unloading. The ratio of shear stress to normal stress seems to control the fluid flow properties during the unloading stage of the experiment demonstrating its significance in fracture flow. The exhumation of the Sellafield area during the Palaeogene–Neogene resulted in considerable stress relaxation and in fractures becoming non-critically stressed. The hysteresis in shear stress during uplift has resulted in faults remaining, or becoming, conductive. The field and laboratory observations illustrate that understanding the stress-history of a fractured rock mass is essential, and a mere understanding of the current stress regime is insufficient to estimate the flow characteristics of present-day fractures.