To save 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 saving content to .
To save 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 saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved 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.
The systems ecology paradigm (SEP) emerged in the late 1960s at a time when societies throughout the world were beginning to recognize that our environment and natural resources were being threatened by their activities. Management practices in rangelands, forests, agricultural lands, wetlands, and waterways were inadequate to meet the challenges of deteriorating environments, many of which were caused by the practices themselves. Scientists recognized an immediate need was developing a knowledge base about how ecosystems function. That effort took nearly two decades (1980s) and concluded with the acceptance that humans were components of ecosystems, not just controllers and manipulators of lands and waters. While ecosystem science was being developed, management options based on ecosystem science were shifting dramatically toward practices supporting sustainability, resilience, ecosystem services, biodiversity, and local to global interconnections of ecosystems. Emerging from the new knowledge about how ecosystems function and the application of the systems ecology approach was the collaboration of scientists, managers, decision-makers, and stakeholders locally and globally. Today’s concepts of ecosystem management and related ideas, such as sustainable agriculture, ecosystem health and restoration, consequences of and adaptation to climate change, and many other important local to global challenges are a direct result of the SEP.
Foraminifera and diatoms preserved in salt-marsh sediments have been used to produce high-resolution records of Holocene relative sea-level (RSL) change. To determine which of these microfossil groups is most appropriate for this purpose we investigated their relative utility from salt marshes in North Carolina, USA. Regional-scale transfer functions were developed using foraminifera, diatoms and a combination of both (multi-proxy) from three salt marshes (Oregon Inlet, Currituck Barrier Island and Pea Island). We evaluated each approach on the basis of transfer-function performance. Foraminifera, diatoms and multi-proxy-based transfer functions all demonstrated a strong relationship between observed and predicted elevations (r2jack > 0.74 and RMSEP < 0.05 m), suggesting that they have equal utility. Application of the transfer functions to a fossil core from Salvo to reconstruct former sea levels enabled us to consider relative utility in light of ‘paleo-performance’. Fossil foraminifera had strong modern analogues, whilst diatoms had poor modern analogues making them unreliable. This result reflects the high diversity and site-specific distribution of modern diatoms. Consequently, we used foraminifera to reconstruct RSL change for the period since ∼ AD 1800 using a 210Pb- and 14C-based chronology, and we were able to reconcile this with tide-gauge records.
To compare a specialized interprofessional team approach to community-based stroke rehabilitation with usual home care for stroke survivors using home care services.
Randomized controlled trial of 101 community-living stroke survivors (<18 months post-stroke) using home care services. Subjects were randomized to intervention (n=52) or control (n=49) groups. The intervention was a 12-month specialized, evidence-based rehabilitation strategy involving an interprofessional team. The primary outcome was change in health-related quality of life and functioning (SF-36) from baseline to 12 months. Secondary outcomes were number of strokes during the 12-month follow-up, and changes in community reintegration (RNLI), perceived social support (PRQ85-Part 2), anxiety and depressive symptoms (Kessler-10), cognitive function (SPMSQ), and costs of use of health services from baseline to 12 months.
A total of 82 subjects completed the 12-month follow-up. Compared with the usual care group, stroke survivors in the intervention group showed clinically important (although not statistically significant) greater improvements from baseline in mean SF-36 physical functioning score (5.87, 95% CI -3.98 to 15.7; p=0.24) and social functioning score (9.03, CI-7.50 to 25.6; p=0.28). The groups did not differ for any of the secondary effectiveness outcomes. There was a higher total per-person costs of use of health services in the intervention group compared to usual home care although the difference was not statistically significant (p = 0.76).
A 12-month specialized, interprofessional team is a feasible and acceptable approach to community-based stroke rehabilitation that produced greater improvements in quality of life compared to usual home care. Clinicaltrials.gov identifier: NCT00463229
This study determined the effects and costs of a multifactorial, interdisciplinary team approach to falls prevention. Randomized controlled trial of 109 older adults who are at risk for falls. This was a six-month multifactorial and evidence-based prevention strategy involving an interdisciplinary team. The primary outcome was number of falls during the six-month follow-up. At six months, no difference in the mean number of falls between groups. Subgroup analyses showed that the intervention effectively reduced falls in men (75–84 years old) with a fear of falling or negative fall history. Number of slips and trips was greatly reduced; and emotional health had a greater improvement in role functioning related to emotional health in the intervention group. Quality of life was improved, slips and trips were reduced, as were falls among males (75–84 years old) with a fear of falling or negative fall history.
This study examined the six-month prevalence, risk factors, and costs of falls in older people using home support services who are at risk of falling. Of the 109 participants, 70.6 per cent reported ≥ one fall in the previous six months, and 27.5 per cent experienced multiple falls. Although there was no statistically significant difference in any fall-related risk factor between fallers (1+ falls) and non-fallers (0 falls), fallers had clinically important trends towards lower levels of physical, social, and psychological functioning. There was no statistically significant difference between fallers and non-fallers in the total per-person costs of use of health services in the previous six months; however, there were significant differences between groups in specific types of health services. The multivariate analysis revealed the presence of five risk factors for falls: neurological disorder (e.g., cognitive impairment, Parkinson’s disease), age ≥ 85 years, environmental hazards, previous slip or trip, and visual impairment.
The overlap of large carnivores, livestock and people can engender conflicts that often threaten the future viability of carnivore populations in the pastoral systems of Africa. A playback survey of lions Panthera leo, spotted hyenas Crocuta crocuta and black-backed jackals Canis mesomelas and a transect count of wild herbivores was conducted in the Maasai Mara National Reserve and adjoining pastoral ranches to assess the effect of pastoralism and protection on the density and distribution of carnivores in June 2003. Reliability of the prey counts depended on an assumption of similar observability between the protected and pastoral areas, which we assessed using distance sampling in November 2003 and computer simulations and determined to be similar. Estimates of wild prey biomass density was 2.6 times higher in the ranches (14212 kg/km2) than in the reserve (5472 kg/km2) during this wet season count. Apparent hyena density estimates were 1.3 times higher in the ranches (0.561 hyenas/km2) than in the reserve (0.404 hyenas/km2), in correspondence with the regional pattern of prey density. This distribution of hyenas is biased towards the reserve, if it is dependent on prey density. Estimates of apparent jackal density were similar in both areas whereas lion density was anomalously 8.0 times lower in the ranches (0.046 lions/km2) than in the reserve (0.369 lions/km2). Lion and hyena densities and prey biomass did not differ between June 1991 (5172.273 kg/km2) and June 2003 (5472 kg/km2) in the reserve, but jackal density increased in the same period. Lions never responded to playbacks in the ranches, so the potential shift in lion behavioural response for different land use zones is another potential explanation for the patterns found here. We think a real shift in lion populations is a better explanation than a behavioural change in relation to playbacks based on additional data from independent systematic and intensive censuses and playback surveys conducted in the ranches. Lion populations in the pastoral ranches seemed headed for extinction, probably owing to conflicts with pastoralism, necessitating urgent conservation interventions that integrate pastoral economic welfare with large carnivore conservation goals to foster long-term viability of lion populations in the pastoral systems.
Objectives: There is a view that antipsychotic drugs can be successfully withdrawn from people with intellectual disabilities with resultant health gain. This study critically examines whether antipsychotic drug withdrawal is beneficial.
Methods: 119 adults with intellectual disabilities were included in a programme of antipsychotic drug withdrawal.
Results: The clinical outcomes of this programme are poor. Only 7.6% completely withdrew from antipsychotic drugs, and 48.7% experienced onset/deterioration in problem behaviours or mental ill-health. Significant drug side effects with the introduction of new drugs were experienced by 23.3%. Resultant mean antipsychotic drug doses were higher compared with those at the start of the programme. The cost to the intellectual disabilities psychiatric service (over and above that of routine psychiatric care) was £258,050 (€391,693), and the human cost was considered high. Primary care, social care and family costs were not calculated. The only specific factors found to be associated with poor outcome were increased severity of intellectual disabilities and female gender.
Conclusions: The successful role of antipsychotic drugs in the management of problem behaviours in people who do not have verbal communication skills may relate to the pathoplastic effect of intellectual disabilities on clinical presentation, with problem behaviours being markers of eg. psychosis and anxiety disorders. Our original findings challenge the view that routine withdrawal of antipsychotic drugs is good practice; we reinterpret the existing literature, and recommend caution and vigilance in pharmacotherapy.
Three thousand four hundred and forty-five cases of cancer of the larynx were examined and 3,235 assigned to their TNM group. While good correlation with prognosis could be seen, the value of the detailed subsite (as opposed to the main laryngeal regions) was limited to defining T1a and T1b and aiding that of T2. T status gives some indication of prognosis, but the N status is of almost overriding importance.
Email your librarian or administrator to recommend adding this to your organisation's collection.