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This is the first report on the association between trauma exposure and depression from the Advancing Understanding of RecOvery afteR traumA(AURORA) multisite longitudinal study of adverse post-traumatic neuropsychiatric sequelae (APNS) among participants seeking emergency department (ED) treatment in the aftermath of a traumatic life experience.
We focus on participants presenting at EDs after a motor vehicle collision (MVC), which characterizes most AURORA participants, and examine associations of participant socio-demographics and MVC characteristics with 8-week depression as mediated through peritraumatic symptoms and 2-week depression.
Eight-week depression prevalence was relatively high (27.8%) and associated with several MVC characteristics (being passenger v. driver; injuries to other people). Peritraumatic distress was associated with 2-week but not 8-week depression. Most of these associations held when controlling for peritraumatic symptoms and, to a lesser degree, depressive symptoms at 2-weeks post-trauma.
These observations, coupled with substantial variation in the relative strength of the mediating pathways across predictors, raises the possibility of diverse and potentially complex underlying biological and psychological processes that remain to be elucidated in more in-depth analyses of the rich and evolving AURORA database to find new targets for intervention and new tools for risk-based stratification following trauma exposure.
Ventenata dubia (Leers) Coss., an invasive winter annual grass, negatively impacts grassland community composition and function in the Pacific Northwest. Ventenata dubia established in Palouse prairie and canyon grasslands of northern Idaho/eastern Washington in the mid-1980s to early 1990s. Understanding and comparing patterns of invasion can elucidate future trends as its range expands. We performed surveys in Palouse prairie (2012 and 2013) and canyon grasslands (2018) to assess V. dubia abundance. Specifically, we correlated species richness, Shannon diversity, rank abundance, and indicator species with no, low (<12.5%), and high (>12.5%) V. dubia cover. We used non-metric multidimensional scaling analysis (NMDS) to visualize species similarities and associations with abiotic variables. In both ecoregions, V. dubia was very common, appearing in nearly 60% of 450 plots. When present, V. dubia cover averaged 26% (± 2.3 SE) in Palouse prairie and 19% (± 1.8 SE) in canyon grasslands. Indigenous plant species richness and diversity were lowest in plots with high V. dubia cover. In canyon grasslands this relationship held for nonindigenous species; in Palouse prairie, nonindigenous plant richness and diversity were higher with high V. dubia cover. Ventenata dubia and other winter annual grasses [Bromus spp., Taeniatherum caput-medusae (L.) Nevski] were moderately associated according to the NMDS analysis. Indicator species analysis showed V. dubia was positively associated with nonindigenous winter annual grasses and negatively associated with indigenous low shrub species. Abiotic factors that explained V. dubia abundance included shallow soils and a south to west aspect. Overall, these findings indicate V. dubia can successfully invade both dry and relatively wet plant communities and is more abundant than other invasive annual grasses. We suggest these findings foreshadow what will happen in sagebrush steppe and Great Plains grasslands, regions where V. dubia recently became established.
Finite-amplitude hydromagnetic Rossby waves in the magnetostrophic regime are studied. We consider the slow mode, which travels in the opposite direction to the hydrodynamic or fast mode, in the presence of a toroidal magnetic field and zonal flow by means of quasi-geostrophic models for thick spherical shells. The weakly nonlinear long waves are derived asymptotically using a reductive perturbation method. The problem at the first order is found to obey a second-order ordinary differential equation, leading to a hypergeometric equation for a Malkus field and a confluent Heun equation for an electrical wire field, and is non-singular when the wave speed approaches the mean flow. Investigating its neutral non-singular eigensolutions for different basic states, we find the evolution is described by the Korteweg–de Vries equation. This implies that the nonlinear slow wave forms solitons and solitary waves. These may take the form of a coherent eddy, such as a single anticyclone. We speculate on the relation of the anticyclone to the asymmetric gyre seen in the Earth's fluid core, and in state-of-the-art dynamo direct numerical simulations.
With human influences driving populations of apex predators into decline, more information is required on how factors affect species at national and global scales. However, camera-trap studies are seldom executed at a broad spatial scale. We demonstrate how uniting fine-scale studies and utilizing camera-trap data of non-target species is an effective approach for broadscale assessments through a case study of the brown hyaena Parahyaena brunnea. We collated camera-trap data from 25 protected and unprotected sites across South Africa into the largest detection/non-detection dataset collected on the brown hyaena, and investigated the influence of biological and anthropogenic factors on brown hyaena occupancy. Spatial autocorrelation had a significant effect on the data, and was corrected using a Bayesian Gibbs sampler. We show that brown hyaena occupancy is driven by specific co-occurring apex predator species and human disturbance. The relative abundance of spotted hyaenas Crocuta crocuta and people on foot had a negative effect on brown hyaena occupancy, whereas the relative abundance of leopards Panthera pardus and vehicles had a positive influence. We estimated that brown hyaenas occur across 66% of the surveyed camera-trap station sites. Occupancy varied geographically, with lower estimates in eastern and southern South Africa. Our findings suggest that brown hyaena conservation is dependent upon a multi-species approach focussed on implementing conservation policies that better facilitate coexistence between people and hyaenas. We also validate the conservation value of pooling fine-scale datasets and utilizing bycatch data to examine species trends at broad spatial scales.
Agricultural intensification within forage systems has reduced grassland floral diversity by promoting ryegrass (Lolium spp.), damaging soil functionality which underpins critical ecosystem services. Diverse forage mixtures may enhance environmental benefits of pastures by decreasing nutrient leaching, increasing soil carbon storage, and with legume inclusion, reduce nitrogen fertilizer input. This UK study reports on how species-rich forage mixtures affect soil carbon, phosphorus, and nitrogen at dry, medium and wet soil moisture sites, compared to ryegrass monoculture. Increasing forage mixture diversity (from 1 to 17 species) affected soil carbon at the dry site. No effect of forage mixture on soil phosphorus was found, while forage mixture and site did interact to affect soil nitrate/nitrite availability. Results suggest that forage mixtures could be used to improve soil function, but longer-term studies are needed to conclusively demonstrate environmental and production benefits of high-diversity forages.
There are sparse data on the outcomes of endoscopic stapling of pharyngeal pouches. The Mersey ENT Trainee Collaborative compared regional practice against published benchmarks.
A 10-year retrospective analysis of endoscopic pharyngeal pouch surgery was conducted and practice was assessed against eight standards. Comparisons were made between results from the tertiary centre and other sites.
A total of 225 procedures were performed (range of 1.2–9.2 cases per centre per year). All centres achieved 90 per cent resumption of oral intake within 2 days. All centres achieved less than 2-day hospital stays. Primary success (84 per cent (i.e. abandonment of endoscopic stapling in 16 per cent)), symptom resolution (83 per cent) and recurrence rates (13 per cent) failed to meet the standard across the non-tertiary centres.
Endoscopic pharyngeal pouch stapling is a procedure with a low mortality and brief in-patient stay. There was significant variance in outcomes across the region. This raises the question of whether this service should become centralised and the preserve of either tertiary centres or sub-specialist practitioners.
Lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth face many challenges in today’s global environment. In addition to the expansive range of attitudes, social pressures, and unique personal development, LGBTQ youth are often faced with issues of social injustice. In many parts of the world, continued discrimination and punishment occurs against LGBTQ individuals and the lack of legal protection is an extra burden for young people in an already oppressive environment. Access to proper developmental support and psychological support can be limited or inappropriate for many of these young people. Inclusive legislation, education, and truthful information relevant to LGBTQ issues can help reduce the consequences of stress seen by many LGBTQ youth. Legislative and social advocacy to reduce stigma and provide healthy, supportive development of LGBTQ individuals are additional ways of reducing social injustice.
A new high time resolution observing mode for the Murchison Widefield Array (MWA) is described, enabling full polarimetric observations with up to
MHz of bandwidth and a time resolution of
s. This mode makes use of a polyphase synthesis filter to ‘undo’ the polyphase analysis filter stage of the standard MWA’s Voltage Capture System observing mode. Sources of potential error in the reconstruction of the high time resolution data are identified and quantified, with the
loss induced by the back-to-back system not exceeding
dB for typical noise-dominated samples. The system is further verified by observing three pulsars with known structure on microsecond timescales.
Praziquantel (PZQ) is the drug of choice for schistosomiasis. The potential drug resistance necessitates the search for adjunct or alternative therapies to PZQ. Previous functional genomics has shown that RNAi inhibition of Ca2+/calmodulin-dependent protein kinase II (CaMKII) gene in Schistosoma adult worms significantly improved the effectiveness of PZQ. Here we tested the in vitro efficacy of 15 selective and non-selective CaMK inhibitors against Schistosoma mansoni and showed that PZQ efficacy was improved against refractory juvenile parasites when combined with these CaMK inhibitors. By measuring CaMK activity and the mobility of adult S. mansoni, we identified two non-selective CaMK inhibitors, Staurosporine (STSP) and 1Naphthyl PP1 (1NAPP1), as promising candidates for further study. The impact of STSP and 1NAPP1 was investigated in mice infected with S. mansoni in the presence or absence of a sub-lethal dose of PZQ against 2- and 7-day-old schistosomula and adults. Treatment with STSP/PZQ induced a significant (47–68%) liver egg burden reduction compared with mice treated with PZQ alone. The findings indicate that the combination of STSP and PZQ dosages significantly improved anti-schistosomal activity compared to PZQ alone, demonstrating the potential of selective and non-selective CaMK/kinase inhibitors as a combination therapy with PZQ in treating schistosomiasis.
Global pork production has largely adopted on-farm biosecurity to minimize vectors of disease transmission and protect swine health. Feed and ingredients were not originally thought to be substantial vectors, but recent incidents have demonstrated their ability to harbor disease. The objective of this paper is to review the potential role of swine feed as a disease vector and describe biosecurity measures that have been evaluated as a way of maintaining swine health. Recent research has demonstrated that viruses such as porcine epidemic diarrhea virus and African Swine Fever Virus can survive conditions of transboundary shipment in soybean meal, lysine, and complete feed, and contaminated feed can cause animal illness. Recent research has focused on potential methods of preventing feed-based pathogens from infecting pigs, including prevention of entry to the feed system, mitigation by thermal processing, or decontamination by chemical additives. Strategies have been designed to understand the spread of pathogens throughout the feed manufacturing environment, including potential batch-to-batch carryover, thus reducing transmission risk. In summary, the focus on feed biosecurity in recent years is warranted, but additional research is needed to further understand the risk and identify cost-effective approaches to maintain feed biosecurity as a way of protecting swine health.
To utilise a community-based participatory approach in the design and implementation of an intervention targeting diet-related health problems on Navajo Nation.
A dual strategy approach of community needs/assets assessment and engagement of cross-sectorial partners in programme design with systematic cyclical feedback for programme modifications.
Navajo Nation, USA.
Navajo families with individuals meeting criteria for programme enrolment. Participant enrolment increased with iterative cycles.
The Navajo Fruit and Vegetable Prescription (FVRx) Programme.
A broad, community-driven and culturally relevant programme design has resulted in a programme able to maintain core programmatic principles, while also allowing for flexible adaptation to changing needs.
Raw milk cheeses are commonly consumed in France and are also a common source of foodborne outbreaks (FBOs). Both an FBO surveillance system and a laboratory-based surveillance system aim to detect Salmonella outbreaks. In early August 2018, five familial FBOs due to Salmonella spp. were reported to a regional health authority. Investigation identified common exposure to a raw goats' milk cheese, from which Salmonella spp. were also isolated, leading to an international product recall. Three weeks later, on 22 August, a national increase in Salmonella Newport ST118 was detected through laboratory surveillance. Concomitantly isolates from the earlier familial clusters were confirmed as S. Newport ST118. Interviews with a selection of the laboratory-identified cases revealed exposure to the same cheese, including exposure to batches not included in the previous recall, leading to an expansion of the recall. The outbreak affected 153 cases, including six cases in Scotland. S. Newport was detected in the cheese and in the milk of one of the producer's goats. The difference in the two alerts generated by this outbreak highlight the timeliness of the FBO system and the precision of the laboratory-based surveillance system. It is also a reminder of the risks associated with raw milk cheeses.
Introduction: Medical record review (MRR) studies are commonly used in Emergency Medicine (EM) research. It is not always clear how sample size calculations are reported, or the methods by which they were derived. This scoping review sought to examine reporting and justification of MRR sample sizes from the EM literature. Methods: Using Web of Science, we identified the top ten journals, based on impact factor rating in 2018, within the field of Emergency Medicine. Journals were excluded if they were not in English or did not include sufficient articles for analysis. Within each of these ten selected journals, we searched for chart reviews and related terms: "medical record", "outpatient record", "inpatient record", "clinical record", and "nursing note". From this search subset, five articles were randomly selected from each journal. Data about sample size and sample size selection were extracted and analyzed by two reviewers independently for each article. Results: Of the 50 articles randomly selected, 48 articles were retrospective MRRs and two articles were prospective MRRs. 78% (39 articles) chose sample size based on availability, 14% (seven articles) chose sample size based on power calculations, 4% (two articles) chose sample size based on a previous study's methodology, and 4% (two articles) did not give details on sample size selection. Conclusion: While some emergency medicine MRRs based sample size selection on power or previous studies, the vast majority are based on availability with study-specific exclusion/inclusion criteria. This may indicate they are using a smaller sample size than necessary to be sufficiently powered to assess their end goal. More work is required to determine the effect of this on outcomes and interpretability of results, as well as which method is most accurate and efficient.
The term auditory verbal hallucination (AVH) covers a diverse phenomenological experience. One model of AVHs proposes they result from self-monitoring deficits causing inner speech to be experienced as alien. The experimental evidence for such a model is briefly summarised. The fit of inner speech models with the phenomenology of AVHs is then critically examined. The form, function, and development of private and inner speech is discussed, and contrasted with the phenomenology of a range of AVHs. It is argued that only a subset of AVHs are phenomenologically consistent with inner speech models. Implications for the study of AVHs are discussed.
ICD-10 delineates Acute and Transient Psychotic Disorders (ATPD, F 23) as distinct from schizophrenia and affective psychosis. We investigated the descriptive epidemiology of ATPD and predictive validity of the diagnosis, compared its three-year outcomes with affective psychosis and schizophrenia, and explored whether acute onset and early remission identify a distinct good outcome subgroup in non-affective psychoses.
Between 1992-1994, all first-episode psychosis patients in Nottingham were identified and assigned an intake ICD-10 diagnosis. Patients were assessed three years later using established outcome measures and longitudinal diagnosis assigned. Multivariate analyses were conducted to determine whether acute onset and early remission predicted favourable three-year outcome in non-affective psychotic disorders.
Of 168 cases of first-episode psychosis, 112 received an intake diagnosis of non-affective psychoses (F20-29) and 32 (19%) of ATPD (F23). ATPD diagnosis was stable in women over three years, but not in men. Outcomes of ATPD were better than schizophrenia and similar to affective psychosis. In non-affective psychoses, favourable outcomes were a function of gender and good premorbid functioning rather than acute onset and early remission.
ICD-10 ATPD criteria identify a diagnostically unstable group of disorders consisting of ‘good outcome’ schizophrenia, affective psychosis and a very small group of ‘true’ non-affective, non-schizophrenic acute and transient psychoses. Although ATPD have a better outcome than schizophrenia, in non-affective psychoses, acute onset and early remission do not independently predict favourable outcome over three years.
To investigate the feasibility, and patient/psychiatrist acceptability, of an SMS text messaging system reminding patients receiving quetiapine to take their medication.
8-12(mean:9.4) week, non-interventional, psychiatrist assessed, pilot study of 27 outpatients receiving quetiapine (mean age[range]: 35.3[19-57] years). Patients were asked to reply to SMS messages sent twice daily to their cellular phone to remind them to take their medication (morning) and enquire about their well-being (evening). Patients' response (morning-yes/no; evening-positive/negative/neutral) was monitored by psychiatrists (n=7) via a website, and subsequently used to assess technical feasibility. Psychiatrists rated acceptability and feasibility of the system by completing case report forms (CRFs). Data are from the LOCF population.
Patients responded to 77% (compliance) of the 5,000 SMS messages sent (84% correctly, 13% inaccurately, 3% responded late [eg, day after]). 7/27 patients withdrew prematurely. The most common benefits expressed by patients were that they felt cared for (n=11/21) and were reminded to take their medication (n=7/21). Psychiatrists' ratings of the system improved over time, with SMS compliance and increased patient contact seen as the most valuable aspects. At study end, CRF data showed psychiatrists felt the system was valuable to 19/22 patients, 16/24 patients remained compliant with the system and 16/22 patients felt the frequency of SMS messages was acceptable. There was a strong correlation between patients giving positive well-being responses and SMS compliance (R Pearson=0.72, p<0.001).
The high levels of SMS compliance and benefits expressed by patients and psychiatrists support a larger-scale assessment of this system.
Among the 10 categories of personality disorders (PDs), interventions for antisocial and borderline personality disorder are best studied. However, the remaining PDs also pose major problems in everyday health care settings. People affected often additionally present with Axis-I disorders such as substance-related, mood or anxiety disorders, and are among those most difficult to treat. Cluster A PDs (paranoid, schizoid, schizotypal) are of particular significance as some authors argue that they may be part of a continuum of mental disorders and be considered as sub-syndrome of schizophrenia
In the context of Cochrane Collaboration reviews for Cluster A, B and C PDs, exhaustive literature searches were completed to identify the current RCT evidence for PD treatments. Retrievals were assessed and evaluated by two reviewers independently and trials for Cluster A PD were identified.
Only very few (under five) RCTs specifically for Cluster A PDs were identified. Some studies reported on mixed PD samples but it was not always possible to extract data specifically for Cluster A disorders. Participants mostly also suffered from Axis-I disorders. Reported outcomes also focus on Axis-I disorder outcomes or general measures such as overall functioning rather than specific PD symptoms.
The current evidence for psychpathological treatment of Cluster A PD is sparse and does not allow for distinct treatment recommendations. Symptom-driven treatment regimes as suggested by several guidelines are not supported by current evidence.