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The transition from adolescent to adult mental health services (AMHS) is associated with disengagement, poor continuity of care and patient dissatisfaction. The aim of this retrospective and descriptive study was to describe the ‘care pathways’ in an independent mental health service when adolescents reach age 18 and to investigate the level of engagement of those who transitioned to independent AMHS.
This is a retrospective, naturalistic and descriptive study in design. All patients discharged from the St Patrick’s Adolescent Mental Health Service aged 17 years and 6 months and older, during a 3-year period between January 2014 and December 2016, were included. Electronic records were used to collect socio-demographic and clinical details and to determine engagement rates in adolescents who transferred to independent adult services.
A total of 180 patients aged over 17 years and 6 months were discharged from the adolescent service. Of these, 45.6% were discharged to their GP, 28.9% to public mental health services and 25.6% to independent mental health services. The majority who transitioned to independent AMHS went to a Young Adult Service, which had high engagement rates at 3 and 12 months post-transition.
In this independent mental health service, less than half of adolescents who reach the transition age are referred onto AMHS. Engagement rates were found to be high among those referred on to a specialised young adult service.
In Sweden, leishmaniasis is an imported disease and its epidemiology and incidence were not known until now. We conducted a retrospective, nationwide, epidemiological study from 1993 to 2016. Probable cases were patients with leishmaniasis diagnoses reported to the Swedish Patient registry, collecting data on admitted patients in Swedish healthcare since 1993 and out-patient visits since 2001. Confirmed cases were those with a laboratory test positive for leishmaniasis during 1993–2016. 299 probable cases and 182 confirmed cases were identified. Annual incidence ranged from 0.023 to 0.35 per 100 000 with a rapid increase in the last 4 years. Of 182 laboratory-verified cases, 96 were diagnosed from 2013 to 2016, and in this group, almost half of the patients were children under 18 years. Patients presented in different healthcare settings in all regions of Sweden. Cutaneous leishmaniasis was the most common clinical manifestation and the majority of infections were acquired in Asia including the Middle East, specifically Syria and Afghanistan. Leishmania tropica was responsible for the majority of cases (42%). A combination of laboratory methods increased the sensitivity of diagnosis among confirmed cases. In 2016, one-tenth of the Swedish population were born in Leishmania-endemic countries and many Swedes travel to these countries for work or vacation. Swedish residents who have spent time in Leishmania-endemic areas, could be at risk of developing disease some time during their lives. Increased awareness and knowledge are needed for correct diagnosis and management of leishmaniasis in Sweden.
Childhood obesity rates are higher among Indigenous compared with non-Indigenous Australian children. It has been hypothesized that early-life influences beginning with the intrauterine environment predict the development of obesity in the offspring. The aim of this paper was to assess, in 227 mother–child dyads from the Gomeroi gaaynggal cohort, associations between prematurity, Gestation Related-Optimal Weight (GROW) centiles, maternal adiposity (percentage body fat, visceral fat area), maternal non-fasting plasma glucose levels (measured at mean gestational age of 23.1 weeks) and offspring BMI and adiposity (abdominal circumference, subscapular skinfold thickness) in early childhood (mean age 23.4 months). Maternal non-fasting plasma glucose concentrations were positively associated with infant birth weight (P=0.005) and GROW customized birth weight centiles (P=0.008). There was a significant association between maternal percentage body fat (P=0.02) and visceral fat area (P=0.00) with infant body weight in early childhood. Body mass index (BMI) in early childhood was significantly higher in offspring born preterm compared with those born at term (P=0.03). GROW customized birth weight centiles was significantly associated with body weight (P=0.01), BMI (P=0.007) and abdominal circumference (P=0.039) at early childhood. Our findings suggest that being born preterm, large for gestational age or exposed to an obesogenic intrauterine environment and higher maternal non-fasting plasma glucose concentrations are associated with increased obesity risk in early childhood. Future strategies should aim to reduce the prevalence of overweight/obesity in women of child-bearing age and emphasize the importance of optimal glycemia during pregnancy, particularly in Indigenous women.
For livestock production systems to play a positive role in global food security, the balance between their benefits and disbenefits to society must be appropriately managed. Based on the evidence provided by field-scale randomised controlled trials around the world, this debate has traditionally centred on the concept of economic-environmental trade-offs, of which existence is theoretically assured when resource allocation is perfect on the farm. Recent research conducted on commercial farms indicates, however, that the economic-environmental nexus is not nearly as straightforward in the real world, with environmental performances of enterprises often positively correlated with their economic profitability. Using high-resolution primary data from the North Wyke Farm Platform, an intensively instrumented farm-scale ruminant research facility located in southwest United Kingdom, this paper proposes a novel, information-driven approach to carry out comprehensive assessments of economic-environmental trade-offs inherent within pasture-based cattle and sheep production systems. The results of a data-mining exercise suggest that a potentially systematic interaction exists between ‘soil health’, ecological surroundings and livestock grazing, whereby a higher level of soil organic carbon (SOC) stock is associated with a better animal performance and less nutrient losses into watercourses, and a higher stocking density with greater botanical diversity and elevated SOC. We contend that a combination of farming system-wide trials and environmental instrumentation provides an ideal setting for enrolling scientifically sound and biologically informative metrics for agricultural sustainability, through which agricultural producers could obtain guidance to manage soils, water, pasture and livestock in an economically and environmentally acceptable manner. Priority areas for future farm-scale research to ensure long-term sustainability are also discussed.
The moisture content of horse hoof horn is important as it affects its function, quality and mechanical properties. It is believed for horse hoof horn that there is an inverse relationship between the amount of water present and stiffness, or the ability of hoof horn to resist deformation. The majority of studies, until the work of Leach (1980) and Douglas et al. (1996) concentrated on quantitative values for moisture content for the full hoof wall depth (HWD) for horse hoof horn. Douglas et al. (1996) divided the hoof wall into inner and outer wall samples and showed a moisture content of 28% for the outer wall and 35% for the inner wall, confirming a dorsopalmar increase in moisture content. Whether a similar gradient exists for donkey hoof horn is not known. The existence of such a dorso-palmar moisture gradient may have a profound effect on the mechanical properties of the hoof horn and would further contribute towards the understanding of how moisture content affects the function of the hoof.
The moisture content of keratinous materials such as hoof horn is important as the presence of moisture has an inverse relationship on the mechanical properties of hoof horn and may have a subsequent effect on the function of the hoof. Methods previously used to dehydrate samples to calculate the moisture content of hoof horn vary considerably (Hopegood, 2002). Subsequent comparison of results is therefore unreliable. A comparison of different methods of dehydrating hoof horn was therefore carried out to establish a standardised protocol for dehydrating hoof horn to assess its moisture content. The moisture content of donkey hoof horn from normal animals and those with laminitis has not been reported. Maclean (1971) established that the moisture content of cattle suffering from laminitis was significantly higher than normal hooves. The resultant standardised protocol from the first part of this study was then used to compare the moisture content of hoof horn samples taken from horses, donkeys and those donkeys that had suffered from laminitis.
Recently, a laboratory-scale method for measuring the rapid energy release from milligram quantities of energetic material has been developed based on the high-temperature plasma chemistry induced by a focused, nanosecond laser pulse. The ensuing exothermic chemical reactions result in an increase in the laser-induced shock wave velocity compared to inert materials. Laser-induced air shock from energetic materials (LASEM) provides a method for estimating the detonation performance of novel organic-based energetic materials prior to scale-up and full detonation testing. Here, the extension of LASEM to non-organic energetic materials is discussed. The laser-induced shock velocities from reactive materials such as Al/PTFE, Al/CuO, Al/Zr alloys, Al/aluminum iodate hexahydrate, and porous silicon composites have been measured; in many cases, the high sensitivity of the samples resulted in propagation of the reaction to the surrounding material, producing significantly higher shock velocities than conventional energetic materials. Methods for compensating for this effect will be discussed. Despite this limitation, the relative comparison of the shock velocities, emission spectra, and combustion behavior of each type of material provides some insight into the mechanisms for increasing the energy release of the material on a fast (μs) and/or slow (ms) timescale.
The East African Orogen contains a series of high-strain zones that formed as Gondwana amalgamated. The Tulu Dimtu shear belt is one of these N–S structures within the Barka–Tulu Dimtu zone in western Ethiopia, and contains ultramafic bodies of equivocal origin. Identifying the petrogenetic origin of these enigmatic rocks provides evidence for the geodynamic significance of these shear zones. Owing to their altered state, these ultramafic rocks’ well-preserved chrome spinels provide the only reliable evidence for their source and tectonic affiliation. Chrome spinels have high Cr2O3 (30.04–68.76 wt %), while recalculated Fe2O3 (< 2 %) and TiO2 (0.01–0.51 %) values are low. The Cr# (molar Cr3+/Cr3+ + Al2+) and Mg# (Mg2+/Mg2+ + Fe2+) have averages of 0.88 and 0.22, respectively. Based on olivine–spinel equilibria, the calculated fO2 values (FMQ +3.03) for the dunites reveal a highly oxidized environment. This spinel chemistry (high Cr# > 0.6 and low Ti) supports a supra-subduction origin, with an oxidized mantle source more refractory than depleted MORB mantle (DMM). These spinel compositions indicate that some ultramafic bodies in western Ethiopia, including those from Daleti, Tulu and Dimtu, are serpentinized peridotites emplaced as obducted ophiolite complexes. By contrast, the ultramafic rocks from the Yubdo locality have a different spinel chemistry, with strong affiliation with igneous spinels formed in Alaskan-style mafic intrusions. These collective results suggest that regardless of their origin as supra-subduction ophiolites or as Alaskan-type intrusions, these spinels were formed on a convergent-subduction margin.
We are working on an all-sky sample of radio-selected elliptical galaxies to provide a powerful probe of clustering & streaming velocities on 10–100 Mpc scales. Our eventual sample will have the limits (i) S>0.5 Jy at 1.4 GHz; (ii) 0.01<z<0.1; (iii) |b| >15°; about 400 galaxies satisfy these criteria. We are pursuing an optical programme to obtain (i) B & I CCD frames for all galaxies; (ii) spectra for the galaxies without accurate redshifts; this is now about 30% complete. Accurate optical luminosity indicators exist for radio galaxies, without needing to measure velocity dispersions (using the correlations with optical core radius and radio central-component luminosity: Hoessel 1980: Ap. J. 241, 493; Fabbiano et al. 1984: Ap. J. 277, 115). We therefore expect to provide an accurate test of the Rubin-Ford effect, and to extend such studies to higher redshift. We also have a preliminary result for the 3D two-point correlation function of radio galaxies (see Figure). This strong clustering signal is seen only from galaxies in the decade of radio power below the Fanaroff-Riley division. These objects are known a priori to lie in cluster environments of average Abell richness 0 (Longair & Seldner 1979: MNRAS 189, 433). This result therefore provides confirmation of a trend of clustering with richness independent of optical selection effects in choosing a cluster sample.
The purpose of this study was to dosimetrically compare TomoDirect, TomoHelical and linear accelerator-based 3D-conformal radiotherapy (Linac-3DCRT) for craniospinal irradiation (CSI) in the treatment of medulloblastoma.
Five CSI patients were replanned with Linac-3DCRT, TomoHelical, TomoDirect-3DCRT and TomoDirect-intensity-modulated radiotherapy (IMRT). Dose of 36 Gy in 20 fractions was prescribed to the planning target volume (PTV). Homogeneity index (HI), non-target integral dose (NTID), dose–volume histograms, organs-at-risk (OARs) Dmax, Dmean and treatment times were compared.
TomoHelical achieved the best PTV homogeneity compared with Linac-3DCRT, TomoDirect-3DCRT and TomoDirect-IMRT (HI of 3·6 versus 20·9, 8·7 and 9·4%, respectively). TomoDirect-IMRT achieved the lowest NTID compared with TomoDirect-3DCRT, TomoHelical and Linac-3DCRT (141 J versus 151 J, 181 J and 250 J), indicating least biological damage to normal tissues. TomoHelical plans achieved the lowest Dmax in all organs except the breasts, and lowest Dmean for most OARs, except in laterally situated OARs, where TomoDirect triumphed. Beam-on time was longest for TomoHelical, followed by TomoDirect and Linac-3DCRT.
TomoDirect has the potential to lower NTID and shorten treatment times compared with TomoHelical. It reduces PTV inhomogeneity and better spares OARs compared with Linac-3DCRT. Therefore, TomoDirect may be a CSI treatment alternative to TomoHelical and in place of Linac-3DCRT.
The Omani basement is located spatially distant from the dominantly juvenile Arabian–Nubian Shield (ANS) to its west, and its relationship to the amalgamation of those arc terranes has yet to be properly constrained. The Jebel Ja'alan (NE Oman) basement inlier provides an excellent opportunity to better understand the Neoproterozoic tectonic geography of Oman and its relationship to the ANS. To understand the origin of this basement inlier, we present new radiogenic isotopic data from igneous bodies in Jebel Ja'alan. U–Pb and 40Ar/39Ar geochronological data are used to constrain the timing of magmatism and metamorphism in the jebel. Positive εHf and εNd values indicate a juvenile origin for the igneous lithologies. Phase equilibria modelling is used to constrain the metamorphic conditions recorded by basement. Pressure–temperature (P–T) pseudosections show that basement schists followed a clockwise P–T path, reaching peak metamorphic conditions of c. 650–700°C at 4–7.5 kbar, corresponding to a thermal gradient of c. 90–160°C/kbar. From the calculated thermal gradient, in conjunction with collected trace-element data, we interpret that the Jebel Ja'alan basement formed in an arc environment. Geochronological data indicate that this juvenile arc formed during Tonian time and is older than basement further west in Oman. We argue that the difference in timing is related to westwards arc accretion and migration, which implies that the Omani basement represents its own tectonic domain separate to the ANS and may be the leading edge of the Neoproterozoic accretionary margin of India.
There is a paucity of information on the risk from potable water in non-passenger merchant vessels (NPMVs) particularly with regard to Legionella and other bacteria. This retrospective study examined water samples from 550 NPMVs docked in eight UK ports. A total of 1027 samples from 412 NPMVs were examined for total aerobic colony counts (ACC), coliforms, Escherichia coli and enterococci; 41% of samples yielded ACC above the action level (>1 × 103 c.f.u./ml) and 4·5% contained actionable levels (>1 c.f.u./100 ml) of faecal indicator bacteria. Eight hundred and three samples from 360 NPMVs were cultured specifically for Legionella and 58% of vessels proved positive for these organisms with 27% of samples showing levels greater than the UK upper action limit of 1 × 103 c.f.u./l. Cabin showers (49%) and hospital shower (45%) were frequently positive. A subset of 106 samples was analysed by quantitative polymerase chain reaction for Legionella and identified a further 11 Legionella-positive NPMVs, returning a negative predictive value of 100%. There was no correlation between NPMV age or size and any microbial parameters (P > 0·05). Legionella pneumophila serogroup 1 was isolated from 46% of NPMVs and sequence-based typing of 17 isolates revealed four sequence types (STs) previously associated with human disease. These data raise significant concerns regarding the management of microbial and Legionella risks on board NPMVs and suggest that better guidance and compliance are required to improve control.
Altered hypothalamus-pituitary-adrenal (HPA) axis function and reduced hippocampal volume (HV) are established correlates of stress vulnerability. We have previously shown an attenuated cortisol awakening response (CAR) and associations with HV specifically in male first-episode psychosis patients. Findings in individuals at ultra-high risk (UHR) for psychosis regarding these neurobiological markers are inconsistent, and assessment of their interplay, accounting for sex differences, could explain incongruent results.
Study participants were 42 antipsychotic-naive UHR subjects (24 men) and 46 healthy community controls (23 men). Saliva samples for the assessment of CAR were collected at 0, 30 and 60 min after awakening. HV was determined from high-resolution structural magnetic resonance imaging scans using a semi-automatic segmentation protocol.
Cortisol measures and HV were not significantly different between UHR subjects and controls in total, but repeated-measures multivariate regression analyses revealed reduced cortisol levels 60 min after awakening and smaller left HV in male UHR individuals. In UHR participants only, smaller left and right HV was significantly correlated with a smaller total CAR (ρ = 0.42, p = 0.036 and ρ = 0.44, p = 0.029, respectively), corresponding to 18% and 19% of shared variance (medium effect size).
Our findings suggest that HV reduction in individuals at UHR for psychosis is specific to men and linked to reduced post-awakening cortisol concentrations. Abnormalities in the neuroendocrine circuitry modulating stress vulnerability specifically in male UHR subjects might explain increased psychosis risk and disadvantageous illness outcomes in men compared to women.
We present preliminary results of a galaxy redshift survey we are accomplishing as an ESO Key Project over about 40 square degrees in a region near the South Galactic Pole, to a limiting magnitude bJ = 19.4. Up to now ∼ 50% of the survey has been completed, providing about 2000 galaxy redshifts.
The ESO Slice Project (ESP) is a galaxy redshift survey we have recently completed as an ESO Key-Project over about 30 square degrees, in a region near the South Galactic Pole (Vettolani et al., submitted to A&A). The survey is nearly complete to the limiting magnitude bJ = 19.4 and consists of more than three thousands galaxies with reliable redshift determination.
The evidence underpinning the developmental origins of health and disease (DOHaD) is overwhelming. As the emphasis shifts more towards interventions and the translational strategies for disease prevention, it is important to capitalize on collaboration and knowledge sharing to maximize opportunities for discovery and replication. DOHaD meetings are facilitating this interaction. However, strategies to perpetuate focussed discussions and collaborations around and between conferences are more likely to facilitate the development of DOHaD research. For this reason, the DOHaD Society of Australia and New Zealand (DOHaD ANZ) has initiated themed Working Groups, which convened at the 2014–2015 conferences. This report introduces the DOHaD ANZ Working Groups and summarizes their plans and activities. One of the first Working Groups to form was the ActEarly birth cohort group, which is moving towards more translational goals. Reflecting growing emphasis on the impact of early life biodiversity – even before birth – we also have a Working Group titled Infection, inflammation and the microbiome. We have several Working Groups exploring other major non-cancerous disease outcomes over the lifespan, including Brain, behaviour and development and Obesity, cardiovascular and metabolic health. The Epigenetics and Animal Models Working Groups cut across all these areas and seeks to ensure interaction between researchers. Finally, we have a group focussed on ‘Translation, policy and communication’ which focusses on how we can best take the evidence we produce into the community to effect change. By coordinating and perpetuating DOHaD discussions in this way we aim to enhance DOHaD research in our region.
It is shown that, in the case of NGC 5548, photoionization models cannot account for line fluxes, line ratios, and line variations. The assumption that a fraction of the broad-line region is mechanically heated can solve the problem.