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We assessed the impact of an embedded electronic medical record decision-support matrix (Cerner software system) for the reduction of hospital-onset Clostridioides difficile. A critical review of 3,124 patients highlighted excessive testing frequency in an academic medical center and demonstrated the impact of decision support following a testing fidelity algorithm.
We investigated the impact of discontinuation of contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus infected or colonized patients on central-line associated bloodstream infection rates at an academic children’s hospital. Discontinuation of contact precautions with a bundled horizontal infection prevention platform resulted in no adverse impact on CLABSI rates.
The Research Domain Criteria initiative was launched by the US National Institute of Mental Health to establish a multi-level framework for understanding psychological constructs relevant to human psychiatric disorders, and identified ‘effort valuation/willingness to work’ as a clinically useful construct worthy of further study. This construct encompasses the processes by which the cost(s) of obtaining an outcome are calculated, and the tendency to overcome response costs to obtain a reinforcer. The current study aims to examine effort valuation as a correlate of psychopathology in children and adults, and the moderating effects of sex on this relationship.
Participants were 1215 children aged 6–12 and their parents (n = 1044). All participants completed the Effort Expenditure for Rewards Task as a measure of effort expenditure. Child psychopathology was measured via the Child Behavior Checklist, while adult psychopathology was measured via the Adult Self Report. Additionally, the Social Adjustment Inventory for Children and Adolescents and Injury Behavior Checklist were used to examine child social impairments/problem behaviors.
In children, significant interactions between reward sensitivity and sex were observed in association with anxiety and thought problems, specifically at low reward sensitivity levels. In adults, main effects of effort expenditure were seen in drug and alcohol abuse, where higher effort was associated with higher degrees of abuse.
These results establish effort valuation as a relevant psychological construct for understanding psychopathology, but with different profiles of associated psychopathology across sex in children and adults.
Shallow ice cores were obtained from widely distributed sites across the West Antarctic ice sheet, as part of the United States portion of the International Trans-Antarctic Scientific Expedition (US ITASE) program. The US ITASE cores have been dated by annual-layer counting, primarily through the identification of summer peaks in non-sea-salt sulfate (nssSO42–) concentration. Absolute dating accuracy of better than 2 years and relative dating accuracy better than 1 year is demonstrated by the identification of multiple volcanic marker horizons in each of the cores, Tambora, Indonesia (1815), being the most prominent. Independent validation is provided by the tracing of isochronal layers from site to site using high-frequency ice-penetrating radar observations, and by the timing of mid-winter warming events in stable-isotope ratios, which demonstrate significantly better than 1 year accuracy in the last 20 years. Dating precision to ±1 month is demonstrated by the occurrence of summer nitrate peaks and stable-isotope ratios in phase with nssSO42–, and winter-time sea-salt peaks out of phase, with phase variation of <1 month. Dating precision and accuracy are uniform with depth, for at least the last 100 years.
We have initiated an extensive atomic modeling effort applicable to X-ray line emission in high-temperature astrophysical plasmas. The emphasis of our program is on the detailed accounting of the mechanisms which populate excited states of highly ionized atoms over a wide range of electron temperatures and densities. As a first demonstration we have calculated spectra for the important L -shell ions Fe XVI-XIX in a complete collisional-radiative model under conditions appropriate to solar coronal plasmas. Using methods presented here, we have synthesized the X-ray spectra of solar flares and active regions over the wavelength interval 13 – 18 Ǡ. The atomic model, which includes 705 atomic energy levels, is the largest and most detailed of its kind. In this introductory paper, we discuss the effects of dielectronic recombination on the spectrum of Fe XVII and present a new technique whereby the 3s lines can be used as a diagnostic of the electron temperature. Also included are new values for the rate of resonance excitation of the n=3 Fe XVII excited states. These rates are lower than those previously obtained and suggest that resonance excitation does not contribute significantly to the population kinetics. Finally, we present a direct comparison of our a calculated model spectrum with data from a solar flare.
Biopolitics is the study of the relationship between our biological makeup and our political behavior. While this line of inquiry can be traced back to Plato and Aristotle, the contemporary surge of interest dates from the middle 1960s. Among the major contributing factors then were—take your pick—James C. Davies' Human Nature in Politics (1963), a 1964 essay by Lynton K. Caldwell, and a panel chaired by Albert Somit at the Southern Political Science Association (1967). Over the past two decades, there has been a dramatic growth of interest in “biopolitics,” as the area came to be known, to the point where some 900 works have now appeared (Peterson and Somit, in press).
A variety of indicators testify to the acceptance that biopolitics has since achieved within the discipline: formal recognition by the International Political Science Association (1972); biopolitical articles in our leading professional journals; books bearing the imprint of leading publishers; the regular inclusion of panels on biology and politics at regional, national, and international conferences; support from major foundations, such as the Rockefeller and Lilly Foundations; awards by NSF and NIA for biopolitical research; the establishment of the Association for Politics and the Life Sciences (1981) and its journal, Politics and the Life Sciences (1982) and, most recently, recognition by the American Political Science Association of biopolitics as an “organized subfield.”
This study investigated the reciprocal relationship between parental caregiving and labour force participation to determine whether (1) caregiving related to subsequent employment; (2) employment related to subsequent caregiving; (3) caregiving and labour force participation had a reciprocal relationship across time; and (4) gender differences existed in these relationships. A cross-lagged panel design was applied with structural equation modeling. The study sample included adult children aged 51 or older with living parents or parents-in-law. No reciprocal relationship was found between caregiving and labour force participation, but gender differences were evident. Women caregivers in 2006 were less likely to be working in 2008, whereas employment status was not related to subsequent caregiving. In contrast, men working in 2008 were less likely to be caregiving in 2010, whereas caregiving was not related to subsequent employment status. Findings suggest that gender plays an important role in the relationship between caregiving and labour force participation.
Late-life depression may increase the risk of incident dementia, in
particular of Alzheimer's disease and vascular dementia.
To conduct a systematic review and meta-analysis to evaluate the risk of
incident all-cause dementia, Alzheimer's disease and vascular dementia in
individuals with late-life depression in population-based prospective
A total of 23 studies were included in the meta-analysis. We used the
generic inverse variance method with a random-effects model to calculate
the pooled risk of dementia, Alzheimer's disease and vascular dementia in
older adults with late-life depression.
Late-life depression was associated with a significant risk of all-cause
dementia (1.85, 95% CI 1.67-2.04, P< 0.001), Alzheimer's disease
(1.65, 95% CI 1.42-1.92, P<0.001) and vascular dementia (2.52, 95% CI
1.77-3.59, P<0.001). Subgroup analysis, based on five studies, showed
that the risk of vascular dementia was significantly higher than for
Alzheimer's disease (P=0.03).
Late-life depression is associated with an increased risk for all-cause
dementia, vascular dementia and Alzheimer's disease. The present results
suggest that it will be valuable to design clinical trials to investigate
the effect of late-life depression prevention on risk of dementia, in
particular vascular dementia and Alzheimer's disease.
The real-time electronic performance of a gallium nitride nanowire-based field effect transistor was investigated at five-minute intervals over thirty minutes of continuous irradiation by Xenon-124 relativistic heavy ions. An initial current surge that resulted in device improvement rather than device failure was observed. The current surge, and subsequent electronic behavior, was modeled using a combined thermionic emission-tunnelling approach, leading to information about barrier height, carrier concentrations, expected temperature behavior, and tunnelling.
Background: Subthreshold depressive symptoms are common in older adults. The threshold for the clinical significance of such symptoms is unclear. Mechanisms linking depressed mood to increased risk of disability need further investigation.
Methods: Among older adults who did not meet criteria for depression, respondents reporting no anhedonia and dysphoria over the past two weeks were compared to respondents reporting occasional symptoms with respect to self-reported disability and cognitive, psychomotor, and physical performance tests.
Results: Of 312 community-resident participants without dementia, 35.3% (n = 110) reported one or both of the two depressive symptoms at mild severity (no more than “several days” in the past two weeks). Older adults with mild depressive symptoms reported more physician-diagnosed medical conditions (2.2 vs. 1.8, p < 0.01) and mobility problems (3.0 vs. 1.8, 0–7 scale, p < 0.001), and were slower in gait (0.80 vs. 0.73 m/sec, p < 0.01) and speed of cognitive processing (Trail B, 166.1 vs. 184.7 sec, p < 0.001). In regression models that adjusted for sociodemographic and medical status, subthreshold symptoms were not a significant correlate of slowing in gait speed or cognitive performance. However, subthreshold depressive symptoms were associated with self-reported mobility limitation in models that adjusted for observed performance.
Conclusions: Mild depressive symptoms in this sample were not an independent correlate of slowed performance. However, the presence of mild depressive symptoms was associated with poorer appraisal of mobility after adjustment for objective measures of mobility.
Biodiversity is the variability among living organisms, from genes to the biosphere. The value of biodiversity is multifold, from preserving the integrity of the biosphere as a whole, to providing food and medicines, to spiritual and aesthetic well-being.
One of the major drivers of biodiversity loss in Europe is atmospheric deposition of reactive nitrogen (Nr).
This chapter focuses on Nr impacts on European plant species diversity; in particular, the number and abundance of different species in a given area, and the presence of characteristic species of sensitive ecosystems.
We summarise both the scientific and the policy aspects of Nr impacts on diversity and identify, using a range of evidence, the most vulnerable ecosystems and regions in Europe.
Key findings/state of knowledge
Reactive nitrogen impacts vegetation diversity through direct foliar damage, eutrophication, acidification, and susceptibility to secondary stress.
Species and communities most sensitive to chronically elevated Nr deposition are those that are adapted to low nutrient levels, or are poorly buffered against acidification. Grassland, heathland, peatland, forest, and arctic/montane ecosystems are recognised as vulnerable habitats in Europe; other habitats may be vulnerable but are still poorly studied.
It is not yet clear if different wet-deposited forms of Nr (e.g. nitrate, NO3− versus ammonium, NH4+) have different effects on biodiversity. However, gaseous ammonia (NH3) can be particularly harmful to vegetation, especially lower plants, through direct foliar damage.
The year 2009 marks 20 years since the Environmental Management program was first established in the Department of Energy. At that time, nearly 50 years of nuclear activity had left a legacy that included nuclear waste and environmental contamination at more than 100 sites across the United States. The extent of the risk to our citizens and communities was unknown, and certainly many of the processes and technologies to reduce that risk had not yet been invented. Since then, the Department of Energy has closed 86 of 108 sites originally assigned to the program nationwide. The Department of Energy has packaged and safely stored the nation’s entire excess plutonium inventory. The Department has pioneered new technologies that have allowed progress in retrieving millions of liters of tank waste and safely disposing of tens of thousands of cubic meters of transuranic waste. In Fiscal years 2006 and 2007 alone, the Department of Energy demolished approximately 500 buildings (nuclear, radioactive, and industrial) as part of our decontamination and decommissioning projects. Finally, there have been great strides in restoring groundwater contaminated with radionuclides using innovative treatment systems. In August 2005, a rigorous project management system was instituted. This Department of Energy program was built on the principle of prioritizing risk reduction supported by our four guiding tenets of safety, performance, clean-up, and closure. The mission activities at our clean-up sites are targeted at our highest risk activities. In planning its environmental clean-up efforts and developing the budget for those activities, the Department seeks to focus on work that will produce the greatest environmental benefit and the largest amount of risk reduction.
A coupled hydro-chemical-mechanical constitutive law for the Belgian Eurobitum bituminized waste is being developed by the International Centre for Numerical Methods and Engineering (Polytechnical University of Cataluña, Spain) to contribute to the study of the compatibility of Eurobitum with Boom Clay as a geological disposal environment. A large experimental programme is ongoing at SCK•CEN to support the development of a constitutive law for Eurobitum. Water uptake tests are being performed under different conditions to obtain insights in the parameters that influence the water uptake behaviour of Eurobitum. Furthermore, Environmental Scanning Electron Microscopy and microfocus X-ray Computer Tomography are used to characterize hydrated samples in order to improve the understanding of the water uptake processes.
The salt content, the distribution of the salt crystals, and the membrane efficiency in the Eurobitum samples affect the swelling and pressure increase rate. High membrane efficiencies and a large amount of hygroscopic salts inside the Eurobitum samples result in very high pressures when almost no swelling is allowed. The pressure in small inactive samples with 28 wt.% NaNO3has risen to ∼19 MPa after ∼3 years of hydration in nearly constant volume conditions. Slower pressure increase rates are being measured for samples with 6, 12, 18, and 33 wt.% NaNO3.
Waveguide prism-coupling methods were used to measure the ordinary and extraordinary refractive indices of AlxGa1-xN films grown on sapphire substrates by HVPE and MOCVD. Several discrete wavelengths ranging from 442 nm to 1064 nm were used and the results were fit to one-term Sellmeier equations. The maximum standard uncertainty in the refractive index measurements was ± 0.005 and the maximum standard uncertainty in the self-consistent calculation for film thickness was ± 15 nm. Analysis of normal-incidence spectroscopic transmittance and reflectance measurements, correlated with the prism-coupling results, was used to determine the ordinary refractive index as a continuous function of wavelength from the band gap wavelength of each sample (between 252 nm and 364 nm) to 2500 nm. The Al compositions of the samples were determined using energy-dispersive X-ray spectroscopy analysis (EDS). HVPE grown samples had compositions x = 0.279, 0.363, 0.593, and 0.657. MOCVD samples had x = 0.00, 0.419, 0.507, 0.618, 0.660, and 0.666. The maximum standard uncertainty in the absolute EDS-determined value for x was ± 0.02.
Evaluation of a dietary Na reduction trial in a community setting.
Community-based randomized trial. Ten-week nutrition intervention activities focused on lifestyle modification to decrease dietary Na intake, under the supervision of a registered dietitian. Twenty-four hour urine specimens were collected at baseline and follow-up visits to determine 24 h urinary Na excretion.
The University of Pittsburgh Center for Healthy Aging, Key to Life Nutrition Program.
Hypertensive adults at least 65 years of age.
Mean age of participants was 75 years. Twenty-four hour mean urinary Na excretion at baseline was 3174 mg/d. This reduced to 2944 mg/d (P = 0·30) and 2875 mg/d (P ≤ 0·03) at 6- and 12-month follow-ups, respectively. In a sub-sample (urine volume of ≥1000 ml, baseline to 12 months), mean urinary Na excretion decreased from 3220 mg/d to 2875 mg/d (P ≤ 0·02).
Significant reductions in mean 24 h urinary Na were reported, but results fell short of the recommended guidelines of 1500 mg/d for at-risk individuals. Our results reiterate the difficulty in implementing these guidelines in community-based programmes. More aggressive public health efforts, food industry support and health policy changes are needed to decrease Na levels in older adults to the recommended guidelines.