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Escherichia coli O157:H7 is the largest cause of hemolytic uremic syndrome (HUS). Previous studies proposed that HUS risk varies across the E. coli O157:H7 phylogenetic tree (hypervirulent clade 8), but the role of age in the association is unknown. We determined phylogenetic lineage of E. coli O157:H7 isolates from 1160 culture-confirmed E. coli O157:H7 cases reported in Washington State, 2004–2015. Using generalised estimating equations, we tested the association between phylogenetic lineage and HUS. Age was evaluated as an effect modifier. Among 1082 E. coli O157:H7 cases with both phylogenetic lineage and HUS status (HUS n = 76), stratified analysis suggested effect modification by age. Lineages IIa and IIb, relative to Ib, did not appear associated with HUS in children 0–9-years-old. For cases 10–59-years-old, lineages IIa and IIb appeared to confer increased risk of HUS, relative to lineage Ib. The association reversed in ⩾60-year-olds. Results were similar for clade 8. Phylogenetic lineage appears to be associated with HUS risk only among those ⩾10-years-old. Among children <10, the age group most frequently affected, lineage does not explain progression to HUS. However, lineage frequency varied across age groups, suggesting differences in exposure and/or early disease manifestation.
Coinfection with human immunodeficiency virus (HIV) and viral hepatitis is associated with high morbidity and mortality in the absence of clinical management, making identification of these cases crucial. We examined characteristics of HIV and viral hepatitis coinfections by using surveillance data from 15 US states and two cities. Each jurisdiction used an automated deterministic matching method to link surveillance data for persons with reported acute and chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infections, to persons reported with HIV infection. Of the 504 398 persons living with diagnosed HIV infection at the end of 2014, 2.0% were coinfected with HBV and 6.7% were coinfected with HCV. Of the 269 884 persons ever reported with HBV, 5.2% were reported with HIV. Of the 1 093 050 persons ever reported with HCV, 4.3% were reported with HIV. A greater proportion of persons coinfected with HIV and HBV were males and blacks/African Americans, compared with those with HIV monoinfection. Persons who inject drugs represented a greater proportion of those coinfected with HIV and HCV, compared with those with HIV monoinfection. Matching HIV and viral hepatitis surveillance data highlights epidemiological characteristics of persons coinfected and can be used to routinely monitor health status and guide state and national public health interventions.
Compulsory admission can be experienced as devaluing and stigmatising by people with mental illness. Emotional reactions to involuntary hospitalisation and stigma-related stress may affect recovery, but longitudinal data are lacking. We, therefore, examined the impact of stigma-related emotional reactions and stigma stress on recovery over a 2-year period.
Shame and self-contempt as emotional reactions to involuntary hospitalisation, stigma stress, self-stigma and empowerment, as well as recovery were assessed among 186 individuals with serious mental illness and a history of recent involuntary hospitalisation.
More shame, self-contempt and stigma stress at baseline were correlated with increased self-stigma and reduced empowerment after 1 year. More stigma stress at baseline was associated with poor recovery after 2 years. In a longitudinal path analysis more stigma stress at baseline predicted poorer recovery after 2 years, mediated by decreased empowerment after 1 year, controlling for age, gender, symptoms and recovery at baseline.
Stigma stress may have a lasting detrimental effect on recovery among people with mental illness and a history of involuntary hospitalisation. Anti-stigma interventions that reduce stigma stress and programs that enhance empowerment could improve recovery. Future research should test the effect of such interventions on recovery.
There is no doubt that family carers who look after a family member with dementia or with a functional mental illness fulfill an important role, not only for their loved one, but also for the health and aged care systems of the countries they live in. Due to increasing life expectancy, but also improved healthcare the number of family carers supporting older care recipients with functional mental illness or dementia is on the rise. While the carer role often can offer rewarding experiences caregivers are at increased risk of stress, depression, sleep problems, and often experience poor health outcomes with increased morbidity and mortality (Oyebode, 2003). Next to the stressors directly associated with the carer role, they often do not have the time to engage in healthy behavior to protect their physical, mental, and cognitive health (Loi et al., 2014). There is a wealth of literature providing evidence about effective strategies to support carers and the recent Lancet Commission on Dementia prevention, intervention, and care highlighted the importance of exploring how the use of technological innovations could support carers better (Livingston et al., 2017). The use of modern technology in this context can mean a variety of approaches, such as internet-based programs to provide education and skill-building, virtual support to assist with monitoring and managing challenging behavior, online support groups, and the use of assistive or therapeutic technology to improve safety, enable positive activities, and support communication between carer and care recipient, to name just a few (D'Onofrio et al., 2017; Ienca et al., 2017; Livingston et al., 2017). More specifically, telehealth approaches via videoconferences have the potential to better support carers who live in rural or remote regions (O'Connell et al., 2014) or who cannot attend face-to-face support programs for other reasons such as inability to leave the care recipient alone at home, being a multiple carer or having a disability themselves to give just some examples.
There is a long-standing debate in the literature of stratified flows over topography concerning the correct dimensionless number to refer to as a Froude number. Common definitions using external quantities of the flow include
are, respectively, scales for the background velocity and buoyancy frequency,
is the depth, and
are, respectively, height and width scales of the topography. It is also possible to define an internal Froude number
are, respectively, the characteristic velocity, reduced gravity, and vertical length scale of the perturbation above the topography. For the case of hydrostatic lee waves in a deep ocean, both
are insignificantly small, rendering the dimensionless number
the only relevant dynamical parameter. However, although it appears to be an inverse Froude number, such an interpretation is incorrect. By non-dimensionalizing the stratified Euler equations describing the flow of an infinitely deep fluid over topography, we show that
is in fact the square of the internal Froude number because it can identically be written in terms of the inner variables,
. Our scaling also identifies
as the ratio of the vertical velocity scale within the lee wave to the group velocity of the lee wave, which we term the vertical Froude number,
. To encapsulate such behaviour, we suggest referring to
as the lee-wave Froude number,
The applicability of volcanic ash deposits on Vatnajökull ice cap, Iceland, as a time reference marker for measuring accumulation by the analysis of time sequential SAR backscatter data was investigated. A volcanic eruption at Grímsvötn caldera, a subglacial volcanic system beneath Vatnajökull, deposited an ash layer north of the vent in early November 2004. This ash layer covered a V-shaped area of ∽88km2 on the glacier surface. The ash fall, which was subsequently buried by snow, reveals a distinct backscatter signal in SAR images. In total, the σ0 backscatter values of 40 ENVISAT-ASAR images were analyzed, covering two post-eruption accumulation periods (4 November 2004 to 31 March 2005 and 25 October 2006 to 14 March 2006). Significant differences over time were observed in the SAR backscatter signals over the deposited ash, which appear to be related to the snow accumulation history. The backscatter signals were compared to meteorological conditions at the time of SAR acquisition and to accumulation data derived from two snow pits, one located within the ash fall. A linear regression analysis between the accumulation data and the SAR backscattering coefficient results in high R2 confidence values (>0.8), indicating that the SAR data can be used for estimating the areal accumulation distribution in areas with an existing ash layer.
Heat stress has a significant impact on all livestock and poultry species causing economic losses and animal well-being concerns. Providing shade is one heat-abatement strategy that has been studied for years. Material selected to provide shade for animals greatly influences the overall stress reduction provided by shade. A study was conducted to quantify both the environment and animal response, when cattle had no shade access during summertime exposure or were given access to shade provided by three different materials. A total of 32 Black Angus heifers were assigned to one of the four treatment pens according to weight (eight animals per pen). Each pen was assigned a shade treatment: No Shade, Snow Fence, 60% Aluminet Shade Cloth and 100% Shade Cloth. In the shaded treatment pens, the shade structure covered ~40% of the pen (7.5 m2/animal). Animals were moved to a different treatment every 2 weeks in a 4×4 Latin square design to ensure each treatment was applied to each group of animals. Both environmental parameters and physiological responses were measured during the experiment. Environmental parameters included dry-bulb temperature, relative humidity, wind speed, black globe temperature (BGT), solar radiation (SR) and feedlot surface temperature. Animal response measurements included manual respiration rate (RRm), electronic respiration rate (RRe), vaginal temperature (body temperature (BT)), complete blood count (CBC) and plasma cortisol. The environmental data demonstrated changes proportional to the quality of shade offered. However, the animal responses did not follow this same trend. Some of the data suggest that any amount of shade was beneficial to the animals. However, Snow Fence may not offer adequate protection to reduce BT. For some of the parameters (BT, CBC and cortisol), 60% Aluminet and 100% Shade Cloth offers similar protection. The 60% Aluminet lowered RRe the most during extreme conditions. When considering all parameters, environmental and physiological, 60% Aluminet Shade Cloth offered reductions of BGT, SR, feedlot surface temperature and the best (or equal to the best) overall protection for the animals (RRe, RRm, BT, blood parameters).
The reliability of radiocarbon ages based on soil organic matter (SOM) from Holocene buried soils in Middle Park, Colorado, is assessed by comparison with ages of charcoal. On average, 14C ages of SOM from buried surface horizons are 880 ± 230 14C yr younger than charcoal ages from the same horizon. Humic acid (HA) and low-temperature (400 °) combustion residue (LT) fractions are 390 ± 230 and 1290 ± 230 14C yr younger than charcoal ages, respectively, and HA ages are on average 860 ± 140 14C yr older than LT fractions. We interpret the offsets between 14C ages of charcoal and SOM fractions and the consistent offsets between the HA and LT fractions to reflect the duration of pedogenesis and different residence times of the SOM fractions examined here. The stratigraphic coherence of charcoal 14C ages suggests short residence time on the landscape, with little subsequent reworking. 14C ages of HA and LT fractions are complimentary to charcoal, and HA ages are interpreted to represent minimum ages for the onset of pedogenesis and LT ages are considered maximum ages for burial. The 14C chronology from buried soils indicates an episode of hillslope erosion in Middle Park during the early Holocene, followed by a long period of land surface stability and soil formation between 9000–4500 BP. Two episodes of late Holocene hillslope erosion between 3500–2500 and 1000–500 BP correspond with warming recognized in the Colorado Front Range, while surface stability and soil formation between 2500–1000 BP is contemporaneous with evidence for cooling at higher elevations.
Shared decision making has been advocated as a means to improve patient-orientation and quality of health care. There is a lack of knowledge on clinical decision making and its relation to outcome in the routine treatment of people with severe mental illness. This study examined preferred and experienced clinical decision making from the perspectives of patients and staff, and how these affect treatment outcome.
“Clinical Decision Making and Outcome in Routine Care for People with Severe Mental Illness” (CEDAR; ISRCTN75841675) is a naturalistic prospective observational study with bimonthly assessments during a 12-month observation period. Between November 2009 and December 2010, adults with severe mental illness were consecutively recruited from caseloads of community mental health services at the six study sites (Ulm, Germany; London, UK; Naples, Italy; Debrecen, Hungary; Aalborg, Denmark; and Zurich, Switzerland). Clinical decision making was assessed using two instruments which both have parallel patient and staff versions: (a) The Clinical Decision Making Style Scale (CDMS) measured preferences for decision making at baseline; and (b) the Clinical Decision Making Involvement and Satisfaction Scale (CDIS) measured involvement and satisfaction with a specific decision at all time points. Primary outcome was patient-rated unmet needs measured with the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS). Mixed-effects multinomial regression was used to examine differences and course over time in involvement in and satisfaction with actual decision making. The effect of clinical decision making on the primary outcome was examined using hierarchical linear modelling controlling for covariates (study centre, patient age, duration of illness, and diagnosis). Analysis were also controlled for nesting of patients within staff.
Of 708 individuals approached, 588 adults with severe mental illness (52% female, mean age = 41.7) gave informed consent. Paired staff participants (N = 213) were 61.8% female and 46.0 years old on average. Shared decision making was preferred by patients (χ2 = 135.08; p < 0.001) and staff (χ2 = 368.17; p < 0.001). Decision making style of staff significantly affected unmet needs over time, with unmet needs decreasing more in patients whose clinicians preferred active to passive (−0.406 unmet needs per two months, p = 0.007) or shared (−0.303 unmet needs per two months, p = 0.015) decision making.
Decision making style of staff is a prime candidate for the development of targeted intervention. If proven effective in future trials, this would pave the ground for a shift from shared to active involvement of patients including changes to professional socialization through training in principles of active decision making.
We report on a comprehensive study of the defect structure in GaN grown on c-oriented sapphire by gas source molecular beam epitaxy and metal organic vapour phase epitaxy. Transmission electron microscopy is used to investigate the defect structures which are dominated by threading dislocations perpendicular to the sapphire surface and stacking faults. Additionally, dislocation densities are determined. For determination of dislocation densities by x-ray diffraction we employ a model that uses the linewidth of x-ray rocking curves for this purpose. Finally, Rutherford backscattering spectrometry is performed to complement the structural investigation.
To evaluate the relative validity and reliability of the SEARCH FFQ that was modified from the Block Kids Questionnaire.
Study participants completed the eighty-five-item FFQ twice plus three 24 h dietary recalls within one month. We estimated correlations between frequencies obtained from participants with the true usual intake for food groups and nutrients, using a two-part model for episodically consumed foods and measurement error adjustment.
The multi-centre SEARCH for Diabetes in Youth Nutrition Ancillary Study.
A subgroup of 172 participants aged 10–24 years with type 1 diabetes.
The mean correlations, adjusted for measurement error, of food groups and nutrients between the FFQ and true usual intake were 0·41 and 0·38, respectively, with 57 % of food groups and 70 % of nutrients exhibiting correlations >0·35. Correlations were high for low-fat dairy (0·80), sugar-sweetened beverages (0·54), cholesterol (0·59) and saturated fat (0·51), while correlations were poor for high-fibre bread and cereal (0·16) and folate (0·11). Reliability of FFQ intake based on two FFQ administrations was also reasonable, with 54 % of Pearson correlation coefficients ≥0·5. Reliability was high for low-fat dairy (0·7), vegetables (0·6), carbohydrates, fibre, folate and vitamin C (all 0·5), but less than desirable for low-fat poultry and high-fibre bread, cereal, rice and pasta (0·2–0·3).
While there is some room for improvement, our findings suggest that the SEARCH FFQ performs quite well for the assessment of many nutrients and food groups in a sample of youth with type 1 diabetes.
Multi-epoch, high-resolution (R ∼ 50 000) optical spectrosco-py of the O-type (O9 III – IV) star HD 152246 suggests that it is a triple system where a close inner pair (Aa–Ab) with a circular orbit and a period of 6 days is in a 53–d eccentric orbit (e = 0.68) with a third component Ac. The mass ratios for the inner and outer system are 0.10 and 0.96, respectively. The strengths of various He lines classify Aa and Ac as late O-type stars while Ab is invisible in our spectra.
Yellow luminescence (YL) has been studied in GaN:Mg doped with Mg concentrations ranging from 1019 to 1021 cm−3 by spectral CL (T=5K) and TEM and explained by suggesting that a different mechanism could be responsible for the YL in p-type GaN with respect to that acting in n-type GaN.
Transitions at 2.2, 2.8, 3.27, 3.21, and 3.44 eV were found. In addition to the wurtzite phase, TEM showed a different amount of the cubic phase in the samples. Nano tubes with a density of 3×109 cm−2 were also observed by approaching the layer/substrate interface. Besides this, coherent inclusions were found with a diameter in the nm range and a volume fraction of about 1%.
The 2.8 eV transition was correlated to a deep level at 600 meV below the conduction band (CB) due to MgGa-VN complexes. The 3.27 eV emission was ascribed to a shallow acceptor at about 170-190 meV above the valence band (VB) due to MgGa.
The 2.2 eV yellow band, not present in low doped samples, increased by increasing the Mg concentration. It was ascribed to a transition between a deep donor level at 0.8-1.1 eV below the CB edge due to NGa and the shallow acceptor due to MgGa. This assumption was checked by studying the role of C in Mg compensation. CL spectra from a sample with high C content showed transitions between a C-related 200 meV shallow donor and a deep donor level at about 0.9- 1.1 eV below the CB due to a NGa-VN complex. In our hypothesis this should induce a decrease of the integrated intensity in both the 2.2 and 2.8 eV bands, as actually shown by CL investigations.