To send 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 sending content to .
To send 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 sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent 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 aim of the current study was to explore the changing interrelationships among clinical variables through the stages of schizophrenia in order to assemble a comprehensive and meaningful disease model.
Twenty-nine centers from 25 countries participated and included 2358 patients aged 37.21 ± 11.87 years with schizophrenia. Multiple linear regression analysis and visual inspection of plots were performed.
The results suggest that with progression stages, there are changing correlations among Positive and Negative Syndrome Scale factors at each stage and each factor correlates with all the others in that particular stage, in which this factor is dominant. This internal structure further supports the validity of an already proposed four stages model, with positive symptoms dominating the first stage, excitement/hostility the second, depression the third, and neurocognitive decline the last stage.
The current study investigated the mental organization and functioning in patients with schizophrenia in relation to different stages of illness progression. It revealed two distinct “cores” of schizophrenia, the “Positive” and the “Negative,” while neurocognitive decline escalates during the later stages. Future research should focus on the therapeutic implications of such a model. Stopping the progress of the illness could demand to stop the succession of stages. This could be achieved not only by both halting the triggering effect of positive and negative symptoms, but also by stopping the sensitization effect on the neural pathways responsible for the development of hostility, excitement, anxiety, and depression as well as the deleterious effect on neural networks responsible for neurocognition.
To describe the infection control preparedness measures undertaken for coronavirus disease (COVID-19) due to SARS-CoV-2 (previously known as 2019 novel coronavirus) in the first 42 days after announcement of a cluster of pneumonia in China, on December 31, 2019 (day 1) in Hong Kong.
A bundled approach of active and enhanced laboratory surveillance, early airborne infection isolation, rapid molecular diagnostic testing, and contact tracing for healthcare workers (HCWs) with unprotected exposure in the hospitals was implemented. Epidemiological characteristics of confirmed cases, environmental samples, and air samples were collected and analyzed.
From day 1 to day 42, 42 of 1,275 patients (3.3%) fulfilling active (n = 29) and enhanced laboratory surveillance (n = 13) were confirmed to have the SARS-CoV-2 infection. The number of locally acquired case significantly increased from 1 of 13 confirmed cases (7.7%, day 22 to day 32) to 27 of 29 confirmed cases (93.1%, day 33 to day 42; P < .001). Among them, 28 patients (66.6%) came from 8 family clusters. Of 413 HCWs caring for these confirmed cases, 11 (2.7%) had unprotected exposure requiring quarantine for 14 days. None of these was infected, and nosocomial transmission of SARS-CoV-2 was not observed. Environmental surveillance was performed in the room of a patient with viral load of 3.3 × 106 copies/mL (pooled nasopharyngeal and throat swabs) and 5.9 × 106 copies/mL (saliva), respectively. SARS-CoV-2 was identified in 1 of 13 environmental samples (7.7%) but not in 8 air samples collected at a distance of 10 cm from the patient’s chin with or without wearing a surgical mask.
Appropriate hospital infection control measures was able to prevent nosocomial transmission of SARS-CoV-2.
Oldowan sites in primary geological context are rare in the archaeological record. Here we describe the depositional environment of Oldowan occurrences at Kanjera South, Kenya, based on field descriptions and granulometric analysis. Excavations have recovered a large Oldowan artefact sample as well as the oldest substantial sample of archaeological fauna. The deposits at Kanjera South consist of 30 m of fluvial, colluvial and lacustrine sediments. Magneto- and biostratigraphy indicate the Kanjera South Member of the Kanjera Formation was deposited during 2.3–1.92 Ma, with 2.0 Ma being a likely age for the archaeological occurrences. Oldowan artefacts and associated fauna were deposited in the colluvial and alluvial silts and sands of beds KS1–3, in the margins of a lake basin. Field descriptions and granulometric analysis of the sediment fine fraction indicate that sediments from within the main archaeological horizon were emplaced as a combination of tractional and hyperconcentrated flows with limited evidence of debris-flow deposition. This style of deposition is unlikely to significantly erode or disturb the underlying surface, and therefore promotes preservation of surface archaeological accumulations. Hominins were repeatedly attracted to the site locale, and rapid sedimentation, minimal bone weathering and an absence of bone or artefact rounding further indicate that fossils and artefacts were quickly buried.
To investigate the effects of the nozzle-exit conditions on jet flow and sound fields, large-eddy simulations of an isothermal Mach 0.9 jet issued from a convergent-straight nozzle are performed at a diameter-based Reynolds number of
. The simulations feature near-wall adaptive mesh refinement, synthetic turbulence and wall modelling inside the nozzle. This leads to fully turbulent nozzle-exit boundary layers and results in significant improvements for the flow field and sound predictions compared with those obtained from the typical approach based on laminar flow in the nozzle. The far-field pressure spectra for the turbulent jet match companion experimental measurements, which use a boundary-layer trip to ensure a turbulent nozzle-exit boundary layer to within 0.5 dB for all relevant angles and frequencies. By contrast, the initially laminar jet results in greater high-frequency noise. For both initially laminar and turbulent jets, decomposition of the radiated noise into azimuthal Fourier modes is performed, and the results show similar azimuthal characteristics for the two jets. The axisymmetric mode is the dominant source of sound at the peak radiation angles and frequencies. The first three azimuthal modes recover more than 97 % of the total acoustic energy at these angles and more than 65 % (i.e. error less than 2 dB) for all angles. For the main azimuthal modes, linear stability analysis of the near-nozzle mean-velocity profiles is conducted in both jets. The analysis suggests that the differences in radiated noise between the initially laminar and turbulent jets are related to the differences in growth rate of the Kelvin–Helmholtz mode in the near-nozzle region.
Ecosystem services related to biodiversity, including cultural services, are essential for agricultural production such as viticulture. In agricultural landscapes, pesticides and mechanization threaten biodiversity, lead to landscape simplification and may reduce ecosystem services. On the other hand, consumers are more and more aware of environmental issues in food production. We investigated if landscape complexity, including soil management practices, was (i) appreciated by visitors and (ii) presented by winegrowers and tourism professionals in the French vineyards with the designation of geographical origin (DGO) ‘Coteaux du Layon’. Our goal was to determine if landscape complexity provides cultural ecosystem services such as aesthetics beneficial for the wine trade and the DGO region's attractiveness. We analyzed the iconographic content and the composition of landscape photographs on 50 websites to investigate if local winegrowers and tourism professionals associate biodiversity in the landscape and soil management practices with wine promotion. A questionnaire was realized to study the perception of local landscapes by interviewing 192 visitors of the region. The benefits of landscape complexity and soil management practices favoring biodiversity in viticulture were known and appreciated by many visitors, even if photographs of wine and traditional practices appeared to encourage wine purchasing. Local winegrowers’ representation of the DGO region only partially served these preferences; instead they mainly presented the wine-growing region by photographs focusing on wine bottles and vineyards. Consumer's preferences showed that complex landscapes could provide cultural ecosystem services that winegrowers are still less aware of. Therefore, complexity-targeted landscape planning including vegetation cover in soil management should be included in policy recommendations as agroecological measures for sustainable DGO production.
To examine the relationships between objectively measured sleep patterns
(sleep duration, sleep efficiency and bedtime) and sugar-sweetened beverage
(SSB) consumption (regular soft drinks, energy drinks, sports drinks and
fruit juice) among children from all inhabited continents of the world.
Multinational, cross-sectional study.
The International Study of Childhood Obesity, Lifestyle and the Environment
Children (n 5873) 9–11 years of age.
Sleep duration was 12 min per night shorter in children who reported
consuming regular soft drinks ‘at least once a day’
compared with those who reported consuming ‘never’ or
‘less than once a week’. Children were more likely to
sleep the recommended 9–11 h/night if they reported
lower regular soft drink consumption or higher sports drinks consumption.
Children who reported consuming energy drinks ‘once a week or
more’ reported a 25-min earlier bedtime than those who reported
never consuming energy drinks. Children who reported consuming sports drinks
‘2–4 d a week or more’ also reported a
25-min earlier bedtime compared with those who reported never consuming
sports drinks. The associations between sleep efficiency and SSB consumption
were not significant. Similar associations between sleep patterns and SSB
consumption were observed across all twelve study sites.
Shorter sleep duration was associated with higher intake of regular soft
drinks, while earlier bedtimes were associated with lower intake of regular
soft drinks and higher intake of energy drinks and sports drinks in this
international study of children. Future work is needed to establish
causality and to investigate underlying mechanisms.
Multidrug-resistant organisms (MDROs) are increasingly reported in residential care homes for the elderly (RCHEs). We assessed whether implementation of directly observed hand hygiene (DOHH) by hand hygiene ambassadors can reduce environmental contamination with MDROs.
From July to August 2017, a cluster-randomized controlled study was conducted at 10 RCHEs (5 intervention versus 5 nonintervention controls), where DOHH was performed at two-hourly intervals during daytime, before meals and medication rounds by a one trained nurse in each intervention RCHE. Environmental contamination by MRDOs, such as methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Acinetobacter species (CRA), and extended-spectrum β-lactamse (ESBL)–producing Enterobacteriaceae, was evaluated using specimens collected from communal areas at baseline, then twice weekly. The volume of alcohol-based hand rub (ABHR) consumed per resident per week was measured.
The overall environmental contamination of communal areas was culture-positive for MRSA in 33 of 100 specimens (33%), CRA in 26 of 100 specimens (26%), and ESBL-producing Enterobacteriaceae in 3 of 100 specimens (3%) in intervention and nonintervention RCHEs at baseline. Serial monitoring of environmental specimens revealed a significant reduction in MRSA (79 of 600 [13.2%] vs 197 of 600 [32.8%]; P<.001) and CRA (56 of 600 [9.3%] vs 94 of 600 [15.7%]; P=.001) contamination in the intervention arm compared with the nonintervention arm during the study period. The volume of ABHR consumed per resident per week was 3 times higher in the intervention arm compared with the baseline (59.3±12.9 mL vs 19.7±12.6 mL; P<.001) and was significantly higher than the nonintervention arm (59.3±12.9 mL vs 23.3±17.2 mL; P=.006).
The direct observation of hand hygiene of residents could reduce environmental contamination by MDROs in RCHEs.
We present the glacier-wide summer surface mass balances determined by a detailed hydrological balance (sSMBhydro) and the quantification of the uncertainties of the calculations on the Argentière and Mer de Glace-Leschaux drainage basins, located in the upper Arve watershed (French Alps), over the period 1996–2004. The spatial distribution of precipitation within the study area was adjusted using in situ winter mass-balance measurements. The sSMBhydro performance was assessed via a comparison with the summer surface mass balances based on in situ glaciological observations (sSMBglacio). Our results show that the sSMBhydro has an uncertainty of ± 0.67 m w.e. a−1 at Argentière and ± 0.66 m w.e. a−1 at Mer de Glace-Leschaux. Estimates of the Argentière sSMBhydro values are in good agreement with the sSMBglacio values. These time series show almost the same interannual variability. From the marked difference between the sSMBhydro and sSMBglacio values for the Mer de Glace-Leschaux glacier, we suspect a significant role of groundwater fluxes in the hydrological balance. This study underlines the importance of taking into account the groundwater transfers to represent and predict the hydro-glaciological behaviour of a catchment.
Predicting recurrent Clostridium difficile infection (rCDI) remains difficult. METHODS. We employed a retrospective cohort design. Granular electronic medical record (EMR) data had been collected from patients hospitalized at 21 Kaiser Permanente Northern California hospitals. The derivation dataset (2007–2013) included data from 9,386 patients who experienced incident CDI (iCDI) and 1,311 who experienced their first CDI recurrences (rCDI). The validation dataset (2014) included data from 1,865 patients who experienced incident CDI and 144 who experienced rCDI. Using multiple techniques, including machine learning, we evaluated more than 150 potential predictors. Our final analyses evaluated 3 models with varying degrees of complexity and 1 previously published model.
Despite having a large multicenter cohort and access to granular EMR data (eg, vital signs, and laboratory test results), none of the models discriminated well (c statistics, 0.591–0.605), had good calibration, or had good explanatory power.
Our ability to predict rCDI remains limited. Given currently available EMR technology, improvements in prediction will require incorporating new variables because currently available data elements lack adequate explanatory power.
The Gaia astrometric reference catalogue will provide star proper motions with an accuracy of one mas one century ago for stars of magnitude 14 or brighter. Our project is to re-reduced the old observations with the new catalogue allowing to have an astrometric accuracy only limited by the observational biases and not by reference stars. Then, we plan to get an accuracy of 50 mas where the old reductions were not better than 500 mas!
For our purpose, we will digitize old photographic plates with a sub-micrometric scanner. Tests were made using the UCAC catalogue showing that old photographic plates have an intrinsect accuracy of 30 to 60 mas.
Accurate positional measurements of planets and satellites are used to improve our knowledge of their orbits and dynamics, and to infer the accuracy of the planet and satellite ephemerides. With the arrival of the Gaia-DR1 reference star catalog and its complete release afterward, the methods for ground-based astrometry become outdated in terms of their formal accuracy compared to the catalog's which is used. Systematic and zonal errors of the reference stars are eliminated, and the astrometric process now dominates in the error budget.
We present a set of algorithms for computing the apparent directions of planets, satellites and stars on any date to micro-arcsecond precision. The expressions are consistent with the ICRS reference system, and define the transformation between theoretical reference data, and ground-based astrometric observables.
Internet-based cognitive–behavioural treatment (ICBT) for anxiety disorders has shown some promise, but no study has yet examined unguided ICBT in primary care. This randomized controlled trial (RCT) investigated whether a transdiagnostic, unguided ICBT programme for anxiety disorders is effective in primary care settings, after a face-to-face consultation with a physician (MD). We hypothesized that care as usual (CAU) plus unguided ICBT would be superior to CAU in reducing anxiety and related symptoms among patients with social anxiety disorder (SAD), panic disorder with or without agoraphobia (PDA) and/or generalized anxiety disorder (GAD).
Adults (n = 139) with at least one of these anxiety disorders, as reported by their MD and confirmed by a structured diagnostic interview, were randomized. Unguided ICBT was provided by a novel transdiagnostic ICBT programme (‘velibra’). Primary outcomes were generic measures, such as anxiety and depression symptom severity, and diagnostic status at post-treatment (9 weeks). Secondary outcomes included anxiety disorder-specific measures, quality of life, treatment adherence, satisfaction, and general psychiatric symptomatology at follow-up (6 months after randomization).
CAU plus unguided ICBT was more effective than CAU at post-treatment, with small to medium between-group effect sizes on primary (Cohen's d = 0.41–0.47) and secondary (Cohen's d = 0.16–0.61) outcomes. Treatment gains were maintained at follow-up. In the treatment group, 28.2% of those with a SAD diagnosis, 38.3% with a PDA diagnosis, and 44.8% with a GAD diagnosis at pretreatment no longer fulfilled diagnostic criteria at post-treatment.
The unguided ICBT intervention examined is effective for anxiety disorders when delivered in primary care.
To assess the performance of two pediatric length-based tapes (Broselow and Handtevy) in predicting actual weights of US children.
In this descriptive study, weights and lengths of children (newborn through 13 years of age) were extracted from the 2009-2010 National Health and Nutrition Examination Survey (NHANES). Using the measured length ranges for each tape and the NHANES-extracted length data, every case from the study sample was coded into Broselow and Handtevy zones. Mean weights were calculated for each zone and compared to the predicted Broselow and Handtevy weights using measures of bias, precision, and accuracy. A sub-sample was examined that excluded cases with body mass index (BMI)≥95th percentile. Weights of children longer than each tape also were examined.
A total of 3,018 cases from the NHANES database met criteria. Although both tapes underestimated children’s weight, the Broselow tape outperformed the Handtevy tape across most length ranges in measures of bias, precision, and accuracy of predicted weights relative to actual weights. Accuracy was higher in the Broselow tape for shorter children and in the Handtevy tape for taller children. Among the sub-sample with cases of BMI≥95th percentile removed, performance of the Handtevy tape improved, yet the Broselow tape still performed better. When assessing the weights of children who were longer than either tape, the actual mean weights did not approximate adult weights; although, those exceeding the Handtevy tape were closer.
For pediatric weight estimation, the Broselow tape performed better overall than the Handtevy tape and more closely approximated actual weight.
LoweCG, CampwalaRT, ZivN, WangVJ. The Broselow and Handtevy Resuscitation Tapes: A Comparison of the Performance of Pediatric Weight Prediction. Prehosp Disaster Med. 2016;31(4):364–375.
Carbapenem-resistant Acinetobacter baumannii (CRAB) with diverse multilocus sequence typing emerged among our nursing home residents (6.5%) with a high background rate of MRSA (32.2%). Rectal swabs yielded a higher rate of CRAB detection than axillary or nasal swabs. Bed-bound status, use of adult diapers, and nasogastric tube were risk factors for CRAB colonization.
We present the updated glaciological mass balance (MB) of Chhota Shigri Glacier, the longest continuous annual MB record in the Hindu-Kush Karakoram Himalaya (HKH) region. Additionally, 4 years of seasonal MBs are presented and analyzed using the data acquired at an automatic weather station (AWS-M) installed in 2009 on a lateral moraine (4863ma.s.l.). The glaciological MB series since 2002 is first recalculated using an updated glacier hypsometry and then validated against geodetic MB derived from satellite stereo-imagery between 2005 (SPOT5) and 2014 (Pléiades). Chhota Shigri Glacier lost mass between 2002 and 2014 with a cumulative glaciological MB of –6.72mw.e. corresponding to a mean annual glacier-wide MB (Ba) of –0.56mw.e. a–1. Equilibrium-line altitude (ELA0) for the steady-state condition is calculated as ~4950ma.s.l., corresponding to an accumulation–area ratio (AAR0) of ~61%. Analysis of seasonal MBs between 2009 and 2013 with air temperature from AWS-M and precipitation from the nearest meteorological station at Bhuntar (1050ma.s.l.) suggests that the summer monsoon is the key season driving the interannual variability of Ba for this glacier. The intensity of summer snowfall events controls the Ba evolution via controlling summer glacier-wide MB (Bs).
Lutein is a carotenoid with strong antioxidant properties. Previous studies in adults suggest a beneficial role of lutein on cardiometabolic health. However, it is unknown whether this relation also exists in children; therefore, we aimed to assess the relation between lutein intake at 13 months of age and cardiometabolic outcomes at the age of 6 years. We included 2044 Dutch children participating in a population-based prospective cohort study. Diet was measured at 13 months of age with an FFQ. Lutein intake was standardised for energy and β-carotene intake. Blood pressure, anthropometrics, serum lipids and insulin were measured at the age of 6 years. Dual-energy X-ray absorptiometry was performed to measure total and regional fat and lean mass. A continuous cardiometabolic risk factor score was created, including the components body fat percentage, blood pressure, insulin, HDL-cholesterol and TAG. Age- and sex-specific standard deviation scores were created for all outcomes. Multivariable linear regression was performed, including socio-demographic and lifestyle variables. Median (energy-standardised) lutein intake was 1317 mcg/d (95 % range 87, 6069 mcg/d). There were no consistent associations between lutein intake at 13 months and anthropometrics and body composition measures at 6 years of age. In addition, lutein intake was not associated with a continuous cardiometabolic risk factor score, nor was it associated with any of the individual components of the cardiometabolic risk factor score. Results from this large population-based prospective cohort study do not support the hypothesis that lutein intake early in life has a beneficial role for later cardiometabolic health.