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.
Food manufacturers are under increasing pressure to limit the amount of free sugars in their products. Many have reformulated products to replace sucrose, glucose and fructose with alternative sweeteners, but some of these have been associated with additional health concerns. Rare sugars are “monosaccharides and their derivatives that hardly exist in nature”, and there is increasing evidence that they could have health benefits. This review aimed to scope the existing literature in order to identify the most commonly researched rare sugars, to ascertain their proposed health benefits, mechanisms of action and potential uses, and to highlight knowledge gaps. A process of iterative database searching identified 55 relevant articles. The reported effects of rare sugars were noted, along with details of the research methodologies conducted. Our results indicated that the most common rare sugars investigated are D-psicose and D-tagatose, with the potential health benefits divided into three topics: glycaemic control, body composition and cardiovascular disease. All the rare sugars investigated have the potential to suppress postprandial elevation of blood glucose and improve glycaemic control in both human and animal models. Some animal studies have suggested that certain rare sugars may also improve lipid profiles, alter the gut microbiome and reduce pro-inflammatory cytokine expression. The present review demonstrates that rare sugars could play a role in reducing the development of obesity, type 2 diabetes, and/or cardiovascular disease. However, understanding of the mechanisms by which rare sugars may exert their effects is limited, and their effectiveness when used in reformulated products is unknown.
The degree to which suicide risk aggregates in US families is unknown. The authors aimed to determine the familial risk of suicide in Utah, and tested whether familial risk varies based on the characteristics of the suicides and their relatives.
A population-based sample of 12 160 suicides from 1904 to 2014 were identified from the Utah Population Database and matched 1:5 to controls based on sex and age using at-risk sampling. All first through third- and fifth-degree relatives of suicide probands and controls were identified (N = 13 480 122). The familial risk of suicide was estimated based on hazard ratios (HR) from an unsupervised Cox regression model in a unified framework. Moderation by sex of the proband or relative and age of the proband at time of suicide (<25 v. ⩾25 years) was examined.
Significantly elevated HRs were observed in first- (HR 3.45; 95% CI 3.12–3.82) through fifth-degree relatives (HR 1.07; 95% CI 1.02–1.12) of suicide probands. Among first-degree relatives of female suicide probands, the HR of suicide was 6.99 (95% CI 3.99–12.25) in mothers, 6.39 in sisters (95% CI 3.78–10.82), and 5.65 (95% CI 3.38–9.44) in daughters. The HR in first-degree relatives of suicide probands under 25 years at death was 4.29 (95% CI 3.49–5.26).
Elevated familial suicide risk in relatives of female and younger suicide probands suggests that there are unique risk groups to which prevention efforts should be directed – namely suicidal young adults and women with a strong family history of suicide.
The global COVID-19 pandemic has disrupted healthcare worldwide. In low- and middle-income countries (LMICs), where people may have limited access to affordable quality care, the COVID-19 pandemic has the potential to have a particularly adverse impact on the health and healthcare of individuals with noncommunicable diseases (NCDs). A World Health Organization survey found that disruption of delivery of healthcare for NCDs was more significant in LMICs than in high-income countries. However, the study did not elicit insights into the day-to-day impacts of COVID-19 on healthcare by front-line healthcare workers (FLHCWs).
To gain insights directly from FLHCWs working in countries with a high NCD burden, and thereby identify opportunities to improve the provision of healthcare during the current pandemic and in future healthcare emergencies.
We recruited selected frontline healthcare workers (general practitioners, pharmacists, and other medical specialists) from nine countries to complete an online survey (n = 1347). Survey questions focused on the impact of COVID-19 pandemic on clinical practice and NCDs; barriers to clinical care during the pandemic; and innovative responses to the many challenges presented by the pandemic.
The majority of FLHCWs responding to our survey reported that their care of patients had been impacted both adversely and positively by the public health measures imposed. Most FLHCs (95%) reported a deterioration in the mental health of their patients.
Continuity of care for NCDs as part of pandemic preparedness is needed so that chronic conditions are not exacerbated by public health measures and the direct impacts of the pandemic.
Background: Due to limited therapeutic options and potential for spread, carbapenem-resistant Enterobacteriaceae (CRE)-producing New Delhi metallo-β-lactamases (NDMs) are a public health priority. We investigated the epidemiology of NDM-producing CRE reported to the CDC to clarify its distribution and relative prevalence. Methods: The CDC’s Antibiotic Resistance Laboratory Network supports molecular testing of CRE for 5 carbapenemases nationally. Although KPC is the most common carbapenemase in the United States, non-KPC carbapenemases are a growing concern. We analyzed CRE with any of 4 non-KPC plasmid-mediated carbapenemases (NDM, VIM, IMP, or OXA-48 type) isolated from specimens collected from January 1, 2017, through June 30, 2019; only a patient’s first isolate per organism–carbapenemase combination was included. We excluded isolates from specimen sources associated with colonization screening (eg, perirectal). We compared the proportion of NDM-producing CRE to all non-KPC–producing CP-CRE between period A (January to June 2018) and period B (January to June 2019). Health departments and the CDC collected additional exposure and molecular information in selected states to better describe current NDM-producing CRE epidemiology. Results: Overall, 47 states reported 1,013 non–KPC-producing CP-CRE (range/state, 1–109 isolates; median, 11 isolates); 46 states reported 631 NDM-producing CRE (range/state, 1–84; median, 6). NDM-producing CRE increased quarterly from the third quarter of 2018 through the second quarter of 2019; CP-CRE isolates with other non-KPC carbapenemases remained stable (Fig. 1). In period A, 124 of 216 emerging CP-CRE had NDM (57.1%), compared with 255 of 359 emerging CP-CRE (71.0%) during period B (P = .1179). Among NDM-producing CRE, the proportion of Enterobacter spp increased from 10.5% in 2018 to 18.4% in 2019 (P = .0467) (Fig. 2). In total, 18 states reported more NDM-producing CRE in the first 6 months of 2019 than in all of 2018. Connecticut, Ohio, and Oregon were among states that conducted detailed investigations; these 3 states identified 24 NDM-producing CRE isolates from 23 patients in period B. Overall, 5 (21.7%) of 22 patients with history available traveled internationally ≤12 months prior to culture; 17 (73.9%) acquired NDM-producing CRE domestically. Among 15 isolates sequenced, 8 (53.3%) carried NDM-5 (6 E. coli, 1 Enterobacter spp and 1 Klebsiella spp) and 7 (46.7%) carried NDM-1 (6 Enterobacter spp and 1 Klebsiella spp). Species were diverse; no single strain type was shared by >2 isolates. Conclusions: Detection of NDM-producing CRE has increased across the AR Lab Network. Among states with detailed information available, domestic acquisition was common, and no single variant or strain predominated. Aggressive public health response and further understanding of current US NDM-CRE epidemiology are needed to prevent further spread.
Observational studies have linked elevated homocysteine to vascular conditions. Folate intake has been associated with lower homocysteine concentration, although randomised controlled trials of folic acid supplementation to decrease the incidence of vascular conditions have been inconclusive. We investigated determinants of maternal homocysteine during pregnancy, particularly in a folic acid-fortified population.
Data were from the Ottawa and Kingston Birth Cohort of 8085 participants. We used multivariable regression analyses to identify factors associated with maternal homocysteine, adjusted for gestational age at bloodwork. Continuous factors were modelled using restricted cubic splines. A subgroup analysis examined the modifying effect of MTHFR 677C>T genotype on folate, in determining homocysteine concentration.
Participants were recruited in Ottawa and Kingston, Canada, from 2002 to 2009.
Women were recruited when presenting for prenatal care in the early second trimester.
In 7587 participants, factors significantly associated with higher homocysteine concentration were nulliparous, smoking and chronic hypertension, while factors significantly associated with lower homocysteine concentration were non-Caucasian race, history of a placenta-mediated complication and folic acid supplementation. Maternal age and BMI demonstrated U-shaped associations. Folic acid supplementation of >1 mg/d during pregnancy did not substantially increase folate concentration. In the subgroup analysis, MTHFR 677C>T modified the effect of folate status on homocysteine concentration.
We identified determinants of maternal homocysteine relevant to the lowering of homocysteine in the post-folic acid fortification era, characterised by folate-replete populations. A focus on periconceptional folic acid supplementation and improving health status may form an effective approach to lower homocysteine.
Building on a growing body of research suggesting that political attitudes are part of broader individual and biological orientations, we test whether the detection of the hormone androstenone is predictive of political attitudes. The particular social chemical analyzed in this study is androstenone, a nonandrogenic steroid found in the sweat and saliva of many mammals, including humans. A primary reason for scholarly interest in odor detection is that it varies so dramatically from person to person. Using participants’ self-reported perceptions of androstenone intensity, together with a battery of survey items testing social and political preferences and orientations, this research supports the idea that perceptions of androstenone intensity relate to political orientations—most notably, preferences for social order—lending further support to theories positing the influence of underlying biological traits on sociopolitical attitudes and behaviors.
Objectives: Agenesis of the corpus callosum (AgCC), characterized by developmental absence of the corpus callosum, is one of the most common congenital brain malformations. To date, there are limited data on the neuropsychological consequences of AgCC and factors that modulate different outcomes, especially in children. This study aimed to describe general intellectual, academic, executive, social and behavioral functioning in a cohort of school-aged children presenting for clinical services to a hospital and diagnosed with AgCC. The influences of age, social risk and neurological factors were examined. Methods: Twenty-eight school-aged children (8 to 17 years) diagnosed with AgCC completed tests of general intelligence (IQ) and academic functioning. Executive, social and behavioral functioning in daily life, and social risk, were estimated from parent and teacher rated questionnaires. MRI findings reviewed by a pediatric neurologist confirmed diagnosis and identified brain characteristics. Clinical details including the presence of epilepsy and diagnosed genetic condition were obtained from medical records. Results: In our cohort, ~50% of children experienced general intellectual, academic, executive, social and/or behavioral difficulties and ~20% were functioning at a level comparable to typically developing children. Social risk was important for understanding variability in neuropsychological outcomes. Brain anomalies and complete AgCC were associated with lower mathematics performance and poorer executive functioning. Conclusions: This is the first comprehensive report of general intellectual, academic, executive social and behavioral consequences of AgCC in school-aged children. The findings have important clinical implications, suggesting that support to families and targeted intervention could promote positive neuropsychological functioning in children with AgCC who come to clinical attention. (JINS, 2018, 24, 445–455)
Transportation is critical to older adults’ ability to participate in social activities in their community. We examined the association between modes of transportation and restrictions in social activity (i.e. visiting with others, religious attendance, clubs and organised activities, and going out for enjoyment), with particular attention to the moderating effects of economic vulnerability. We used logistic regression to analyse data from 7,197 community-dwelling older adults from the 2011 wave of the National Health and Aging Trends Study, a representative sample of adults aged 65 and over in the United States of America. Economic vulnerability moderated the association between transportation mode and social activity restrictions. Findings suggest that even when economically vulnerable older adults have access to driving, walking or public transit, they may be at a higher risk for social exclusion than their counterparts with more financial resources.
One of the most notable currents in social, cultural and political historiography is the interrogation of the categories of 'elite' and 'popular' politics and their relationship to each other, as wellas the exploration of why and how different sorts of people engaged with politics and behaved politically. While such issues are timeless, they hold a special importance for a society experiencing rapid political and social change, like early modern England. No one has done more to define these agendas for early modern historians than John Walter. His work has been hugely influential, and at itsheart has been the analysis of the political agency of ordinary people. The essays in this volume engage with the central issues of Walter's work, ranging across the politics of poverty, dearth and household, popular political consciousness and practice more broadly, and religion and politics during the English revolution. This outstanding collection, bringing together some of the leading historians of this period with some of the field's rising stars, will appeal to anyone interested in the social, cultural and political history of early modern England or issues of popular political consciousness and behaviour more generally.
MICHAEL J. BRADDICK is professor of history at the University of Sheffield. PHIL WITHINGTON is professor of history at the University of Sheffield.
CONTRIBUTORS: Michael J. Braddick, J. C. Davis, Amanda Flather, Steve Hindle, Mark Knights, John Morrill, Alexandra Shepard, Paul Slack, Richard M. Smith, Clodagh Tait, Keith Thomas, Phil Withington, Andy Wood, Keith Wrightson.
In 1642, Anne Read's husband died of grief. In the same year, Sir Con Magennis died tormented by his evil deeds and ‘much … affrighted with the apprehension and conceipt that … Mr Tudge [a minister he had slain] was still in his presence’.Early modern people attributed huge consequence to ‘passions’ (they would not have used the word ‘emotion’) like grief, anger and fear. When uncontrolled, ‘passion’ started wars and ended life. Little wonder that contemporaries urged the restraint of potentially damaging feelings. However, there were times when emotions were particularly difficult to check.
John Walter's recent work on the collection of documents called the 1641 Depositions has assisted in building a new understanding of the outbreak of waves of violence in Ireland in 1641–2 and subsequently. The depositions contain testimonies from about 3,000 people, mostly British Protestant settlers, who had been dispossessed of their lands, homes and goods by Catholic rebels. Some had been confronted by crowds of local people, though as the rebellion continued, gentlemen tended to take over the leadership of these attacks. Either way, most of the deponents could identify at least some of those involved. The majority had been threatened with violence, and many bore tales of loss of property, personal injury and the torture and violent deaths of their family members, friends and neighbours. There were also accounts of incidents of desecration of sacred space and iconoclasm and of the deliberate humiliation of victims, who were routinely stripped and insulted. The depositions also contain a later set of ‘examinations’, usually conducted to probe particular crimes that had occurred in the early 1640s. The testimonies here included those of both settler and native witnesses and alleged perpetrators. It is no surprise, therefore, that Nicholas Canny should have described the depositions as ‘a body of material which is emotional’. Historians of the period often reflect on the emotional state of the Gaelic Irish and Old English participants, to paint a picture of simmering humiliation, shame, resentment, hostility, fear, hatred, anxiety and despair that led to outpourings of vengeful rage. Though economic and other grievances are pinpointed as arousing these emotions, they are regularly fathered above all on religion: Inga Jones argues that ‘religion has the capacity to arouse passions which go beyond what political and localist concerns can stimulate, a passion which … could and did spill over into unrestrained slaughter’.