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 email@example.com
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.
Maternal adversity and prenatal stress confer risk for child behavioral health problems. Few studies have examined this intergenerational process across multiple dimensions of stress; fewer have explored potential protective factors. Using a large, diverse sample of mother–child dyads, we examined associations between maternal childhood trauma, prenatal stressors, and offspring socioemotional-behavioral development, while also examining potential resilience-promoting factors. The Conditions Affecting Neurocognitive Development and Learning and Early Childhood (CANDLE) study prospectively followed 1503 mother–child dyads (65% Black, 32% White) from pregnancy. Exposures included maternal childhood trauma, socioeconomic risk, intimate partner violence, and geocode-linked neighborhood violent crime during pregnancy. Child socioemotional-behavioral functioning was measured via the Brief Infant Toddler Social Emotional Assessment (mean age = 1.1 years). Maternal social support and parenting knowledge during pregnancy were tested as potential moderators. Multiple linear regressions (N = 1127) revealed that maternal childhood trauma, socioeconomic risk, and intimate partner violence were independently, positively associated with child socioemotional-behavioral problems at age one in fully adjusted models. Maternal parenting knowledge moderated associations between both maternal childhood trauma and prenatal socioeconomic risk on child problems: greater knowledge was protective against the effects of socioeconomic risk and was promotive in the context of low maternal history of childhood trauma. Findings indicate that multiple dimensions of maternal stress and adversity are independently associated with child socioemotional-behavioral problems. Further, modifiable environmental factors, including knowledge regarding child development, can mitigate these risks. Both findings support the importance of parental screening and early intervention to promote child socioemotional-behavioral health.
Emergency preparedness programs have evolved over the last several decades as communities have responded to natural, intentional, and accidental disasters. This evolution has resulted in a comprehensive all-hazards approach centered around 4 fundamental phases spanning the entire disaster life cycle: mitigation, preparedness, response, and recovery. Increasing frequency of outbreaks and epidemics of emerging and reemerging infectious diseases in the last decade has emphasized the significance of healthcare emergency preparedness programs, but the coronavirus disease 2019 (COVID-19) pandemic has tested healthcare facilities’ emergency plans and exposed vulnerabilities in healthcare emergency preparedness on a scale unexperienced in recent history. We review the 4 phases of emergency management and explore the lessons to be learned from recent events in enhancing health systems capabilities and capacities to mitigate, prepare for, respond to, and recover from biological threats or events, whether it be a pandemic or a single case of an unknown infectious disease. A recurring cycle of assessing, planning, training, exercising, and revising is vital to maintaining healthcare system preparedness, even in absence of an immediate, high probability threat. Healthcare epidemiologists and infection preventionists must play a pivotal role in incorporating lessons learned from the pandemic into emergency preparedness programs and building more robust preparedness plans.
Agitation is a common complication of Alzheimer’s dementia (Agit-AD) associated with substantial morbidity, high healthcare service utilization, and adverse emotional and physical impact on care partners. There are currently no FDA-approved pharmacological treatments for Agit-AD. We present the study design and baseline data for an ongoing multisite, three-week, double-blind, placebo-controlled, randomized clinical trial of dronabinol (synthetic tetrahydrocannabinol [THC]), titrated to a dose of 10 mg daily, in 80 participants to examine the safety and efficacy of dronabinol as an adjunctive treatment for Agit-AD. Preliminary findings for 44 participants enrolled thus far show a predominately female, white sample with advanced cognitive impairment (Mini Mental Status Examination mean 7.8) and agitation (Neuropsychiatric Inventory-Clinician Agitation subscale mean 14.1). Adjustments to study design in light of the COVID-19 pandemic are described. Findings from this study will provide guidance for the clinical utility of dronabinol for Agit-AD. ClinicalTrials.gov Identifier: NCT02792257.
Zirconium alloys are common fuel claddings in nuclear fission reactors and are susceptible to the effects of hydrogen embrittlement. There is a need to be able to detect and image hydrogen at the atomic scale to gain the experimental evidence necessary to fully understand hydrogen embrittlement. Through the use of deuterium tracers, atom probe tomography (APT) is able to detect and spatially locate hydrogen at the atomic scale. Previous works have highlighted issues with quantifying deuterium concentrations using APT due to complex peak overlaps in the mass-to-charge-state ratio spectrum between molecular hydrogen and deuterium (H2 and D). In this work, we use new methods to analyze historic and simulated atom probe data, by applying currently available data analysis tools, to optimize solving peak overlaps to improve the quantification of deuterium. This method has been applied to literature data to quantify the deuterium concentrations in a concentration line profile across an α-Zr/deuteride interface.
Decades of research has debated whether women first need to reach a “critical mass” in the legislature before they can effectively influence legislative outcomes. This study contributes to the debate using supervised tree-based machine learning to study the relationship between increasing variation in women's legislative representation and the allocation of government expenditures in three policy areas: education, healthcare, and defense. We find that women's representation predicts spending in all three areas. We also find evidence of critical mass effects as the relationships between women's representation and government spending are nonlinear. However, beyond critical mass, our research points to a potential critical mass interval or critical limit point in women's representation. We offer guidance on how these results can inform future research using standard parametric models.
In the wake of the COVID-19 pandemic, those planning and conducting research involving older adults have faced many challenges, in part because of the public health measures in place. This article details the early steps and corresponding strategies implemented by our multidisciplinary team to pivot our large-scale aging and mobility study. Based on the premise that all current and emerging research in aging has been impacted by the pandemic, we propose a continuum approach whereby the research question, analysis, and interpretation are situated in accordance with the stage of the pandemic. Using examples from our own study, we outline potential ways to partner with older adults and other stakeholders as well as to encourage collaboration beyond disciplinary silos even under the current circumstances. Finally, we suggest the formation of a Canadian-led consortium that leverages cross-disciplinary expertise to address the complexities of our aging population in the COVID-19 era and beyond.
Outcome of schizophrenia in later life can be evaluated from different perspectives. The recovery concept has moved forward this evaluation, discerning clinical-based and patient-based definitions. Longitudinal data on measures of recovery in older individuals with schizophrenia are scant. This study evaluated the five-year outcome of clinical recovery and subjective well-being in a sample of 73 older Dutch schizophrenia patients (mean age 65.9 years; SD 5.4), employing a catchment-area based design that included both community living and institutionalized patients regardless of the age of onset of their disorder. At baseline (T1), 5.5% of participants qualified for clinical recovery, while at five-year follow-up (T2), this rate was 12.3% (p = 0.18; exact McNemar’s test). Subjective well-being was reported by 20.5% of participants at T1 and by 27.4% at T2 (p = 0.27; exact McNemar’s test). Concurrence of clinical recovery and subjective well-being was exceptional, being present in only one participant (1.4%) at T1 and in two participants (2.7%) at T2. Clinical recovery and subjective well-being were not correlated neither at T1 (p = 0.82; phi = 0.027) nor at T2 (p = 0.71; phi = −0.044). There was no significant correlation over time between clinical recovery at T1 and subjective well-being at T2 (p = 0.30; phi = 0.122) nor between subjective well-being at T1 and clinical recovery at T2 (p = 0.45; phi = −0.088). These results indicate that while reaching clinical recovery is relatively rare in older individuals with schizophrenia, it is not a prerequisite to experience subjective well-being.
The Quaternary Isotope Laboratory (QIL) at the University of Washington was launched in 1969 and directed by Minze Stuiver until his retirement in 1998. Here we review some of the scientific work undertaken in the QIL and the memories of some of Minze’s former students and colleagues.
The expansion of the Umayyad and Abbasid Caliphates (seventh to ninth centuries AD) brought diverse regions from the Indus Valley to the Eurasian Steppe under hegemonic control. An overlooked aspect of this political process is the subsequent translocation of species across ecological zones. This article explores species introduction in the early Islamic world, presenting the first archaeological evidence for domestic water buffalo in the Caucasus—identified using zooarchaeological and ZooMS methods on material from the historical site of Bardhaʿa in Azerbaijan. We contextualise these finds with historical accounts to demonstrate the exploitation of medieval marginal zones and the effects of centralised social reorganisation upon species dispersal.
Enrichment of the heavy rare earth elements (HREE) in carbonatites is rare as carbonatite petrogenesis favours the light (L)REE. We describe HREE enrichment in fenitized phonolite breccia, focusing on small satellite occurrences 1–2 km from the Songwe Hill carbonatite, Malawi. Within the breccia groundmass, a HREE-bearing mineral assemblage comprises xenotime, zircon, anatase/rutile and minor huttonite/thorite, as well as fluorite and apatite.
A genetic link between HREE mineralization and carbonatite emplacement is indicated by the presence of Sr-bearing carbonate veins, carbonatite xenoliths and extensive fenitization. We propose that the HREE are retained in hydrothermal fluids which are residually derived from a carbonatite after precipitation of LREE minerals. Brecciation provides a focusing conduit for such fluids, enabling HREE transport and xenotime precipitation in the fenite. Continued fluid–rock interaction leads to dissolution of HREE-bearing minerals and further precipitation of xenotime and huttonite/thorite.
At a maximum Y content of 3100 µg g−1, HREE concentrations in the presented example are not sufficient to constitute ore, but the similar composition and texture of these rocks to other cases of carbonatite-related HREE enrichment suggests that all form via a common mechanism linked to fenitization. Precipitation of HREE minerals only occurs where a pre-existing structure provides a focusing conduit for fenitizing fluids, reducing fluid – country-rock interaction. Enrichment of HREE and Th in fenite breccia serves as an indicator of fluid expulsion from a carbonatite, and may indicate the presence of LREE mineralization within the source carbonatite body at depth.
Substantial progress has been made in the standardization of nomenclature for paediatric and congenital cardiac care. In 1936, Maude Abbott published her Atlas of Congenital Cardiac Disease, which was the first formal attempt to classify congenital heart disease. The International Paediatric and Congenital Cardiac Code (IPCCC) is now utilized worldwide and has most recently become the paediatric and congenital cardiac component of the Eleventh Revision of the International Classification of Diseases (ICD-11). The most recent publication of the IPCCC was in 2017. This manuscript provides an updated 2021 version of the IPCCC.
The International Society for Nomenclature of Paediatric and Congenital Heart Disease (ISNPCHD), in collaboration with the World Health Organization (WHO), developed the paediatric and congenital cardiac nomenclature that is now within the eleventh version of the International Classification of Diseases (ICD-11). This unification of IPCCC and ICD-11 is the IPCCC ICD-11 Nomenclature and is the first time that the clinical nomenclature for paediatric and congenital cardiac care and the administrative nomenclature for paediatric and congenital cardiac care are harmonized. The resultant congenital cardiac component of ICD-11 was increased from 29 congenital cardiac codes in ICD-9 and 73 congenital cardiac codes in ICD-10 to 318 codes submitted by ISNPCHD through 2018 for incorporation into ICD-11. After these 318 terms were incorporated into ICD-11 in 2018, the WHO ICD-11 team added an additional 49 terms, some of which are acceptable legacy terms from ICD-10, while others provide greater granularity than the ISNPCHD thought was originally acceptable. Thus, the total number of paediatric and congenital cardiac terms in ICD-11 is 367. In this manuscript, we describe and review the terminology, hierarchy, and definitions of the IPCCC ICD-11 Nomenclature. This article, therefore, presents a global system of nomenclature for paediatric and congenital cardiac care that unifies clinical and administrative nomenclature.
The members of ISNPCHD realize that the nomenclature published in this manuscript will continue to evolve. The version of the IPCCC that was published in 2017 has evolved and changed, and it is now replaced by this 2021 version. In the future, ISNPCHD will again publish updated versions of IPCCC, as IPCCC continues to evolve.
To determine the utility of the Sofia SARS rapid antigen fluorescent immunoassay (FIA) to guide hospital-bed placement of patients being admitted through the emergency department (ED).
Cross-sectional analysis of a clinical quality improvement study.
This study was conducted in 2 community hospitals in Maryland from September 21, 2020, to December 3, 2020. In total, 2,887 patients simultaneously received the Sofia SARS rapid antigen FIA and SARS-CoV-2 RT-PCR assays on admission through the ED.
Rapid antigen results and symptom assessment guided initial patient placement while confirmatory RT-PCR was pending. The sensitivity, specificity, positive predictive values, and negative predictive values of the rapid antigen assay were calculated relative to RT-PCR, overall and separately for symptomatic and asymptomatic patients. Assay sensitivity was compared to RT-PCR cycle threshold (Ct) values. Assay turnaround times were compared. Clinical characteristics of RT-PCR–positive patients and potential exposures from false-negative antigen assays were evaluated.
For all patients, overall agreement was 97.9%; sensitivity was 76.6% (95% confidence interval [CI], 71%–82%), and specificity was 99.7% (95% CI, 99%–100%). We detected no differences in performance between asymptomatic and symptomatic individuals. As RT-PCR Ct increased, the sensitivity of the antigen assay decreased. The mean turnaround time for the antigen assay was 1.2 hours (95% CI, 1.0–1.3) and for RT-PCR it was 20.1 hours (95% CI, 18.9–40.3) (P < .001). No transmission from antigen-negative/RT-PCR–positive patients was identified.
Although not a replacement for RT-PCR for detection of all SARS-CoV-2 infections, the Sofia SARS antigen FIA has clinical utility for potential initial timely patient placement.
Hailstone structures have been studied for over a century, but so far mainly by manual optical means. This paper presents new texture and microstructure data (i.e. crystal lattice orientations, grain sizes and shapes) measured with an Automatic Ice Texture Analyzer, which gives access to high spatial and angular resolutions. The hailstones show two main characteristics: (1) they are structured with several concentric layers composed of alternating fine equiaxed grains and coarse elongated and radially oriented grains, and (2) they show two texture types with c-axes oriented either parallel or perpendicular to the radial direction. Such textures are compared with the ones observed in lake S1 and S2 ices, respectively. The S1 texture type (with c-axes parallel to the columnar crystals that grew in the radial direction) may result from epitaxial growth from a polycrystalline embryo, while the S2 texture (c-axes in the plane perpendicular to the column direction) may result from the growth from an embryo made of a few crystals with mainly one crystallographic orientation. Our novel high-resolution maps and measurements of both microstructure and texture may help to shed new light on the long-term discussion on the growth mechanisms of large hailstones.