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A standardised multi-site approach to manage paediatric post-operative chylothorax does not exist and leads to unnecessary practice variation. The Chylothorax Work Group utilised the Pediatric Critical Care Consortium infrastructure to address this gap.
Over 60 multi-disciplinary providers representing 22 centres convened virtually as a quality initiative to develop an algorithm to manage paediatric post-operative chylothorax. Agreement was objectively quantified for each recommendation in the algorithm by utilising an anonymous survey. “Consensus” was defined as ≥ 80% of responses as “agree” or “strongly agree” to a recommendation. In order to determine if the algorithm recommendations would be correctly interpreted in the clinical environment, we developed ex vivo simulations and surveyed patients who developed the algorithm and patients who did not.
The algorithm is intended for all children (<18 years of age) within 30 days of cardiac surgery. It contains rationale for 11 central chylothorax management recommendations; diagnostic criteria and evaluation, trial of fat-modified diet, stratification by volume of daily output, timing of first-line medical therapy for “low” and “high” volume patients, and timing and duration of fat-modified diet. All recommendations achieved “consensus” (agreement >80%) by the workgroup (range 81–100%). Ex vivo simulations demonstrated good understanding by developers (range 94–100%) and non-developers (73%–100%).
The quality improvement effort represents the first multi-site algorithm for the management of paediatric post-operative chylothorax. The algorithm includes transparent and objective measures of agreement and understanding. Agreement to the algorithm recommendations was >80%, and overall understanding was 94%.
Contemporary theories of early development and emerging child psychopathology all posit a major, if not central role for physiological responsiveness. To understand infants’ potential risk for emergent psychopathology, consideration is needed to both autonomic reactivity and environmental contexts (e.g., parent–child interactions). The current study maps infants’ arousal during the face-to-face still-face paradigm using skin conductance (n = 255 ethnically-diverse mother–infant dyads; 52.5% girls, mean infant age = 7.4 months; SD = 0.9 months). A novel statistical approach was designed to model the potential build-up of nonlinear counter electromotive force over the course of the task. Results showed a significant increase in infants’ skin conductance between the Baseline Free-play and the Still-Face phase, and a significant decrease in skin conductance during the Reunion Play when compared to the Still-Face phase. Skin conductance during the Reunion Play phase remained significantly higher than during the Baseline Play phase; indicating that infants had not fully recovered from the mild social stressor. These results further our understanding of infant arousal during dyadic interactions, and the role of caregivers in the development of emotion regulation during infancy.
OBJECTIVES/GOALS: The history of immune suppression, especially CD4 nadir, has been shown to be a strong predictor of HIV-associated neurocognitive disorders (HAND). However, the potential mechanism of this association is not well understood. This study examined the relationship between CD4 nadir and brain atrophy. METHODS/STUDY POPULATION: Fifty-nine people with HIV participated in the cross-sectional study (mean age, 56.5 ± 5.8; age range, 41-69; 15 females; 46 African-Americans). High resolution structural MRI images were obtained using a 3T Siemens scanner. From a comprehensive 7-domain neuropsychological test battery, a global deficit score (GDS) and HAND diagnoses were determined for each participant. The correlation between CD4 nadir (the lowest ever lymphocyte CD4 count) and cortical thickness was investigated using a vertex-wise non-parametric approach with a conservative statistical threshold of p < 0.05 (FWE-corrected). RESULTS/ANTICIPATED RESULTS: Out of the 59 participants, 12 met standard Frascati criteria for asymptomatic neurocognitive impairment (ANI) and two met the criteria for mild neurocognitive disorder (MND). Across all participants, low CD4 nadir was associated with widespread cortical thinning, especially in the frontal and temporal regions. Higher GDS (indicating worse global neurocognitive function) was associated with bilateral frontal cortical thinning, and the association largely persisted in the subset of participants who did not meet HAND criteria. DISCUSSION/SIGNIFICANCE OF IMPACT: These results suggest that the low CD4 nadir may be associated with widespread neural injury in the brain, especially in the frontal and temporal regions. This spatial profile might contribute to the prevalence/phenotypes of HAND in the cART era, such as the frequently observed deficits in the executive domain.
Darwin's frogs Rhinoderma darwinii and Rhinoderma rufum are the only known species of amphibians in which males brood their offspring in their vocal sacs. We propose these frogs as flagship species for the conservation of the Austral temperate forests of Chile and Argentina. This recommendation forms part of the vision of the Binational Conservation Strategy for Darwin's Frogs, which was launched in 2018. The strategy is a conservation initiative led by the IUCN SSC Amphibian Specialist Group, which in 2017 convened 30 governmental, non-profit and private organizations from Chile, Argentina and elsewhere. Darwin's frogs are iconic examples of the global amphibian conservation crisis: R. rufum is categorized as Critically Endangered (Possibly Extinct) on the IUCN Red List, and R. darwinii as Endangered. Here we articulate the conservation planning process that led to the development of the conservation strategy for these species and present its main findings and recommendations. Using an evidence-based approach, the Binational Conservation Strategy for Darwin's Frogs contains a comprehensive status review of Rhinoderma spp., including critical threat analyses, and proposes 39 prioritized conservation actions. Its goal is that by 2028, key information gaps on Rhinoderma spp. will be filled, the main threats to these species will be reduced, and financial, legal and societal support will have been achieved. The strategy is a multi-disciplinary, transnational endeavour aimed at ensuring the long-term viability of these unique frogs and their particular habitat.
Sharing information between different countries is key for developing sustainable solutions to environmental change. Coastal wetlands in the Gulf of Mexico are suffering significant environmental and human-related threats. Working across national boundaries, this research project brings together scientists, specialists and local communities from Cuba and the USA. While important advances have been made in strengthening collaborations, important obstacles remain in terms of international policy constraints, different institutional and academic cultures and technology. Overcoming these limitations is essential to formulating a comprehensive understanding of the challenges that coastal socioecological systems are facing now and into the future.
Decisions on the use of nature reflect the values and rights of individuals, communities and society at large. The values of nature are expressed through cultural norms, rules and legislation, and they can be elicited using a wide range of tools, including those of economics. None of the approaches to elicit peoples’ values are neutral. Unequal power relations influence valuation and decision-making and are at the core of most environmental conflicts. As actors in sustainability thinking, environmental scientists and practitioners are becoming more aware of their own posture, normative stance, responsibility and relative power in society. Based on a transdisciplinary workshop, our perspective paper provides a normative basis for this new community of scientists and practitioners engaged in the plural valuation of nature.
This paper examines how monuments with ‘local’ idiosyncrasies are key in processes of place-making and how, through persistence, such places can engage in supra-local and even ‘global’ dynamics. Departing from a detailed revision of its context, materiality and iconography, we show how a remarkable Iberian ‘warrior’ stela brings together the geo-strategic potential of a unique site, located literally between the Mediterranean and the Atlantic worlds, the century-long dialogue between shared and local identities and the power of connectivity of inexorable global processes. Previous approaches to Iberian late prehistoric stelae have had problems in developing bottom-up, theoretically informed and empirically sound approaches to their simultaneously local and supra-local character. The remarkable site of Almargen provides the opportunity to explore this issue. Located in Lands of Antequera (Málaga), a region with a strong tradition of landscape-making through monuments going back to the Late Neolithic, the Almargen ‘warrior’ stela serves us to explore the notion of ‘glocalization’, which embodies persistent local engagements with material culture, sites and landscapes on the one hand, and their connections with wider regional and even ‘global’ worlds on the other.
Positive symptoms are a useful predictor of aggression in schizophrenia. Although a similar pattern of abnormal brain structures related to both positive symptoms and aggression has been reported, this observation has not yet been confirmed in a single sample.
To study the association between positive symptoms and aggression in schizophrenia on a neurobiological level, a prospective meta-analytic approach was employed to analyze harmonized structural neuroimaging data from 10 research centers worldwide. We analyzed brain MRI scans from 902 individuals with a primary diagnosis of schizophrenia and 952 healthy controls.
The result identified a widespread cortical thickness reduction in schizophrenia compared to their controls. Two separate meta-regression analyses revealed that a common pattern of reduced cortical gray matter thickness within the left lateral temporal lobe and right midcingulate cortex was significantly associated with both positive symptoms and aggression.
These findings suggested that positive symptoms such as formal thought disorder and auditory misperception, combined with cognitive impairments reflecting difficulties in deploying an adaptive control toward perceived threats, could escalate the likelihood of aggression in schizophrenia.
After five positive randomized controlled trials showed benefit of mechanical thrombectomy in the management of acute ischemic stroke with emergent large-vessel occlusion, a multi-society meeting was organized during the 17th Congress of the World Federation of Interventional and Therapeutic Neuroradiology in October 2017 in Budapest, Hungary. This multi-society meeting was dedicated to establish standards of practice in acute ischemic stroke intervention aiming for a consensus on the minimum requirements for centers providing such treatment. In an ideal situation, all patients would be treated at a center offering a full spectrum of neuroendovascular care (a level 1 center). However, for geographical reasons, some patients are unable to reach such a center in a reasonable period of time. With this in mind, the group paid special attention to define recommendations on the prerequisites of organizing stroke centers providing medical thrombectomy for acute ischemic stroke, but not for other neurovascular diseases (level 2 centers). Finally, some centers will have a stroke unit and offer intravenous thrombolysis, but not any endovascular stroke therapy (level 3 centers). Together, these level 1, 2, and 3 centers form a complete stroke system of care. The multi-society group provides recommendations and a framework for the development of medical thrombectomy services worldwide.
Important Bird and Biodiversity Areas (IBAs) are sites identified as being globally important for the conservation of bird populations on the basis of an internationally agreed set of criteria. We present the first review of the development and spread of the IBA concept since it was launched by BirdLife International (then ICBP) in 1979 and examine some of the characteristics of the resulting inventory. Over 13,000 global and regional IBAs have so far been identified and documented in terrestrial, freshwater and marine ecosystems in almost all of the world’s countries and territories, making this the largest global network of sites of significance for biodiversity. IBAs have been identified using standardised, data-driven criteria that have been developed and applied at global and regional levels. These criteria capture multiple dimensions of a site’s significance for avian biodiversity and relate to populations of globally threatened species (68.6% of the 10,746 IBAs that meet global criteria), restricted-range species (25.4%), biome-restricted species (27.5%) and congregatory species (50.3%); many global IBAs (52.7%) trigger two or more of these criteria. IBAs range in size from < 1 km2 to over 300,000 km2 and have an approximately log-normal size distribution (median = 125.0 km2, mean = 1,202.6 km2). They cover approximately 6.7% of the terrestrial, 1.6% of the marine and 3.1% of the total surface area of the Earth. The launch in 2016 of the KBA Global Standard, which aims to identify, document and conserve sites that contribute to the global persistence of wider biodiversity, and whose criteria for site identification build on those developed for IBAs, is a logical evolution of the IBA concept. The role of IBAs in conservation planning, policy and practice is reviewed elsewhere. Future technical priorities for the IBA initiative include completion of the global inventory, particularly in the marine environment, keeping the dataset up to date, and improving the systematic monitoring of these sites.
This work presents the recent progress in the development of the concurrent atomistic-continuum (CAC) method for coarse-grained space- and time-resolved atomistic simulations of phonon transport. Application examples, including heat pulses propagating across grain boundaries and phase interfaces, as well as the interactions between phonons and moving dislocations, are provided to demonstrate the capabilities of CAC. The simulation results provide visual evidence and reveal the underlying physics of a variety of phenomena, including phonon focusing, wave interference, dislocation drag, interfacial Kapitza resistance caused by quasi-ballistic phonon transport, etc. A new method to quantify fluxes in transient transport processes is also introduced.
A remarkable stela from Montoro, southern Spain, is unique in its morphology, epigraphic traits and landscape context. A programme of chemical characterisation, digital imaging, and geo-lithological and epigraphic analyses were conducted to determine its age and significance, and the results were integrated with data from archaeological investigations of the surrounding area. This multi-faceted approach allowed the stela to be interpreted within the context of early interactions between literate Mediterranean societies of the Late Bronze Age and Iron Age and non-literate Iberian societies. A key outcome of this research is a wider understanding of the complex patterns in the use and perception of early scripts.
Since work organizations became the subject of scientific research, how to operationalize and measure dimensions of work design has been an issue, mainly due to concerns about internal consistency and factor structure. In response, Morgeson and Humphrey (2006) built the Work Design Questionnaire –WDQ–, an instrument that identifies and measures these dimensions in different work and organizational contexts. This paper presents the instruent’s adaptation into Spanish using reliability and validity analysis and drawing on a sample of 1035 Spanish workers who hold various jobs in an array of occupational categories. The total instrument’s internal consistency was Cronbach’s alpha of .92 and the various scales’ reliability ranged from .70 to .96, except for three dimensions. There was initially a difference in the comparative fit of the two versions’ factor structures, but the model with 21 work characteristics (motivational -task and knowledge-, social, and work context) showed the highest goodness of fit of the various models tested, confirming previous results from the U.S. version as well as adaptations into other languages and contexts. CFA results indicated goodness of fit of factor configurations corresponding to each of the four major categories of work characteristics, with CFI and TLI around .90, as well as SRMR and RMSEA below .08. Thus it brings to the table a reliable, valid measure of work design with clear potential applications in research as well as professional practice, applications that could improve working conditions, boost productivity, and generate more personal and professional development opportunities for workers.
There is a need for clinical tools to identify cultural issues in diagnostic assessment.
To assess the feasibility, acceptability and clinical utility of the DSM-5 Cultural Formulation Interview (CFI) in routine clinical practice.
Mixed-methods evaluation of field trial data from six countries. The CFI was administered to diagnostically diverse psychiatric out-patients during a diagnostic interview. In post-evaluation sessions, patients and clinicians completed debriefing qualitative interviews and Likert-scale questionnaires. The duration of CFI administration and the full diagnostic session were monitored.
Mixed-methods data from 318 patients and 75 clinicians found the CFI feasible, acceptable and useful. Clinician feasibility ratings were significantly lower than patient ratings and other clinician-assessed outcomes. After administering one CFI, however, clinician feasibility ratings improved significantly and subsequent interviews required less time.
The CFI was included in DSM-5 as a feasible, acceptable and useful cultural assessment tool.
The Calar Alto Secondary Eclipse study was a program dedicated to observe secondary eclipses in the near-IR of two known close-orbiting exoplanets around K-dwarfs: WASP-10b and Qatar-1b. Such observations reveal hints on the orbital configuration of the system and on the thermal emission of the exoplanet, which allows the study of the brightness temperature of its atmosphere. The observations were performed at the Calar Alto Observatory (Spain). We used the OMEGA2000 instrument (Ks band) at the 3.5m telescope. The data was acquired with the telescope strongly defocused. The differential light curve was corrected from systematic effects using the Principal Component Analysis (PCA) technique. The final light curve was fitted using an occultation model to find the eclipse depth and a possible phase shift by performing a MCMC analysis. The observations have revealed a secondary eclipse of WASP-10b with depth of 0.137%, and a depth of 0.196% for Qatar-1b. The observed phase offset from expected mid-eclipse was of −0.0028 for WASP-10b, and of −0.0079 for Qatar-1b. These measured offsets led to a value for |ecosω| of 0.0044 for the WASP-10b system, leading to a derived eccentricity which was too small to be of any significance. For Qatar-1b, we have derived a |ecosω| of 0.0123, however, this last result needs to be confirmed with more data. The estimated Ks-band brightness temperatures are of 1647 K and 1885 K for WASP-10b and Qatar-1b, respectively. We also found an empirical correlation between the (R′HK) activity index of planet hosts and the Ks-band brightness temperature of exoplanets, considering a small number of systems.
The characterization of short-period detached low-mass binaries, by the determination of their physical and orbital parameters, reveal the most precise basic parameters of low-mass stars. Particularly, when photometric and spectroscopic data of eclipsing binaries (EBs) are combined. Recently, 16 new low-mass EBs were discovered by the WFCAM Transit Survey (WTS), however, only three of them were fully characterized. Therefore, new spectroscopic data were already acquired with the objective to characterize five new detached low-mass EBs discovered in the WTS, with short periods between 0.59 and 1.72 days. A preliminary analysis of the radial velocity and light curves was performed, where we have derived orbital separations of 2.88 to 6.69 R⊙, and considering both components, we have found stellar radii ranging from 0.40 to 0.80 R⊙, and masses between 0.24 and 0.71 M⊙. In addition to the determination of the orbital parameters of these systems, the relation between mass, radius and orbital period of these objects can be investigated in order to study the mass-radius relationship and the radius anomaly in the low main-sequence.
The aim of this study was to evaluate the spatial effect of a natural source of sulphur pollution on the species diversity, richness and distribution of corticolous lichens in a páramo zone at the mine ‘El Vinagre’ (Puracé, Cauca, Colombia). Three zones at different distances from the pollution source were established: zone 1 with a high degree of contamination, a potentially mildly affected or transitional zone 2, and a zone 3 free of disturbance. In each zone, 10 phorophytes of Weinmannia microphylla (Cunoniaceae) were sampled, and all lichens in a 150 cm vertical transect 50 cm above the ground were collected and identified. Phorophyte parameters were measured (bark pH and diameter at breast height) and the samples were georeferenced. In order to evaluate the impact on lichens, non-metric multidimensional scaling (NMS) and indicator species analysis were carried out. ANOVA and Spearman correlations were performed to assess the relationships of environmental and tree variables between zones and with lichen community structure. The index of atmospheric purity (IAP) and the environmental rating factor (FCA) were evaluated for the three zones. In total, 104 lichen species were recorded, of which 72 were identified to species, 17 to genus, and four to family; 11 samples could not be identified. NMS clustered samples according to zone and the main axis which were correlated with bark pH and distance from pollution source. We found eight indicator species characterizing different zones, and four marginally significant indicator species. Using the IAP, we established three isocontamination areas, with zones 2 and 3 classified as more or less pristine zones and zone 1 as a polluted zone (supported by bark pH as a proxy for current pollution). Diversity was lowest in zone 1, closest to the pollution source, and lichen species composition differed between zones. Differences between lichens in zones 2 and 3 appear mostly unrelated to the current pollution source and might be more related to historical differences in impact from a 20-year-old pollution source.