To save 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 saving content to .
To save 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 saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved 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.
Suicidal behaviors are prevalent among college students; however, students remain reluctant to seek support. We developed a predictive algorithm to identify students at risk of suicidal behavior and used telehealth to reduce subsequent risk.
Data come from several waves of a prospective cohort study (2016–2022) of college students (n = 5454). All first-year students were invited to participate as volunteers. (Response rates range: 16.00–19.93%). A stepped-care approach was implemented: (i) all students received a comprehensive list of services; (ii) those reporting past 12-month suicidal ideation were directed to a safety planning application; (iii) those identified as high risk of suicidal behavior by the algorithm or reporting 12-month suicide attempt were contacted via telephone within 24-h of survey completion. Intervention focused on support/safety-planning, and referral to services for this high-risk group.
5454 students ranging in age from 17–36 (s.d. = 5.346) participated; 65% female. The algorithm identified 77% of students reporting subsequent suicidal behavior in the top 15% of predicted probabilities (Sensitivity = 26.26 [95% CI 17.93–36.07]; Specificity = 97.46 [95% CI 96.21–98.38], PPV = 53.06 [95% CI 40.16–65.56]; AUC range: 0.895 [95% CIs 0.872–0.917] to 0.966 [95% CIs 0.939–0.994]). High-risk students in the Intervention Cohort showed a 41.7% reduction in probability of suicidal behavior at 12-month follow-up compared to high-risk students in the Control Cohort.
Predictive risk algorithms embedded into universal screening, coupled with telehealth intervention, offer significant potential as a suicide prevention approach for students.
To examine differences in noticing and use of nutrition information comparing jurisdictions with and without mandatory menu labelling policies and examine differences among sociodemographic groups.
Cross-sectional data from the International Food Policy Study (IFPS) online survey.
IFPS participants from Australia, Canada, Mexico, United Kingdom and USA in 2019.
Adults aged 18–99; n 19 393.
Participants in jurisdictions with mandatory policies were significantly more likely to notice and use nutrition information, order something different, eat less of their order and change restaurants compared to jurisdictions without policies. For noticed nutrition information, the differences between policy groups were greatest comparing older to younger age groups and comparing high education (difference of 10·7 %, 95 % CI 8·9, 12·6) to low education (difference of 4·1 %, 95 % CI 1·8, 6·3). For used nutrition information, differences were greatest comparing high education (difference of 4·9 %, 95 % CI 3·5, 6·4) to low education (difference of 1·8 %, 95 % CI 0·2, 3·5). Mandatory labelling was associated with an increase in ordering something different among the majority ethnicity group and a decrease among the minority ethnicity group. For changed restaurant visited, differences were greater for medium and high education compared to low education, and differences were greater for higher compared to lower income adequacy.
Participants living in jurisdictions with mandatory nutrition information in restaurants were more likely to report noticing and using nutrition information, as well as greater efforts to modify their consumption. However, the magnitudes of these differences were relatively small.
Mild cognitive impairment (MCI) may represent an intermediate, prodromal phase of dementia. Although persons with MCI (PwMCI) are able to function independently, they often experience reduced ability to carry out their usual activities. This can result in social, emotional and functional challenges.
To explore the understanding and psychosocial impact of receiving a diagnosis of MCI on patients and carers.
A cross-sectional cohort study was conducted at St James's Hospital Memory Clinic involving patients who attended the clinic for assessment from 1 January 2020 to 30 April 2021 and received a diagnosis of MCI. We completed questionnaires with patients and a nominated family member or friend of each patient (FwMCI).
Forty-seven PwMCI participated in the study, and 36 nominated family members and/or friends completed the FwMCI questionnaire. In our cohort of PwMCI, most of the participants were not aware of their diagnosis; only 21% used the term MCI, and only 25% attributed their problems to a pathological cause. The majority of participants had no recollection of any discussion around the likelihood of progression. One-third of participants expressed relief that they did not have dementia. Most PwMCI reported positive psychological well-being and did not endorse symptoms of depression or anxiety. There was slight discordance of illness perception among the PwMCI–FwMCI dyads. Forty-seven per cent of FwMCI reported at least a mild degree of carer burden on the Zarit Burden Scale.
Patients’ awareness of being diagnosed with MCI is relatively limited. Public education campaigns raising awareness about MCI can help influence the ‘illness representation’ for MCI and enable people to seek timely advice and support.
This essay adapts Dietrich Bonhoeffer's ‘orders of preservation’ to address the sharp rise in species extinctions due to human causes. I argue that Bonhoeffer's creative use of preservation orders to build an international alliance provides the scope required to meet the present biodiversity crisis while pre-empting Karl Barth's criticism of static regionalism and avoiding problematic elements in Carl Schmitt's concept of the ‘restraining force’. Drawing on Bonhoeffer's 1932 address, ‘On the Theological Foundation of the Work of the World Alliance’, I present three convictions to guide the task of preservation today, which include the formation of alliances between ecclesial and scientific communities in order to properly specify God's commandment.
Government regulation shapes many aspects of the design of a product. This paper addresses the effect of the complexity of a regulation on product architecture through the structure of the regulation itself. The structure of a regulation derives from dependencies among requirements and parameters in the regulation that are ipso facto design elements. Since design elements such as requirements and parameters have no formal definition in regulation, it is difficult to identify them accurately and consistently. We apply two approaches to defining and coding requirements and parameters in the context of washing machine regulation. The two coding approaches generate networks of design elements that are analyzed to measure the complexity of the regulation and by extension the product. We find significant differences in the complexity of the regulation when coded in different ways and note deficiencies and strengths of each approach. These findings will support future research to measure the impact of regulatory complexity on product architecture.
Rapid antigen detection tests (Ag-RDT) for SARS-CoV-2 with emergency use authorization generally include a condition of authorization to evaluate the test’s performance in asymptomatic individuals when used serially. We aim to describe a novel study design that was used to generate regulatory-quality data to evaluate the serial use of Ag-RDT in detecting SARS-CoV-2 virus among asymptomatic individuals.
This prospective cohort study used a siteless, digital approach to assess longitudinal performance of Ag-RDT. Individuals over 2 years old from across the USA with no reported COVID-19 symptoms in the 14 days prior to study enrollment were eligible to enroll in this study. Participants throughout the mainland USA were enrolled through a digital platform between October 18, 2021 and February 15, 2022. Participants were asked to test using Ag-RDT and molecular comparators every 48 hours for 15 days. Enrollment demographics, geographic distribution, and SARS-CoV-2 infection rates are reported.
A total of 7361 participants enrolled in the study, and 492 participants tested positive for SARS-CoV-2, including 154 who were asymptomatic and tested negative to start the study. This exceeded the initial enrollment goals of 60 positive participants. We enrolled participants from 44 US states, and geographic distribution of participants shifted in accordance with the changing COVID-19 prevalence nationwide.
The digital site-less approach employed in the “Test Us At Home” study enabled rapid, efficient, and rigorous evaluation of rapid diagnostics for COVID-19 and can be adapted across research disciplines to optimize study enrollment and accessibility.
Waterhemp has evolved resistance to seven herbicide modes of action in the United States and to five in Canada, which limits weed control options for producers. The objective of this research was to quantify the level and duration of residual control of multiple herbicide-resistant (MHR) waterhemp with five Group 15 herbicides (acetochlor, dimethenamid-p, flufenacet, pyroxasulfone, and S-metolachlor) applied preemergence in a non-crop area. Four field trials were conducted over a 2-yr period (2021, 2022) in southwestern Ontario, Canada. By 4 wk after application (WAA) 91% of waterhemp had emerged in the nontreated control area. The numerical control of waterhemp with all Group 15 herbicides, with the exception of pyroxasulfone, was greatest at 4 WAA, then control declined. Flufenacet provided the lowest waterhemp control; dimethenamid-p and S-metolachlor provided intermediate control, and acetochlor and pyroxasulfone provided the highest control. Waterhemp control with pyroxasulfone peaked at 6 WAA with 99% and declined to 77% at 12 WAA. Flufenacet (low and high rates) was predicted to reduce waterhemp emergence by 50% for 42 to 44 d after application (DAA). Dimethenamid-p, S-metolachlor, and acetochlor (both formulations and three rates) were predicted to reduce waterhemp emergence by 80% for 36, 43, and 33 to 51 DAA, respectively; in contrast, pyroxasulfone was predicted to reduce waterhemp emergence by 80% for 82 DAA. This study concludes that of the Group 15 herbicides evaluated, flufenacet provides the lowest and shortest residual control of waterhemp, and pyroxasulfone provides the highest and longest residual control of waterhemp.
OBJECTIVES/GOALS: Physical therapy (PT) is key for treating functional decline that inpatients experience but is a constrained resource in hospital settings. The Activity Measure Post-Acute Care (AM-PAC) score is a mobility measurement tool that has been used to define misallocation of PT. We aim to optimize PT referrals using AM-PAC-based clinical decision support . METHODS/STUDY POPULATION: We conducted a prospective study of patients admitted to University of Chicago Medical Center. AM-PAC scores were assessed by nursing staff every 12 hours. Clinical decision support was designed using validated AM-PAC cutoffs (> 18, a predictor of discharge to home). The tool was embedded in hospital medicine note templates, requiring providers to indicate PT referral status based on current AM-PAC scores. The primary outcome, unskilled consult , was defined as PT referral for patients with AM-PAC > 18. Data were collected for one year prior to implementation and one year after implementation for intervention (hospital medicine) and control (general internal medicine) services. Difference in differences analysis was used to assess the association between the intervention and unskilled consults. RESULTS/ANTICIPATED RESULTS: Between October 2018 and March 2021, 18,241 admissions were eligible for the study. Compared to preintervention, there was a lower rate of referral to PT for patients with high AM-PAC mobility scores in the post-intervention period [18.5% vs 16.6%; X2(1) = 7.02; p < 0.01]. In the postintervention time period, the control group experienced a 2.6% increase in unskilled consults while the intervention group experienced a 2.3% decrease, a difference in differences of 4.9% (95% CI -0.07–-0.03 for difference in differences) controlling for age sex, race, LOS, and change in mobility. Compared to preintervention, there was no statistically significant difference in mean change in mobility score post-intervention for either group. DISCUSSION/SIGNIFICANCE: Our results suggest that clinical decision support can decrease unskilled PT consults. Many functionally independent patients can mobilize with nursing or other mobilization staff. Hospitals should consider mobility score-based decision support to prioritize PT for impaired and at-risk patients.
Coronary artery dilation associated with bicuspid/unicuspid aortic valves is described in adults with limited data in children. We aimed to describe the clinical course of children with bicuspid/unicuspid aortic valves and coronary dilation including coronary Z-score changes over time, association of coronary changes with aortic valve anatomy/function, and complications.
Materials and methods:
Institutional databases were searched for children ≤18 years with both bicuspid/unicuspid aortic valves and coronary dilation (1/2006-6/2021). Kawasaki disease and isolated supra-/subvalvar aortic stenosis were excluded. Statistics were descriptive with associations measured by Fisher’s exact test and overlapping 83.7% confidence intervals.
Of 17 children, bicuspid/unicuspid aortic valve was diagnosed at birth in 14 (82%). Median age at coronary dilation diagnosis was 6.4 years (range: 0-17.0). Aortic stenosis was present in 14 (82%) [2 (14%) moderate, 8 (57%) severe]; 10 (59%) had aortic regurgitation; 8 (47%) had aortic dilation. The right coronary was dilated in 15 (88%), left main in 6 (35%), and left anterior descending in 1 (6%) with no relationship between leaflet fusion pattern or severity of aortic regurgitation/stenosis on coronary Z-score. Follow-up evaluations were available for 11 (mean 9.3 years, range 1.1–14.8) with coronary Z-scores increasing in 9/11 (82%). Aspirin was used in 10 (59%). There were no deaths or coronary artery thrombosis.
In children with bicuspid/unicuspid aortic valves and coronary dilation, the right coronary artery was most frequently involved. Coronary dilation was observed in early childhood and frequently progressed. Antiplatelet medication use was inconsistent, but no child died nor developed thrombosis.
Across South Africa, Lesotho, and Eswatini, long-term citizen science atlas data have suggested concerning declines in the population of Black Stork Ciconia nigra. Unlike the Asian and European populations, the southern African Black Stork population is described as resident and is listed as “Vulnerable” in South Africa, Lesotho, and Eswatini. Here we report on surveys of historical nesting locations across northern South Africa, finding evidence for nest site abandonment and limited evidence of recent breeding. We undertook detailed species distribution modelling within a maximum entropy framework, using occurrence records from the BirdLasser mobile app. We cross-validated the models against information in the Southern African Bird Atlas Project (SABAP2) database, highlighting Lesotho as an important potential breeding area. Additionally, we used SABAP2 to assess population trends by investigating interannual patterns in reporting rate. Comparing current reporting rates with those from SABAP1 (1987–1992), we found that there has been a dramatic decrease. We noted that a large proportion of the population occurs outside the breeding range during the breeding season, suggesting a considerable non-breeding population, especially in the extensive wildlife refuge of the Kruger National Park. The slow declines observed might be indicative of a population which is not losing many adults but is failing to recruit significant numbers of juveniles due to limited breeding. Using densities derived from transect surveys, we used predictive models to derive estimates of breeding range carrying capacity and a population estimate, which suggested declines to numbers around 600 for this subregion. Minimising disturbance at breeding sites of this cliff-nesting species and improving water quality at key population strongholds are pathways to improving the status of the species in the subregion.
The development of glufosinate-resistant soybean cultivars has created opportunities for use of glufosinate applied postemergence for weed control. Four field experiments were conducted in 2021 and 2022 to ascertain the effect of glufosinate rate and the addition of ammonium sulfate on annual weed control in glyphosate/glufosinate/2,4-D–resistant soybean. An increased glufosinate rate of 500 from 300 g ai ha−1 improved control of common ragweed, common lambsquarters, redroot pigweed, and foxtail species and resulted in decreased density and dry biomass of common lambsquarters and foxtail species. The addition of ammonium sulfate to glufosinate increased control of common lambsquarters, 2 and 8 wk after application (WAA), and of foxtail species, 2, 4, and 8 WAA, but did not improve control of common ragweed and redroot pigweed. Increasing the dose of glufosinate from 300 to 500 g ai ha−1 improves control of common ragweed, redroot pigweed, common lambsquarters, and foxtail species; however, the benefit of the addition of ammonium sulfate to glufosinate is weed species-specific.
Glyphosate-resistant (GR) biotypes of horseweed were first confirmed in southern Ontario in 2010 and have spread across southern Ontario. A total of four field experiments were conducted between 2021 and 2022 to determine GR horseweed control with one- and two-pass herbicide programs in glyphosate/glufosinate/2,4-D-resistant (GG2R) soybean. 2,4-D choline/glyphosate DMA, halauxifen-methyl, and saflufenacil applied preplant (PP) controlled GR horseweed by 59%, 72%, and 78% 8 wk after postemergence (POST) application (WAA-POST); there was no improvement of GR horseweed control when 2,4-D choline/glyphosate DMA was added to saflufenacil; in contrast, there was improved GR horseweed control when saflufenacil was added to 2,4-D choline/glyphosate DMA. Glufosinate and 2,4-D choline/glyphosate DMA applied POST controlled glyphosate-resistant horseweed by 71% and 86%, respectively, 8 WAA-POST. Two-pass herbicide programs of a PP followed by POST application provided greater GR horseweed control than a PP or POST herbicide applied alone. Glufosinate or 2,4-D choline/glyphosate DMA applied POST following 2,4-D choline/glyphosate DMA or halauxifen-methyl applied PP improved GR horseweed control by 29% to 38% and 24%, respectively at 8 WAA-POST. The application of 2,4-D choline/glyphosate DMA applied POST following saflufenacil applied PP improved control by 20% 8 WAA-POST; there was no improvement of GR horseweed control when glufosinate was applied POST following saflufenacil applied PP or when either POST herbicide was applied following saflufenacil + 2,4-D choline/glyphosate DMA applied PP. When used in a two-pass program, 2,4-D choline/glyphosate DMA POST provided 2% to 3% greater control of GR horseweed than glufosinate.
Waterhemp control in Ontario has increased in complexity due to the evolution of biotypes that are resistant to five herbicide modes of action (Groups 2, 5, 9, 14, and 27 as categorized by the Weed Science Society of America). Four field trials were carried out over a 2-yr period in 2021 and 2022 to assess the control of multiple-herbicide-resistant (MHR) waterhemp biotypes in glyphosate/glufosinate/2,4-D-resistant (GG2R) soybean using one- and two-pass herbicide programs. S-metolachlor/metribuzin, pyroxasulfone/sulfentrazone, pyroxasulfone/flumioxazin, and pyroxasulfone + metribuzin applied preemergence (PRE) controlled MHR waterhemp similarly by 46%, 63%, 60%, and 69%, respectively, at 8 wk after postemergence (POST) application (WAA-B). A one-pass application of 2,4-D choline/glyphosate DMA POST provided greater control of MHR waterhemp than glufosinate. Two-pass herbicide programs of a PRE herbicide followed by (fb) a POST-applied herbicide resulted in greater MHR waterhemp control compared to a single PRE or POST herbicide application. PRE herbicides fb glufosinate or 2,4-D choline/glyphosate DMA POST controlled MHR waterhemp by 74% to 91% and by 84% to 96%, respectively, at 8 WAA-B. Two-pass herbicide applications of an effective PRE residual herbicide fb 2,4-D choline/glyphosate DMA POST in GG2R soybean can effectively manage waterhemp that is resistant to herbicides in Groups 2, 5, 9, 14, and 27.
Motor unit number index of the upper trapezius (MUNIX-Trapezius) is a candidate biomarker for bulbar lower motor neuron function; however, reliability data is incomplete. To assess MUNIX-Trapezius reliability in controls, we conducted a systematic review, a cross-sectional study (n = 20), and a meta-analysis. We demonstrated a high inter- and intra-rater intraclass correlation (0.86 and 0.94, respectively), indicating that MUNIX-Trapezius is reliable with between-study variability moderated by age and MUNIX technique. With further validation, this measure can serve as a disease monitoring and response biomarker of bulbar function in the therapeutic development for amyotrophic lateral sclerosis.
This paper uses proprietary data from a blackjack table in Las Vegas to analyze how the expectation of regret affects peoples’ decisions during gambles. Even among a group of people who choose to participate in a risk-taking activity, we find strong evidence of an economically significant omission bias: 80% of the mistakes at the table are caused by playing too conservatively, resulting in substantial monetary losses. This behavior is equally prevalent among large-stakes gamblers and does not change in the face of more complicated strategic decisions.
Child protection systems monitoring is key to ensuring children’s wellbeing. In England, monitoring is rooted in onsite inspection, culminating in judgements ranging from ‘outstanding’ to ‘inadequate’. But inspection may carry unintended consequences where child protection systems are weak. One potential consequence is increased child welfare intervention rates. In this longitudinal ecological study of local authorities in England, we used Poisson mixed-effects regression models to assess whether child welfare intervention rates are higher in an inspection year, whether this is driven by inspection judgement, and whether more deprived areas experience different rates for a given inspection judgement. We investigated the impact of inspection on care entry, Child Protection Plan-initiation, and child-in-need status. We found that inspection was associated with a rise in rates across the spectrum of interventions. Worse judgements yielded higher rates. Inspection may also exacerbate existing inequalities. Unlike less deprived areas, more deprived areas judged inadequate did not experience an increase in the less intrusive ‘child-in-need’ interventions. Our findings suggest that a narrow focus on social work practice is unlikely to address weaknesses in the child protection system. Child protection systems monitoring should be guided by a holistic model of systems improvement, encompassing the socioeconomic determinants of quality.
Boys who were tonsured by their bishop acquired clerical status. Bishops might confer the tonsure at or near a general ordination but also on their progress around their diocese or when resident at one of their manor houses. Candidates had to be ‘literate’, possessing a certain level of Latin, free (or manumitted), legitimate (or dispensed) and ‘suitable’. There is evidence of local selection and candidates were examined before being tonsured. Tonsuring could be the first stage in progress to the priesthood, but many did not proceed beyond the first tonsure and others progressed only to ordination as acolyte.
Approximately 40–50 per cent of the 9,000–10,000 parochial beneficed clergy in England died during the Black Death. Records of the institutions of the clergy who succeeded them in their rectories and vicarages have been used extensively for studying the progress of the plague and the mortality it caused. The present study uses these records to examine the extent to which the clergy who succeeded the deceased were similar to or differed from their predecessors and to assess whether the plague caused an immediate and significant change in the filling of benefices and the character of the beneficed clergy. It is focused on five dioceses in the midlands and north of England – Coventry and Lichfield, Hereford, Lincoln, Worcester and York – but comparisons will be drawn with other dioceses where this is helpful.
Filling Vacant Benefices
A benefice which became vacant was in the gift of a patron, who must present a new incumbent to the bishop within six months, failing which the bishop could collate the benefice to a man of his own choice through lapse of time. Parochial benefices were, with certain exceptions, either rectories or vicarages. When a benefice fell vacant, the patron presented a clerk to the bishop, who normally ordered an enquiry into the benefice and the person presented. On receiving a satisfactory report the bishop admitted and instituted the clerk to the benefice and issued a mandate for his induction. Although details of the enquiry are very rarely given, the person presented seems hardly ever to have been refused institution, at least by the mid-fourteenth century.
The whole process seems normally to have been carried out expeditiously. For one diocese, Coventry and Lichfield, we have records of the time lapse between the start of the vacancy and the institution of the new incumbent. When the vacancy was caused by the death of the incumbent and therefore often unexpected, between 1322 and 1348 38 per cent of benefices were filled within twenty days, 38 per cent in twenty-one to fifty days, and 13 per cent in fifty-one to ninety days, with only 12 per cent taking more than ninety days. The median interval was twenty-six days. Episcopal collations ‘by lapse’ occurred on no more than seven occasions.
Many studies have documented the interaction between 4-hydroxyphenylpyruvate dioxygenase (HPPD)-inhibiting and photosystem II (PSII)-inhibiting herbicides. Most have focused on the interaction between mesotrione and atrazine, with only a few studies characterizing the nature of the interaction between tolpyralate and atrazine. Therefore, five field experiments were conducted in Ontario, Canada, over a 3-yr period (2019 to 2021) to characterize the interaction between three rates of tolpyralate (15, 30, and 45 g ai ha−1) and three rates of atrazine (140, 280, and 560 g ai ha−1) for the control of seven annual weed species in corn (Zea mays L.). Tolpyralate at 30 or 45 g ha−1 applied with atrazine at 280 or 560 g ha−1 controlled velvetleaf (Abutilon theophrasti Medik.), redroot pigweed (Amaranthus retroflexus L.), common ragweed (Ambrosia artemisiifolia L.), common lambsquarters (Chenopodium album L.), and wild mustard (Sinapis arvensis L.) >90% at 8 wk after application (WAA). Tolpyralate and atrazine were synergistic at each rate combination for the control of A. theophrasti at 8 WAA. In contrast, A. retroflexus and S. arvensis control at 8 WAA was additive with each rate combination. At 8 WAA, C. album control was generally additive, but one rate combination was synergistic. Ambrosia artemisiifolia control at 8 WAA was synergistic with five rate combinations and additive with the other four. Barnyardgrass [Echinochloa crus-galli (L.) P. Beauv.] control at 8 WAA was additive with seven of the rate combinations and synergistic with two. Setaria spp. control at 8 WAA was synergistic with one more rate combination compared with E. crus-galli, but the two weed species shared the same synergistic rate combinations. This study concludes that extrapolation or broad classifications of the interaction between tolpyralate and atrazine would be inappropriate, as the interaction can vary due to herbicide rate, weed species, and the response parameter analyzed.