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HIV-associated neurocognitive disorders (HANDs) are prevalent in older people living with HIV (PLWH) worldwide. HAND prevalence and incidence studies of the newly emergent population of combination antiretroviral therapy (cART)-treated older PLWH in sub-Saharan Africa are currently lacking. We aimed to estimate HAND prevalence and incidence using robust measures in stable, cART-treated older adults under long-term follow-up in Tanzania and report cognitive comorbidities.
A systematic sample of consenting HIV-positive adults aged ≥50 years attending routine clinical care at an HIV Care and Treatment Centre during March–May 2016 and followed up March–May 2017.
HAND by consensus panel Frascati criteria based on detailed locally normed low-literacy neuropsychological battery, structured neuropsychiatric clinical assessment, and collateral history. Demographic and etiological factors by self-report and clinical records.
In this cohort (n = 253, 72.3% female, median age 57), HAND prevalence was 47.0% (95% CI 40.9–53.2, n = 119) despite well-managed HIV disease (Mn CD4 516 (98-1719), 95.5% on cART). Of these, 64 (25.3%) were asymptomatic neurocognitive impairment, 46 (18.2%) mild neurocognitive disorder, and 9 (3.6%) HIV-associated dementia. One-year incidence was high (37.2%, 95% CI 25.9 to 51.8), but some reversibility (17.6%, 95% CI 10.0–28.6 n = 16) was observed.
HAND appear highly prevalent in older PLWH in this setting, where demographic profile differs markedly to high-income cohorts, and comorbidities are frequent. Incidence and reversibility also appear high. Future studies should focus on etiologies and potentially reversible factors in this setting.
Despite advances in endovascular interventions, including the introduction of drug-eluting stents (DES), high target lesion revascularization (TLR) rates still burden the treatment of symptomatic lower-limb peripheral arterial disease (PAD). EluviaTM, a novel, sustained-release, paclitaxel-eluting DES, was shown to further reduce TLRs when compared with the paclitaxel-coated Zilver® PTX® stent, in the IMPERIAL randomized controlled trial. This evaluation estimated the cost-effectiveness of Eluvia when compared with Zilver PTX in Australia, based on 12-month clinical outcomes from the IMPERIAL trial.
A state-transition, decision-analytic model with a 12-month time horizon was developed from an Australian public healthcare system perspective. Cost parameters were obtained from the Australian National Hospital Cost Data Collection Cost Report (2016–17). All costs were captured in Australian dollars (AUD), where AUD 1 = USD 0.69 (June 2020). Complete sets of clinical parameters (primary patency loss, TLR, amputation, and death) and cost parameters from their respective distributions were bootstrapped in samples of 1,000 patients, for each intervention arm of the model. One-way and probabilistic sensitivity analyses were performed.
At 12 months, modeled TLR rates were 4.5 percent for Eluvia and 8.9 percent for Zilver PTX, and mean total direct costs were AUD 6,537 [USD 4,511] and AUD 6,908 [USD 4,767], respectively (Eluvia average per patient savings; overall cohort=AUD 371 [USD 256]; diabetic cohort=AUD 625 [USD 431]). In probabilistic sensitivity analyses, Eluvia was cost-effective relative to Zilver PTX in 92.0 percent of all simulations at a threshold of $10,000 per TLR avoided. Eluvia was more effective and less costly (dominant) than Zilver PTX in 76.0 percent of simulations.
In the first year after the intervention, Eluvia was more effective and less costly than Zilver PTX, making Eluvia the dominant treatment strategy for treatment of symptomatic lower-limb PAD, from an Australian public healthcare system perspective. These findings should be considered when formulating policy and practice guidelines in the context of priority setting and making evidence-based resource allocation decisions for treatment of PAD in Australia.
Bulachite specimens from Cap Garonne, France, comprise two intimately mixed hydrated aluminium arsenate minerals with the same Al:As ratio of 2:1 and with different water contents. The crystal structures of both minerals have been solved using data from low-dose electron diffraction tomography combined with synchrotron powder X-ray diffraction. One of the minerals has the same powder X-ray diffraction pattern (PXRD) as for published bulachite. It has orthorhombic symmetry, space group Pnma with unit-cell parameters a = 15.3994(3), b = 17.6598(3), c = 7.8083(1) Å and Z = 4, with the formula [Al6(AsO4)3(OH)9(H2O)4]⋅2H2O. The second mineral is a higher hydrate with composition [Al6(AsO4)3(OH)9(H2O)4]⋅8H2O. It has the same Pnma space group and unit-cell parameters a = 19.855(4), b = 17.6933(11) and c = 7.7799(5) Å i.e. almost the same b and c parameters but a much larger a parameter. The structures are based on polyhedral layers, parallel to (100), of composition [Al6(AsO4)3(OH)9(H2O)4] and with H-bonded H2O between the layers. The layers contain  spiral chains of edge-shared octahedra, decorated with corner connected AsO4 tetrahedra that are the same as in the mineral liskeardite. The spiral chains are joined together by octahedral edge-sharing to form layers parallel to (100). Synchrotron PXRD patterns collected at different temperatures during heating of the specimen show that the higher-hydrate mineral starts transforming to bulachite when heated to 50°C, and the transformation is complete between 75 and 100°C.
Application timing and environmental factors reportedly influence the efficacy of auxinic herbicides. In resistance-prone weed species such as Palmer amaranth (Amaranthus palmeri S. Watson), efficacy of auxinic herbicides recently adopted for use in resistant crops is of utmost importance to reduce selection pressure for herbicide-resistance traits. Growth chamber experiments were conducted comparing the interaction of different environmental effects with application time to determine the influence of these factors on visible phytotoxicity and hydrogen peroxide (H2O2) formation in A. palmeri. Temperature displayed a high degree of influence on 2,4-D and dicamba efficacy in general, with applications at the low-temperature treatment (31/20 C day/night) resulting in an increase in phytotoxicity compared with high-temperature treatments (41/30 C day/night). Application time across temperature treatments significantly affected 2,4-D–induced phytotoxicity, resulting in a ≥30% increase across rates with treatments at 4:00 PM compared with 8:00 AM. Temperature differential had a significant influence on dicamba efficacy based on visible phytotoxicity data, with a ≥46% increase with a high (37/20 C day/night) compared with a low differential (41/30 C day/night). Concentration of H2O2 in herbicide-treated plants was 34% higher under a high temperature differential compared with the low differential. Humidity treatments and application time interactions displayed undetected or inconsistent effects on visible phytotoxicity and H2O2 production. Overall, temperature-related influences seem to have the largest environmental effect on auxinic herbicides within conditions evaluated in this study. Leaf concentration of H2O2 appears to be generally correlated with phytotoxicity, providing a potentially useful tool in determining efficacy of auxinic herbicides in field settings.
This volume has achieved a large coverage of the experimentally well-studied areas of the temperate and subtropical coasts of the world (see Figure 1.1) – venturing into the tropics in some regions (Chapter 14, South-East Asia) and including mangroves (Chapter 17). Coral reef systems have not been considered. Much of the emphasis has been on rocky habitats as this is where the majority of experimental work on interactions has been done (but see Chapter 6). As well as reviewing regions where there has been a long history of experimental research (e.g., Chapters 2–4, 6, 10, 11, 13, 15, 16), areas of emerging experimental research in the last twenty-five years (e.g., Chapter 8, western Mediterranean; Chapter 12, south-east Pacific) and understudied regions (e.g., Chapter 7, Argentina; Chapter 14, South-East Asia) have also been included, allowing more comprehensive insights into the processes important for shaping these communities. In this short synthesis chapter, we first consider the main processes determining patterns covered by the previous chapters. We then consider major human impacts in these regions. Finally, we identify gaps in knowledge and make some suggestions for the way forward. We make the case for combining phylogeographic studies with macro-ecology and biogeography, coupled with well-designed hypothesis testing experiments, to better understand processes generating patterns on micro-evolutionary (hundreds to thousands of years) and ecological (up to hundreds of years) time scales.
The synthesis of the Aquatic Biodiversity and Ecosystems Conference (ABEC) 2015, which was held to assess scientific progress over the past twnety-five years, this book provides a comprehensive and global review of work since the 1992 publication of Plant-Animal Interactions in the Marine Benthos. Taking a regional and, where appropriate, habitat perspective, it considers sites of coastal biodiversity from around the world to incorporate a global approach. The volume analyses abiotic and biotic interactions, and the factors determining distribution patterns, community structure and ecosystem functioning of coastal systems. It explores themes of how phylogeography and biogeographic process influence assemblage composition, and hence drive community structure and the respective roles of environmental factors and biological interactions, with the overall goal to establish how general are the processes in different regions and habitats. For researchers, graduate students and academics studying coastal ecosystems, with interest for conservation practitioners managing areas of high biodiversity.
At the end of the 2015 Aquatic Biodiversity and Ecosystems Conference, a day was set aside for a workshop following up on the 1990 Plant–Animal Interactions meeting and its associated Systematics Association book – Plant–Animal Interactions in the Marine Benthos (John et al., 1992). Talks given throughout the 2015 conference also informed the present volume and its chapters. The 2015 workshop took a comparative approach with a series of informal presentations and discussion sessions from selected participants from around the world. The general aim was to take a regionally based view of the role of interactions in setting distribution patterns, community structure and functioning of shallow-water marine ecosystems. The coverage was predominantly coastal, down to the limit of light penetration. Most contributions were from those working on rocky intertidal and subtidal habitats, reflecting the size (and willingness to contribute) of the research community coupled with the greater tradition of experimental approaches to examine interactions on more tractable hard substrata. In addition, mangroves, biofilms and the deep sea were also considered as special systems that are ubiquitous across several oceans where significant advances have been made and, therefore, warranted inclusion. Recent advances in remotely operated vehicles, for example, have increased the scope for observation and experiment in the deep sea (Johnson et al., 2013); whereas mangroves are important ecosystem engineers which provide important ecosystem services, but are declining globally (Polidoro et al., 2010; Chee et al., 2017). Biofilms were also included as a subject given their global distribution and importance as the site of first settlement of macrobenthic organisms and as a food source for grazers (Abreu et al., 2007). While this volume does not feature any chapters specifically on artificial structures, ocean sprawl or eco-engineering, a large number of talks and posters at the conference dealt with these emerging issues, reflecting their global importance (see Firth et al., 2016; Bishop et al., 2017 and Strain et al., 2018 for reviews). A notable omission is coral reefs, which were not covered because they already have a well-established community of research workers and deserve a volume in their own right. Inevitably, there are gaps in coverage reflecting difficulties in soliciting and delivering input, especially on soft shores as well as certain geographic locations. Coverage in 1992 and 2018 is shown on the maps in Figure 1.1.
Despite its long coastline, relatively little is known about mainland China’s intertidal communities compared to Europe and the United States, although more is known from Taiwan and Hong Kong. In general, northern areas are dominated by temperate species, with tropical species in the south and subtropical areas supporting a diversity of species from both regions. Studies of intertidal systems are in their infancy, developing since the 1930s and particularly after the 1960s with a primary focus on taxonomy and distribution patterns. While species lists and distributions have been available for mainland China since the 1930s, and more recently Taiwan and Hong Kong, many of these are outdated and recent approaches reveal many cryptic species complexes. Basic information of spatial and temporal patterns is available, but is focussed on few locations, while larger-scale or temporally replicated studies are rare, with Hong Kong being an exception. As a result, we know a lot about a few small areas, and have often used this to generalise much larger areas. This bias is even more true for studies investigating intertidal processes. Clearly, this is an under-studied region and, given the unprecedented anthropogenic pressures it faces, we may already be documenting a highly degraded intertidal system.
Depression in older people is likely to become a growing global health problem with aging populations. Significant cultural variation exists in beliefs about depression (terminology, symptomatology, and treatments) but data from sub-Saharan Africa are minimal. Low-resource interventions for depression have been effective in low-income settings but cannot be utilized without accurate diagnosis. This study aimed to achieve a shared understanding of depression in Tanzania in older people.
Using a qualitative design, focus groups were conducted with participants aged 60 and over. Participants from rural villages of Kilimanjaro, Tanzania, were selected via randomized sampling using census data. Topic guides were developed including locally developed case vignettes. Transcripts were translated into English from Swahili and thematic analysis conducted.
Ten focus groups were held with 81 participants. Three main themes were developed: a) conceptualization of depression by older people and differentiation from other related conditions (“too many thoughts,” cognitive symptoms, affective and biological symptoms, wish to die, somatic symptoms, and its difference to other concepts); b) the causes of depression (inability to work, loss of physical strength and independence, lack of resources, family difficulties, chronic disease); c) management of depression (love and comfort, advice, spiritual support, providing help, medical help).
This research expands our understanding of how depression presents in older Tanzanians and provides information about lay beliefs regarding causes and management options. This may allow development of culturally specific screening tools for depression that, in turn, increase diagnosis rates, support accurate diagnosis, improve service use, and reduce stigma.
Recent funding from Welsh Government for mental health has helped to develop liaison psychiatry services in Wales. Systematic data collection was undertaken to map the liaison psychiatry services in Wales in collaboration with the Royal College of Psychiatrists in Wales and Public Health Wales 1000 Lives Improvement. A questionnaire was designed and circulated to all the health boards in Wales to gather information to map liaison psychiatry services in Wales. Up-to-date information was confirmed in January 2018, via email.
Over the past 2 years, liaison psychiatry services have been set up in six out of seven health boards in Wales. Staffing levels have increased and the remit of services has broadened.
Mapping has highlighted that liaison psychiatry services in Wales continue to evolve. It will be important to continue to monitor these developments and their effects. Comparison with services in England will provide a useful comparison of service provision. A particular challenge will be to establish and monitor liaison psychiatry standards in Wales.
The earliest generations of stars were produced in galaxies at high redshift. The physical conditions in which these stars formed, produced heavy elements and dust, and subsequently ended their life cycles, however, are vastly different from those in the Milky Way. Nearby low metal-abundance galaxies provide critical laboratories within which it is possible to observe conditions similar to those at high redshift, shedding light on the lifecycle of dust and metals in the early Universe. Does the process of star formation change at low metallicity? How did galaxies in the early Universe produce significant amounts of dust without the elapsed time necessary for stars to evolve to the asymptotic giant branch (AGB) phase and contribute via mass loss? Here we present work cataloging dust-producing sources in the nearby metal-poor galaxy NGC 6822 and outline forthcoming GTO observations of this system and the blue compact dwarf I Zw 18 with JWST.
Fomesafen provides effective control of glyphosate-resistant Palmer amaranth in cotton. However, cotton seedlings can be injured when fomesafen is applied PRE. Therefore, greenhouse and field experiments were conducted at Athens, GA, and at six locations in Alabama and Georgia in 2013 and 2016 to evaluate cotton growth and yield response to fomesafen applied PRE at 70, 140, 280, 560, 1,120, or 2,240 g ai ha−1, and in combination with pendimethalin, diuron, acetochlor, and fluridone at 1×label rates. Greenhouse bioassays indicated that fomesafen reduced cotton height and dry weight with increasing rate in Cecil sandy loam and Tifton loamy sand but not in Greenville sandy clay loam––possibly as a result of this soil’s higher organic matter (OM) and clay content. Fomesafen applied at 2,240 g ai ha−1 reduced cotton stand by as much as 83% compared to the nontreated check (NTC) at all field locations except Alabama’s Macon and Baldwin counties, and 1,120 g ai ha−1 reduced cotton stand only at Pulaski County, GA, by 52%. Cotton height was reduced by the two highest rates of fomesafen at all locations except Clarke County, GA, and Baldwin County, AL. Injury data indicated more visual injury followed increasing fomesafen rates, and high-rate treatments produced more injury in sandier soils. Cotton yield was unaffected by herbicide treatments at any location, except for the 1,120 g ai ha−1 rate at Pulaski County (49% yield loss compared to NTC), 2,240 g ai ha−1 at Pulaski County (72% yield loss), and Tift County (29% yield loss). These data indicated cotton yield should not be negatively affected by fomesafen applied PRE alone within label rates or in combination with pendimethalin, diuron, acetochlor, and fluridone at 1×label rates, although some visual injury, or stand or height reduction may occur early in the growing season.
The number of people living with dementia in sub-Saharan Africa (SSA) is expected to increase rapidly in the coming decades. However, our understanding of how best to reduce dementia risk in the population is very limited. As a first step in developing intervention strategies to manage dementia risk in this setting, we investigated rates of cognitive decline in a rural population in Tanzania and attempted to identify associated factors.
The study was conducted in the rural Hai district of northern Tanzania. In 2014, community-dwelling people aged 65 years and over living in six villages were invited to take part in a cognitive screening program. All participants from four of the six villages were followed-up at two years and cognitive function re-tested. At baseline and follow-up, participants were assessed for functional disability, hypertension, and grip strength (as a measure of frailty). At follow-up, additional assessments of visual acuity, hearing impairment, tobacco and alcohol consumption, and clinical assessment for stroke were completed.
Baseline and follow-up data were available for 327 people. Fifty people had significant cognitive decline at two-year follow-up. Having no formal education, low grip strength at baseline, being female and having depression at follow-up were independently associated with cognitive decline.
This is one of the first studies of cognitive decline conducted in SSA. Rates of decline at two years were relatively high. Future work should focus on identification of specific modifiable risk factors for cognitive decline with a view to developing culturally appropriate interventions.
By now there is not much resistance to the notion that historians of modern Germany should pay heed to events outside the borders of the Reich or nation-state (though, even now, Austria and Switzerland often remain an afterthought). At the 2006 annual conference of the German Studies Association in Pittsburgh, Michael Geyer spoke of transnational history as “the new consensus.” His keynote address bore the title “Where Germans Dwell”—a clear indication that the subject matter of German history must include transplants such as Jürgen Klinsmann and Arnold Schwarzenegger, as well as the German diaspora of prior centuries. In keeping with this agenda, H. Glenn Penny has played a significant role in organizing scholarship on Germans abroad, whereas Kira Thurman is exploring how African Americans experienced German musical culture. The scope of transnational German history remains vast.