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.
A series of measures of calf welfare was developed through a process of expert consultation. A welfare assessment of group-housed calves was carried out on 53 UK dairy farms during the winter of 2000/01. The assessment used animal-based measures including direct observation of the calves and examination of their health history through a review of farm records. The findings from this were compiled into a profile of calf welfare which outlined the range of results for each measure used. The results fell into the three categories of respiratory health, nutrition and general appearance. A broad range of results was found across the farms visited for the measures in each of these categories. Some farms performed well for all measures taken, and no farms performed consistently badly across all aspects of calf welfare. The majority of farms combined aspects of both good and poor welfare performance.
This paper describes an approach to assessing the overall welfare of cows on dairy farms. Veterinary and behaviour experts were shown results for ten selected welfare parameters for 25 pairs of dairy farms paired for farm assurance status but with similar geographical location and husbandry system. From this information alone they were asked to state which farms had better welfare. Overall, there were no significant differences between the conclusions of veterinary and behaviour experts. There was a significant relationship between the proportion of experts rating a farm as poorer and the measured difference in the number of cows with lameness or rising restrictions between the paired farms. There were no significant relationships between the expert decisions and differences in milk yield, flight distance, swollen hocks, mastitis incidence, dystocia level, conception rates, prevalence of thin cows and proportion of cows with dirty udders. Clearly, experts rate lameness and discomfort as highly important indices of poor welfare in dairy cows.
A Delphi technique was used to gather the opinions of animal welfare experts on the most appropriate measures for welfare assessment of farm animals. The experts were asked to consider measures that were directed towards the animal (animal-based), rather than measurement of their environment. This systematic approach was designed to achieve a degree of consensus of opinion between a large number of experts. Two rounds of postal questionnaires were targeted at people with expertise in one or more of the species of interest. The respondents suggested measures based upon observations of health status, behaviour, and examination of records. These measures reflect the animal's welfare state — in other words, how the animal is coping within the environment and husbandry system in which it lives. The measures for cattle, pigs and laying hens were categorised into 22, 23 and 28 aspects, respectively, with the highest ranking of importance being given to observation of lameness in dairy cattle and pigs and to observation of feather condition in laying hens. This Delphi study was the basis for the development of a series of protocols to assess the welfare state of dairy cattle, pigs and laying hens.
Gun ownership is a highly consequential political behavior. It often signifies a belief about the inadequacy of state-provided security and leads to membership in a powerful political constituency. As a result, it is important to understand why people buy guns and how shifting purchasing patterns affect the composition of the broader gun-owning community. We address these topics by exploring the dynamics of the gun-buying spike that took place during the COVID-19 pandemic, which was one of the largest in American history. We find that feelings of diffuse threat prompted many individuals to buy guns. Moreover, we show that new gun owners, even more than buyers who already owned guns, exhibit strong conspiracy and anti-system beliefs. These findings have substantial consequences for the subsequent population of gun owners and provide insight into how social disruptions can alter the nature of political groups.
The purpose of this investigation was to expand upon the limited existing research examining the test–retest reliability, cross-sectional validity and longitudinal validity of a sample of bioelectrical impedance analysis (BIA) devices as compared with a laboratory four-compartment (4C) model. Seventy-three healthy participants aged 19–50 years were assessed by each of fifteen BIA devices, with resulting body fat percentage estimates compared with a 4C model utilising air displacement plethysmography, dual-energy X-ray absorptiometry and bioimpedance spectroscopy. A subset of thirty-seven participants returned for a second visit 12–16 weeks later and were included in an analysis of longitudinal validity. The sample of devices included fourteen consumer-grade and one research-grade model in a variety of configurations: hand-to-hand, foot-to-foot and bilateral hand-to-foot (octapolar). BIA devices demonstrated high reliability, with precision error ranging from 0·0 to 0·49 %. Cross-sectional validity varied, with constant error relative to the 4C model ranging from −3·5 (sd 4·1) % to 11·7 (sd 4·7) %, standard error of the estimate values of 3·1–7·5 % and Lin’s concordance correlation coefficients (CCC) of 0·48–0·94. For longitudinal validity, constant error ranged from −0·4 (sd 2·1) % to 1·3 (sd 2·7) %, with standard error of the estimate values of 1·7–2·6 % and Lin’s CCC of 0·37–0·78. While performance varied widely across the sample investigated, select models of BIA devices (particularly octapolar and select foot-to-foot devices) may hold potential utility for the tracking of body composition over time, particularly in contexts in which the purchase or use of a research-grade device is infeasible.
Burnout, anxiety and depression are commonly reported among surgical residents and faculty members. Resident training programmes are encouraged to implement structured wellness initiatives, to address emotional stress.
Thirty otolaryngology residents and faculty members were invited to participate in this prospective pilot trial. Participants were randomised to either the intervention group, which involved completing 10 mobile meditation sessions, or the control group. Outcomes were measured with the Generalized Anxiety Disorder scale-7, Patient Health Questionnaire and Professional Quality of Life scale.
Nineteen participants completed the study. Participants in the intervention group had a significantly greater mean change in Generalized Anxiety Disorder scale-7 score (−2.7 ± 3.335 vs 0.33 ± 1.225; p = 0.04). There was no significant difference in average change in Patient Health Questionnaire-9 scores or Professional Quality of Life scale sub-scores between the intervention and control groups.
Short meditation sessions can significantly improve anxiety in surgical residents and faculty members, and they offer a simple, attainable and effective wellness intervention.
The diatomic free radical methylidyne (CH) is an important tracer of the interstellar medium, and the study of it was critical to our earliest understanding of star formation. Although it is detectable across the electromagnetic spectrum, observations at radio frequencies allow for a study of the kinematics of the diffuse and dense gas in regions of new star formation. There is only two published (single-dish) detections of the low-frequency hyperfine transitions between 700 and 725 MHz, despite the precise frequencies being known. These low-frequency transitions are of particular interest as they are shown in laboratory experiments to be more sensitive to magnetic fields than their high-frequency counterparts (with more pronounced Zeeman splitting). In this work, we take advantage of the radio quiet environment and increased resolution of the Australian Square Kilometre Array Pathfinder (ASKAP) over previous searches to make a pilot interferometric search for CH at 724.7883 MHz (the strongest of the hyperfine transitions) in RCW 38. We found the band is clean of radio frequency interference, but we did not detect the signal from this transition to a five-sigma sensitivity limit of 0.09 Jy, which corresponds to a total column density upper limit of 1.9
cm–2 for emission and 1.3
cm–2 for absorption with an optical depth limit of 0.95. Achieved within 5 h of integration, this column density sensitivity should have been adequate to detect the emission or absorption in RCW 38, if it had similar properties to the only previous reported detections in W51.
We present an overview of PION, an open-source software project for solving radiation-magnetohydrodynamics equations on a nested grid, aimed at modelling asymmetric nebulae around massive stars. A new implementation of hybrid OpenMP/MPI parallel algorithms is briefly introduced, and improved scaling is demonstrated compared with the current release version. Three-dimensional simulations of an expanding nebula around a Wolf-Rayet star are then presented and analysed, similar to previous 2D simulations in the literature. The evolution of the emission measure of the gas and the X-ray surface brightness are calculated as a function of time, and some qualitative comparison with observations is made.
Levamisole is an increasingly common cutting agent used with cocaine. Both cocaine and levamisole can have local and systemic effects on patients.
A retrospective case series was conducted of patients with a cocaine-induced midline destructive lesion or levamisole-induced vasculitis, who presented to a Dundee hospital or the practice of a single surgeon in Paisley, from April 2016 to April 2019. A literature review on the topic was also carried out.
Nine patients from the two centres were identified. One patient appeared to have levamisole-induced vasculitis, with raised proteinase 3, perinuclear antineutrophil cytoplasmic antibodies positivity and arthralgia which improved on systemic steroids. The other eight patients had features of a cocaine-induced midline destructive lesion.
As the use of cocaine increases, ENT surgeons will see more of the complications associated with it. This paper highlights some of the diagnostic issues and proposes a management strategy as a guide to this complex patient group. Often, multidisciplinary management is needed.
Introduction: Paramedics commonly administer intravenous dextrose to severely hypoglycemic patients. Typically, the treatment provided is a 25g ampule of 50% dextrose (D50). This dose of D50 is meant to ensure a return to consciousness. However, this dose may be unnecessary and lead to harm or difficulties regulating blood glucose post treatment. We hypothesize that a lower dose such as dextrose 10% (D10) or titrating the D50 to desired level of consciousness may be optimal and avoid adverse events. Methods: We systematically searched Medline, Embase, CINAHL and Cochrane Central on June 5th 2019. PRISMA guidelines were followed. The GRADE methods and risk of bias assessments were applied to determine the certainty of the evidence. We included primary literature investigating the use of intravenous dextrose in hypoglycemic diabetic patients presenting to paramedics or the emergency department. Outcomes of interest were related to the safe and effective reversal of symptoms and blood glucose levels (BGL). Results: 660 abstracts were screened, 40 full text articles, with eight studies included. Data from three randomized controlled trials and five observational studies were analyzed. A single RCT comparing D10 to D50 was identified. The primary significant finding of the study was an increased post-treatment glycemic profile by 3.2 mmol/L in the D50 group; no other outcomes had significant differences between groups. When comparing pooled data from all the included studies we find higher symptom resolution in the D10 group compared to the D50 group; at 99.8% and 94.9% respectively. However, the mean time to resolution was approximately 4 minutes longer in the D10 group (4.1 minutes (D50) and 8 minutes (D10)). There was more need for subsequent doses in the D10 group at 23.0% versus 16.5% in the D50 group. The post treatment glycemic profile was lower in the D10 group at 5.9 mmol/L versus 8.5 mmol/L in the D50 group. Both treatments had nearly complete resolution of hypoglycemia; 98.7% (D50) and 99.2% (D10). No adverse events were observed in the D10 group (0/871) compared to 12/133 adverse events in the D50 group. Conclusion: D10 may be as effective as D50 at resolving symptoms and correcting hypoglycemia. Although the desired effect can take several minutes longer there appear to be fewer adverse events. The post treatment glycemic profile may facilitate less challenging ongoing glucose management by the patients.
Introduction: The Prehospital Evidence-based Practice (PEP) program is an online, freely accessible, continuously updated repository of appraised EMS research evidence. This report is an analysis of published evidence for EMS interventions used to assess and treat patients suffering from hypoglycemia. Methods: PubMed was systematically searched in June 2019. One author screened titles, abstracts and full-texts for relevance. Trained appraisers reviewed full text articles, scored each on a three-point Level of Evidence (LOE) scale (based on study design and quality) and three-point Direction of Evidence (DOE) scale (supportive, neutral, or opposing findings for each intervention's primary outcome), abstracted the primary outcome, setting and assigned an outcome category (patient or process). Second party appraisal was conducted for all included studies. The level and direction of each intervention was plotted in an evidence matrix, based on appraisals. Results: Twenty-nine studies were included and appraised for seven interventions: 5 drugs (Dextrose 50% (D50), Dextrose 10% (D10), glucagon, oral glucose and thiamine), one assessment tool (point-of-care (POC) glucose testing) and one call disposition (treat-and-release). The most frequently reported study primary outcomes were related to: clinical improvement (n = 15, 51.7%), feasibility/safety (n = 8, 27.6%), and diagnostics (n = 6, 20.7%). The majority of outcomes were patient focused (n = 18, 62.0%). Conclusion: EMS interventions for treating hypoglycemia are informed by high-quality supportive evidence. Both D50 and D10 are supported by high-quality evidence; suggesting D10 may be an effective alternative to the standard D50. “Treat-and-release” practices for hypoglycemia are supported by moderate-quality evidence for the patient related outcomes of relapse, patient preference and complications. This body of evidence is high-quality, patient-focused and conducted in the prehospital setting thus generalizable paramedic practice.
In the winter of 1928, Herbert Hensley Henson, Lord Bishop, delivered his second quadrennial charge to the diocese of Durham. This was no ordinary visitation document. Its 83-page ‘Introduction’ outlined a compelling argument in favour of the disestablishment of the Church of England. That so senior a bishop of the realm should have publicly advocated so subversive a measure was strange in itself. To be sure, many disgruntled clergymen had conceived of suitably drastic solutions in the wake of the parliamentary defeat of the proposed revision of The book of common prayer the previous year. But no comparably significant figure had openly declared the necessity of such a fundamental dislocation in England's ecclesiastical state. Disestablishment had been the great dissenting cause of the nineteenth century. Suddenly, it was espoused by the most articulate prelate on the bench. Moreover, Disestablishment was a report conceived with a vengeance. It called for immediate separation, it envisaged speedy disendowment, it pointed to the desirability of strengthening the ecclesiastical courts, and it insisted upon a thorough reworking of the Church’s administrative machinery. It was cast as a polemic; but it meant business.
No small part of Disestablishment's intellectual force lay in the fact that it did not represent Henson's first statement of his highly unorthodox case. That had been rehearsed in a dramatic sermon, delivered before the bishop of London and the editor of The Tablet, at St Mary's Church in the University of Cambridge, on 29 January 1928. Instead, it described what had by then become Henson's definitive word on the matter. The still greater extent of the political shock waves that this book provoked can be explained only in terms of its author’s personal history. For Henson was not merely a curious convert to this heterodox plan. He was a notorious ‘turncoat’ too. From 1886, Henson had fought with every available weapon at his disposal, whether institutional position, personal connection, crusading pen or even waspish tongue for the continued establishment of the Church of England. After the House of Commons rejected the revised prayer book, first in 1927 and then again in 1928, he devoted all those same endowments to a pursuit of the opposite end.
We describe an ultra-wide-bandwidth, low-frequency receiver recently installed on the Parkes radio telescope. The receiver system provides continuous frequency coverage from 704 to 4032 MHz. For much of the band (
), the system temperature is approximately 22 K and the receiver system remains in a linear regime even in the presence of strong mobile phone transmissions. We discuss the scientific and technical aspects of the new receiver, including its astronomical objectives, as well as the feed, receiver, digitiser, and signal processor design. We describe the pipeline routines that form the archive-ready data products and how those data files can be accessed from the archives. The system performance is quantified, including the system noise and linearity, beam shape, antenna efficiency, polarisation calibration, and timing stability.
Horseweed is one of Kentucky’s most common and problematic weeds in no-till soybean production systems. Emergence in the fall and spring necessitates control at these times because horseweed is best managed when small. Control is typically achieved through herbicides or cover crops (CCs); integrating these practices can lead to more sustainable weed management. Two years of field experiments were conducted over 2016 to 2017 and 2017 to 2018 in Versailles, KY, to examine the use of fall herbicide (FH; namely, saflufenacil or none), spring herbicide (SH; namely, 2,4-D; dicamba; or none), and CC (namely, cereal rye or none) for horseweed management prior to soybean. Treatments were examined with a fully factorial design to assess potential interactions. The CC biomass in 2016 to 2017 was higher relative to 2017 to 2018 and both herbicide programs reduced winter weed biomass in that year. The CC reduced horseweed density while growing and after termination in 1 yr. The FH reduced horseweed density through mid-spring. The FH also killed winter weeds that may have suppressed horseweed emergence; higher horseweed density resulted by soybean planting unless the CC was present to suppress the additional spring emergence. If either FH or CC was used, SH typically did not result in additional horseweed control. The SH killed emerged plants but did not provide residual control of a late horseweed flush in 2017 to 2018. These results suggest CCs can help manage spring flushes of horseweed emergence when nonresidual herbicide products are used, though this effect was short-lived when less CC biomass was present.
The first case of evolved protoporphyrinogen oxidase (PPO)-inhibitor resistance was observed in 2001 in common waterhemp [Amaranthus tuberculatus (Moq.) Sauer var. rudis (Sauer) Costea and Tardif]. This resistance in A. tuberculatus is most commonly conferred by deletion of the amino acid glycine at the 210th position (ΔGly-210) of the PPO enzyme (PPO2) encoded by PPX2. In a field in Kentucky in 2015, inadequate control of Amaranthus plants was observed following application of a PPO inhibitor. Morphological observations indicated that survivors included both A. tuberculatus and Palmer amaranth (Amaranthus palmeri S. Watson). Research was conducted to confirm species identities and resistance and then to determine whether resistance evolved independently in the two species or via hybridization. Results from a quantitative PCR assay based on the ribosomal internal transcribed spacer confirmed that both A. tuberculatus and A. palmeri coexisted in the field. The mutation conferring ΔGly-210 in PPO2 was identified in both species; phylogenetic analysis of a region of PPX2, however, indicated that the mutation evolved independently in the two species. Genotyping of greenhouse-grown plants that survived lactofen indicated that all A. tuberculatus survivors, but only a third of A. palmeri survivors, contained the ΔGly-210 mutation. Consequently, A. palmeri plants were evaluated for the presence of an arginine to glycine or methionine substitution at position 128 of PPO2 (Arg-128-Gly and Arg-128-Met). The Arg-128-Gly substitution was found to account for resistance that was not accounted for by the ΔGly-210 mutation in plants from the A. palmeri population. Results from this study provide a modern-day example of both parallel and convergent evolution occurring within a single field.
Introduction: Early and accurate diagnosis of critical conditions is essential in emergency medical services (EMS). Serum lactate testing may be used to identify patients with worse prognosis, including sepsis. Recently, the use of a point-of-care lactate (POCL) test has been evaluated in guiding treatment in patients with sepsis. Operating as part of the Prehospital Evidence Based Practice (PEP) Program, the authors sought to identify and describe the body of evidence for POCL use in EMS and the emergency department (ED) for patients with sepsis. Methods: Following PEP methodology, in May 2018, PubMed was searched in a systematic manner. Title and abstract screening were conducted by the program coordinator. These studies were collected, appraised and added to the existing body of literature contained within the PEP database. Evidence appraisal was conducted by two reviewers who assigned both a level of evidence (LOE) on a novel three tier scale and a direction of evidence (supportive, neutral or opposing; based on primary outcome). Data on setting and study design were also extracted. Results: Eight studies were included in our analysis. Three of these studies were conducted in the ED setting; each investigating the POCL test's ability to predict severe sepsis, ICU admission or death. All three studies found supportive results for POCL. A systematic review on the use of POCL in the ED determined that this test can also improve time to treatment. Five of the total 8 studies were conducted prehospitally. Two of these studies were supportive of POCL use in the prehospital setting; in terms of feasibility and the ability to predict sepsis. Both of these study sites used this early information as part of initiating a “sepsis alert” pathway. The other three prehospital studies provide neutral support for POCL. One study demonstrated moderate ability of POCL to predict severe illness. Two studies found poor agreement between prehospital POCL and serum lactate values. Conclusion: Limited low and moderate quality evidence suggest POCL may be feasible and helpful in predicting sepsis in the prehospital setting. However, there is sparse and inconsistent support for specific important outcomes, including accuracy.
Introduction: The Prehospital Evidence-Based Practice (PEP) program is an online, freely accessible, continuously updated Emergency Medical Services (EMS) evidence repository. This summary describes the research evidence for the identification and management of adult patients suffering from sepsis syndrome or septic shock. Methods: PubMed was searched in a systematic manner. One author reviewed titles and abstracts for relevance and two authors appraised each study selected for inclusion. Primary outcomes were extracted. Studies were scored by trained appraisers on a three-point Level of Evidence (LOE) scale (based on study design and quality) and a three-point Direction of Evidence (DOE) scale (supportive, neutral, or opposing findings based on the studies’ primary outcome for each intervention). LOE and DOE of each intervention were plotted on an evidence matrix (DOE x LOE). Results: Eighty-eight studies were included for 15 interventions listed in PEP. The interventions with the most evidence were related to identification tools (ID) (n = 26, 30%) and early goal directed therapy (EGDT) (n = 21, 24%). ID tools included Systematic Inflammatory Response Syndrome (SIRS), quick Sequential Organ Failure Assessment (qSOFA) and other unique measures. The most common primary outcomes were related to diagnosis (n = 30, 34%), mortality (n = 40, 45%) and treatment goals (e.g. time to antibiotic) (n = 14, 16%). The evidence rank for the supported interventions were: supportive-high quality (n = 1, 7%) for crystalloid infusion, supportive-moderate quality (n = 7, 47%) for identification tools, prenotification, point of care lactate, titrated oxygen, temperature monitoring, and supportive-low quality (n = 1, 7%) for vasopressors. The benefit of prehospital antibiotics and EGDT remain inconclusive with a neutral DOE. There is moderate level evidence opposing use of high flow oxygen. Conclusion: EMS sepsis interventions are informed primarily by moderate quality supportive evidence. Several standard treatments are well supported by moderate to high quality evidence, as are identification tools. However, some standard in-hospital therapies are not supported by evidence in the prehospital setting, such as antibiotics, and EGDT. Based on primary outcomes, no identification tool appears superior. This evidence analysis can guide selection of appropriate prehospital therapies.