To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
To achieve the elimination of the hepatitis C virus (HCV), sustained and sufficient levels of HCV testing is critical. The purpose of this study was to assess trends in testing and evaluate the effectiveness of strategies to diagnose people living with HCV. Data were from 12 primary care clinics in Victoria, Australia, that provide targeted services to people who inject drugs (PWID), alongside general health care. This ecological study spanned 2009–2019 and included analyses of trends in annual numbers of HCV antibody tests among individuals with no previous positive HCV antibody test recorded and annual test yield (positive HCV antibody tests/all HCV antibody tests). Generalised linear models estimated the association between count outcomes (HCV antibody tests and positive HCV antibody tests) and time, and χ2 test assessed the trend in test yield. A total of 44 889 HCV antibody tests were conducted 2009–2019; test numbers increased 6% annually on average [95% confidence interval (CI) 4–9]. Test yield declined from 2009 (21%) to 2019 (9%) (χ2P = <0.01). In more recent years (2013–2019) annual test yield remained relatively stable. Modest increases in HCV antibody testing and stable but high test yield within clinics delivering services to PWID highlights testing strategies are resulting in people are being diagnosed however further increases in the testing of people at risk of HCV or living with HCV may be needed to reach Australia's HCV elimination goals.
The Promoting Activity, Independence and Stability in Early Dementia (PrAISED) is delivering an exercise programme for people with dementia. The Lincolnshire partnership NHS foundation Trust successfully delivered PrAISED through a video-calling platform during the COVID-19 pandemic.
This qualitative case-study identified participants that video delivery worked for, and highlighted its benefits and challenges.
Interviews were conducted with participants with dementia, caregivers and therapists, and analysed through thematic analysis.
Video delivery worked best when participants had a supporting carer, when therapists showed enthusiasm and had an established rapport with the client. Benefits included time-efficiency of sessions, enhancing participants’ motivation, caregivers’ dementia awareness and therapists’ creativity. Limitations included users’ poor IT skills and resources.
The COVID-19 pandemic required innovative ways of delivering rehabilitation. This study supports that people with dementia can use tele rehab, but success is reliant on having a caregiver and an enthusiastic and known therapist.
Nonsuicidal self-injury (NSSI) is prevalent among adolescents and research is needed to clarify the mechanisms which contribute to the behavior. Here, the authors relate behavioral neurocognitive measures of impulsivity and compulsivity to repetitive and sporadic NSSI in a community sample of adolescents.
Computerized laboratory tasks (Affective Go/No-Go, Cambridge Gambling Task, and Probabilistic Reversal Task) were used to evaluate cognitive performance. Participants were adolescents aged 15 to 17 with (n = 50) and without (n = 190) NSSI history, sampled from the ROOTS project which recruited adolescents from secondary schools in Cambridgeshire, UK. NSSI was categorized as sporadic (1-3 instances per year) or repetitive (4 or more instances per year). Analyses were carried out in a series of linear and negative binomial regressions, controlling for age, gender, intelligence, and recent depressive symptoms.
Adolescents with lifetime NSSI, and repetitive NSSI specifically, made significantly more perseverative errors on the Probabilistic Reversal Task and exhibited significantly lower quality of decision making on the Cambridge Gambling Task compared to no-NSSI controls. Those with sporadic NSSI did not significantly differ from no-NSSI controls on task performance. NSSI was not associated with behavioral measures of impulsivity.
Repetitive NSSI is associated with increased behavioral compulsivity and disadvantageous decision making, but not with behavioral impulsivity. Future research should continue to investigate how neurocognitive phenotypes contribute to the onset and maintenance of NSSI, and determine whether compulsivity and addictive features of NSSI are potential targets for treatment.
We propose using fully Bayesian Gaussian process emulation (GPE) as a surrogate for expensive computer experiments of transport infrastructure cut slopes in high-plasticity clay soils that are associated with an increased risk of failure. Our deterioration experiments simulate the dissipation of excess pore water pressure and seasonal pore water pressure cycles to determine slope failure time. It is impractical to perform the number of computer simulations that would be sufficient to make slope stability predictions over a meaningful range of geometries and strength parameters. Therefore, a GPE is used as an interpolator over a set of optimally spaced simulator runs modeling the time to slope failure as a function of geometry, strength, and permeability. Bayesian inference and Markov chain Monte Carlo simulation are used to obtain posterior estimates of the GPE parameters. For the experiments that do not reach failure within model time of 184 years, the time to failure is stochastically imputed by the Bayesian model. The trained GPE has the potential to inform infrastructure slope design, management, and maintenance. The reduction in computational cost compared with the original simulator makes it a highly attractive tool which can be applied to the different spatio-temporal scales of transport networks.
Dietary protein is a pre-requisite for the maintenance of skeletal muscle mass; stimulating increases in muscle protein synthesis (MPS), via essential amino acids (EAA), and attenuating muscle protein breakdown, via insulin. Muscles are receptive to the anabolic effects of dietary protein, and in particular the EAA leucine, for only a short period (i.e. about 2–3 h) in the rested state. Thereafter, MPS exhibits tachyphylaxis despite continued EAA availability and sustained mechanistic target of rapamycin complex 1 signalling. Other notable characteristics of this ‘muscle full’ phenomenon include: (i) it cannot be overcome by proximal intake of additional nutrient signals/substrates regulating MPS; meaning a refractory period exists before a next stimulation is possible, (ii) it is refractory to pharmacological/nutraceutical enhancement of muscle blood flow and thus is not induced by muscle hypo-perfusion, (iii) it manifests independently of whether protein intake occurs in a bolus or intermittent feeding pattern, and (iv) it does not appear to be dependent on protein dose per se. Instead, the main factor associated with altering muscle full is physical activity. For instance, when coupled to protein intake, resistance exercise delays the muscle full set-point to permit additional use of available EAA for MPS to promote muscle remodelling/growth. In contrast, ageing is associated with blunted MPS responses to protein/exercise (anabolic resistance), while physical inactivity (e.g. immobilisation) induces a premature muscle full, promoting muscle atrophy. It is crucial that in catabolic scenarios, anabolic strategies are sought to mitigate muscle decline. This review highlights regulatory protein turnover interactions by dietary protein, exercise, ageing and physical inactivity.
To understand how consumers use ‘dessert-only’ retail food outlets which represent one of the UK’s top ten growing retail business categories and a high-street source of energy-dense, low nutrient foods.
Responses to open-ended questions about dessert-only restaurant usage and closed-ended questions about demographic information including frequency of use and BMI were collected.
Online questionnaire launched from the UK.
Totally, 203 participants (female = 153; mean age = 33·5 years (sd = 14·2); mean BMI = 25·05 kg/m2 (sd = 5·29)) assisted with the study.
Quantitative results showed that participants used dessert-only restaurants infrequently, and qualitative results showed that they regarded a visit as a treat. Many participants also described ways that they modified their eating pattern to accommodate a visit. Thematic analysis also showed that consumer visits were influenced by properties of the foods on offer, opportunities for socialisation (especially with children) as well as convenience, price and a perceived relaxation of meal-time ‘rules’.
Despite some media opinion, this type of food retail outlet is being used somewhat judiciously by consumers. A fruitful public health focus may be on the management of treats within the broader context of the diet as opposed to targeting the treat itself, this may be especially helpful for parents/caregivers taking their children out for a treat to a dessert-only restaurant.
The scarcity of Romano-British human remains from north-west England has hindered understanding of burial practice in this region. Here, we report on the excavation of human and non-human animal remains1 and material culture from Dog Hole Cave, Haverbrack. Foetal and neonatal infants had been interred alongside a horse burial and puppies, lambs, calves and piglets in the very latest Iron Age to early Romano-British period, while the mid- to late Roman period is characterised by burials of older individuals with copper-alloy jewellery and beads. This material culture is more characteristic of urban sites, while isotope analysis indicates that the later individuals were largely from the local area. We discuss these results in terms of burial ritual in Cumbria and rural acculturation. Supplementary material is available online (https://doi.org/10.1017/S0068113X20000136), and contains further information about the site and excavations, small finds, zooarchaeology, human osteology, site taphonomy, the palaeoenvironment, isotope methods and analysis, and finds listed in Benson and Bland 1963.
ON 9 October 1273 at Sorde-l’Abbaye in southern Gascony, the English king Edward I negotiated a matrimonial alliance ‘per verba de futuro’ between his daughter by his queen consort, Eleanor of Castile, and the eldest son of the Aragonese infante Peter. In an age when a royal marriage was usually too important a matter to be decided by the bride and groom alone, from a parental perspective there were a number of potential political reasons for this particular match. Behind it, on the part of the Aragonese, lay, perhaps, a desire to find allies who might counter Charles of Anjou's aggressive domination of Sicily. After all, Charles had seized the Sicilian Regno from its Hohenstaufen rulers, with papal backing, between 1265 and 1268. Constance, Peter of Aragon's wife, was the daughter of Manfred (d. 1266), the last Hohenstaufen ruler of Sicily; after her nephew Corradin's execution at Charles’ hands in 1268, Constance inherited a strong claim to her father's throne there. The Aragonese might, similarly, have hoped for support against the Capetians in securing their rights to contested territories in the south of France. Peter and Edward I also probably welcomed the opportunity to strengthen the security of the Aragonese-Catalan border with Gascony. Such a concern on Edward's part is strongly suggested by the way in which a second, but ultimately ill-fated union that apparently served a broadly similar purpose was proposed just a few months later, in December 1273, this time between Edward's eldest surviving son, Henry, and Juana, the heiress to the neighbouring kingdom of Navarre. Edward I might well have felt attached to his family's remaining territories in south-west France; he had exercised personal lordship over them since 1254, when Gascony had formed part of the appanage bestowed upon Edward at the time of his own marriage.
In the midst of the diplomatic manoeuvrings of 1273, however, it is difficult to trace any particular concern for the personal welfare of the young bride-to-be and her intended groom. The mooted Anglo-Aragonese marriage did not take place straight away – Eleanor, who was the oldest English royal daughter, was still only four years old, while Alfonso, Peter's heir, was seven.
‘Munchausen's syndrome by proxy’ characteristically describes women alleged to have fabricated or induced illnesses in children under their care, purportedly to attract attention. Where conclusive evidence exists the condition's aetiology remains speculative, where such evidence is lacking diagnosis hinges upon denial of wrong-doing (conduct also compatible with innocence). How might investigators obtain objective evidence of guilt or innocence? Here, we examine the case of a woman convicted of poisoning a child. She served a prison sentence but continues to profess her innocence. Using a modified fMRI protocol (previously published in 2001) we scanned the subject while she affirmed her account of events and that of her accusers. We hypothesized that she would exhibit longer response times in association with greater activation of ventrolateral prefrontal and anterior cingulate cortices when endorsing those statements she believed to be false (i.e., when she ‘lied’). The subject was scanned 4 times at 3 Tesla. Results revealed significantly longer response times and relatively greater activation of ventrolateral prefrontal and anterior cingulate cortices when she endorsed her accusers' version of events. Hence, while we have not ‘proven’ that this subject is innocent, we demonstrate that her behavioural and functional anatomical parameters behave as if she were.
Anorexia nervosa is a mental health disorder characterised by deliberate weight loss (through restrictive eating, excessive exercise and/or purging), disordered body image, and intrusive overvalued fears of gaining weight. the National Institute for Clinical Excellence recommends that family interventions that directly address the eating disorder should be offered to children and adolescents with anorexia nervosa.
To perform a literature review to assess whether family therapy is a more effective intervention than other treatments in the management of adolescents with anorexia nervosa.
Search of PubMed, the Cochrane Library and NHS Evidence for randomised controlled trials that compared a family intervention with another treatment for anorexia nervosa in adolescence.
Results and discussion:
This literature search revealed only six randomised controlled trials investigating the use of family therapy in the treatment of adolescents with anorexia nervosa, and these all had small sample sizes. Some, but not all, of these trials suggest that family therapy may be advantageous over individual psychotherapy in terms of physical improvement (weight gain and resumption of menstruation) and reduction of cognitive distortions, particularly in younger patients. Due to the small sample sizes and the significant risk of bias (particularly information bias) in some of the studies the evidence in favour of family therapy over individual therapy is weak. in the future, larger randomised controlled trials with long term follow-up are required to assess whether family therapy is the most effective treatment for anorexia nervosa in adolescence.
Effective management of uncertainty can lead to better, more informed decisions. However, many decision makers and their advisers do not always face up to uncertainty, in part because there is little constructive guidance or tools available to help. This paper outlines six Uncertainty Principles to manage uncertainty.
Face up to uncertainty
Deconstruct the problem
Don’t be fooled (un/intentional biases)
Models can be helpful, but also dangerous
Think about adaptability and resilience
Bring people with you
These were arrived at following extensive discussions and literature reviews over a 5-year period. While this is an important topic for actuaries, the intended audience is any decision maker or advisor in any sector (public or private).
Mental health services in Cambodia required rebuilding in their entirety after their destruction during conflict in the 1970s. During the late 1990s there was rapid growth and development of professional mental health training and education. Currently, basic mental healthcare is available primarily in urban areas and is provided by a mixture of government, non-government and private services. Despite the initial rapid growth of services and the development of a national mental health strategy in 2010, significant challenges remain in achieving an acceptable, standardised level of mental healthcare nationally.
Concurrent chemotherapy with radiotherapy is the standard treatment for locoregionally advanced nasopharyngeal cancer. Cetuximab can be used in the treatment of head and neck squamous cell carcinoma. However, the randomised studies that led to approval for its use in this setting excluded nasopharyngeal cancer. In the context of limited data for the use of cetuximab in nasopharyngeal cancer in the medical literature, this review aimed to summarise the current evidence for its use in both primary and recurrent or metastatic disease.
A literature search was performed using the keywords ‘nasopharyngeal neoplasm’, ‘cetuximab’ and ‘Erbitux’.
Twenty studies were included. There were no randomised phase III trials, but there were nine phase II trials. The use of cetuximab in the treatment of nasopharyngeal carcinoma has been tested in various settings, including in combination with induction chemotherapy and concurrent chemoradiotherapy, and in the palliative setting.
There is no evidence of benefit from the addition of cetuximab to standard management protocols, and there is some evidence of increased toxicity. There is more promise for its use in metastatic or locally recurrent settings. This review draws together the existing evidence and could provide a focus for future studies.
Evidence from the literature shows that clinicians’ knowledge of rules and legislation surrounding driving can often be poor. A closed-loop audit was conducted to gauge the level of driving advice given to patients with dizziness.
The clinical notes of 100 patients referred to the vertigo clinic at a tertiary referral centre were retrospectively searched for evidence of driving advice. Education sessions were undertaken and a patient information leaflet was developed before a second cycle of the audit.
Results and conclusion
The proportion of patients having documented evidence of receiving driving advice increased from 6.3 per cent to 10.4 per cent. It is therefore clear that, despite this improvement, a significant proportion of patients’ notes did not contain documentation about driving. This is likely because of many reasons, including individual interpretation by clinicians. This paper provides a reminder of the rules, and discusses their interpretation and implementation in an increasingly medicolegal environment.
Born into a kingdom where the king prohibited female inheritance, the eponymous heroine of the thirteenth–century Old French romance Silence was raised as a boy, much to the frustration of Nature and satisfaction of Nurture. Silence's education in masculine courtly behaviour and in the arts of war as her father's only heir was so successful that ‘He (sic) [became] … a valiant and noble knight;/ no king or count was ever better’ (‘Chevaliers est vallans et buens,/ Mellor n'engendra rois ne cuens’). Silence's true gender was only unmasked when he/she captured the prophet Merlin, who could only be seized if tricked by a woman. At the end of the tale, Nature recovered ‘her rights’ (‘sa droiture’) over Silence's body and restored her feminine appearance, whereupon Silence, who became known as Silentia rather than Silentius, abandoned her masculine knightly attire and married the king.
With its focus on violence, power and knighthood, chivalry appears first and foremost as a masculine social ideal in both medieval literature and life. Carrying arms and engaging personally in knightly forms of combat were male preserves; it was unnatural for women to participate in them. As Nature admonished Silence, before she reassumed her true gender:
‘It's a very nasty thing you're doing to me, leading this sort of life.
You [as a woman] have no business going off into the forest, jousting, hunting, shooting off arrows.
Desist from all of this!’ …
‘Go to a chamber and learn to sew!’
Yet the centrality of aristocratic ladies to courtly life and lordship allowed women to participate in chivalric culture in ways that were not entirely divorced from those of their male kin. Although women often featured in romances as lovers or unattainable figures for whom aristocratic men performed various feats of arms, they also appeared as agents, rather than as purely passive recipients of male affection or admiration. This chapter considers how far chivalric practices, values and modes of conduct were gendered, and explores how far female experiences differed from those of men between the twelfth and early fourteenth centuries. It adopts a broad definition of chivalry that encompasses the lifestyles and ideals of behaviour of those persons who belonged to the aristocracy. It also recognises that chivalric literature was interwoven with gendered ideas and stereotypes that reflected many of the tenets of elite society.
To verify the previously untested assumption that eating more salad enhances vegetable intake and determine if salad consumption is in fact associated with higher vegetable intake and greater adherence to the Dietary Guidelines for Americans (DGA) recommendations.
Individuals were classified as salad reporters or non-reporters based upon whether they consumed a salad composed primarily of raw vegetables on the intake day. Regression analyses were applied to calculate adjusted estimates of food group intakes and assess the likelihood of meeting Healthy US-Style Food Pattern recommendations by salad reporting status.
Cross-sectional analysis of data collected in 2011–2014 in What We Eat in America, the dietary intake component of the National Health and Nutrition Examination Survey.
US adults (n 9678) aged ≥20 years (excluding pregnant and lactating women).
On the intake day, 23 % of adults ate salad. The proportion of individuals reporting salad varied by sex, age, race, income, education and smoking status (P<0·001). Compared with non-reporters, salad reporters consumed significantly larger quantities of vegetables (total, dark green, red/orange and other), which translated into a two- to threefold greater likelihood of meeting recommendations for these food groups. More modest associations were observed between salad consumption and differences in intake and likelihood of meeting recommendations for protein foods (total and seafood), oils and refined grains.
Study results confirm the DGA message that incorporating more salads in the diet is one effective strategy (among others, such as eating more cooked vegetables) to augment vegetable consumption and adherence to dietary recommendations concerning vegetables.