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 firstname.lastname@example.org
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.
Data on species trade profiles and volumes of wild animals on sale in local markets can provide useful insights into the bushmeat trade, enabling identification of priorities for management and conservation planning. We monitored bushmeat traded in three markets (Sandema, Chiana and Fumbisi) in the Upper East Region of Ghana during October 2018–October 2019. More than 80% of carcasses sold were amphibians (frogs). Species composition and volumes of bushmeat traded varied significantly across markets. Bushmeat sales were highest during the dry season (75% of total biomass traded). The bulk (60% of total biomass) traded in the local markets was transported long distances for resale in major urban markets in southern Ghana. Large-bodied species were comparatively low in number and sold almost exclusively for resale in southern markets. This study highlights the importance of frog meat as an affordable protein source for consumers and as income for traders in an economically deprived region. Seasonal fluctuations of bushmeat sales demonstrated the importance of bushmeat as part of a diversified livelihood strategy for hunters and traders. Furthermore, this study underscores the significant role that long-distance trade networks play as key drivers of the bushmeat trade in these parts of northern Ghana, and highlights the risks posed by current extraction levels for species conservation in this understudied region. Our recommendations include investigating the potential of sustainable amphibian production, improving protection of particular vulnerable species and of the protected areas in the region and exploring alternative livelihoods during the peak hunting season.
Inequalities in health outcomes, and avoidable deaths, in people with intellectual disability has highlighted the need for improved training and education in Intellectual Disability and Autism. Simulation training facilitated by actors with intellectual disability has been shown to improve connection with people with intellectual disability (Attoe et al 2017). The aim of this project was to develop a simulation-based training course, focused on topics in mental health, intellectual disability and autism, to improve participant confidence in clinical knowledge and skills, as well as support leadership and professionalism training. Here we evaluate the impact of the training on participants’ confidence, and the longer-term effect on attitudes and working practice after attendance.
A novel simulation-based training course, directed at Specialty Trainees, was developed based on the Specialty Training in Learning Disability curriculum. The course was co-delivered by a person with intellectual disability. Participants who attended the simulation training completed general feedback, pre-course and post-course confidence questionnaires and attended a semi-structured group interview at 2 months. Questionnaire data weres analysed using descriptive and inferential statistics. Group interview data were analysed using open & axial coding, and thematic analysis of content. The project was approved by East London NHS Foundation Trust Governance and Ethics Committee for Studies and Evaluations.
Eight psychiatrists participated in the training and completed the pre-course and post-course questionnaires. Independent t-test found significant increase in confidence for all scores from pre-course (M = 6.54, SE0.24) to post-course (M = 7.81, SE = 0.36), t= –2.93 p = 0.01. This included ratings of confidence in knowledge in areas such as mental health legislation, and improved confidence in skills such as communication with families of people with intellectual disability and difficult conversations with senior supervisors. In follow-up interviews we elucidated themes of the importance of supported, structured training opportunities with people with intellectual disability, and the value of connection with peers and supervisors.
Simulation based training in psychiatry, co-delivered with actors with intellectual disability, was reported to be an engaging and enjoyable form of learning. The evaluation suggests such training is effective in increasing trainee confidence in knowledge and skills at the time of training as well as resulting in a lasting change in attitudes after the training. We recommend such training be further developed and delivered at both postgraduate and undergraduate level.
Tacitus’ Germania is notable for its absences: lacking a preface and programmatic statements, and being the only ethnographic monograph to have survived from Greco-Roman antiquity, readers have often leapt to fill in its perceived blanks. This chapter aims at redressing the effects of overdetermined readings by interpreting the text’s absences as significant in their own right.
This article is a discussion of Plin. Ep. 7.29 and Ep. 8.6, in which he presents his reaction to seeing the grave monument of Marcus Antonius Pallas, the freedman and minister of the Emperor Claudius, beside the Via Tiburtina. The monument records a senatorial vote of thanks to Pallas, and Pliny expresses intense indignation at the Senate's subservience and at the power and influence wielded by a freedman. This article compares Pliny's letters with Tacitus’ account of the senatorial vote of thanks to Pallas at Ann. 12.52–3 and explores the differences between the ways in which the two authors encourage readers to relate to past events. It is noted that the Pallas letters are unusual amongst Pliny's letters for their treatment of material unconnected with the life and career of Pliny and his friends, and argued that in Ep. 7.29 Pliny uses language and attitudes drawn from satire to evoke the past. Ep. 8.6 is read as an idiosyncratic piece of historical enquiry, considering Pliny's use of citation and his anonymization of historical individuals. Both letters are considered in the context of the surrounding letters, and a hypothesis is offered regarding the identity of their addressee Montanus, considering evidence from Tacitus’ Histories and Annals. Discussion of Tac. Ann. 12.52–3 focusses on the use of irony. Pliny's evocation of enargeia (‘vividness’) is compared with that of Tacitus. The article concludes with comparison of the historical accounts offered by Pliny and Tacitus through reflection on Juvenal, Satire 1.
Over the past decade, the World Health Summit (WHS) has provided a global platform for policy-makers and decision-makers to interact with academics and practitioners on global health. Recently the WHS adopted health security into their agenda for transnational disease risks (eg, Ebola and antimicrobial resistance) that increasingly threaten multiple sectors. Global health engagement (GHE) focuses efforts across interdisciplinary and interorganizational lines to identify critical threats and provide rapid deployment of key resources at the right time for addressing health security risks. As a product of subject matter experts convening at the WHS, a special side-group has organically risen with leadership and coordination from the German Institute for Defense and Strategic Studies in support of GHE activities across governmental, academic, and industry partners. Through novel approaches and targeted methodology that maximize outcomes and streamline global health operational process, the Global Health Security Alliance (GloHSA) was born. This short conference report describes in more detail the GloHSA.
Milrinone may be an appropriate adjuvant therapy for infants with persistent pulmonary hypertension of the newborn. We aimed to describe the effect of milrinone administration on right and left ventricular function in infants with persistent pulmonary hypertension not responding to inhaled nitric oxide after 4 hours of administration.
Materials and methods
This is a retrospective review of infants born after or at 34 weeks of gestation with persistent pulmonary hypertension who received milrinone treatment. The primary endpoint was the effect of milrinone on myocardial performance and haemodynamics, including right and left ventricular outputs, tissue Doppler velocities, right ventricle and septal strain, and strain rate. Secondary endpoints examined included duration of inhaled nitric oxide and oxygen support.
A total of 17 infants with a mean (standard deviation) gestation and birth weight of 39.8 (2.0) weeks and 3.45 (0.39) kilograms, respectively, were included in the study. The first echocardiogram was performed 15 hours after the commencement of nitric oxide inhalation. Milrinone treatment was started at a median time of 1 hour after the echocardiogram and was associated with an increase in left ventricular output (p=0.04), right ventricular output (p=0.004), right ventricle strain (p=0.01) and strain rate (p=0.002), and left ventricle s` (p<0.001) and a` (p=0.02) waves. There was a reduction in nitric oxide dose and oxygen requirement over the subsequent 72 hours (all p<0.05).
The use of milrinone as an adjunct to nitric oxide is worth further exploration, with preliminary evidence suggesting an improvement in both oxygenation and myocardial performance in this group of infants.
There is little information on the changing role of bushmeat hunting in the agricultural areas of West Africa. We assessed the status and role of bushmeat hunting and rural consumption in three communities in Ghana, through household surveys (n = 250), and interviews with hunters (n = 69), eatery owners (n = 18) and bushmeat traders (n = 3). Hunting was embedded within dynamic livelihood strategies, with two broad categories of hunters identified: a large group who targeted pests on their own farms using traps, and a smaller group of professional hunters. The professional hunters included a group of young men who hunted with dogs, and another group of older firearm hunters who tended to be members of Hunters’ Associations. All professional hunters reported a decline in bushmeat availability and expressed concerns about the viability of hunting as a livelihood. The frequency of consumption of bushmeat increased with distance from the region's main urban centre, Kumasi, but bushmeat was not found to be a major component of the diet in any of the villages. Few men self-identified as hunters, although bushmeat hunting continued to play an important role in the rural economy, primarily for crop protection. Conservation efforts need to consider the full spectrum of hunting behaviours. Specific measures should target forest-based hunters, who are more likely to damage forest ecosystems than crop pest hunters but also show more concern for the sustainability of hunting, and commitment to hunting as an institution.
Snowpack base temperatures vary during accumulation and diurnally. Their measurement provides insight into physical, biological and chemical processes occurring at the snow/soil interface. Recent advances in Raman-spectra instruments, which use the scattered light in a standard telecommunications fiber-optic cable to infer absolute temperature along the entire length of the fiber, offer a unique opportunity to obtain basal snow temperatures at resolutions of 1 m, 10 s and 0.1°C. Measurements along a 330 m fiber over 24 hours during late-spring snowmelt at Mammoth Mountain, California, USA, showed basal snow temperatures of 0 ± 0.2°C using 10 s averages. Where the fiber-optic cable traversed bare ground, surface temperatures approached 40°C during midday. The durability of the fiber optic was excellent; no major damage or breaks occurred through the winter of burial. Data from the Dry Creek experimental watershed in Idaho across a small stream valley showed little variability of temperature on the northeast-facing, snow-covered slope, but clearly showed melting patterns and the effects of solar heating on southwest-facing slopes. These proof-of-concept experiments show that the technology enables more detailed spatial and temporal coverage than traditional point measurements of temperature.
The past two decades of fighting the HIV/AIDS epidemic has led to an explosion of therapies developed to limit viral replication or to combat the complications of HIV infection. More antiviral agents are licensed and available to treat HIV than any other viral infection. In the USA, 20 drugs are currently approved in adults for use in HIV infection and 12 have pediatric label information. These approvals are the result of hundreds of clinical studies performed in adults and children through collaborations of clinical investigators, industry, and government partners to support drug development. All too frequently, clinicians find that drugs approved for use in adults or some pediatric populations have insufficient dosing information for their younger patients. Pediatricians know that children are not just small adults. Typically dose recommendations for children are not obtained by simply scaling an adult dose by weight. Additionally, potential risks may well be different in a child that is growing and developing. As a result we have a critical need to conduct clinical studies in children to ensure that they too have the potential to benefit from drug discoveries that are of benefit to older patient populations. It is well recognized though, that children, since they are not able to consent for research themselves, are a population that warrant special protections. Thus, clinical trials in pediatric populations are conducted with due caution for the child's safety while being balanced with moving forward as quickly as possible to open new treatment options.
The epilepsies represent a heterogeneous group of disorders with diverse etiologies, electrographical and behavioral seizure patterns, and pharmacological sensitivities. The subtype termed complex partial epilepsy (Commission on Classification and Terminology of the ILAE, 1981) is one of the most devastating forms of human epilepsy. Complex partial seizures (CPSs) constitute the single most common seizure type, accounting for approximately 40% of all cases in adults (Hauser & Kurland, 1975). CPSs are often quite resistant to available anticonvulsant drugs; only 25% of adults with CPS experience complete seizure control despite optimal contemporaneous treatment (Mattson et al., 1985). CPSs induce impairment of consciousness, thereby limiting performance of many tasks, such as driving a motor vehicle; as a result, finding and maintaining employment is difficult for sufferers. Complex partial epilepsy is a major public health problem affecting at least 800 000 people in the United States alone.
Insight into the mechanisms underlying this disorder is limited. Three main questions arise, (a) What is(are) the mechanism(s) underlying the expression of the hyperexcitability? (b) How does hyperexcitability develop? (c) Why does hyperexcitability persist? Developing answers to these questions in cellular and molecular terms may lead to more effective therapy, prevention, or even cure of this disorder.
Email your librarian or administrator to recommend adding this to your organisation's collection.