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Offending behaviour and intellectual disabilities have long been associated in the literature. This erroneous linkage has had a significant influence on the development of services for this population. In this chapter, the relationship between intellectual disability and offending behaviour is outlined, along with legislative and criminal justice system issues that have impact on this client group. The historical and current policy context is described before the prevalence of offending and recidivism in this population is considered. Developments in risk assessment and clinical interventions for anger aggression, sexually harmful behavior and firesetting are briefly reviewed. Although over the last 20 years there have been significant developments in policy, service design, clinical assessment and treatment approaches for people with intellectual disabilities who offend or are at risk of offending, more rigorous and larger scale research is required to support further advances.
The loss of methyl bromide led vegetable growers to rely more heavily on herbicides to control weeds. Although herbicides can be effective, limited options in vegetable production challenge growers. Identifying new, effective tools to be applied over plastic mulch before planting, for improved weed control with minimal crop injury, would be beneficial. The objective of these experiments was to evaluate the persistence of preplant applications of glyphosate (1,125 or 2,250 g ae ha−1) plus 2,4-D (1,065 or 2,130 g ae ha−1) or dicamba (560 g ae ha−1) over plastic mulch, using analytical techniques and subsequent yellow squash and watermelon response. Glyphosate and 2,4-D were not analytically detected at damaging concentrations on plastic mulch when at least 3.5 cm of rainfall was received after application and before planting. In addition, bioassay results showing less than 10% visual injury for either squash and watermelon, with no growth or yield suppression observed, supported analytical results. In contrast, dicamba concentrations on plastic mulch, regardless of rainfall amount or time between application and planting, remained at damaging levels. Squash yields were reduced by dicamba applied 1 to 30 d before planting, whereas watermelon was more resilient. 2,4-D plus glyphosate applied preplant over plastic mulch can provide an additional herbicide option for vegetable growers. More research is needed to understand the impact of residual activity of 2,4-D when transplants land directly in holes in plastic mulch at the time of application. The relationship of dicamba with plastic mulch is complex, because the herbicide cannot be easily removed by rainfall. Thus, dicamba should not be included in a weed management system in plasticulture vegetable production.
The first demonstration of laser action in ruby was made in 1960 by T. H. Maiman of Hughes Research Laboratories, USA. Many laboratories worldwide began the search for lasers using different materials, operating at different wavelengths. In the UK, academia, industry and the central laboratories took up the challenge from the earliest days to develop these systems for a broad range of applications. This historical review looks at the contribution the UK has made to the advancement of the technology, the development of systems and components and their exploitation over the last 60 years.
True Colours is an automated symptom monitoring programme used by National Health Service psychiatric services. This study explored whether patients with unipolar treatment-resistant depression (TRD) found this a useful addition to their treatment regimes. Semi-structured qualitative interviews were conducted with 21 patients with TRD, who had engaged in True Colours monitoring as part of the Lithium versus Quetiapine in Depression study. A thematic analysis was used to assess participant experiences of the system.
Six main themes emerged from the data, the most notable indicating that mood monitoring increased patients' insight into their disorder, but that subsequent behaviour change was absent.
Patients with TRD can benefit from mood monitoring via True Colours, making it a worthwhile addition to treatment. Further development of such systems and additional support may be required for patients with TRD to experience further benefits as reported by other patient groups.
Patent systems commonly empower courts to order accused or adjudged infringers to refrain from continuing infringing conduct in the future. Some patentees file suit for the primary purpose of obtaining and enforcing an injunction against infringement by a competitor, and even in cases in which the patentee is willing to license an invention to an accused infringer for an agreed price, the indirect monetary value of an injunction against future infringement can dwarf the amount a finder of fact is likely to award as compensation for past infringement. In some of these cases, an injunction, if granted, would impose costs on accused infringers or third parties that go well beyond the more intrinsic value of the patented technology. This chapter explores the theory behind injunctive relief in patent cases, surveys the availability of this remedy in major patent systems, and suggests a general framework for courts to use when deciding whether injunctive relief is appropriate in individual cases.
A national need is to prepare for and respond to accidental or intentional disasters categorized as chemical, biological, radiological, nuclear, or explosive (CBRNE). These incidents require specific subject-matter expertise, yet have commonalities. We identify 7 core elements comprising CBRNE science that require integration for effective preparedness planning and public health and medical response and recovery. These core elements are (1) basic and clinical sciences, (2) modeling and systems management, (3) planning, (4) response and incident management, (5) recovery and resilience, (6) lessons learned, and (7) continuous improvement. A key feature is the ability of relevant subject matter experts to integrate information into response operations. We propose the CBRNE medical operations science support expert as a professional who (1) understands that CBRNE incidents require an integrated systems approach, (2) understands the key functions and contributions of CBRNE science practitioners, (3) helps direct strategic and tactical CBRNE planning and responses through first-hand experience, and (4) provides advice to senior decision-makers managing response activities. Recognition of both CBRNE science as a distinct competency and the establishment of the CBRNE medical operations science support expert informs the public of the enormous progress made, broadcasts opportunities for new talent, and enhances the sophistication and analytic expertise of senior managers planning for and responding to CBRNE incidents.
The Transforming Care national plan for England to develop community services and close hospital beds for people with intellectual disabilities and/or autism was published in October 2015 and is due to finish in March 2019. In this editorial the key plan objectives are evaluated, with particular reference to people with intellectual disabilities and/or autism who offend or are at risk of offending. The conclusion is that, to date, the plan has failed to meet its targets to reduce the number of in-patients with intellectual disabilities and/or autism and to invest in community services, and the number of patients in independent sector beds is increasing.
We sought to define the prevalence of echocardiographic abnormalities in long-term survivors of paediatric hematopoietic stem cell transplantation and determine the utility of screening in asymptomatic patients. We analysed echocardiograms performed on survivors who underwent hematopoietic stem cell transplantation from 1982 to 2006. A total of 389 patients were alive in 2017, with 114 having an echocardiogram obtained ⩾5 years post-infusion. A total of 95 patients had echocardiogram performed for routine surveillance. The mean time post-hematopoietic stem cell transplantation was 13 years. Of 95 patients, 77 (82.1%) had ejection fraction measured, and 10/77 (13.0%) had ejection fraction z-scores ⩽−2.0, which is abnormally low. Those patients with abnormal ejection fraction were significantly more likely to have been exposed to anthracyclines or total body irradiation. Among individuals who received neither anthracyclines nor total body irradiation, only 1/31 (3.2%) was found to have an abnormal ejection fraction of 51.4%, z-score −2.73. In the cohort of 77 patients, the negative predictive value of having a normal ejection fraction given no exposure to total body irradiation or anthracyclines was 96.7% at 95% confidence interval (83.3–99.8%). Systolic dysfunction is relatively common in long-term survivors of paediatric hematopoietic stem cell transplantation who have received anthracyclines or total body irradiation. Survivors who are asymptomatic and did not receive radiation or anthracyclines likely do not require surveillance echocardiograms, unless otherwise indicated.
The landmark US Multimodal Treatment of ADHD (MTA) study established the
benefits of individualised medication titration and optimisation
strategies to improve short- to medium-term outcomes in attention-deficit
hyperactivity disorder (ADHD). This individualised medication management
approach was subsequently incorporated into the National Institute for
Health and Care Excellence (NICE) ADHD Clinical Guidelines (NICE CG78).
However, little is known about clinicians' attitudes towards implementing
these medication management strategies for ADHD in routine care.
To examine National Health Service (NHS) healthcare professionals'
consensus on ADHD medication management strategies.
Using the Delphi method, we examined perceptions on the importance and
feasibility of implementing 103 ADHD treatment statements from sources
including the UK NICE ADHD guidelines and US medication management
Certain recommendations for ADHD medication management were judged as
important and feasible to implement, including a stepwise titration of
stimulant medication. Other recommendations were perceived as important
but not feasible to implement in routine practice, such as weekly clinic
follow-up with the family during titration and collection of follow-up
Many of the key guideline recommendations for ADHD medication management
are viewed by clinicians as important and feasible to implement. However,
some recommendations present significant implementation challenges within
the context of routine NHS clinical care in England.
Research on the cities of the Classical Greek world has traditionally focused on mapping the organisation of urban space and studying major civic or religious buildings. More recently, newer techniques such as field survey and geophysical survey have facilitated exploration of the extent and character of larger areas within urban settlements, raising questions about economic processes. At the same time, detailed analysis of residential buildings has also supported a change of emphasis towards understanding some of the functional and social aspects of the built environment as well as purely formal ones. This article argues for the advantages of analysing Greek cities using a multidisciplinary, multi-scalar framework which encompasses all of these various approaches and adds to them other analytical techniques (particularly micro-archaeology). We suggest that this strategy can lead towards a more holistic view of a city, not only as a physical place, but also as a dynamic community, revealing its origins, development and patterns of social and economic activity. Our argument is made with reference to the research design, methodology and results of the first three seasons of fieldwork at the city of Olynthos, carried out by the Olynthos Project.
NHS England recently published a national plan to develop community services for people with intellectual disabilities and autism who display challenging behaviour by using resources from the closure of a large number of hospital beds. An ambitious timescale has been set to implement this plan. The bed closure programme is moving ahead rapidly, but there has been little progress in developing community services to support it. This paper discusses the impact of the gap between policy and practice on the care and safety of patients with intellectual disabilities and forensic needs who form a distinct subgroup of the target population and are being disproportionately affected by this government policy.
To investigate an outbreak of Burkholderia cepacia complex and describe the measures that revealed the source.
A 629-bed, tertiary-care, pediatric hospital in Houston, Texas.
Pediatric patients without cystic fibrosis (CF) hospitalized in the pediatric and cardiovascular intensive care units.
We investigated an outbreak of B. cepacia complex from February through July 2016. Isolates were evaluated for molecular relatedness with repetitive extragenic palindromic polymerase chain reaction (rep-PCR); specific species identification and genotyping were performed at an independent laboratory. The investigation included a detailed review of all cases, direct observation of clinical practices, and respiratory surveillance cultures. Environmental and product cultures were performed at an accredited reference environmental microbiology laboratory.
Overall, 18 respiratory tract cultures, 5 blood cultures, 4 urine cultures, and 3 stool cultures were positive in 24 patients. Among the 24 patients, 17 had symptomatic infections and 7 were colonized. The median age of the patients was 22.5 months (range, 2–148 months). Rep-PCR typing showed that 21 of 24 cases represented the same strain, which was identified as a novel species within the B. cepacia complex. Product cultures of liquid docusate were positive with an identical strain of B. cepacia complex. Local and state health departments, as well as the CDC and FDA, were notified, prompting a multistate investigation.
Our investigation revealed an outbreak of a unique strain of B. cepacia complex isolated in clinical specimens from non-CF pediatric patients and from liquid docusate. This resulted in a national alert and voluntary recall by the manufacturer.
The Laurentian Great Lakes represent the world's largest freshwater ecosystem and contain irreplaceable biodiversity. Lakewide Action and Management Plans (LAMPs) hold the highest potential for ecosystem management in the Great Lakes but have not specifically addressed biodiversity status or strategies for conservation. For four Great Lakes, recently completed biodiversity conservation strategies (blueprints) have assessed the status and threats to biodiversity and recommended strategies for conservation and restoration; a blueprint is under way also for Lake Superior. Here, we compare the completed blueprints and explore challenges to conservation planning for large ecosystems. We also assess whether earlier blueprints are being adopted and offer suggestions for more effective implementation. All of the blueprints focus on biodiversity in the lakes and coastal areas, and some include tributaries and migratory species. Biodiversity status was rated as fair (out of desirable range but restorable) in each lake, with some exceptions and considerable spatial variability. Aquatic invasive species ranked as a top threat to biodiversity in all four blueprints. Other highly ranked threats included incompatible development, climate change, terrestrial invasive species, dams and barriers, and non-point-source pollutants. The recommended strategies are characterized by six themes: coastal conservation, invasive species, connectivity and hydrology, fish restoration, nearshore water quality, and climate change. Each blueprint highlights high-priority strategies, but successful protection and restoration of Great Lakes biodiversity require revisiting these priorities in an adaptive approach.
The purpose of this article is to set the context for this special issue of Disaster Medicine and Public Health Preparedness on the allocation of scarce resources in an improvised nuclear device incident. A nuclear detonation occurs when a sufficient amount of fissile material is brought suddenly together to reach critical mass and cause an explosion. Although the chance of a nuclear detonation is thought to be small, the consequences are potentially catastrophic, so planning for an effective medical response is necessary, albeit complex. A substantial nuclear detonation will result in physical effects and a great number of casualties that will require an organized medical response to save lives. With this type of incident, the demand for resources to treat casualties will far exceed what is available. To meet the goal of providing medical care (including symptomatic/palliative care) with fairness as the underlying ethical principle, planning for allocation of scarce resources among all involved sectors needs to be integrated and practiced. With thoughtful and realistic planning, the medical response in the chaotic environment may be made more effective and efficient for both victims and medical responders.
(Disaster Med Public Health Preparedness. 2011;5:S20-S31)