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Older adults’ mental health problems are a growing public health concern, especially because their rate of mental health service use is particularly low. Decades of mental health service utilisation models have been developed, yet key assumptions from these models focus primarily on factors that facilitate or inhibit access into the treatment system without taking into considering the dynamics of how individuals respond to their mental health problems and engage in service utilisation. More recently, dynamic models like the Network Episode Model (NEM-II) have been developed to challenge the underlying, rational choice assumption of traditional utilisation models. Given the multifaceted and complex nature of older adults’ mental health problems, the objective of this study was to examine whether the NEM-II is a helpful and appropriate model for understanding the dynamic process of how older adults navigate the mental health system, including factors that advanced and delayed help-seeking. Our qualitative analyses from 15 interviews with older adults revealed that their backgrounds, social supports and treatment systems influence, and are influenced by, their illness careers. Factors that delayed help-seeking included: a lack of support, ‘inappropriate’ referrals/advice from treatment professionals and poor mental health literacy. This research suggests the NEM-II is a helpful and appropriate theory for understanding older adults’ pathways to treatment, and has implications to enhance older adults’ access to psychological services.
OBJECTIVES/GOALS: Juvenile idiopathic arthritis (JIA) is the most common childhood rheumatologic disease childhood and a cause of pain and potential disability. JIA has a strong genetic component and no known cure. The goal of this study is to evaluate allele-dependent effects of a novel JIA risk variant at 1q24.3. METHODS/STUDY POPULATION: JIA patients meeting criteria for the two most common disease subtypes (oligoarticular and RF neg polyarthritis) were genotyped using the Immunochip, an Illumina array with dense coverage of the HLA region and 186 other loci previously reported in autoimmune diseases. Phase I association findings (Hinks, 2013) and Phase II analysis (unpublished) of an expanded cohort (4,271 JIA and 14,390 controls) identified new risk loci, including rs78037977 at 1q24.3. We prioritized rs78037977 and predicted possible impacted mechanisms based on Bayesian predictions of attributable risk, the surrounding chromatin landscape, and transcription factor binding data. A luciferase reporter assay was used to assess allele-dependent enhancer activity. RESULTS/ANTICIPATED RESULTS: rs78037977 is located between FASLG and TNFSF18 at chromosome 1q24.3 is associated with JIA (p = 6.3x10−09), and explains 94% of the posterior probability at this locus; no other SNPs in linkage disequilibrium (r2>0.6). The chromatin landscape around rs78037977 contains H3K4Me1 and H3K27Ac marks, which are indicative of enhancer activity. Further, >160 transcription factors have chromatin immunoprecipitation followed by sequencing (ChIP-seq) peaks overlapping rs78037977 in various cellular contexts. In luciferase reporter assays, the region around rs78037977 containing the reference A allele had ~2-fold increased enhancer activity compared to the non-reference allele. DISCUSSION/SIGNIFICANCE OF IMPACT: This work provides in vitro evidence to support allele-dependent enhancer activity of a novel JIA-risk variant at 1q24.3. Our ongoing work investigates the effect of the DNA-containing region of rs78037977 on gene expression and differential transcription factor binding at rs78037977.
Dietary patterns describe the combination of foods and beverages in a diet and the frequency of habitual consumption. Better understanding of childhood dietary patterns and antenatal influences could inform intervention strategies to prevent childhood obesity. We derived empirical dietary patterns in 1142 children (average age 6·0 (sd 0·2) years) in New Zealand, whose mothers had participated in the Screening for Pregnancy Endpoints (SCOPE) cohort study and explored associations with measures of body composition. Participants (Children of SCOPE) had their diet assessed by FFQ, and dietary patterns were extracted using factor analysis. Three distinct dietary patterns were identified: ‘Healthy’, ‘Traditional’ and ‘Junk’. Associations between dietary patterns and measures of childhood body composition (waist, hip, arm circumferences, BMI, bioelectrical impedance analysis-derived body fat % and sum of skinfold thicknesses (SST)) were assessed by linear regression, with adjustment for maternal influences. Children who had higher ‘Junk’ dietary pattern scores had 0·24 (sd 0·08; 95 % CI 0·04, 0·13) cm greater arm and 0·44 (sd 0·05; 95 % CI 0·01, 0·10) cm greater hip circumferences and 1·13 (sd 0·07; 95 % CI 0·03, 0·12) cm greater SST and were more likely to be obese (OR 1·74; 95 % CI 1·07, 2·82); those with higher ‘Healthy’ pattern scores were less likely to be obese (OR 0·62; 95 % CI 0·39, 1·00). In a large mother–child cohort, a dietary pattern characterised by high-sugar and -fat foods was associated with greater adiposity and obesity risk in children aged 6 years, while a ‘Healthy’ dietary pattern offered some protection against obesity. Targeting unhealthy dietary patterns could inform public health strategies to reduce the prevalence of childhood obesity.
Flapping wings of insects can follow various complex-motion waveforms, influencing the flow structures over a wing and consequently the aerodynamic performance. However, most studies of insect-wing models incorporate either simple harmonic or robofly-like motion waveforms. The effects of other waveforms appear to be under-explored. Motivated by this, the present study investigates the individual and combined effects of the sweep- and pitch-motion waveforms for fixed flapping frequency and amplitude of a fruit-fly wing planform. Physical experiments are conducted to directly measure the forces and torques acting on the wing. Interestingly, the sweep waveform is observed to influence the overall variation in the lift coefficient (
), whereas the pitch waveform is observed to influence only the instantaneous
during stroke reversal. Carefully validated three-dimensional numerical simulations reveal that a change in the strength of the large-scale vortex over the wing as the sweep profile parameter is varied is responsible for the observed variations in
. An exploration over wide ranges of the sweep and the pitch profile parameters shows that the waveforms maximising the mean lift coefficient are different from those maximising the power economy. Consistent with some previous experiments on robotic insects, the possibility of passive pitch motion is observed at slower pitching rates. Contours of the mean lift coefficient and power economy mapped on the planes of the sweep and the pitch profile parameters can help designers of flapping-wing micro air vehicles in selecting the waveforms appropriate for their design criteria.
Cybermentoring refers to virtual peer support in which young people themselves are trained as cybermentors and interact with those needing help and advice (cybermentees) online. This article describes the training in, and implementation of, a cross-national cybermentoring scheme, Beatbullying Europe, developed in the United Kingdom. It involved train-the-trainer workshops for partners and life mentors in six European countries (Italy, Spain, Portugal, Romania, Poland and the Czech Republic) in 2013–2014, followed by training sessions for pupil cybermentors aged 11–16 years. Although BeatBullying went into liquidation in November 2014, the project was largely completed. We (1) report an evaluation of the training of the life mentors and mentors, via questionnaire survey; and (2) discuss findings about the implementation of the scheme and its potential at a cross-national level, via partner interviews during and at the end of the project. The training was found to be highly rated in all respects, and in all six countries involved. The overall consensus from the data available is that there was a positive impact for the schools and professionals involved; some challenges encountered are discussed. The BeatBullying Europe project, despite being unfinished, was promising, and a similar approach deserves further support and evaluation in the future.
The rocky shores of the north-east Atlantic have been long studied. Our focus is from Gibraltar to Norway plus the Azores and Iceland. Phylogeographic processes shape biogeographic patterns of biodiversity. Long-term and broadscale studies have shown the responses of biota to past climate fluctuations and more recent anthropogenic climate change. Inter- and intra-specific species interactions along sharp local environmental gradients shape distributions and community structure and hence ecosystem functioning. Shifts in domination by fucoids in shelter to barnacles/mussels in exposure are mediated by grazing by patellid limpets. Further south fucoids become increasingly rare, with species disappearing or restricted to estuarine refuges, caused by greater desiccation and grazing pressure. Mesoscale processes influence bottom-up nutrient forcing and larval supply, hence affecting species abundance and distribution, and can be proximate factors setting range edges (e.g., the English Channel, the Iberian Peninsula). Impacts of invasive non-native species are reviewed. Knowledge gaps such as the work on rockpools and host–parasite dynamics are also outlined.
Folic acid (FA) supplementation is recommended in the periconceptional period, for the prevention of neural tube defects. Limited data are available on the folate status of New Zealand (NZ) pregnant women and its association with FA supplementation intake. Objectives were to examine the relationship between plasma folate (PF) and reported FA supplement use at 15 weeks’ gestation and to explore socio-demographic and lifestyle factors associated with PF. We used data and blood samples from NZ participants of the Screening for Pregnancy Endpoints cohort study. Healthy nulliparous women with singleton pregnancy (n 1921) were interviewed and blood samples collected. PF was analysed via microbiological assay. Of the participants, 73 % reported taking an FA supplement at 15 weeks’ gestation – of these, 79 % were taking FA as part of/alongside a multivitamin supplement. Of FA supplement users, 56 % reported consuming a daily dose of ≥800 μg; 39 % reported taking less than 400 µg/d. Mean PF was significantly higher in women reporting FA supplementation (54·6 (se 1·5) nmol/l) v. no FA supplementation (35·1 (se 1·6) nmol/l) (P<0·0001). Reported daily FA supplement dose and PF were significantly positively correlated (r 0·41; P<0·05). Younger maternal age, Pacific and Maori ethnicity and obesity were negatively associated with PF levels; vegetarianism was positively associated with PF. Reported FA supplement dose was significantly associated with PF after adjustment for socio-demographic, lifestyle confounders and multivitamin intake. The relationship observed between FA supplementation and PF demonstrates that self-reported intake is a reliable proxy for FA supplement use in this study population.
The repeated patterns of metropolitan urban activities that act as palimpsest in Chaucer’s fiction also impose themselves on our understanding of his place and achievement in late medieval and early modern London book history. The London Chaucer legacy takes on many different, often quasi-autobiographical, forms in the two hundred years following his death. Sensitivity to the dynamics of reader response inherent in his fiction among near contemporary and later writers ensured Chaucer’s works remained an important part of a vibrant metropolitan English literary culture. The making and celebration of an English past that glorified London remained a high priority within that culture among the book producers, copyists and printers who also serve as the first chroniclers of London’s Chaucer.
Wing shape is an important factor affecting the aerodynamic performance of wings of monocopters and flapping-wing micro air vehicles. Here, an evolutionary structural optimisation method is adapted to optimise wing shape to enhance the lift force due to aerodynamic pressure on the wing surfaces. The pressure distribution is observed to vary with the span-based Reynolds number over a range covering most insects and samaras. Accordingly, the optimised wing shapes derived using this evolutionary approach are shown to adjust with Reynolds number. Moreover, these optimised shapes exhibit significantly higher lift coefficients (
) than the initial rectangular wing forebear. Interestingly, the optimised shapes are found to have a large area outboard, broadly in line with the features of high-lift forewings of multi-winged insects. According to specific aerodynamic performance requirements, this novel method could be employed in the optimisation of improved wing shapes for micro air vehicles.
Many children have sound intuitions about the mathematical patterns in our world that become extended and refined as they learn in educational and informal settings. This chapter examines how children’s understanding of fractions develops, considering their early competence with nonsymbolic fractions as well as later difficulties with symbolic fractions. Along the way, key methodological contributions and concerns are discussed, with the novice developmental scientist in mind.
The individual and combined influences of aspect ratio (
), Reynolds number (
) and Rossby number (
) on the leading-edge vortex (LEV) of a rotating wing of insect-like planform are investigated numerically. A previous study from our group has determined the wingspan to be an appropriate length scale governing the large-scale LEV structure. In this study, the
range considered is further extended, to show that this scaling works well as
is varied by a factor of 4 (
$1.8\leqslant A\leqslant 7.28$
) and over a
range of two orders of magnitude. The present study also extends this scaling for wings with an offset from the rotation axis, which is typically the case for actual insects and often for experiments. Remarkably, the optimum range of
based on the lift coefficients at different
coincides with that observed in nature. The scaling based on the wingspan is extended to the acceleration terms of the Navier–Stokes equations, suggesting a modified scaling of
, which decouples the effects of
. A detailed investigation of the flow structures, by increasing
in a wide range, reveals the weakening of the LEV due to the reduced spanwise flow, resulting in a reduced lift. Overall, the use of span-based scaling of
, together with
, may help reconcile apparent conflicting trends between observed variations in aerodynamic performance in different sets of experiments and simulations.
Two central features of global history over the past century have been the pre-eminent power of the United States in world politics and the growth of international organizations. The relationship between these phenomena has been variously interpreted, in ways that reflect theoretical and methodological commitments as well as political perspectives. The Realist school, for whom power relationships are always determinative, have followed Carl Schmitt and E. H. Carr in seeing international institutions, and the norms and laws they uphold, as instruments through which dominant powers seek legitimacy as well as influence. By contrast, liberal theorists have viewed the pursuit of a rule-governed world order, and the development of the idea of a ‘world community’, as a more autonomous and broadly based enterprise, one spurred by increased interdependence and greater concern with matters of common interest to all nations – not least that of avoiding the devastating effects of great power warfare in the modern era. As is usually the case with such analytically sharp distinctions, neither of these positions conveys the whole truth. From the Concert of Europe on, great powers have recognized a collective interest in peace and stability but the growth of international institutions has also been the product of wider ideals and interests. As Mark Mazower has shown in his wide-ranging study, Governing the world, the relationship between the narrower interests of great powers on the one hand and various forms of internationalism on the other has been a complex one, involving elements both of conflict and of congruence. But, Mazower emphasizes, since the Second World War, the structure and activities of the United Nations, the International Monetary Fund, the World Bank, and other international organizations have been largely shaped by Washington. A generation earlier, however, the United States did not even become a member of the League of Nations, making it more possible to distinguish between the role of American power and that of other sources of support for international bodies, and also to assess the relationship and comparative importance of these two novel elements in world politics. It is perhaps not surprising that much of the recent scholarship on the international history of the post-First World War period has focused, in one way or another, on this issue.
Children with CHD and acquired heart disease have unique, high-risk physiology. They may have a higher risk of adverse tracheal-intubation-associated events, as compared with children with non-cardiac disease.
Materials and methods
We sought to evaluate the occurrence of adverse tracheal-intubation-associated events in children with cardiac disease compared to children with non-cardiac disease. A retrospective analysis of tracheal intubations from 38 international paediatric ICUs was performed using the National Emergency Airway Registry for Children (NEAR4KIDS) quality improvement registry. The primary outcome was the occurrence of any tracheal-intubation-associated event. Secondary outcomes included the occurrence of severe tracheal-intubation-associated events, multiple intubation attempts, and oxygen desaturation.
A total of 8851 intubations were reported between July, 2012 and March, 2016. Cardiac patients were younger, more likely to have haemodynamic instability, and less likely to have respiratory failure as an indication. The overall frequency of tracheal-intubation-associated events was not different (cardiac: 17% versus non-cardiac: 16%, p=0.13), nor was the rate of severe tracheal-intubation-associated events (cardiac: 7% versus non-cardiac: 6%, p=0.11). Tracheal-intubation-associated cardiac arrest occurred more often in cardiac patients (2.80 versus 1.28%; p<0.001), even after adjusting for patient and provider differences (adjusted odds ratio 1.79; p=0.03). Multiple intubation attempts occurred less often in cardiac patients (p=0.04), and oxygen desaturations occurred more often, even after excluding patients with cyanotic heart disease.
The overall incidence of adverse tracheal-intubation-associated events in cardiac patients was not different from that in non-cardiac patients. However, the presence of a cardiac diagnosis was associated with a higher occurrence of both tracheal-intubation-associated cardiac arrest and oxygen desaturation.
This study aimed to (1) explore how palliative care in long-term care (LTC) addresses the tensions associated with caring for the living and dying within one care community, and (2) to inform how palliative care practices may be improved to better address the needs of all residents living and dying in LTC as well as those of the families and support staff. This article reports findings from 19 focus groups and 117 participants. Study findings reveal that LTC home staff, resident, and family perspectives of end-of-life comfort applied to those who were actively dying and to their families. Our findings further suggest that eliciting residents’ perceptions of end-of-life comfort, sharing information about a fellow resident’s death more personally, and ensuring that residents, families, and staff can constructively participate in providing comfort care to dying residents could extend the purview of end-of-life comfort and support expanded integration of palliative principles within LTC.
Recession of the Laurentide Ice Sheet from northern New Hampshire was interrupted by the Littleton-Bethlehem (L-B) readvance and deposition of the extensive White Mountain Moraine System (WMMS). Our mapping of this moraine belt and related glacial lake sequence has refined the deglaciation history of the region. The age of the western part of the WMMS is constrained to ~14.0–13.8 cal ka BP by glacial Lake Hitchcock varves that occur beneath and above L-B readvance till and were matched to a revised calibration of the North American Varve Chronology presented here. Using this age for when boulders were deposited on the moraines has enabled calibration of regional cosmogenic-nuclide production rates to improve the precision of exposure dating in New England. The L-B readvance coincided with the Older Dryas (OD) cooling documented by workers in Europe and the equivalent GI-1d cooling event in the Greenland Ice Core Chronology 2005 (GICC05) time scale. The readvance and associated moraines provide the first well-documented and dated evidence of the OD event in the northeastern United States. Our lake sediment cores show that the Younger Dryas cooling was likewise prominent in the White Mountains, thus extending the record of this event westward from Maine and Maritime Canada.
The debate which is evoked by this title goes well beyond the limits of a discussion about the foundations of the social sciences. It raises the question of what I shall call the fundamental gesture of philosophy. Is this gesture an avowal of the historical conditions to which all human understanding is subsumed under the reign of finitude? Or rather is it, in the last analysis, an act of defiance, a critical gesture, relentlessly repeated and indefinitely turned against ‘false consciousness’, against the distortions of human communication which conceal the permanent exercise of domination and violence? Such is the philosophical stake of a debate which at first seems tied to the epistemological plane of the human sciences. What is at stake can be expressed in terms of an alternative: either a hermeneutical consciousness or a critical consciousness. But is it really so? Is it not the alternative itself which must be challenged? Is it possible to formulate a hermeneutics which would render justice to the critique of ideology, which would show the necessity of the latter at the very heart of its own concerns? Clearly the stake is considerable. We are not going to risk everything by beginning with terms which are too general and an attitude which is too ambitious. We shall, instead, focus on a contemporary discussion which presents the problem in the form of an alternative. Even if ultimately this alternative must be surpassed, we shall not be in ignorance of the difficulties to be overcome.
The principal protagonists in the debate are, on the side of hermeneutics, Hans-Georg Gadamer; and on the side of critique, Jürgen Habermas. The dossier of their polemic is now public, partially reproduced in the little volume entitled Hermeneutik und Ideologiekritik. It is from this dossier that I shall extract the lines of force which characterise the conflict between hermeneutics and the critical theory of ideology. I shall take the assessment of tradition by each of these philosophies as the touchstone of the debate. In contrast to the positive assessment by hermeneutics, the theory of ideology adopts a suspicious approach, seeing tradition as merely the systematically distorted expression of communication under unacknowledged conditions of violence. The choice of this touchstone has the advantage of bringing to the fore a confrontation which bears upon the ‘claim to universality’ of hermeneutics.