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 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 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.
Mental Health, Diabetes and Endocrinology examines the main areas of clinical overlap between endocrinology and mental health to address key clinical conundrums. Drawing on the most recent developments from literature and clinical practice, this book gives specific attention to the main areas where clinical conundrums and treatment challenges arise across endocrinology, psychiatry, psychology and primary care. Common challenges in this area include depression which can impact on the person's ability to self-care and to adhere to treatment with consequences for their morbidity and mortality; 'diabulaemia' associated with high mortality rates; obesity and associated mental disorders; cognitive impairment and mental capacity; anti-psychotic medications and their endocrine sequelae; and specific setting-related considerations. Mental Health, Diabetes and Endocrinology is a useful resource for the overlapping conditions across these specialities, and provides clinically-focussed evidence-based resources for all health care professionals who encounter these issues.
Trypanosomes are blood-borne parasites that can infect a variety of different vertebrates, including animals and humans. This study aims to broaden scientific knowledge about the presence and biodiversity of trypanosomes in Australian bats. Molecular and morphological analysis was performed on 86 blood samples collected from seven different species of microbats in Western Australia. Phylogenetic analysis on 18S rDNA and glycosomal glyceraldehyde phosphate dehydrogenase (gGAPDH) sequences identified Trypanosoma dionisii in five different Australian native species of microbats; Chalinolobus gouldii, Chalinolobus morio, Nyctophilus geoffroyi, Nyctophilus major and Scotorepens balstoni. In addition, two novels, genetically distinct T. dionisii genotypes were detected and named T. dionisii genotype Aus 1 and T. dionisii genotype Aus 2. Genotype Aus 2 was the most prevalent and infected 20.9% (18/86) of bats in the present study, while genotype Aus 1 was less prevalent and was identified in 5.8% (5/86) of Australian bats. Morphological analysis was conducted on trypomastigotes identified in blood films, with morphological parameters consistent with trypanosome species in the subgenus Schizotrypanum. This is the first report of T. dionisii in Australia and in Australian native bats, which further contributes to the global distribution of this cosmopolitan bat trypanosome.
The importance of spring grass in the diet of early lactation dairy cows has been widely acknowledged. Numerous studies completed on a plot/paddock basis have identified methods of increasing herbage availability in spring, but little focus was placed on how this impacts animal production. The aim of the current study was to investigate the impact of opening farm cover (OFC; grass availability on farm at turnout in spring; 1036 (high), 748 (medium) and 544 (low) kg DM/ha) and spring rotation length (fast – 56 days and normal – 63 days) on animal performance in early lactation and herbage production and quality. Spring rotation length had little effect on animal performance, herbage variables or sward composition. High OFC increased pre-grazing herbage mass, allowing for increased daily herbage allowance (DHA) compared to medium and low OFC. There was a reduced proportion of leaf in the sward of the high OFC compared to the low OFC, resulting in lower organic matter digestibility. Despite the reduction in sward quality observed as a consequence of achieving high OFC in spring, the greater DHA available to animals increased milk production (+1.4 kg milk/cow/day). Additionally, animals grazing a medium or low OFC had a greater requirement for silage supplementation in spring (+1.3 kg DM/cow/day). The benefits of the higher DHA highlighted in the current study suggest that autumn grazing management must be adapted to increase herbage availability in spring. However, the benefits observed in milk production did not persist beyond the first grazing rotation.
Cyber Operational Risk: Cyber risk is routinely cited as one of the most important sources of operational risks facing organisations today, in various publications and surveys. Further, in recent years, cyber risk has entered the public conscience through highly publicised events involving affected UK organisations such as TalkTalk, Morrisons and the NHS. Regulators and legislators are increasing their focus on this topic, with General Data Protection Regulation (“GDPR”) a notable example of this. Risk actuaries and other risk management professionals at insurance companies therefore need to have a robust assessment of the potential losses stemming from cyber risk that their organisations may face. They should be able to do this as part of an overall risk management framework and be able to demonstrate this to stakeholders such as regulators and shareholders. Given that cyber risks are still very much new territory for insurers and there is no commonly accepted practice, this paper describes a proposed framework in which to perform such an assessment. As part of this, we leverage two existing frameworks – the Chief Risk Officer (“CRO”) Forum cyber incident taxonomy, and the National Institute of Standards and Technology (“NIST”) framework – to describe the taxonomy of a cyber incident, and the relevant cyber security and risk mitigation items for the incident in question, respectively.Summary of Results: Three detailed scenarios have been investigated by the working party:
∙ Employee leaks data at a general (non-life) insurer: Internal attack through social engineering, causing large compensation costs and regulatory fines, driving a 1 in 200 loss of £210.5m (c. 2% of annual revenue).
∙ Cyber extortion at a life insurer: External attack through social engineering, causing large business interruption and reputational damage, driving a 1 in 200 loss of £179.5m (c. 6% of annual revenue).
∙ Motor insurer telematics device hack: External attack through software vulnerabilities, causing large remediation / device replacement costs, driving a 1 in 200 loss of £70.0m (c. 18% of annual revenue).
Limitations: The following sets out key limitations of the work set out in this paper:
∙ While the presented scenarios are deemed material at this point in time, the threat landscape moves fast and could render specific narratives and calibrations obsolete within a short-time frame.
∙ There is a lack of historical data to base certain scenarios on and therefore a high level of subjectivity is used to calibrate them.
∙ No attempt has been made to make an allowance for seasonality of renewals (a cyber event coinciding with peak renewal season could exacerbate cost impacts)
∙ No consideration has been given to the impact of the event on the share price of the company.
∙ Correlation with other risk types has not been explicitly considered.
Conclusions: Cyber risk is a very real threat and should not be ignored or treated lightly in operational risk frameworks, as it has the potential to threaten the ongoing viability of an organisation. Risk managers and capital actuaries should be aware of the various sources of cyber risk and the potential impacts to ensure that the business is sufficiently prepared for such an event. When it comes to quantifying the impact of cyber risk on the operations of an insurer there are significant challenges. Not least that the threat landscape is ever changing and there is a lack of historical experience to base assumptions off. Given this uncertainty, this paper sets out a framework upon which readers can bring consistency to the way scenarios are developed over time. It provides a common taxonomy to ensure that key aspects of cyber risk are considered and sets out examples of how to implement the framework. It is critical that insurers endeavour to understand cyber risk better and look to refine assumptions over time as new information is received. In addition to ensuring that sufficient capital is being held for key operational risks, the investment in understanding cyber risk now will help to educate senior management and could have benefits through influencing internal cyber security capabilities.
A 4-year (2010–2013) plot study was undertaken to evaluate the effect of nitrogen (N) fertilizer rate (0, 60, 120, 196 and 240 kg N/ha/year) on seasonal responses and species persistency in frequently and tightly grazed (⩽4 cm) grass-only (GO) and grass white clover swards (GWc). Increasing N application rate increased herbage removed and pre-grazing sward height. Cows frequently grazed the GWc tighter than the GO. Increasing N rate reduced clover content, especially during the warmest months of the year, but less so up to 120 kg N/ha/year. The GWc had greater amounts of herbage removed than GO in the May–September period but the effect was less as N rate increased. Cumulative herbage removed from GWc was greater than GO swards receiving the same N rate and herbage quality was better in GWc than GO. Such effects were reduced as swards aged and with increasing N rate. It was concluded that under frequent and tight grazing management: (1) clover inclusion increased annual herbage removed; (2) herbage removed from GWc swards receiving no N was the same as the GO sward receiving 240 kg N/ha, and greater for the 240 GWc swards than the 240 GO swards; (3) clover inclusion benefits were mainly from summer onwards; (4) the management strategy applied in the current experiment may be capable of alleviating the detrimental effect of N fertilizer on clover, to a point between 60 and 120 kg N/ha.
Introduction: Resuscitation is a dynamic, complex and time-sensitive field which encompasses management of both critically-ill patients as well as large multidisciplinary teams. Expertise in this area has not been adequately defined, and to date, no research has directly examined the decision-making and cognitive processes involved. The evolving paradigm of competency-based medical education (CBME) makes better defining expertise in this field of critical importance to aid in the development of both educational and assessment methods. The technique of cognitive task analysis (CTA) has been used in a variety of fields to explicate the cognitive underpinnings of experts. Experts, however, often have limited insight and incomplete recall of their decision-making processes. We hypothesized that the use of eye-tracking, which provides the combination of first-person video as well as an overlying gaze indicator, could be used to enhance CTA to better understand the defining characteristics of experts in resuscitation. Methods: Over an 18-month period a sample of 11 traumatic resuscitations were obtained, each led by one of four pre-selected expert physicians outfitted with the Tobii Pro Eye-Tracking Glasses. After each resuscitation, the participant was debriefed using a cued-recall, think-aloud protocol while watching his or her corresponding eye-tracking video. A subsequent qualitative analysis of the resulting video and debrief transcript was performed using an ethnographic approach to establish emerging themes and behaviours of the expert physicians. Results: The expert participants demonstrated specific, common patterns in their cognitive processes. In particular, participants exhibited similar anticipatory and visual behaviours, dynamic communication strategies and the ability to distinguish between task-relevant and task-redundant information. All participants reported that this technique uncovered otherwise subconscious aspects of their cognition. Conclusion: The novel combination of eye-tracking technology to supplement the CTA of expert resuscitationists enriched our understanding of expertise in this field and yielded specific findings that can be applied to better develop and assess resuscitation skills.
Background: The evidence regarding whether co-morbid obsessive compulsive personality disorder (OCPD) is associated with treatment outcomes in obsessive compulsive disorder (OCD) is mixed, with some research indicating that OCPD is associated with poorer response, and some showing that it is associated with improved response. Aims: We sought to explore the role of OCPD diagnosis and the personality domain of conscientiousness on treatment outcomes for exposure and response prevention for OCD. Method: The impact of co-morbid OCPD and conscientiousness on treatment outcomes was examined in a clinical sample of 46 participants with OCD. Results: OCPD diagnosis and scores on conscientiousness were not associated with poorer post-treatment OCD severity, as indexed by Yale-Brown Obsessive Compulsive Scale (YBOCS) scores, although the relative sample size of OCPD was small and thus generalizability is limited. Conclusion: This study found no evidence that OCPD or conscientiousness were associated with treatment outcomes for OCD. Further research with larger clinical samples is required.
Background: Perfectionism is strongly associated with obsessive compulsive disorder (OCD). Cognitive behavioural therapy for perfectionism (CBT-P) has been found to result in reductions in a range of symptoms in individuals with anxiety disorders, depression and eating disorders. Aim: To pilot-test the efficacy of group CBT for perfectionism in participants with OCD and elevated perfectionism. Method: Participants were randomized to receive immediate 8-week group CBT-P (n = 4) or an 8-week waitlist followed by CBT-P (n = 7). Results: Reliable reductions and a large effect size indicated that CBT-P was associated with improvements in perfectionism and OCD severity at post-test. However, these changes were not clinically significant and drop-out was high, resulting in a small final sample. Conclusions: CBT-P may be effective in reducing perfectionism and disorder-specific OCD symptoms. However, the high drop-out rate and lack of clinically significant findings suggest that further research needs to be conducted to determine the efficacy of CBT for perfectionism in OCD.
The current experiment was undertaken to investigate the effect of including white clover (Trifolium repens L.; WC) into perennial ryegrass (Lolium perenne L.; PRG) swards (PRG/WC) receiving 250 kg nitrogen (N) per hectare (ha) per year compared with PRG only swards receiving 250 kg N/ha/year, in an intensive grass-based spring calving dairy production scenario. Forty spring-calving cows were allocated to graze either a PRG/WC or PRG sward (n = 20) from 6 February to 31 October 2012. Fresh herbage was offered daily (17 kg dry matter (DM)/cow) supplemented with concentrate in times of herbage deficit (total supplementation 507 kg/cow). Pre-grazing herbage mass (HM), sward WC content and milk production were measured for the duration of the experiment. Herbage DM intake was estimated in May, July and September. Pre-grazing HM (±s.e.) was similar (1467 ± 173·1 kg DM/ha) for both treatments, as was cumulative herbage production (14 158 ± 769 kg DM/ha). Average WC content of the PRG/WC swards was 236 ± 30 g/kg DM. The PRG/WC cows had greater average daily milk yield and milk solids yield from June onwards. Cumulative milk yield and milk solids yield were greater for the PRG/WC cows compared with the PRG cows (5048 and 4789 ± 34·3 kg milk yield/cow, and 400 and 388 ± 1·87 kg milk solids/cow, respectively). Cows had similar DM intake in all measurements periods (15·1 ± 0·42 kg DM/cow/day). In conclusion, including WC in N-fertilized PRG swards increased milk production from cows grazing the PRG/WC swards compared with PRG, particularly in the second half of the lactation.
The experiment investigated the effect of maternal dietary supplementation of seaweed-derived polysaccharides (SDP) (–SDP v. +SDP, n 20) from day 83 of gestation until weaning (day 28) on selected sow faeces and piglet digesta microbiota populations, piglet small-intestinal morphology, and intestinal nutrient transporter and inflammatory cytokine gene expression at birth, 48 h after birth and weaning. The effect of maternal dietary treatment on the piglet gene expression profile of inflammatory cytokines in the colon following a lipopolysaccharide (LPS) challenge was also investigated. Dietary SDP reduced sow faecal Enterobacteriaceae gene numbers at parturition. Small-intestinal morphology, nutrient transporter and cytokine gene expression in newborn piglets did not differ between maternal dietary treatments (P > 0·10). At 48 h after birth, sodium–glucose-linked transporter 1 gene expression was down-regulated in the ileum of piglets suckling the SDP-supplemented sows compared with those suckling the basal sows (P = 0·050). There was a SDP × LPS challenge interaction on IL-1 and IL-6 gene expression in the colon of piglets (P < 0·05). The gene expression of IL-1 and IL-6 was down-regulated in the LPS-challenged colon of piglets suckling the SDP sows compared with those suckling the basal sows (P < 0·05). However, there was no difference in IL-1 and IL-6 gene expression in the unchallenged colon between treatment groups. At weaning, piglets suckling the SDP-supplemented sows had increased villus height in the jejunum and ileum compared with those suckling the basal-fed sows (P < 0·05). In conclusion, maternal dietary SDP supplementation enhanced the immune response of suckling piglets and improved gut morphology, making them more immune competent to deal with post-weaning adversities.
The Australian Centre for Advanced Photovoltaics (ACAP) co-ordinates the activities of the six Australian research institutions and a group of industrial partners in the Australia-US Institute for Advanced Photovoltaics (AUSIAPV) to develop the next generations of photovoltaic device technology and to provide a pipeline of opportunities for performance increase and cost reduction. AUSIAPV links ACAP with US-based partners. These national and international research collaborations provide a pathway for highly visible, structured photovoltaic research collaboration between Australian and US researchers, institutes and agencies with significant joint programs based on the clear synergies between the participating organizations. The research program is organized in five collaborative Program Packages (PPs). PP1 deals with silicon wafer-based cells, focusing on three main areas: cells from solar grade silicon, rear contact and silicon-based tandem cells. PP2 involves research into a range of organic solar cells, organic/inorganic hybrid cells, "earth abundant" thin-film materials and "third generation" approaches. PP3 is concerned with optics and characterization. PP4 will deliver a substantiated methodology for assessing manufacturing costs of the different technologies and PP5 involves education, training and outreach. The main research topics, results and plans for the future are presented.
Commercial introduction of cultivars of soybean and cotton genetically modified with resistance to the synthetic auxin herbicides dicamba and 2,4-D will allow these compounds to be used with greater flexibility but may expose susceptible soybean and cotton cultivars to nontarget herbicide drift. From past experience, it is well known that soybean and cotton are both highly sensitive to low-dose exposures of dicamba and 2,4-D. In this study, a meta-analysis approach was used to synthesize data from over seven decades of simulated drift experiments in which investigators treated soybean and cotton with low doses of dicamba and 2,4-D and measured the resulting yields. These data were used to produce global dose–response curves for each crop and herbicide, with crop yield plotted against herbicide dose. The meta-analysis showed that soybean is more susceptible to dicamba in the flowering stage and relatively tolerant to 2,4-D at all growth stages. Conversely, cotton is tolerant to dicamba but extremely sensitive to 2,4-D, especially in the vegetative and preflowering squaring stages. Both crops are highly variable in their responses to synthetic auxin herbicide exposure, with soil moisture and air temperature at the time of exposure identified as key factors. Visual injury symptoms, especially during vegetative stages, are not predictive of final yield loss. Global dose–response curves generated by this meta-analysis can inform guidelines for herbicide applications and provide producers and agricultural professionals with a benchmark of the mean and range of crop yield loss that can be expected from drift or other nontarget exposures to 2,4-D or dicamba.
Adenoidectomy is often carried out in children for conditions such as nasal obstruction, otitis media with effusion, and obstructive sleep apnoea. Traditionally, it is performed as a blind procedure with a St Clair Thomson curette. An acceptable alternative technique is suction diathermy adenoidectomy. This study aimed to ensure that the complication rate of this latter technique was within published rates and national guidelines.
A retrospective case note review was conducted, and information regarding surgery, indications and complications was collected.
Post-operative haemorrhage was recorded for 2 of 121 patients (at days 10 and 11 post-operatively): 1 returned to the operating theatre and the other was managed conservatively. Two patients were diagnosed with infection post-operatively and managed with oral antibiotics. A further four patients re-presented with pain; in all cases, this was recorded as secondary to tonsillar fossa infection, rather than being pain related to adenoidectomy.
Given the rare but serious potential complications, the authors support National Institute for Health and Clinical Excellence guidance, which recommends that only surgeons with specific training perform this technique. By using the standard procedures for clinical governance, it is possible to ensure safe practice of even little-used techniques.
A community outbreak of legionellosis occurred in Barrow-in-Furness, Cumbria, during July and August 2002. A descriptive study and active case-finding were instigated and all known wet cooling systems and other potential sources were investigated. Genotypic and phenotypic analysis, and amplified fragment length polymorphism of clinical human and environmental isolates confirmed the air-conditioning unit of a council-owned arts and leisure centre to be the source of infection. Subsequent sequence-based typing confirmed this link. One hundred and seventy-nine cases, including seven deaths [case fatality rate (CFR) 3·9%] were attributed to the outbreak. Timely recognition and management of the incident very likely led to the low CFR compared to other outbreaks. The outbreak highlights the responsibility associated with managing an aerosol-producing system, with the potential to expose and infect a large proportion of the local population and the consequent legal ramifications and human cost.
Intermittent energy restriction may result in greater improvements in insulin sensitivity and weight control than daily energy restriction (DER). We tested two intermittent energy and carbohydrate restriction (IECR) regimens, including one which allowed ad libitum protein and fat (IECR+PF). Overweight women (n 115) aged 20 and 69 years with a family history of breast cancer were randomised to an overall 25 % energy restriction, either as an IECR (2500–2717 kJ/d, < 40 g carbohydrate/d for 2 d/week) or a 25 % DER (approximately 6000 kJ/d for 7 d/week) or an IECR+PF for a 3-month weight-loss period and 1 month of weight maintenance (IECR or IECR+PF for 1 d/week). Insulin resistance reduced with the IECR diets (mean − 0·34 (95 % CI − 0·66, − 0·02) units) and the IECR+PF diet (mean − 0·38 (95 % CI − 0·75, − 0·01) units). Reductions with the IECR diets were significantly greater compared with the DER diet (mean 0·2 (95 % CI − 0·19, 0·66) μU/unit, P= 0·02). Both IECR groups had greater reductions in body fat compared with the DER group (IECR: mean − 3·7 (95 % CI − 2·5, − 4·9) kg, P= 0·007; IECR+PF: mean − 3·7 (95 % CI − 2·8, − 4·7) kg, P= 0·019; DER: mean − 2·0 (95 % CI − 1·0, 3·0) kg). During the weight maintenance phase, 1 d of IECR or IECR+PF per week maintained the reductions in insulin resistance and weight. In the short term, IECR is superior to DER with respect to improved insulin sensitivity and body fat reduction. Longer-term studies into the safety and effectiveness of IECR diets are warranted.