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The Scaling-up Health-Arts Programme: Implementation and Effectiveness Research (SHAPER) project is the world's largest hybrid study on the impact of the arts on mental health embedded into a national healthcare system. This programme, funded by the Wellcome Trust, aims to study the impact and the scalability of the arts as an intervention for mental health. The programme will be delivered by a team of clinicians, research scientists, charities, artists, patients and healthcare professionals in the UK's National Health Service (NHS) and the community, spanning academia, the NHS and the charity sector. SHAPER consists of three studies – Melodies for Mums, Dance for Parkinson's, and Stroke Odysseys – which will recruit over 800 participants, deliver the interventions and draw conclusions on their clinical impact, implementation effectiveness and cost-effectiveness. We hope that this work will inspire organisations and commissioners in the NHS and around the world to expand the remit of social prescribing to include evidence-based arts interventions.
Mastoid surgery is an aerosol-generating procedure that involves the use of a high-speed drill, which produces a mixture of water, bone, blood and tissue that may contain the viable coronavirus disease 2019 pathogen. This potentially puts the surgeon and other operating theatre personnel at risk of acquiring the severe acute respiratory syndrome coronavirus-2 from contact with droplets or aerosols. The use of an additional drape designed to limit the spread of droplets and aerosols has been described; such drapes include the ‘Southampton Tent’ and ‘OtoTent’.
To evaluate the use of a novel drape ‘tent’ that has advantages over established ‘tent’ designs in terms of having: (1) a CE marking; (2) no requirement for modification during assembly; and (3) no obstruction to the surgical visual field.
Results and conclusion
During mastoid surgery, the dispersion of macroscopic droplets and other particulate matter was confined within the novel drape ‘tent’. Use of this drape ‘tent’ had no adverse effects upon the surgeon's manual dexterity or efficiency, the view of the surgical field, or the sterility. Hence, our findings support its use during mastoid surgery in the coronavirus disease 2019 era.
The project PARADISE (Psychosocial fActors Relevant to BrAin DISorders in Europe) funded by the European Community (Grant Agreement 652 no. HEALTH-F2-2009-241572) is being carried out in terms of the theoretical conceptualization of “horizontal epidemiology”, which argues that the psychosocial difficulties (PSDs) people have to deal with when they have a brain disorder - either psychiatric or neurological - And the determinants of those PSDs are common across brain disorders.
To develop and test an innovative approach to collect clinical data on the PSDs based on the horizontal epidemiology.
1) To determine the PSDs and determinants commonly relevant across brain disorders. 2) To create a data collection protocol to describe and assess PSDs and their determinants across brain disorders.
In the first phase, a pilot data collection protocol was developed based on literature reviews and focus groups in 9 brain disorders (dementia, depression, epilepsy, migraine, multiple sclerosis, Parkinson's Disease, schizophrenia, stroke and substance use disorders) as well as data analyses of surveys and expert consultations. in the current second phase, the protocol is being tested in a sample of 700 patients across Europe.
The pilot data collection protocol contains 63 PSDs and 64 determinants, which have been identified as common across brain disorders.
If we are right about the hypothesis of horizontal epidemiology in brain disorders, this way of collecting information would have profound consequences for how we organize and deliver services to people with brain disorders across Europe, improving their lives and life opportunities.
This paper describes a tri-trophic analysis of the ecological dynamics of a crop, an insect pest, and a natural enemy of the insect pest. Worldwide wheat (Triticum Linnaeus) (Poaceae) production in 2018–2019 was estimated at over 700 million metric tons in 2018–2019. Wheat midge, Sitodiplosis mosellana (Géhin) (Diptera: Cecidomyiidae), a serious insect pest of wheat, is widely distributed in many parts of the world where wheat production occurs. Macroglenes penetrans (Kirby) (Hymenoptera: Pteromalidae), a parasitoid of S. mosellana, has successfully established in most wheat midge-infested areas. Mechanistic, or process-based, population models were used in this study to assess the interactive population dynamics of the three species, based on their respective life cycles and meteorological factors. The models were validated with survey data from multiple sites over numerous years (1991–2016). These simulation models helped to detail our understanding of the tri-trophic population dynamics and will help guide pest management decisions both prior to the growing season and until wheat heading, when wheat is no longer susceptible to S. mosellana. The associated models also help identify gaps in system knowledge, provide a foundation for evaluating future innovative management options, and evaluate the potential impact of a changing climate.
Epilepsy is a common neurological condition that shows a marked genetic predisposition. The advent of next-generation sequencing (NGS) has transformed clinical genetic testing by allowing the rapid screen for causative variants in multiple genes. There are currently no NGS-based multigene panel diagnostic tests available for epilepsy as a licensed clinical diagnostic test in Ontario, Canada. Eligible patient samples are sent out of country for testing by commercial laboratories, which incurs significant cost to the public healthcare system.
An expert Working Group of medical geneticists, pediatric neurologists/epileptologists, biochemical geneticists, and clinical molecular geneticists from Ontario was formed by the Laboratories and Genetics Branch of the Ontario Ministry of Health and Long-Term Care to develop a programmatic approach to implementing epilepsy panel testing as a provincial service.
The Working Group made several recommendations for testing to support the clinical delivery of care in Ontario. First, an extension of community healthcare outcomes-based program should be incorporated to inform and educate ordering providers when requesting and interpreting a genetic panel test. Second, any gene panel testing must be “evidence-based” and takes into account varied clinical indications to reduce the chance of uncertain and secondary results. Finally, an ongoing evaluative process was recommended to ensure continued test improvement for the future.
This epilepsy panel testing implementation plan will be a model for genetic care directed toward a specific set of conditions in the province and serve as a prototype for genetic testing for other genetically heterogeneous diseases.
Human–wildlife conflict is one of the most pressing issues in conservation. Low-income rural communities are disproportionately affected by negative interactions with large predators, which often leads to retaliatory killings and persecution of the animals. To overcome this, socio-ecological studies that merge existing knowledge of large predator ecology with long-term livestock depredation monitoring are required. We examined patterns and drivers of livestock depredation in northern Botswana, using a mixed effects model of the government's long-term monitoring data on human–wildlife conflict, to identify ways to reduce depredation at key spatial and temporal scales. We compared the results to farmers’ understanding of their personal risk within the landscape. We analysed 342 depredation events that occurred during 2008–2016, using variables measured at different scales. The variables affecting the locations of depredation events at the 2-km scale were distance to protected areas and predator and herbivore density, with increased depredation in the wet season. At a 1-km scale, herbivore density did not have a significant effect, but the effect of other variables was unchanged. The 4-km scale model was influenced by livestock and herbivore density, with increased depredation in the wet season. Livestock depredation could be reduced by establishing an 8-km livestock-free buffer along the protected area boundary. There was disparity between government data on human–wildlife conflict, depredation reported by farmers in interviews and farmers’ risk awareness. Farmers would benefit from workshops providing tools to make evidence-based decisions and minimize their risk of negative interactions with wildlife. This would ultimately contribute to wildlife conservation in the Kavango-Zambezi Transfrontier Conservation Area.
Background: Cerebellar atrophy is characterized by loss of cerebellar tissue, with evidence on brain imaging of enlarged interfolial spaces compared to the foliae. Genetic ataxias associated with cerebellar atrophy are a heterogeneous group of disorders. We investigated the prevalence in Canada and the diagnostic yield of whole exome sequencing (WES) for this group of conditions. Methods: Between 2011 and 2017, WES was performed in 91 participants with cerebellar atrophy as part of one of two national research programs, Finding of Rare Genetic Disease Genes (FORGE) or Enhanced Care for Rare Genetic Diseases in Canada (Care4Rare). Results: A genetic diagnosis was established in 58% of cases (53/91). Pathogenic variants were found in 24 known genes, providing a diagnosis for 46/53 participants (87%), and in four novel genes, accounting for 7/53 cases (13%). 38/91 cases (42%) remained unsolved. The most common diagnoses were channelopathies in 12/53 patients (23%) and mitochondrial disorders in 9/53 (17%). Inheritance was autosomal recessive in the majority of cases. Additional clinical findings provided useful clues to some of the diagnoses. Conclusions: This is the first report on the prevalence of genetic ataxias associated with cerebellar atrophy in Canada, and the utility of WES for this group of conditions.
Background: Inadequate postoperative pain control is common and is associated with negative clinical outcomes. The objective is to identify preoperative predictors of poor postoperative pain control in the adult population undergoing inpatient surgery. Methods: Meta-analysis was performed according to MOOSE guidelines. Studies were included if they evaluated postoperative pain using a validated instrument in adults undergoing inpatient surgery and reported a measure of association between poor postoperative pain control and at least one preoperative predictor. Measures of association were pooled using random effects models. Results: A total of 33 studies representing 59,259 patients were included. Significant preoperative predictors of poor postoperative pain included sleeping difficulties (OR 2.32 [95% CI 1.46-3.69]), history of depressive symptoms (OR 1.71 [95% CI 1.32-2.22]), use of preoperative analgesia (OR 1.54 [95% CI 1.18-2.03]), smoking (OR 1.33 [95% CI 1.09-1.61]), -female sex (OR 1.29 [95% CI 1.17-1.43]), presence of preoperative pain (OR 1.21 [95% CI 1.10-1.32]], history of anxiety symptoms (OR 1.22 [95% CI 1.09-1.36)], younger age (OR 1.18 [95% CI 1.05-1.32)], and higher BMI (OR 1.02 [95% CI 1.01-1.03]). Conclusions: Nine significant predictors of poor postoperative pain control were identified and these should be recognized as important factors when developing pre- and peri-operative strategies to improve pain outcomes.
Mosquito communities across the globe frequently comprise a mix of native and cosmopolitan species. New Zealand's mosquito communities are no exception. Here we describe the abundance, distribution and phenological patterns for a community of six mosquito taxa resident across the Kaipara Harbour region of northern New Zealand. Adult mosquitoes were sampled using baited light traps, serviced biweekly for 3½ years. Seasonal fluctuations in abundance of adults were examined for correlations with temperature and rainfall over the preceding weeks. Four endemic species comprised over 98% of the total catch, with Coquillettidia iracunda being the most abundant. Two introduced species, Aedes notoscriptus and Culex quinquefasciatus were widely distributed, but each comprised <1% of the total catch. Culiseta tonnoiri was the only species that appeared geographically restricted, occurring at one-third of the sites. Distinct temporal peaks in adult abundance were evident: Aedes antipodeus was most abundant in spring, Ae. notoscriptus and Cq. iracunda were most abundant in summer and Cx. quinquefasciatus was most abundant in autumn. Culiseta tonnoiri and Culex pervigilans were of variable abundance throughout the year. For all species examined, temporal variations in abundance were more strongly associated with temperature in the preceding weeks than with preceding rainfall. A better knowledge of the factors driving patterns of spatial and temporal abundance will allow an improved understanding of how non-native species may integrate themselves into resident mosquito communities.
To describe our experience and provide guidelines for maximum safe balloon sizes according to age in children undergoing balloon dilatation.
A retrospective review was conducted of children undergoing balloon dilatation for subglottic stenosis in a paediatric tertiary unit between May 2006 and February 2016.
A total of 166 patients underwent balloon dilatation. Mean ( ± standard deviation) patient age was 4.5 ± 3.99 years. The median balloon size was 8 mm, the median balloon inflation pressure was 10 atm, and the mean balloon inflation time was 65.1 ± 18.6 seconds. No significant unexpected events occurred. The Pearson correlation co-efficient for the relationship between patient age and balloon size was 0.85 (p = 0.001), suggesting a strongly positive correlation.
This study demonstrated that balloon dilatation is a safe procedure for airway stenosis. The results suggest using a balloon diameter that is equal to the outer diameter of the age-appropriate endotracheal tube +1 mm for the larynx and subglottis and +2 mm for the trachea.
A number of laser facilities coming online all over the world promise the capability of high-power laser experiments with shot repetition rates between 1 and 10 Hz. Target availability and technical issues related to the interaction environment could become a bottleneck for the exploitation of such facilities. In this paper, we report on target needs for three different classes of experiments: dynamic compression physics, electron transport and isochoric heating, and laser-driven particle and radiation sources. We also review some of the most challenging issues in target fabrication and high repetition rate operation. Finally, we discuss current target supply strategies and future perspectives to establish a sustainable target provision infrastructure for advanced laser facilities.
Background: Menkes disease is a rare, X-linked recessive disorder of the ATP7A gene, a copper transporter; resulting in systemic copper deficiency. The deficient function of copper-dependent enzymes manifests clinically with failure to thrive, seizures, hypotonia, coarse hair, connective tissue abnormalities, and neurodegeneration. Cerebral arteries are often elongated, tortuous, and fragile. Methods: This case report was prepared using the patient’s hospital chart, and a review of the literature undertaken using PubMed. Our case was subsequently compared and contrasted to known Menkes’ literature. Results: We present the case of a 2 month old male with Menkes disease who presented with new seizure onset in the setting of a Grade III intraventricular hemorrhage with hydrocephalus. He deteriorated into status epilepticus, and palliative care was instituted. On autopsy, pronounced tortuosity of his cerebral vasculature was noted, as well as a bilaterally cystic brain with an organizing hemorrhage on the ventral surface of the brainstem. Conclusions: Although Menkes disease often presents with seizures, neurologic deterioration, and abnormal cerebral vasculature; the quick demise subsequent to an intraventricular hemorrhage is somewhat unusual and discussed.
In 1975, Hoessel, Elias, Wade and Huchra commenced a near infrared survey of 80 fields in the northern Milky Way with the Palomar 1.2 m Schmidt telescope, (Hoessel et al. 1979). This has now been issued as an atlas reproduced in the form of photographic paper prints. In 1977, the SRC 1.2 m Schmidt telescope at Siding Spring was authorized to commence a complementary survey of the southern Milky Way, consisting of the 151 ESO/SRC survey fields which have centres within 10° of the galactic plane and negative declinations (see Fig. 1). A further 12 fields have subsequently been added to the survey to permit coverage of the Large and Small Magellanic Clouds.
Migratory fishes are natural wonders. For many people, the term migratory fish evokes images of salmon audaciously jumping at waterfalls as they return to their own riverine birthplace to spawn after years of growth in the ocean, but freshwater fishes actually show a broad spectrum of migration strategies. Migratory fishes include small species – three-spined sticklebacks that spawn in coastal streams around the northern Pacific and gobies that move from the ocean into tropical island streams by climbing waterfalls (McDowall, 1988) – as well as some of the largest freshwater fishes in the world, such as the Mekong dog-eating catfish and the Chinese paddlefish (Stone, 2007). Aside from migratory habits, these species have few shared characteristics; they encompass numerous evolutionary lineages, enormous differences in life history, and every possible direction and distance of migration. Biologists treat migratory freshwater fishes as a functional group because their life-history strategy revolves around long-distance movement between ecosystems in a perilous quest to take advantage of both high-quality breeding sites and bountiful feeding areas. As humans have physically blocked fish migrations, degraded breeding and feeding grounds and relentlessly harvested migrants for their flesh and roe, many populations have declined or been extirpated. This chapter will provide an overview of fundamental and applied research that is helping to guide efforts to conserve migratory freshwater fishes.
For practical purposes, we define migratory behaviour as the synchronized movement of a substantial proportion of a population between distinct habitats, which is repeated through time within or across generations. Modern definitions of fish migrations typically recognise both the adaptive benefits of migrating and individual variation in executing the general strategy (see McDowall, 1988; Lucas & Baras, 2001). Not every individual must move, the timing may vary somewhat from year to year, and the motive for migrating may include seeking refuge from harsh conditions in addition to breeding and feeding. Nonetheless, in most cases, migration is critical to individual fitness and population persistence because it enables specialised use of different habitats for growth and reproduction. Where their migration routes are blocked or key habitats are lost, migratory fishes often suffer rapid and catastrophic losses.
Human appropriation and degradation of the Earth's freshwater ecosystems (Vörösmarty et al., 2010; Carpenter et al., 2011) have transformed this reliance on multiple habitats into a detriment for many migratory fishes.
Unlike the massive literature about US Supreme Court confirmation battles, little has been written about lower federal court confirmation fights. However, in the past 20 years much has been written about the lower federal court confirmation process. Here, we take stock of the political science literature in this area and highlight where scholarly interest appears to be going. Believing a contemporary assessment of the state of the field should be of interest and use to scholars of American politics, we dissect the recent empirical literature and offer suggestions for future research. Most importantly, we offer a one-stop shop for recent literature for scholars interested in this topic.
Using the 22-m ‘Mopra’ antenna (near Coonabarabran, NSW) of the Australia Telescope National Facility (ATNF), we have observed emission from the 115-GHz J = 1−0 transition of CO towards the centre of each of the 1101 clouds listed in the Catalogue of Southern Dark Clouds (SDC) of Hartley et al. (1986). The velocity range covered was −96 to +70 km s−1, with a velocity resolution of 0· 120 km s−1. CO was detected at 1049 of the positions, with 367 spectra showing emission at more than one radial velocity. Here we present the most comprehensive general survey of the SDC catalogue, with the intensity, velocity and half-width of the CO detection and a code describing the profile shape. The presence of blue- or red-shifted wings in many observations can provide a starting point in searches for star-forming regions.
Treatment options for large subglottic haemangioma include steroids, laser ablation, open excision, tracheostomy and, more recently, propranolol. This article aims to present the Great Ormond Street Hospital guidelines for using propranolol to treat infantile isolated subglottic haemangioma by ENT surgeons.
The vascular malformations multidisciplinary team at Great Ormond Street Hospital has developed guidelines for treating infantile haemangioma with propranolol.
The Great Ormond Street Hospital guidelines for propranolol treatment for infantile subglottic haemangioma include investigation, treatment and follow up. Propranolol is started at 1 mg/kg/day divided into three doses, increasing to 2 mg/kg/day one week later. On starting propranolol and when increasing the dose, the pulse rate and blood pressure must be checked every 30 minutes for the first 2 hours. Lesion response to treatment is assessed via serial endoscopy.
Recent reports of dramatic responses to oral propranolol in children with haemangioma and acute airway obstruction have led to increased use. We advocate caution, and have developed guidelines (including pre-treatment investigation and monitoring) to improve treatment safety. Propranolol may in time prove to be the best medical treatment for subglottic haemangioma, but at present is considered to be still under evaluation.
The central role of plant secondary metabolites (PSMs) in mediating the ecological interactions between plants and other organisms is both well known and well studied, particularly in the case of the defensive responses of plants against attack by herbivores or pathogens (Dangl & Jones, 2001; Kessler & Baldwin, 2002). Furthermore, because plants face many simultaneous threats (Maleck & Dietrich, 1999; Paul et al., 2000), the chemical changes within plants in response to one attacking organism can influence the behaviour and performance of many others (Thaler et al., 2002; Biere et al., 2004). Thus, chemically mediated plant-based interactions have significant consequences for individual species, ecological communities and ecosystem function, so gaining an in-depth understanding of the chemical basis of these interactions is vital for ecologists (van der Putten, 2003; Dicke, 2006; Schuman & Baldwin, Chapter 15; Dicke et al., Chapter 16).
Recent advances in ecological genomics have demonstrated the complexity of plant responses to biotic challenges at the molecular level: hundreds of genes are now known to be up- or down-regulated in response to herbivore or pathogen attack (Zheng & Dicke, 2008). This has been of great benefit in understanding the molecular basis of plant defence, but microarray data alone cannot unravel the complexity and variability in plant responses, many of which are specific to particular types of natural enemy, and/or vary according to environmental conditions (Kant & Baldwin, 2007). Genomic analysis needs to be supported by manipulative experiments which assess all the metabolic responses of plants to environmental challenges as well as the molecular ones – so-called metabolomic approaches. Metabolomics is the systematic analysis of the set of metabolites synthesised by an organism at a particular ‘snapshot’ in time and can be described as providing the link between genotypes and phenotypes (Fiehn, 2002; Macel et al., 2010). Assuming that this set of metabolites reflects the interactions the plant is having with its abiotic and biotic environment, chemical ecologists can use this technique to study the mechanisms underpinning these interactions (Bundy et al., 2009), including those between plants and other organisms such as herbivores and pathogens (Allwood et al., 2008).