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.
Approximately one in twenty men have sperm counts low enough to impair fertility but little progress has been made in answering fundamental questions in andrology or in developing new diagnostic tools or management strategies in infertile men. Many of these problems increase with age, leading to a growing population of men seeking help. To address this, there is a strong movement towards integrating male reproductive and sexual healthcare involving clinicians such as andrologists, urologists, endocrinologists and counselors. This book will emphasize this integrated approach to male reproductive and sexual health throughout the lifespan. Practical advice on how to perform both clinical and laboratory evaluations of infertile men is given, as well as a variety of methods for medically and surgically managing common issues. This text ties together the three major pillars of clinical andrology: clinical care, the andrology laboratory, and translational research.
To compare the prognostic value of mid-upper arm circumference (MUAC), weight-for-height z-score (WHZ) and weight-for-age z-score (WAZ) for predicting death over periods of one, three and six months follow-up in children.
Pooled analysis of 12 prospective studies examining survival after anthropometric assessment. Sensitivity and false-positive ratios to predict death within one, three and six months were compared for three individual anthropometric indices and their combinations.
Community-based, prospective studies from 12 countries in Africa and Asia
Children aged 6-59 months living in the study areas
For all anthropometric indices, the receiver operating characteristic curves were higher for shorter than for longer durations of follow-up. Sensitivity was higher for death with one month follow-up compared to six months by 49% (95% CI: 30-69%) for MUAC <115 mm (p<0.001), 48% (95%CI: 9.4-87%) for WHZ <-3 (p<0.01) and 28% (95%CI: 7.6-42%) for WAZ <-3 (p<0.005). This was accompanied by an increase in false-positives of only 3% or less. For all durations of follow-up, WAZ <-3 identified more children who died and were not identified by WHZ <-3 or by MUAC <115 mm, 120 mm or 125 mm but the use of WAZ <-3 led to an increased false-positive ratio up to 16.4% (95%CI: 12.0-20.9%) compared to 3.5% (0.4-6.5%) for MUAC <115 mm alone.
Frequent anthropometric measurements significantly improve the identification of malnourished children with a high risk of death without markedly increasing false-positives. Combining two indices increases sensitivity but also increases false-positives among children meeting case definitions.
Among nursing home outbreaks of coronavirus disease 2019 (COVID-19) with ≥3 breakthrough infections when the predominant severe acute respiratory coronavirus virus 2 (SARS-CoV-2) variant circulating was the SARS-CoV-2 δ (delta) variant, fully vaccinated residents were 28% less likely to be infected than were unvaccinated residents. Once infected, they had approximately half the risk for all-cause hospitalization and all-cause death compared with unvaccinated infected residents.
The crystal structure of deracoxib has been solved and refined using synchrotron X-ray powder diffraction data, and optimized using density functional theory techniques. Deracoxib crystallizes in space group Pbca (#61) with a = 9.68338(11), b = 9.50690(5), c = 38.2934(4) Å, V = 3525.25(3) Å3, and Z = 8. The molecules stack in layers parallel to the ab-plane. N–H⋯O hydrogen bonds link the molecules along the b-axis, in chains with the graph set C1,1(4), as well as more-complex patterns. N–H⋯N hydrogen bonds link the layers. The powder pattern has been submitted to ICDD for inclusion in the Powder Diffraction File™ (PDF®).
This review considers current evidence on physical activity and dietary behaviours in the context of prostate cancer prevention and survivorship outcomes. Prostate cancer is the second most common cancer amongst men, with over 1⋅4 million newly diagnosed cases globally each year. Due to earlier detection via screening and advances in treatments, survival rates are amongst the highest of all cancer populations. However, hormone treatments (i.e. androgen deprivation therapy) can lead to undesirable body composition changes, increased fatigue and reduced health-related quality of life, which can impair the overall wellbeing of men living with and beyond prostate cancer. Existing research has only provided limited evidence that physical activity and nutrition can impact a man's risk of prostate cancer but cohort studies suggest they can influence survival outcomes after diagnosis. Additionally, data from observational and intervention studies suggest that habitual physical activity (or structured exercise) and healthy diets can help to ameliorate hormone-related treatment side-effects. Current physical activity guidelines state that prostate cancer patients should complete at least three sessions of moderate-intensity aerobic exercise per week, along with two resistance exercise sessions, but dietary guidelines for prostate cancer patients are less well defined. In conclusion, regular physical activity and nutritional interventions may improve survival outcomes and attenuate some adverse side-effects of hormone treatments in men with prostate cancer. However, further research is required to improve our understanding of the health impacts of physical activity (including structured exercise) and nutrition in relation to prostate cancer prevention and survivorship.
Past research has shown that people consistently believe that others are more easily manipulated by external influences than they themselves are—a phenomenon called the “third-person effect” (Davison, 1983). The present research investigates whether support for public policies aimed at changing behavior using incentives and other decision “nudges” is affected by this bias. Across two studies, we phrased justification for public policy initiatives using either the second- or third-person plural. In Study 1, we found that support for policies is higher when their justification points to people in general rather than the general “you”, and in Study 2 we found that this former phrasing also improves support compared to a no-justification control condition. Policy support is mediated by beliefs about the likelihood of success of the policies (as opposed to beliefs about the policies’ unintended consequences), and, in the second-person condition, is inversely related to a sense of personal agency. These effects suggest that the third-person effect holds true for nudge-type and incentive-based public policies, with implications for their popular support.
The Residual Lesion Score is a novel tool for assessing the achievement of surgical objectives in congenital heart surgery based on widely available clinical and echocardiographic characteristics. This article describes the methodology used to develop the Residual Lesion Score from the previously developed Technical Performance Score for five common congenital cardiac procedures using the RAND Delphi methodology.
A panel of 11 experts from the field of paediatric and congenital cardiology and cardiac surgery, 2 co-chairs, and a consultant were assembled to review and comment on validity and feasibility of measuring the sub-components of intraoperative and discharge Residual Lesion Score for five congenital cardiac procedures. In the first email round, the panel reviewed and commented on the Residual Lesion Score and provided validity and feasibility scores for sub-components of each of the five procedures. In the second in-person round, email comments and scores were reviewed and the Residual Lesion Score revised. The modified Residual Lesion Score was scored independently by each panellist for validity and feasibility and used to develop the “final” Residual Lesion Score.
The Residual Lesion Score sub-components with a median validity score of ≥7 and median feasibility score of ≥4 that were scored without disagreement and with low absolute deviation from the median were included in the “final” Residual Lesion Score.
Using the RAND Delphi methodology, we were able to develop Residual Lesion Score modules for five important congenital cardiac procedures for the Pediatric Heart Network’s Residual Lesion Score study.
Several evidence-informed consent practices (ECPs) have been shown to improve informed consent in clinical trials but are not routinely used. These include optimizing consent formatting, using plain language, using validated instruments to assess understanding, and involving legally authorized representatives when appropriate. We hypothesized that participants receiving an implementation science toolkit and a social media push would have increased adoption of ECPs and other outcomes.
We conducted a 1-year trial with clinical research professionals in the USA (n = 1284) who have trials open to older adults or focus on Alzheimer’s disease. We randomized participants to receive information on ECPs via receiving a toolkit with a social media push (intervention) or receiving an online learning module (active control). Participants completed a baseline survey and a follow-up survey after 1 year. A subset of participants was interviewed (n = 43).
Participants who engaged more with the toolkit were more likely to have tried to implement an ECP during the trial than participants less engaged with the toolkit or the active control group. However, there were no significant differences in the adoption of ECPs, intention to adopt, or positive attitudes. Participants reported the toolkit and social media push were satisfactory, and participating increased their awareness of ECPs. However, they reported lacking the time needed to engage with the toolkit more fully.
Using an implementation science approach to increase the use of ECPs was only modestly successful. Data suggest that having institutional review boards recommend or require ECPs may be an effective way to increase their use.
The megalithic pillar sites found around Lake Turkana, Kenya, are monumental cemeteries built approximately 5000 years ago. Their construction coincides with the spread of pastoralism into the region during a period of profound climate change. Early work at the Jarigole pillar site suggested that these places were secondary burial grounds. Subsequent excavations at other pillar sites, however, have revealed planned mortuary cavities for predominantly primary burials, challenging the idea that all pillar sites belonged to a single ‘Jarigole mortuary tradition’. Here, the authors report new findings from the Jarigole site that resolve long-standing questions about eastern Africa's earliest monuments and provide insight into the social lives, and deaths, of the region's first pastoralists.
Informed consent forms (ICFs) and practices vary widely across institutions. This project expands on previous work at the University of Arkansas for Medical Sciences (UAMS) Center for Health Literacy to develop a plain language ICF template. Our interdisciplinary team of researchers, comprised of biomedical informaticists, health literacy experts, and stakeholders in the Institutional Review Board (IRB) process, has developed the ICF Navigator, a novel tool to facilitate the creation of plain language ICFs that comply with all relevant regulatory requirements.
Our team first developed requirements for the ICF Navigator tool. The tool was then implemented by a technical team of informaticists and software developers, in consultation with an informed consent legal expert. We developed and formalized a detailed knowledge map modeling regulatory requirements for ICFs, which drives workflows within the tool.
The ICF Navigator is a web-based tool that guides researchers through creating an ICF as they answer questions about their project. The navigator uses those responses to produce a clear and compliant ICF, displaying a real-time preview of the final form as content is added. Versioning and edits can be tracked to facilitate collaborative revisions by the research team and communication with the IRB. The navigator helps guide the creation of study-specific language, ensures compliance with regulatory requirements, and ensures that the resulting ICF is easy to read and understand.
The ICF Navigator is an innovative, customizable, open-source software tool that helps researchers produce custom readable and compliant ICFs for research studies involving human subjects.
The present study uses variationist sociolinguistic methods to examine the intensifier system in Oslo Norwegian. Results indicate that both linguistic and social factors influence intensifier use. Predicative adjectives were intensified more frequently than attributive adjectives, women used intensifiers more frequently than men, and younger speakers had higher intensification rates than older speakers. Apparent time analyses also reveal a change in progress toward the use of skikkelig ‘proper’, a change led predominantly by young women. Although veldig ‘very’ was the most frequently used intensifier, its use decreases in apparent time, whereas skikkelig increases in frequency among younger speakers. The development of the intensifier skikkelig appears to follow a common pathway of change from adjective to manner adjunct to degree adverb, as well as from appropriateness to intensification. Comparisons with work on English, German, and Norwegian reveal several crosslinguistic tendencies about the linguistic and social conditioning of intensifiers. This study provides the first variationist sociolinguistic analysis of intensifiers in Oslo Norwegian; it provides support for several crosslinguistic claims about intensifier use; and it contributes to the visibility of variationist sociolinguistic work in the study of Norwegian variation and change.
There is an increasing recognition that non-technical skills, such as teamwork, communication and interpersonal competencies, provide the foundation of any cardiac surgery program. Understanding the human and psychological factors at play can help teams make the transition from good patient care to excellent patient care. This chapter will focus on those human, environmental and cultural factors that can be leveraged to optimize team performance with a focus on perfusion practice.
Emotion reactivity and risk behaviors (ERRB) are transdiagnostic dimensions associated with suicide attempt (SA). ERRB patterns may identify individuals at increased risk of future SAs.
A representative sample of US Army soldiers entering basic combat training (n = 21 772) was surveyed and followed via administrative records for their first 48 months of service. Latent profile analysis of baseline survey items assessing ERRB dimensions, including emotion reactivity, impulsivity, and risk-taking behaviors, identified distinct response patterns (classes). SAs were identified using administrative medical records. A discrete-time survival framework was used to examine associations of ERRB classes with subsequent SA during the first 48 months of service, adjusting for time in service, socio-demographic and service-related variables, and mental health diagnosis (MH-Dx). We examined whether associations of ERRB classes with SA differed by year of service and for soldiers with and without a MH-Dx.
Of 21 772 respondents (86.2% male, 61.8% White non-Hispanic), 253 made a SA. Four ERRB classes were identified: ‘Indirect Harming’ (8.9% of soldiers), ‘Impulsive’ (19.3%), ‘Risk-Taking’ (16.3%), and ‘Low ERRB’ (55.6%). Compared to Low ERRB, Impulsive [OR 1.8 (95% CI 1.3–2.4)] and Risk-Taking [OR 1.6 (95% CI 1.1–2.2)] had higher odds of SA after adjusting for covariates. The ERRB class and MH-Dx interaction was non-significant. Within each class, SA risk varied across service time.
SA risk within the four identified ERRB classes varied across service time. Impulsive and Risk-Taking soldiers had increased risk of future SA. MH-Dx did not modify these associations, which may therefore help identify risk in those not yet receiving mental healthcare.
Child maltreatment (CM) and migrant status are independently associated with psychosis. We examined prevalence of CM by migrant status and tested whether migrant status moderated the association between CM and first-episode psychosis (FEP). We further explored whether differences in CM exposure contributed to variations in the incidence rates of FEP by migrant status.
We included FEP patients aged 18–64 years in 14 European sites and recruited controls representative of the local populations. Migrant status was operationalized according to generation (first/further) and region of origin (Western/non-Western countries). The reference population was composed by individuals of host country's ethnicity. CM was assessed with Childhood Trauma Questionnaire. Prevalence ratios of CM were estimated using Poisson regression. We examined the moderation effect of migrant status on the odds of FEP by CM fitting adjusted logistic regressions with interaction terms. Finally, we calculated the population attributable fractions (PAFs) for CM by migrant status.
We examined 849 FEP cases and 1142 controls. CM prevalence was higher among migrants, their descendants and migrants of non-Western heritage. Migrant status, classified by generation (likelihood test ratio:χ2 = 11.3, p = 0.004) or by region of origin (likelihood test ratio:χ2 = 11.4, p = 0.003), attenuated the association between CM and FEP. PAFs for CM were higher among all migrant groups compared with the reference populations.
The higher exposure to CM, despite a smaller effect on the odds of FEP, accounted for a greater proportion of incident FEP cases among migrants. Policies aimed at reducing CM should consider the increased vulnerability of specific subpopulations.
Lima is one of several cities in Latin America that have been the subject of a relatively large number of studies by anthropologists. About thirty years' worth of anthropological research in Lima has accrued, yet little has been done in the way of synthesis, although Millones (1978), Osterling (1980), and Lloyd (1980) have made summary comments toward this end in introductions to their recent books. No ethnography of the entire city has been attempted, and in many ways, the research has been concerned only with relatively smaller units and bounded groups, particularly squatter settlements and highland migrants. Nor have the linkages between studies and groups often been made. I will briefly discuss here, within a typological framework, the ethnographic studies carried out in Lima with an eye to describing and integrating the nature, focus, and methods of these studies.
Communicating evidence that a policy is effective can increase public support although the effects are small. In the context of policies to increase healthier eating in out-of-home restaurants, we investigate two ways of presenting evidence for a policy's effectiveness: (i) visualising and (ii) re-expressing evidence into a more interpretable form. We conducted an online experiment in which participants were randomly allocated to one of five groups. We used a 2 (text only vs visualisation) × 2 (no re-expression vs re-expression) design with one control group. Participants (n = 4500) representative of the English population were recruited. The primary outcome was perceived effectiveness and the secondary outcome was public support. Evidence of effectiveness increased perceptions of effectiveness (d = 0.14, p < 0.001). There was no evidence that visualising, or re-expressing, changed perceptions of effectiveness (respectively, d = 0.02, p = 0.605; d = −0.02, p = 0.507). Policy support increased with evidence but this was not statistically significant after Bonferroni adjustment (d = 0.08, p = 0.034, α = 0.006). In conclusion, communicating evidence of policy effectiveness increased perceptions that the policy was effective. Neither visualising nor re-expressing evidence increased perceived effectiveness of policies more than merely stating in text that the policy was effective.
Hypertensive disorders of pregnancy including preeclampsia affect 5–7 percent of pregnancies and cause significant morbidity and mortality. The effects extend beyond pregnancy, being associated with increased risk of later life cardiovascular disease in the mother and programming of cardio-metabolic disease in the offspring. The profound changes in maternal metabolic and cardiovascular systems during pregnancy are mediated by altered production of hormones from the ovary, heart, brain, pineal gland, adrenal gland, and thyroid together with production and release of steroid and peptide hormones from the placenta. Production of these hormones is altered in hypertensive pregnancies, but distinction of cause from effect has been difficult to determine. Recent attention has focused on altered placental production of pro- and anti-angiogenic factors that may damage both the vasculature and renal systems. Although there is still debate as to the initiating factors for placenta dysfunction, syncytiotrophoblast stress has been postulated but without clear demonstration of cause versus effect.