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Few studies have examined the healthy eating environments within the Australian out of school hours care (OSHC) setting. This study aims to describe healthy eating environments, consisting of: (a) the alignment of provided food and beverages to Australian Dietary Guidelines; (b) healthy eating promotion practices; (c) nutrition education through cooking experiences; (d) staff role modelling healthy eating and (e) regular water availability.
A cross-sectional study was conducted using direct observations and the validated System for Observing Staff Promotion of Activity and Nutrition (SOSPAN) tool.
OSHC located in urban and semi-rural regions of NSW, Australia.
Staff (151) and children (1549) attending twelve OSHC services operating in the hours after school.
Fifty per cent (50 %) of services offered fruits and 100 % offered water as a part of the afternoon snack on all four observation days. Discretionary foods were offered on more days compared to vegetables (+1·9/d, P = 0·009), lean meats (+2·7/d, P =·0 004) and wholegrains (+2·8/d, P = 0 002). Staff promoted healthy eating on 15 % of days, sat and ate with children 52 %, consumed high sugar drinks 15 % and ate discretionary foods in front of children 8 % of days, respectively. No opportunities for cooking or nutrition education were observed.
Afternoon snacks regularly contained fruits and water. Opportunities exist to improve the frequency by which vegetables, wholegrains and lean meats are offered in addition to staff healthy eating promotion behaviours. Future research is warranted to further explore healthy eating behaviours, practices and policies within the after-school sector.
Since body dissatisfaction is an essential part of anorexia/bulimia nervosa, we wanted to assess the patient’s body experience before and after intensive treatment. Body experience was studied in 290 eating disorder patients, admitted to a specialised unit, after six months and again after one year using the Body Attitude Test (BAT), the Eating Disorder Inventory (EDI), and the Eating Disorder Evaluation Scale (EDES). The clearly negative body experience of eating disorder patients evolved in a positive way after therapy and this improvement lasted for up to one year after admission. EDI scores and Body Mass Index at the time of admission appeared to be the strongest predictors of the total BAT score at follow-up. Athough body dissatisfaction can be quite persistent in eating disorders, intensive treatment can substantially improve the patient’s body experience.
To investigate the reproducibility of the Eurofit physical fitness test battery in patients with schizophrenia or schizoaffective disorder. Secondary aims were to assess clinical and demographic characteristics that correlate with the performance on the Eurofit and evaluation of the feasibility of the test.
Fifty patients with schizophrenia or schizoaffective disorder (mean age of 32.9±9.5years) with a mean body mass index (BMI) of 26.1±6.0kg/m2 performed two Eurofit tests administered within 3days.
All Eurofit items showed good reproducibility with intraclass correlation coefficients ranging from 0.72 for flamingo balance to 0.98 for standing broad jump test. All participants could perform five of the seven test items without problems. The whole body balance and abdominal muscle endurance test could be executed by 74 and 90%, respectively. Significant correlations were found with age, BMI, waist circumference, dose of antipsychotic medication and extrapyramidal, negative and cognitive symptoms.
The Eurofit test showed good reproducibility and can be recommended for evaluating physical fitness parameters in patients with schizophrenia or schizoaffective disorder. Physical fitness measures were related to both physical and mental health parameters.
Physiotherapy can improve the health of people with serious mental illness (SMI) but many are inactive. Adopting theoretically-based evidence considering the motivational processes linked to the adoption and maintenance of an active lifestyle can assist physiotherapists in facilitating lifestyle changes in people with SMI.
Within the Self-Determination Theory (SDT) and the Trans-Theoretical Model (TTM) (stages of change) frameworks, we investigated differences in motives for physical activity between different diagnostic SMI groups.
All participants with SMI from 15 different centers completed the Behavioral Regulation in Exercise Questionnaire 2 (BREQ-2), the International Physical Activity Questionnaire (IPAQ) and the Patient-centered Assessment and Counseling for Exercise (PACE) questionnaire.
Overall 294 persons with SMI (190♀) (43.6 ± 13.6years) agreed to participate. People with affective disorders had higher levels of introjected regulations than people with schizophrenia. No significant differences were found for other motivational regulations. Moreover, no significant differences were found according to gender, setting and educational level. Multivariate analyses showed significantly higher levels of amotivation and external regulations and lower levels of identified and intrinsic regulations in the earlier stages of change. Strongest correlations with the IPAQ were found for motivational regulations towards walking.
Our results suggest that in all people with SMI the level of identified and intrinsic motivation may play an important role in the adoption and maintenance of health promoting behaviours.
The study provides a platform for future research to investigate the relationships between autonomy support, motivational regulations and physical and mental health variables within physiotherapy interventions for this population.
Disclosure of interest
The author has not supplied his declaration of competing interest.
Strategies that reduce the time to antimicrobial administration, such as the availability of premix antimicrobials (PMAs) in the emergency department (ED), may better align with the goals of the Surviving Sepsis Campaign and improve outcomes in septic patients. The objective of this study was to evaluate the impact of antimicrobial preparation on time to administration in septic patients located in the emergency department (ED).
This was a retrospective, single-center, cohort study and adult patients with a diagnosis of sepsis who received at least one initial intravenous (IV) antimicrobial in the ED were included. Time to complete an empiric antimicrobial therapy was defined as the time between prescriber order entry and the infusion initiation time of the final antimicrobial agent of a patient’s antimicrobial regimen. Appropriate, empiric antimicrobial therapy was based on treatment recommendations by nationally accepted guidelines for the specific indication.
The first antimicrobial was initiated earlier when available as a PMA preparation (median (IQR): premix 25 minutes (16.5-42.3) vs. non-premix 46 minutes (20-102), p=0.027). When comparing complete, empiric antimicrobial regimen administration, there was no difference in time to administration between regimens containing one or more non-premix antimicrobials and regimens containing all PMAs (median (IQR): premix 69 minutes (21-115) vs. non-premix 65 minutes (38.5-133.8); p=0.455).
PMA preparations significantly reduced time to administration of the first antimicrobial agent for septic patients treated in the ED, but time to administration of subsequent antimicrobials were not improved.
The Australian Dietary Guidelines recommend Australians choose mostly whole-grain and/or high-fibre varieties within the grains (cereal) foods category, with other groups specifying a whole grain Daily Target Intake of 48 g for Australians aged 9 years or above. The USA and UK report estimates of whole grain intake that are low and declining, and no comprehensive studies on whole grain intake in the Australian population are available. The present study aimed to determine national estimates of whole grain intake, compared with current recommendations.
A recently updated whole grain database was applied to the most current population dietary intake data. Single 24 h dietary recall intake data were reviewed against age group, sex, relative to energy intake and whole grain recommendations.
Australians (2–85 years) participating in the 2011–13 Australian Health Survey (n 12 153).
The median daily whole grain intake was 21 g for adults (19–85 years) and 17 g for children/adolescents (2–18 years), or 28 and 23 g/10 MJ per d, respectively. Approximately 30 % of children/adolescents consumed no whole grains on the day of the survey. Whole grain intake was lowest for the age group 14–18 years (8·7 g/d). Of all participants aged ≥9 years, 73 % did not reach the recommended Daily Target Intake of 48 g.
Whole grain intake in Australia is below recommendations in all age groups. Adolescents may be a key target for campaigns to increase whole grain consumption. This study provides the first quantification of absolute whole grain intake from all food sources in a national sample of Australians.
Cerebral air embolism (CAE) is a common, often lethal, complication in blunt and penetrating chest trauma. The factors affecting the outcome of CAE patients are poorly understood, and there is no generally accepted treatment algorithm. In this report, we present the case of a 28-year-old male motorcyclist with a massive CAE, including bilateral internal carotid artery air on computed tomographic examination following blunt chest trauma. With prehospital intubation, oxygen, transfusion, and open laparotomy but without any specific treatment regarding the CAE, a follow-up computed tomography (CT) scan approximately 6 hours later showed resolution of the cerebrovascular air. Recovery was unremarkable, and the patient was discharged neurologically intact after 22 days.
Individuals with depression have an elevated risk of cardiovascular disease (CVD) and metabolic syndrome (MetS) is an important risk factor for CVD. We aimed to clarify the prevalence and correlates of MetS in persons with robustly defined major depressive disorder (MDD).
We searched Medline, PsycINFO, EMBASE and CINAHL up until June 2013 for studies reporting MetS prevalences in individuals with MDD. Medical subject headings ‘metabolic’ OR ‘diabetes’ or ‘cardiovascular’ or ‘blood pressure’ or ‘glucose’ or ‘lipid’ AND ‘depression’ OR ‘depressive’ were used in the title, abstract or index term fields. Manual searches were conducted using reference lists from identified articles.
The initial electronic database search resulted in 91 valid hits. From candidate publications following exclusions, our search generated 18 studies with interview-defined depression (n = 5531, 38.9% male, mean age = 45.5 years). The overall proportion with MetS was 30.5% [95% confidence interval (CI) 26.3–35.1] using any standardized MetS criteria. Compared with age- and gender-matched control groups, individuals with MDD had a higher MetS prevalence [odds ratio (OR) 1.54, 95% CI 1.21–1.97, p = 0.001]. They also had a higher risk for hyperglycemia (OR 1.33, 95% CI 1.03–1.73, p = 0.03) and hypertriglyceridemia (OR 1.17, 95% CI 1.04–1.30, p = 0.008). Antipsychotic use (p < 0.05) significantly explained higher MetS prevalence estimates in MDD. Differences in MetS prevalences were not moderated by age, gender, geographical area, smoking, antidepressant use, presence of psychiatric co-morbidity, and median year of data collection.
The present findings strongly indicate that persons with MDD are a high-risk group for MetS and related cardiovascular morbidity and mortality. MetS risk may be highest in those prescribed antipsychotics.
In 2008, a cow with marked gross lesions suspicious for bovine tuberculosis (bTB) was identified by meat inspection at home slaughtering in north-western Germany. Epidemiological investigations led to the identification of another 11 affected farms with a total of 135 animals which reacted positive to the skin test. Eight affected farms had been in trade contact with the putative index farm. While the source for the initial introduction remained unknown, it was shown that all isolates tested shared the same molecular characteristics suggesting a common source of infection. The findings demonstrate that bTB can easily be transmitted via animal trade and may remain undetected for years in herds in the absence of tuberculin testing. Hence, we believe that bTB surveillance should not rely only on meat inspection, but on a combination of both meat inspection and intradermal tuberculin testing.
The CRESST-II direct Dark Matter search is located in the Gran Sasso underground laboratories, Italy. CaWO4 crystals are used as scintillating targets for WIMP (weakly interacting massive particle) interactions. They are operated as cryogenic calorimeters in combination with a second cryogenic detector used to measure the scintillation light produced in the target crystal. For each particle interaction, the combination of phonon and light signals provides an event by event discrimination which allows to distinguish known particles (alphas, betas, gammas, neutrons) from the expected signal of WIMPs. A major upgrade of the setup comprises modifications of the shielding, installation of a muon-veto, and new read out electronics, as well as a new detector-support structure to accommodate up to 33 detector modules, i.e. 10 kg of target mass. The experiment was thereafter successfully commissioned in 2007. Data obtained during this commissioning phase from 2 detector modules are presented here. Combining the data collected with these two detector modules with data from one single module obtained during the CRESST-I phase, the experiment could already place a limit of ~6 × 10-7 pb for the spin independent WIMP-nucleon scattering cross section at a WIMP mass of ~60 GeV/c2.
EURECA (European Underground Rare Event Calorimeter Array) is an
astro-particle physics facility aiming to directly detect galactic dark
matter. The Laboratoire Souterrain de Modane has been selected as host
laboratory. The EURECA collaboration unites CRESST, EDELWEISS and the
Spanish-French experiment ROSEBUD, thus concentrating and focussing effort
on cryogenic detector research in Europe into a single facility. EURECA will
use a target mass of up to one ton, enough to explore WIMP – nucleon scalar
scattering cross sections in the region of 10-9 – 10-10 picobarn.
A major advantage of EURECA is the planned use of more than just one target
material (multi target experiment for WIMP identification).
X-linked hypophosphataemic osteomalacia is the most common of the genetically determined forms of osteomalacia. The occurrence of hearing loss in X-linked hypophosphataemic osteomalacia has been known since 1984. However, observations on the progression of such hearing loss, and suggestions regarding possible therapy, have not previously been published.
Case report of a patient with X-linked hypophosphataemic osteomalacia and hearing loss, with three years' audiological follow up, description of empirical therapy and literature review.
The patient presented with fluctuating hearing. An audiogram showed mild to severe sensorineural hearing loss mainly in the low and high frequencies. A temporary improvement of 20–40 dB after steroid therapy was observed. Four weeks later, hearing had deteriorated again, mainly in the low frequencies. After one year of fluctuating hearing levels, stabilisation occurred.
In X-linked hypophosphataemic osteomalacia, hearing loss occurs predominantly in the low and high frequencies. The hearing loss type and progression pattern point to an endolymphatic hydrops as the pathogenetic mechanism. Steroid therapy may be of some benefit.
Physical hyperactivity has often been described in anorexia nervosa (AN) patients but up until now in-depth research has been scarce. Experience sampling methodology (ESM), a structured diary technique assessing momentary mental state at random times during the day, may be useful in studying hyperactivity in AN.
In two single case reports, ESM was used to investigate the variation across time of the urge to move in relation to potentially relevant eliciting conditions such as positive and negative emotions, weight preoccupation and attractiveness.
Frequency distribution of the involved variables indicated substantial individual differences between patients. While both patients' tendency to be hyperactive was positively related to their weight preoccupation and negative emotions, in only one patient, the urge to move turned out to be significantly related to (the absence of) positive emotions.
ESM can be useful to test whether general theories of psychopathology apply to specific patients, and it may be conceived as an individually tailored approach to self-monitoring. As such, it may guide the clinician to devise therapeutic interventions in particular patients.
Field studies were conducted at 35 sites throughout the north-central United States in 1998 and 1999 to determine the effect of postemergence glyphosate application timing on weed control and grain yield in glyphosate-resistant corn. Glyphosate was applied at various timings based on the height of the most dominant weed species. Weed control and corn grain yields were considerably more variable when glyphosate was applied only once. The most effective and consistent season-long annual grass and broadleaf weed control occurred when a single glyphosate application was delayed until weeds were 15 cm or taller. Two glyphosate applications provided more consistent weed control when weeds were 10 cm tall or less and higher corn grain yields when weeds were 5 cm tall or less, compared with a single application. Weed control averaged at least 94 and 97% across all sites in 1998 and 1999, respectively, with two glyphosate applications but was occasionally less than 70% because of late emergence of annual grass and Amaranthus spp. or reduced control of Ipomoea spp. With a single application of glyphosate, corn grain yield was most often reduced when the application was delayed until weeds were 23 cm or taller. Averaged across all sites in 1998 and 1999, corn grain yields from a single glyphosate application at the 5-, 10-, 15-, 23-, and 30-cm timings were 93, 94, 93, 91, and 79% of the weed-free control, respectively. There was a significant effect of herbicide treatment on corn grain yield in 23 of the 35 sites when weed reinfestation was prevented with a second glyphosate application. When weed reinfestation was prevented, corn grain yield at the 5-, 10-, and 15-cm application timings was 101, 97, and 93% of the weed-free control, respectively, averaged across all sites. Results of this study suggested that the optimum timing for initial glyphosate application to avoid corn grain yield loss was when weeds were less than 10 cm in height, no more than 23 d after corn planting, and when corn growth was not more advanced than the V4 stage.
The threatened Kirtland's warbler Dendroica kirtlandii breeds in stands of young jack pine Pinus banksiana growing on well-drained soils in Michigan, USA. We summarize information documenting the range expansion of Kirtland's warbler due to increased habitat management in the core breeding range in the Lower Peninsula of Michigan during 1990–2000. We collected records and conducted searches for the species in Michigan's Upper Peninsula and Wisconsin over 1978–2000. During that time 25 males were found in Wisconsin and 90 males in the Upper Peninsula. We documented colonization of Michigan's Upper Peninsula by six ringed males from the Lower Peninsula of Michigan. Four ringed birds also moved back to the core breeding range, including two males that made two-way movements between the core breeding range and the Upper Peninsula. Thirty-seven females were observed with males from 1995 to 2000, all in Michigan. Nesting activities were noted for 25 pairs and at least nine nests fledged young. One male ringed as a fledgling returned to breed in two subsequent years. After a 19-year period of population stability, the Kirtland's warbler population increased four-fold during 1990–2000, most likely in response to a tripling in habitat area. This increase in sightings and documented breeding may be related to habitat availability in Michigan's Upper Peninsula and to saturation of habitat in the main breeding range. The increase in extra-limital records during 1995–1999 corresponds to the time when the population went from the minimum to the maximum projected population densities, and a decline in natural wildfire habitat was just offset by new managed habitat for the Kirtland's warbler.
Purpose: Radiation techniques employed for breast cancer must be efficient as well as effective in order to minimise waiting lists. Protocol restrictions, or the technical application of treatment, may influence planning and treatment times as radiographers follow departmental policies. A national survey of UK radiotherapy centres was undertaken to establish trends in waiting times for breast cancer irradiation; and to investigate relationships of waiting times with the deployment of equipment and personnel and technical procedures adopted.
Method: A questionnaire was posted to the Head of Radiotherapy Services and a Clinical Oncologist with an interest in breast cancer in the radiotherapy centres in the UK. Survey questions investigated a number of issues, including the number of breast patients planned per week; protocols chosen; average treatment and planning times; levels of personnel and equipment; and the population served.
Results: A total of 53 centres were contacted, of which 51 centres responded to some aspect of the survey (96%). Average waiting times for treatment fluctuated from 1 to 7 weeks and maximum waiting times of 11 weeks were reported. Variation in clinical practice was found, including procedure times and the number of radiographers employed per linear accelerator. A multiple regression analysis indicated that a combination of equipment levels, simulation times, and the number of breast contours taken best predicted the average waiting time for breast treatment.
Conclusion: Waiting times reported were influenced by a combination of levels of equipment available and protocols adopted.