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Diez-Martin and colleagues (2021) experimentally reduce four bifaces and argue that the resultant flakes are smaller and less uniform than those found at the Welling site (33Co2). Welling is an early Paleoindian (Clovis) site excavated by Olaf Prufer over 50 years ago. Based on the experiment, the authors conclude that the site was a “collector-like” base camp and that our previous interpretation must be incorrect. Here, we argue that Diez-Martin and colleagues have mischaracterized our conclusion regarding the purpose of the site, and may have insufficiently addressed data that detract from their new interpretation.
The current study was conducted to examine the types of adjustments used to support students with special educational needs in mainstream classrooms and how schools monitored the effectiveness of the adjustments they use. A range of stakeholders were interviewed in 22 mainstream schools across New South Wales, Australia, and the interviews were analysed for key themes. Some schools had a narrow focus on a few key areas, with teaching assistants being the most commonly reported adjustment. Few schools used formal formative monitoring to evaluate the effectiveness of adjustments. Options for improvement schools could consider include examining the breadth of adjustments, establishing clear measurable goals, considering alternative strategies for use of teaching assistants, and ensuring adjustments are monitored.
A field study was conducted in Mississippi to determine the effect of reduced dicamba rates on sweetpotato crop tolerance and storage root yield, simulating off-target movement or sprayer tank contamination. Treatments included a nontreated control and four rates of dicamba [70 g ae ha−1 (1/8×), 35 g ae ha−1 (1/16×), 8.65 g ae ha−1 (1/64×), and 1.09 g ae ha−1 (1/512×)] applied either 3 d before transplanting (DBP) or 1, 3, 5, or 7 wk after transplanting (WAP). An additional treatment consisted of 560 g ae ha−1 (1×) dicamba applied 3 DBP. Crop injury ratings were taken 1, 2, 3, and 4 wk after treatment (WAT). Across application timings, predicted sweetpotato plant injury 1, 2, 3, and 4 WAT increased from 3T to 22%, 3% to 32%, 2% to 58%, and 1% to 64% as dicamba rate increased from 0 to 70 g ha−1 (1/8×), respectively. As dicamba rate increased from 1/512× to 1/8×, predicted No. 1 yield decreased from 127% to 55%, 103% to 69%, 124% to 31%, and 124% to 41% of the nontreated control for applications made 1, 3, 5, and 7 WAP, respectively. Similarly, as dicamba rate increased from 1/512× to 1/8×, predicted marketable yield decreased from 123% to 57%, 107% to 77%, 121% to 44%, and 110% to 53% of the nontreated control for applications made 1, 3, 5, and 7 WAP, respectively. Dicamba residue (5.3 to 14.3 parts per billion) was detected in roots treated with 1/16× or 1/8× dicamba applied 5 or 7 WAP and 1/64× dicamba applied 7 WAP with the highest residue detected in roots harvested from sweetpotato plants treated at 7 WAP. Collectively, care should be taken to avoid sweetpotato exposure to dicamba especially at 1/8× and 1/16× rates during the growing season.
Medically unexplained symptoms otherwise referred to as persistent physical symptoms (PPS) are debilitating to patients. As many specific PPS syndromes share common behavioural, cognitive, and affective influences, transdiagnostic treatments might be effective for this patient group. We evaluated the clinical efficacy and cost-effectiveness of a therapist-delivered, transdiagnostic cognitive behavioural intervention (TDT-CBT) plus (+) standard medical care (SMC) v. SMC alone for the treatment of patients with PPS in secondary medical care.
Methods
A two-arm randomised controlled trial, with measurements taken at baseline and at 9, 20, 40- and 52-weeks post randomisation. The primary outcome measure was the Work and Social Adjustment Scale (WSAS) at 52 weeks. Secondary outcomes included mood (PHQ-9 and GAD-7), symptom severity (PHQ-15), global measure of change (CGI), and the Persistent Physical Symptoms Questionnaire (PPSQ).
Results
We randomised 324 patients and 74% were followed up at 52 weeks. The difference between groups was not statistically significant for the primary outcome (WSAS at 52 weeks: estimated difference −1.48 points, 95% confidence interval from −3.44 to 0.48, p = 0.139). However, the results indicated that some secondary outcomes had a treatment effect in favour of TDT-CBT + SMC with three outcomes showing a statistically significant difference between groups. These were WSAS at 20 weeks (p = 0.016) at the end of treatment and the PHQ-15 (p = 0.013) and CGI at 52 weeks (p = 0.011).
Conclusion
We have preliminary evidence that TDT-CBT + SMC may be helpful for people with a range of PPS. However, further study is required to maximise or maintain effects seen at end of treatment.
Antibiotics are among the most common medications prescribed in nursing homes. The annual prevalence of antibiotic use in residents of nursing homes ranges from 47% to 79%, and more than half of antibiotic courses initiated in nursing-home settings are unnecessary or prescribed inappropriately (wrong drug, dose, or duration). Inappropriate antibiotic use is associated with a variety of negative consequences including Clostridioides difficile infection (CDI), adverse drug effects, drug–drug interactions, and antimicrobial resistance. In response to this problem, public health authorities have called for efforts to improve the quality of antibiotic prescribing in nursing homes.
Congenital renal and urinary tract anomalies are common, accounting for up to 21% of all congenital abnormalities [1]. The reported incidence is approximately 1:250–1:1000 pregnancies [2] and the routine use of prenatal ultrasonography allows relatively early detection, particularly for the obstructive uropathies, which account for the majority. According to the latest UK renal registry report in 2015, ‘obstructive uropathy’ was the second leading cause (19%) of chronic renal failure in children under 16 years of age after renal dysplasia +/− reflux [3]. The obstructions may occur within the upper or lower urinary tract, and their prognosis varies significantly, with obstructions at the level of the bladder neck being associated with the majority of neonatal mortality and renal failure. In untreated cases, perinatal mortality is high (up to 45%, often because of associated severe oligohydramnios and pulmonary hypoplasia) [4], and 30% of the survivors suffer from end-stage renal failure (ESRF) requiring dialysis and renal transplantation before the age of 5 [5]. The overall chance of survival in childhood is lowest if renal support therapy or transplantation is commenced before 2 years old when compared with starting at 12–16 years old (hazard ratio [HR] of 4.1, 95% confidence interval [CI] 1.7–9.9, P = 0.002) [3]. Therefore, in utero intervention, by the insertion of a vesicoamniotic shunt, or therapeutic treatment by fetal cystoscopy and valvular ablation, has been attempted to attenuate in utero progression of these pathologies (and their consequences) and to alter the natural history of congenital bladder neck obstruction in childhood. In this chapter, we discuss the etiology, pathophysiology, prenatal presentation and diagnosis of congenital bladder neck obstruction. Suggested algorithms for screening and the prenatal prognostic evaluation in selecting candidates for in utero therapy will be discussed.
The Bulge Asymmetries and Dynamical Evolution (BAaDE) survey aims to explore the complex structure of the inner Galaxy and Galactic Bulge, by using the 43 GHz receivers at the Karl G. Jansky Very Large Array (VLA) and the 86 GHz receivers at the Atacama Large Millimeter/submillimeter Array (ALMA) to observe SiO maser lines in red giant stars. The goal is to construct a sample of stellar point-mass probes that can be used to test models of the gravitational potential, and the final sample is expected to provide at least 20,000 line-of-sight velocities and positions. A possible bias between the VLA and the ALMA SiO maser lines is explored, and the 86 GHz SiO line-peak velocities agree using either of the four sampled lines. Additionally, the SiO maser velocities agree with the OH maser derived velocities.
The Bulge Asymmetries and Dynamical Evolution (BAaDE) survey aims to use circumstellar SiO maser line-of-sight velocities as probes for the Galactic gravitational potential and dynamical structure. The SiO masers are detected at a high rate in specific color-selected MSX infrared sources. Furthermore, the SiO maser properties and line ratios, in combination with infrared spectral energy distributions and location in the Galaxy, will statistically yield detailed information on population and evolution of low- to intermediate-mass evolved stars in the Galaxy.
The carbon-rich AGB star V Hya is believed to be in the very brief transition phase between the AGB and a planetary nebula (PN). Using HST/STIS, we previously found a high-velocity (> 200 kms−1) jet or blob of gas ejected only a few years ago from near (< 0.3 arcsec or 150 AU) the star (Sahai et al. 2003, Sahai et al. 2016). From multi-epoch high-resolution spectroscopy we found time-variable high-velocity absorption features in the CO 4.6 μm vibration-rotation lines of V Hya (Sahai et al. 2009). Modeling shows that these are produced in compact clumps of outflowing gas with significant radial temperature gradients consistent with strong shocks. Here, we present very high resolution (∼100 milliarcsecond) imaging of the central region of V Hya using the coronagraphic mode of the Gemini Planet Imager (GPI) in the 1 μm band and spectral-spatial imaging of 4.6 μm CO 1-0 transitions using the Phoenix spectrometer. We report the detection of a compact central dust disk from GPI, and molecular emission from the Phoenix observations at relatively larger scales. We discuss models for the central structures in V Hya, in particular disks and outflows, using these and complementary images in the optical and radio.
We report on the Bulge Asymmetries and Dynamic Evolution (BAaDE) survey which has observed 19 000 MSX color selected red giant stars for SiO maser emission at 43 GHz with the VLA and is in the process of observing 9 000 of these stars with ALMA at 86 GHz in the Southern sky. Our setup covers the main maser transitions, as well as those of isotopologues and selected lines of carbon-bearing species. Observations of this set of lines allow a far-reaching catalog of line-of-sight velocities in the dust-obscured regions where optical surveys cannot reach. Our preliminary detection rate is close to 70%, predicting a wealth of new information on the distribution of metal rich stars, their kinematics as function of location in the Galaxy, as well as the occurrence of lines and line ratios between the different transitions in combination with the spectral energy distribution from about 1 to 100 μm. Similar to the OH/IR stars, a clear kinematic signature between disk and bulge stars can be seen. Furthermore, the SiO J = →10 (v=3) line plays a prominent role in the derived maser properties.
Families of children born with CHD face added stress owing to uncertainty about the magnitude of the financial burden for medical costs they will face. This study seeks to assess the family responsibility for healthcare bills during the first 12 months of life for commercially insured children undergoing surgery for severe CHD.
Methods
The MarketScan® database from Truven was used to identify commercially insured infants in 39 states from 2010 to 2012 with an ICD-9 diagnosis code for transposition of the great arteries, tetralogy of Fallot, or truncus arteriosus, as well as the corresponding procedure code for complete repair. Data extraction identified payment responsibilities of the patients’ families in the form of co-payments, deductibles, and co-insurance during the 1st year of life.
Results
There were 481 infants identified who met the criteria. Average family responsibility for healthcare bills during the 1st year of life was $2928, with no difference between the three groups. The range of out-of-pocket costs was $50–$18,167. Initial hospitalisation and outpatient care accounted for the majority of these responsibilities.
Conclusions
Families of commercially insured children with severe CHD requiring corrective surgery face an average of ~$3000 in out-of-pocket costs for healthcare bills during the first 12 months of their child’s life, although the amount varied considerably. This information provides a framework to alleviate some of the uncertainty surrounding healthcare financial responsibilities, and further examination of the origination of these expenditures may be useful in informing future healthcare policy discussion.
Congenital genitourinary tract anomalies are some of the most commonly identified prenatal abnormalities, being identified in between 1 in 250 and 1 in 1000 pregnancies. They consist of a wide spectrum of heterogeneous malformations. Obstructive uropathies account for the majority of these abnormalities. the second-trimester detailed scan (often at 18+0–21+6 weeks) is the examination in which the majority of genitourinary abnormalities are diagnosed. However, with the widespread use of first-trimester ultrasound screening, severe renal anomalies and “megacystis” are being noted between 11+0 and 13+6 weeks. Additionally, third-trimester ultrasound may reveal late-onset uropathies, often associated with changes in liquor volume.
Epidemiology formed the basis of ‘the Barker hypothesis’, the concept of ‘developmental programming’ and today’s discipline of the Developmental Origins of Health and Disease (DOHaD). Animal experimentation provided proof of the underlying concepts, and continues to generate knowledge of underlying mechanisms. Interventions in humans, based on DOHaD principles, will be informed by experiments in animals. As knowledge in this discipline has accumulated, from studies of humans and other animals, the complexity of interactions between genome, environment and epigenetics, has been revealed. The vast nature of programming stimuli and breadth of effects is becoming known. As a result of our accumulating knowledge we now appreciate the impact of many variables that contribute to programmed outcomes. To guide further animal research in this field, the Australia and New Zealand DOHaD society (ANZ DOHaD) Animals Models of DOHaD Research Working Group convened at the 2nd Annual ANZ DOHaD Congress in Melbourne, Australia in April 2015. This review summarizes the contributions of animal research to the understanding of DOHaD, and makes recommendations for the design and conduct of animal experiments to maximize relevance, reproducibility and translation of knowledge into improving health and well-being.
We summarize work on the central parsec of the Galactic center based on imaging and spectroscopic observations at the Keck and Gemini telescopes. These observations include stellar positions in two dimension and the velocity in three dimensions. Spectroscopic observations also enables measurements of the physical properties of individual stars, such as the spectral type and in some cases the effective temperature, metallicity, and surface gravity. These observations show a complex stellar population with a young (4-6 Myr) compact star cluster in the central 0.5 pc embedded in in an older and much more massive nuclear star cluster. Surprisingly, the old late-type giants do not show a cusp profile as long been expected from theoretical work. The majority of the stars have higher than solar metallicity, with only about 6% of the stars having [M/Fe] < −0.5, which is consistent with an origin from the MW disk.
The history of supermassive black holes’ activity can be partly constrained by monitoring the diffuse X-ray emission possibly created by the echoes of past events propagating through the molecular clouds of their respective environments. In particular, using this method we have demonstrated that our Galaxy’s supermassive black hole, Sgr A⋆, has experienced multiple periods of higher activity in the last centuries, likely due to several short but very energetic events, and we now investigate the possibility of studying the past activity of other supermassive black holes by applying the same method to M31⋆. We set strong constraints on putative phase transitions of this more distant galactic nucleus but the existence of short events such as the ones observed in the Galactic center cannot be assessed with the upper limits we derived.