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For the average person, genetic testing has two very different faces. The rise of genetic testing is often promoted as the democratization of genetics by enabling individuals to gain insights into their unique makeup. At the same time, many have raised concerns that genetic testing and sequencing reveal intensely personal and private information. As these technologies become increasingly available as consumer products, the ethical, legal, and regulatory challenges presented by genomics are ever looming. Assembling multidisciplinary experts, this volume evaluates the different models used to deliver consumer genetics and considers a number of key questions: How should we mediate privacy and other ethical concerns around genetic databases? Does aggregating data from genetic testing turn people into products by commercializing their data? How might this data reduce or exacerbate existing healthcare disparities? Contributing authors also provide guidance on protecting consumer privacy and safety while promoting innovation.
Lifestyle modifications for those with mild cognitive impairment (MCI) may promote functional stability, lesson disease severity, and improve well-being outcomes such as quality of life. The current analysis of our larger comparative effectiveness study evaluated which specific combinations of lifestyle modifications offered as part of the Mayo Clinic Healthy Action to Benefit Independence in Thinking (HABIT) program contributed to the least functional decline in people with MCI (pwMCI) over 18 months.
We undertook to compare evidence-based interventions with one another rather than to a no-treatment control group. The interventions were five behavioral treatments: computerized cognitive training (CCT), yoga, Memory Support System (MSS) training, peer support group (SG), and wellness education (WE), each delivered to both pwMCI and care partners, in a group-based program. To compare interventions, we randomly withheld one of the five HABIT® interventions in each of the group sessions. We conducted 24 group sessions with between 8 and 20 pwMCI–partner dyads in a session.
Withholding yoga led to the greatest declines in functional ability as measured by the Functional Activities Questionnaire and Clinical Dementia Rating. In addition, memory compensation (calendar) training and cognitive exercise appeared to have associations (moderate effect sizes) with better functional outcomes. Withholding SG or WE appeared to have little effect on functioning at 18 months.
Overall, these results add to the growing literature that physical exercise can play a significant and lasting role in modifying outcomes in a host of medical conditions, including neurodegenerative diseases.
This prospective, longitudinal study compared the frequency and pattern of mood changes between outpatients receiving usual care for bipolar disorder who were either taking or not taking antidepressants. One hundred and eighty-two patients with bipolar disorder self-reported mood and psychiatric medications for 4 months using a computerized system (ChronoRecord) and returned 22,626 days of data. One hundred and four patients took antidepressants, 78 did not. Of the antidepressants taken, 95% were selective serotonin or norepinephrine reuptake inhibitors, or second-generation antidepressants. Of the patients taking an antidepressant, 91.3% were concurrently taking a mood stabilizer. The use of antidepressants did not influence the daily rate of switching from depression to mania or the rate of rapid cycling, independent of diagnosis of bipolar I or II. The primary difference in mood pattern was the time spent normal or depressed. Patients taking antidepressants frequently remained in a subsyndromal depression. In this naturalistic study using self-reported data, patients with bipolar disorder who were taking antidepressants—overwhelmingly not tricyclics and with a concurrent mood stabilizer—did not experience an increase in the rate of switches to mania or rapid cycling compared to those not taking antidepressants. Antidepressants had little impact on the mood patterns of bipolar patients taking mood stabilizers.
Two common approaches to identify subgroups of patients with bipolar disorder are clustering methodology (mixture analysis) based on the age of onset, and a birth cohort analysis. This study investigates if a birth cohort effect will influence the results of clustering on the age of onset, using a large, international database.
The database includes 4037 patients with a diagnosis of bipolar I disorder, previously collected at 36 collection sites in 23 countries. Generalized estimating equations (GEE) were used to adjust the data for country median age, and in some models, birth cohort. Model-based clustering (mixture analysis) was then performed on the age of onset data using the residuals. Clinical variables in subgroups were compared.
There was a strong birth cohort effect. Without adjusting for the birth cohort, three subgroups were found by clustering. After adjusting for the birth cohort or when considering only those born after 1959, two subgroups were found. With results of either two or three subgroups, the youngest subgroup was more likely to have a family history of mood disorders and a first episode with depressed polarity. However, without adjusting for birth cohort (three subgroups), family history and polarity of the first episode could not be distinguished between the middle and oldest subgroups.
These results using international data confirm prior findings using single country data, that there are subgroups of bipolar I disorder based on the age of onset, and that there is a birth cohort effect. Including the birth cohort adjustment altered the number and characteristics of subgroups detected when clustering by age of onset. Further investigation is needed to determine if combining both approaches will identify subgroups that are more useful for research.
Whole-genome sequencing (WGS) has yielded new insights into the transmission patterns of healthcare facility-onset Clostridioides difficile infection (HO-CDI). WGS results prompted a focused diagnostic stewardship program, which was associated with a significant and sustained decrease in HO-CDI at large, urban hospital.
It is curious that first-principles quantum simulations for establishing the electronic structure and bonding patterns of molecules and materials are conducted using fields, yet the standard theoretical approach to understanding their thermal behavior, phase transitions, and self-assembly on larger length- and time scales relies on classical force fields acting on particle degrees of freedom. This article discusses how equilibrium models of classical particle assemblies can be exactly reframed as statistical field theories, and how these theories can be numerically simulated. Today, such field-theoretic simulations have emerged as a highly efficient way to study phase transitions and self-assembly behavior in broad classes of soft materials, including block polymers, polyelectrolyte complexes, and polymeric emulsions.
Dementia is a neurodegenerative disorder with global impact, with the largest proportion of cases occurring in low- and middle-income countries. It is estimated that there are 46.8 million cases globally with approximately 10 million new cases each year or a new case occurring every 3 sec (Prince et al., 2015). For comparison there are 36.7 million HIV cases with an estimated 2 million new cases each year (WHO, 2017). The rise in dementia prevalence is largely due to population ageing, with the oldest being at highest risk. To date there are no diseases modifying medications for Alzheimer's disease or the other causes of dementia. Academics and research groups are increasingly focused on prevention or delay of dementia (Brayne and Miller, 2017) and a number of organizations now prioritize dementia, indicating a strong and coherent international effort to address this problem. Examples include the World Health Organisation (WHO), which has established a Global Dementia Observatory; the World Dementia Council; the Organisation for Economic Co-operation and Development (OECD); the U.S. National Alzheimer's Project Act (NAPA); and the Global Council on Brain Health.
Excavations at the 109 hectare site of Kurd Qaburstan on the Erbil plain in the Kurdistan Region of Iraq were conducted by the Johns Hopkins University in 2013 and 2014. The Middle Bronze Age (Old Babylonian period) is the main period of occupation evident on the site, and the project therefore aims to study the character of a north Mesopotamian urban centre of the early second millennium b.c. On the high mound, excavations revealed three phases of Mittani (Late Bronze) period occupation, including evidence of elite residential architecture. On the low mound and the south slope of the high mound, Middle Bronze evidence included domestic remains with numerous ceramic vessels left in situ. Also dating to the Middle Bronze period is evidence of a city wall on the site edges. Later occupations include a cemetery, perhaps of Achaemenid date, on the south slope of the high mound and a Middle Islamic settlement on the southern lower town. Faunal and archaeobotanical analysis provide information on the plant and animal economy of the second millennium b.c. occupations, and geophysical results have documented a thirty-one hectare expanse of dense Middle Bronze Age architecture in the northern lower town.
Although evidence shows that attachment insecurity and disorganization increase risk for the development of psychopathology (Fearon, Bakermans-Kranenburg, van IJzendoorn, Lapsley, & Roisman, 2010; Groh, Roisman, van IJzendoorn, Bakermans-Kranenburg, & Fearon, 2012), implementation challenges have precluded dissemination of attachment interventions on the broad scale at which they are needed. The Circle of Security–Parenting Intervention (COS-P; Cooper, Hoffman, & Powell, 2009), designed with broad implementation in mind, addresses this gap by training community service providers to use a manualized, video-based program to help caregivers provide a secure base and a safe haven for their children. The present study is a randomized controlled trial of COS-P in a low-income sample of Head Start enrolled children and their mothers. Mothers (N = 141; 75 intervention, 66 waitlist control) completed a baseline assessment and returned with their children after the 10-week intervention for the outcome assessment, which included the Strange Situation. Intent to treat analyses revealed a main effect for maternal response to child distress, with mothers assigned to COS-P reporting fewer unsupportive (but not more supportive) responses to distress than control group mothers, and a main effect for one dimension of child executive functioning (inhibitory control but not cognitive flexibility when maternal age and marital status were controlled), with intervention group children showing greater control. There were, however, no main effects of intervention for child attachment or behavior problems. Exploratory follow-up analyses suggested intervention effects were moderated by maternal attachment style or depressive symptoms, with moderated intervention effects emerging for child attachment security and disorganization, but not avoidance; for inhibitory control but not cognitive flexibility; and for child internalizing but not externalizing behavior problems. This initial randomized controlled trial of the efficacy of COS-P sets the stage for further exploration of “what works for whom” in attachment intervention.
Drawing on a two-wave, multimethod, multi-informant design, this study provides the first test of a process model of spillover specifying why and how disruptions in the coparenting relationship influence the parent–adolescent attachment relationship. One hundred ninety-four families with an adolescent aged 12–14 (M age = 12.4) were followed for 1 year. Mothers and adolescents participated in two experimental tasks designed to elicit behavioral expressions of parent and adolescent functioning within the attachment relationship. Using a novel observational approach, maternal safe haven, secure base, and harshness (i.e., hostility and control) were compared as potential unique mediators of the association between conflict in the coparenting relationship and adolescent problems. Path models indicated that, although coparenting conflicts were broadly associated with maternal parenting difficulties, only secure base explained the link to adolescent adjustment. Adding further specificity to the process model, maternal secure base support was uniquely associated with adolescent adjustment through deficits in adolescents' secure exploration. Results support the hypothesis that coparenting disagreements undermine adolescent adjustment in multiple domains specifically by disrupting mothers' ability to provide a caregiving environment that supports adolescent exploration during a developmental period in which developing autonomy is a crucial stage-salient task.
Over the last 25 years subspecies have become an important unit of bird conservation in Australia. Some have evocative common English names which have allowed the subspecies to be vested with meaning among conservation advocates, evoking feelings of concern, loyalty and affection. This suggests that providing subspecies with stable English names can allow development of a ‘brand’ among those in need of conservation action. Also, since scientific names often change with knowledge of taxonomic relationships among birds, a stable list of standardised English names for all species and subspecies can minimise confusion and ambiguity among the public and in legislation. Here we present the arguments for creating a standardised list of English names for Australian bird subspecies and set out principles for formulating subspecies names, along with a list of the names themselves, with the aim of building the general public’s attachment to subspecies, increasing interest in their conservation and as subjects of research.
We investigated the physiology of two closely related albatross species relative to their breeding strategy: black-browed albatrosses (Thalassarche melanophris) breed annually, while grey-headed albatrosses (T. chrysostoma) breed biennially. From observations of breeding fate and blood samples collected at the end of breeding in one season and feather corticosterone levels (fCort) sampled at the beginning of the next breeding season, we found that in both species some post-breeding physiological parameters differed according to breeding outcome (successful, failed, deferred). Correlations between post-breeding physiology and fCort, and links to future breeding decisions, were examined. In black-browed albatrosses, post-breeding physiology and fCort were not significantly correlated, but fCort independently predicted breeding decision the next year, which we interpret as a possible migratory carry-over effect. In grey-headed albatrosses, post-breeding triglyceride levels were negatively correlated with fCort, but only in females, which we interpret as a potential cost of reproduction. However, this potential cost did not carry-over to future breeding in the grey-headed albatrosses. None of the variables predicted future breeding decisions. We suggest that biennial breeding in the grey-headed albatrosses may have evolved as a strategy to buffer against the apparent susceptibility of females to negative physiological costs of reproduction. Future studies are needed to confirm this.
To assess the impact of an emergency intensive care unit (EICU) established concomitantly with a freestanding emergency department (ED) during the aftermath of Hurricane Sandy.
We retrospectively reviewed records of all patients in Bellevue’s EICU from freestanding ED opening (December 10, 2012) until hospital inpatient reopening (February 7, 2013). Temporal and clinical data, and disposition upon EICU arrival, and ultimate disposition were evaluated.
Two hundred twenty-seven patients utilized the EICU, representing approximately 1.8% of freestanding ED patients. Ambulance arrival occurred in 31.6% of all EICU patients. Median length of stay was 11.55 hours; this was significantly longer for patients requiring airborne isolation (25.60 versus 11.37 hours, P<0.0001 by Wilcoxon rank sum test). After stabilization and treatment, 39% of EICU patients had an improvement in their disposition status (P<0.0001 by Wilcoxon signed rank test); upon interhospital transfer, the absolute proportion of patients requiring ICU and SDU resources decreased from 37.8% to 27.1% and from 22.2% to 2.7%, respectively.
An EICU attached to a freestanding ED achieved significant reductions in resource-intensive medical care. Flexible, adaptable care systems should be explored for implementation in disaster response. (Disaster Med Public Health Preparedness. 2016;10:496–502)
We use high-resolution Keck, VLT, or Hubble Space Telescope spectra of background quasars to examine the kinematic properties of the multiphase, metal-enriched circumgalactic medium in the outskirts of galaxies at 0.08 < zgal < 1.0, focusing on the low-ionization Mgii and high-ionization Ovi doublets. The absorption kinematics of low-ionization gas in the circumgalactic medium depend strongly on the star formation activity and the location about the host galaxy, where the largest velocity dispersions are associated with blue, face-on galaxies probed along the minor axis. Conversely, high-ionization gas kinematics are independent of galaxy star formation activity and orientation.
Aminocyclopyrachlor (AMCP) is a synthetic auxin herbicide used for broadleaf
weed control in pasture and rangeland. The tolerance and fate of AMCP within
pertinent grass species is not well understood. Research was conducted to
establish the tolerance of four grass species to AMCP application and
observe their absorption, translocation, and metabolism. Results indicate
that tall fescue is the most tolerant of AMCP at rates required for weed
control. Bahiagrass and bermudagrass are marginally tolerant, and cogongrass
is the most sensitive. Tall fescue and bahiagrass absorbed more AMCP than
bermudagrass and cogongrass, but cogongrass absorption is the most rapid and
complete within 2 days after treatment (DAT). Cogongrass and bermudagrass
translocated the least amount out of the target area, whereas bahiagrass and
tall fescue translocated the most. Radioisotope imaging revealed that tall
fescue may sequester absorbed AMCP in leaf tips. This sequestering may be
the basis of the greater tolerance to AMCP by tall fescue relative to the
other species evaluated. No metabolism of AMCP was detected in any grass
species out to 42 DAT.
The development and spread of glyphosate-resistant (GR) horseweed has increased the use of dicamba as an alternative herbicide treatment. Research evaluated suspected glyphosate-resistant horseweed populations from DeKalb (GR-1) and Cherokee (GR-2) counties, Alabama, for response to glyphosate, dicamba, and glyphosate + dicamba. Populations used for resistance determination were tested at rosette and bolt growth stages. Glyphosate resistance evaluation treatments ranged from 0 to 36.0 kg ae ha−1. Data confirmed that GR-1 and GR-2 horseweed populations were 3.0 to 38 times more resistant to glyphosate than the susceptible population, according to population, data type, and growth stage at treatment. GR-1 and GR-2 populations were further evaluated for response to dicamba. Dicamba was applied at 0 to 1.12 kg ai ha−1, both with and without the addition of glyphosate at 1.12 kg ae ha−1. All populations had similar tolerance to dicamba, with the exception of GR-2 treated at the rosette growth stage, which had ~2-fold greater tolerance. When glyphosate was tank-mixed with dicamba, the response of GR populations was similar to that of dicamba alone. Therefore, any potential resistance-management benefit of tank-mixing dicamba with glyphosate may be negated when one is attempting to control GR horseweed. Conversely, adding glyphosate to dicamba drastically enhanced control of the susceptible population at both growth stages.