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The Suyanggae archeological complex is located in Aegok-li, Danyang County, Chungbuk Province, Korea (128°20'00"E, 365˚7'15"N, elevation 132 m). We investigated two Suyanggae Paleolithic localities (1 and 6). A total of 31 samples (18 localities) were analyzed for radiocarbon (14C) ages in three paleolithic cultural horizons of Suyanggae Locality 6 (SYG-6). The purpose of this paper is to report all dating results of SYG-6. It was found that ranges of 14C ages (BP) of cultural layers of SYG-6 are known to be 17,550 ± 80 ∼ 20,470 ± 70, 30,360 ± 350 ∼ 44,100 ± 1900, and 34,870 ± 540 ∼ 46,360 ± 510 BP for cultural layers 2, 3, and 4, respectively. We compared these age data with those of the previous study associated with Gunang Cave near Suyanggae Locality 1 (SYG-1). Based on the chronological information of the three archaeological sites, early humans lived in a rather cold environment from approximately 30,000 to 46,000 BP and disappeared between 30,000 ∼ 20,000 BP and then settled again in SYG-6 site during LGM period. This study demonstrates that archaeological study is important not only for understanding human occupations with their cultural development but also establishing climatic signals to which they have been adapted as a part of the human evolutional process.
Disease-related malnutrition is prevalent among older adults; therefore, identifying the modifiable risk factors in the diet is essential for the prevention and management of disease-related malnutrition. The present study examined the cross-sectional association between dietary patterns and malnutrition in Chinese community-dwelling older adults aged ≥65 years in Hong Kong. Dietary patterns, including Diet Quality Index International (DQI-I), Dietary Approaches to Stop Hypertension (DASH), the Mediterranean Diet Score, ‘vegetable–fruit’ pattern, ‘snack–drink–milk product’ pattern and ‘meat–fish’ pattern, were estimated and generated from a validated food frequency questionnaire. Malnutrition was classified according to the modified Global Leadership Initiative on Malnutrition (GLIM) criteria based on two phenotypic components (low body mass index and reduced muscle mass) and one aetiologic component (inflammation/disease burden). The association between the tertile or level of adherence of each dietary pattern and modified GLIM criteria was analysed using adjusted binary logistic regression models. Data of 3694 participants were available (49 % men). Malnutrition was present in 397 participants (10⋅7 %). In men, a higher DQI-I score, a higher ‘vegetable–fruit’ pattern score and a lower ‘meat–fish’ pattern score were associated with a lower risk of malnutrition. In women, higher adherence to the DASH diet was associated with a lower risk of malnutrition. After the Bonferroni correction, the association remained statistically significant only in men for the DQI-I score. To conclude, a higher DQI-I score was associated with a lower risk of malnutrition in Chinese older men. Nutritional strategies for the prevention and management of malnutrition could potentially be targeted on dietary quality.
Introduction: Point-of-care ultrasound (POCUS) has become standard practice in emergency departments ranging from remote rural hospitals to well-resourced academic centres. To facilitate quality assurance, the Canadian Association of Emergency Physicians (CAEP) recommends image archiving. Due in part to poor infrastructure and lack of a national standard, however, archiving remains uncommon. Our objective was to establish a minimum standard archiving protocol for the core emergency department POCUS indications. Methods: Itemization of potential archiving standards was created through an extensive literature review. An online, three-round, modified Delphi survey was conducted with the thirteen POCUS experts on the national CAEP Emergency Ultrasound Committee tasked with representing diverse practice locations and experiences. Participants were surveyed to determine the images or clips, measurements, mode, and number of views that should comprise the minimum standard for archiving. Consensus was pre-defined as 80%. Results: All thirteen experts participated fully in the three rounds. In establishing minimum image archiving standards for emergency department POCUS, complete consensus was achieved for first trimester pregnancy, hydronephrosis, cardiac activity versus standstill, lower extremity deep venous thrombosis, and ultrasound-guided central line placement. Consensus was achieved for the majority of statements regarding abdominal aortic aneurysm, extended focused assessment with sonography in trauma, pericardial effusion, left and right ventricular function, thoracic B-line assessment, cholelithiasis and cholecystitis scans. In total, consensus was reached for 58 of 69 statements (84.1%). This included agreement on 41 of 43 statements (95.3%) describing mandatory images for archiving in the above indications. Conclusion: Our modified Delphi-derived consensus represents the first national standard archiving requirements for emergency department POCUS. Depending on the clinical context, additional images may be required beyond this minimum standard to support a diagnosis.
Introduction: Cricothyrotomy is an intervention performed to salvage “can't intubate, can't ventilate” situations. Studies have shown poor accuracy landmarking the cricothyroid membrane, particularly in female patients by surgeons and anesthesiologists. There is less data available about emergency physician performance. This study examines the perceived versus actual success rate of landmarking the cricothyroid membrane by resident and staff emergency physicians using obese and non-obese models. Methods: Five male and female volunteers were selected as models. Each model was placed supine, and a point-of-care ultrasound expert landmarked the borders of each cricothyroid membrane. 20 residents and 15 staff emergency physicians were given one attempt to landmark five models. Data was gathered on each participant's perceived likelihood of success and attempt difficulty. Overall accuracy and accuracy stratified by sex and obesity status were calculated. Results: Overall landmarking accuracy amongst all participants was 58% (SD 18%). A difference in accuracy was found for obese males (88%) versus obese females (40%) (difference = 48%, 95% CI = 30-65%, p < 0.0001); and non-obese males (77%) versus non-obese females (46%) (difference = 31%, 95% CI = 12-51%, p = 0.004). There was no association between perceived difficulty and success (correlation = 0.07, 95% CI=−0.081-0.214, p = 0.37). Confidence levels overall were higher amongst staff physicians (3.0) than residents (2.7) (difference = 0.3, 95% CI = 0.1-0.6, p = 0.02), but there was no correlation between confidence in an attempt and its success (p = 0.33). Conclusion: We found that physicians demonstrate significantly lower accuracy when landmarking cricothyroid membranes of females. Emergency physicians were unable to predict their own accuracy while landmarking, which can potentially lead to increased failed attempts and longer time to secure the airway. Improved training techniques and a modified approach to cricothyrotomy may reduce failed attempts and improve the time to secure the airway.
Introduction: Biliary colic is a frequent cause for emergency department visits. Ultrasound is the initial test of choice for gallstone disease. We evaluated the effectiveness of a brief online educational module aimed to improve Emergency Physicians’ (EP) and General Surgeons’ (GS) accuracy in interpreting gallbladder ultrasound. Methods: EPs and GSs (resident/fellow and attending) from a single academic tertiary care hospital were invited to participate in a pre- and post- assessment of the interpretation of gallbladder ultrasound. Demographic information was obtained in a standardized survey. All questions developed for the pre- and post- assessment were reviewed for content and clarity by 3 EP and GS experts. Participants were asked 22 multiple-choice questions and then directed to a 7-minute video-tutorial on gallbladder ultrasound interpretation. After a 3-week period, participants then completed a post-intervention assessment. Following pre- and post- assessment, participants were surveyed on their confidence in gallbladder ultrasound interpretation. Data was analyzed using descriptive statistics and paired t-test. Results: The overall response rate of the pre-intervention was 50.9% (116/228) and 40.8% (93/228) for the post-intervention. In pre-intervention assessment, 27.7% of participants reported they were “not at all confident” in interpreting gallbladder ultrasound. This contrasted with post-intervention confidence level, where only minority (7.8%) reported “not at all confident”. There was a significant increase from the pre- to post- intervention (75.7% to 85.4%; p < 0.01) in correct interpretations. The greatest improvement was seen in those with previous experience interpreting gallbladder ultrasound (from 79.6% to 91.1%; p < 0.01). EPs scored significantly higher than GSs in the pre-intervention (EPs 78.2% compared to GSs 71.0%; p < 0.01). This trend was also observed in post-intervention, although the difference was no longer significant (EPs 88.9% compared to GSs 82.8%; p = 0.05). There was no significant difference in performance between residents/fellows compared to attendings. Conclusion: This brief, online intervention improved the accuracy of EPs’ and GSs’ interpretation of gallbladder ultrasound. This is an easily accessible tutorial that can be used as part of a comprehensive ultrasound educational program. Further studies are required to determine if EPs’ and GSs’ interpretations of gallbladder ultrasound impacts patient-oriented outcomes.
There have been many changes in the treatment of bipolar disorder.
It is necessary to develop guidelines that can more aptly respond to cultural issues and specifics in different countries.
The Korean Medication Algorithm for Bipolar Disorder (KMAP-BP) was firstly published in 2002, with updates in 2006 and 2010. This third update reviewed the experts' consensus of opinion on the pharmacological treatments of bipolar disorder.
The newly revised questionnaire composed of 55 key questions about clinical situations including 223 sub-items was sent to the experts.
Combination of mood stabilizer (MS) and atypical antipsychotic (AAP) was the first-line treatment option in acute mania. For the management of severe psychotic bipolar depression, combination of MS and AAP, combination of AAP and LTG, combination of MS, AAP and AD or LTG, combination of AAP and AD, and combination of AAP, AD and LTG was the first-line treatments. Combination of MS and AAP was the treatment of choice for management of mixed features. Combination of MS and AAP, MS or AAP monotherapy was the first-line options for management of maintenance phase after manic episode. For maintenance treatment after bipolar I depression, combination of MS and AAP, combination of MS and LTG, combination of AAP and LTG, MS or LTG monotherapy, and combination of MS, AAP and LTG were the first-line options.
Despite the limitations of expert consensus guideline, KMAP-BP 2014 may reflect the current patterns of clinical practice and recent researches.
The international guideline for treating depression has been widely used.
The current study focused on the maintenance treatment section of the third revision of Korean Medication Algorithm for Depressive Disorder (KMAP-DD)
A 44-item questionnaire was used to obtain the consensus of experts regarding pharmacological treatment strategies for depressive disorder. Of the 144 committee members, 79 psychiatrists responded to the survey. Each treatment strategy or treatment option was evaluated with the nine-point scale.
Most clinicians answered to maintain both antidepressants (AD) and atypical antipsychotics (AAP) for psychotic depression in remission state. The duration of AD maintenance: from 19.8 weeks to 46.8 weeks for patients in remission of the first episode, from 34.8 weeks to 78.4 weeks for the second depressive episode, and long-term continuation for three or more depressive episodes. Aripiprazole was the most preferred AAP. The preferred doses of AD and AAP in maintenance treatment were about 75% and 50% of those in acute treatment The maintenance of AAP in the psychotic depression in remission was similar to the AD, although shorter and less.
The maintenance strategies of KMAP-DD 2017 were similar to those of KMAP-DD 2012. Most clinicians preferred to maintain AD for substantial duration after achieving remission. The maintenance of AAP was also preferred, but the duration was shorter than AD.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
The primary aim of this non-inferiority study was to investigate the clinical effectiveness and safety of generic escitalopram (Lexacure) versus branded escitalopram (Lexapro) for patients with major depressive disorder (MDD).
The present study included 158 patients who were randomized (1:1) to receive a flexible dose of generic escitalopram (n = 78) or branded escitalopram (n = 80) over a 6-week single-blind treatment period. The clinical benefits in the two groups were evaluated using the Montgomery–Åsberg Depression Rating Scale (MADRS), the 17-item Hamilton Depression Rating Scale (HDRS), the Clinical Global Impressions-Severity Scale (CGI-S), and the Clinical Global Impressions-Improvement Scale (CGI-I) at baseline, week 1, week 2, week 4, and week 6. The frequency of adverse events (AEs) was also assessed to determine safety at each follow-up visit.
At week 6, 28 patients (57.1%) in the generic escitalopram group and 35 patients (67.3%) in the branded escitalopram group had responded to treatment (P = 0.126), and the remission rates (MADRS score: ≤ 10) were 42.9% (n = 21) in generic escitalopram group and 53.8% (n = 28) in the branded escitalopram group (P = 0.135). The most frequently reported AEs were nausea (17.9%) in the generic escitalopram group and nausea (20.0%) in the branded escitalopram group.
The present non-inferiority study demonstrated that generic escitalopram is a safe and effective initial treatment for patients with MDD and may also be considered as an additional therapeutic option for this population.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Tools applied at the point of care can provide valuable prognostic information for practitioners. In this one-year, prospective observational study, we examined the association of the short performance physical battery (SPPB) and one-year emergency department (ED) visits and hospitalizations. Overall, 191 new referrals attending an outpatient geriatric clinic in Hamilton, Ontario, were approached, and 120 were enrolled. SPPB and other assessments were completed during the routine clinical visit. ED visits and hospitalizations within one year of the baseline assessment were abstracted from electronic medical records. Logistic regression analyses were used to determine ED visits and hospitalization predictors. The mean SPPB score in the study cohort (mean age 80.6, SD 6.3 years; 53% female) was 6.3 (SD 3.2). SPPB score was associated with a one-year ED visit (OR = 0.90 [0.78–1.03]) and hospitalization (OR = 0.84 [0.72–0.97]) after adjusting for age, sex, and co-morbidities.
Global inequity in access to and availability of essential mental health services is well recognized. The mental health treatment gap is approximately 50% in all countries, with up to 90% of people in the lowest-income countries lacking access to required mental health services. Increased investment in global mental health (GMH) has increased innovation in mental health service delivery in LMICs. Situational analyses in areas where mental health services and systems are poorly developed and resourced are essential when planning for research and implementation, however, little guidance is available to inform methodological approaches to conducting these types of studies. This scoping review provides an analysis of methodological approaches to situational analysis in GMH, including an assessment of the extent to which situational analyses include equity in study designs. It is intended as a resource that identifies current gaps and areas for future development in GMH. Formative research, including situational analysis, is an essential first step in conducting robust implementation research, an essential area of study in GMH that will help to promote improved availability of, access to and reach of mental health services for people living with mental illness in low- and middle-income countries (LMICs). While strong leadership in this field exists, there remain significant opportunities for enhanced research representing different LMICs and regions.
It has not been well established whether dietary folate intake reduces the risk of diabetes development. We aimed to clarify the prospective association between dietary folate intake and type 2 diabetes (T2D) risk among 7333 Korean adults aged 40 years or older who were included in the Multi-Rural Communities Cohort. Dietary folate intake was estimated from all 106 food items listed on a FFQ, not including folate intake from supplements. Two different measurements of dietary folate intake were used: the baseline consumption and the average consumption from baseline until just before the end of follow-up. The association between folate intake and T2D risk was determined through a modified Poisson regression model with a robust error estimator controlling for potential confounders. For 29 745 person years, 319 cases of diabetes were ascertained. In multivariable analyses, dietary folate intake was inversely associated with risk of T2D for women, not for men. For women, the incidence rate ratio of diabetes in the third tertile compared with the first tertile was 0·57 (95 % CI 0·38–0·87, Pfor trend=0·0085) in the baseline consumption model and 0·64 (95 % CI 0·43–0·95, Pfor trend=0·0244) in the average consumption model. These inverse associations was found in both normal fasting blood glucose group and impaired fasting glucose group among women. Among non-users of multinutrients and vitamin supplements, the significant inverse association remained. Thus, higher dietary intake of folate is prospectively associated with lower risk of diabetes for women.
Vitamin D deficiency (plasma 25-hydroxycholecalciferol (25(OH)D)<50 nmol/l) is highly prevalent, increases risk of non-communicable diseases (NCD) and associates with increased oxidative stress in obese subjects, the elderly and patients suffering from NCD. If confirmed as an independent driver of oxidative stress, nutritional and other public health strategies to improve vitamin D status would be strongly supported. We investigated vitamin D/oxidative stress links without the confounding effects of advanced age, obesity, smoking or pre-existing disease. Plasma 25(OH)D and biomarkers of oxidative stress and antioxidant status (plasma allantoin, oxidised LDL, ferric reducing antioxidant power (FRAP), ascorbic acid, urine 8-oxo-7,8-dihydro-2'-deoxyguanosine) were measured in fasting samples from 196 consenting, healthy adults aged 18–26 years. Correlation between 25(OH)D and each biomarker as well as biomarker differences across 25(OH)D quartiles and groups (<25/25–49/≥50 nmol/l) were investigated. Median 25(OH)D was 40 nmol/l; >70 % of participants were vitamin D deficient. No significant correlations and no biomarker differences across 25(OH)D quartiles or groups were seen except for total antioxidant status. A weak direct association (r 0·252, P<0·05) was observed between 25(OH)D and FRAP, and those in the lowest 25(OH)D quartile and group had significantly lower FRAP values. Results did not reveal a clear link between vitamin D status and oxidative stress biomarkers in the absence of advanced age, obesity and disease, though some evidence of depleted antioxidant status in those with vitamin D deficiency was seen. Poor antioxidant status may pre-date increased oxidative stress. Study of effects of correction of deficiency on antioxidant status and oxidative stress in vitamin D-deficient but otherwise healthy subjects is needed.
In their focal article, Cucina, Walmsley, Gast, Martin, and Curtin (2017) raise a number of concerns about survey key driver analysis (SKDA). Although many are valid, we think their critique ultimately goes too far and risks throwing the baby out with the bathwater. We have found that SKDA can be an effective way to generate insight and action when analysis is done correctly and results are used appropriately. In this response article, we first provide data that counters Cucina et al.’s findings. Then we describe the approach we take to survey key driver analytics and application. In doing so, we hope to address some of the core concerns raised in the focal article and identify ways for scientists and practitioners to conduct SKDA in a responsible way.
To identify clinical factors that can explain the differences in treatment outcome, and examine the value of human papillomavirus infection as a prognostic biomarker in stage IVa tonsillar carcinomas.
Fifty-nine patients with tonsillar carcinoma classified as stage IVa were retrospectively analysed for survival outcomes according to various clinical factors. Human papillomavirus infection was evaluated using a human papillomavirus DNA chip test and immunohistochemical staining for p16 and p53.
Lower disease-free survival rates were associated with increasing local invasiveness and nodal status. Although human papillomavirus positivity and p16 expression was more common in locally advanced tonsillar carcinomas with advanced nodal status, the overall survival rate was better for patients with human papillomavirus positive, p16-positive tumours.
The disease-free survival rate may differ according to local tumour invasiveness and nodal status, even for stage IVa tonsillar cancers. Human papillomavirus infection may be a useful biomarker for predicting treatment outcomes for stage VIa tumours.
This study aimed to evaluate the efficacy of post-operative voice therapy after phonomicrosurgery for vocal polyp removal.
The study retrospectively enrolled 55 consecutive patients who had undergone voice therapy after phonomicrosurgery for vocal polyp removal occurring between June 2010 and June 2011. A historical group of 63 similar patients not receiving voice therapy was used as an external control. We compared voice analysis parameters and Voice Handicap Index scores for the two groups.
Most objective and subjective voice outcome parameters were significantly improved after surgical treatment. Although the study and control groups showed no significant difference regarding objective parameters (using acoustic and aerodynamic analysis) or the subjective parameters assessed using the grade-roughness-breathiness-asthenia-strain scale, the study group had significantly better final Voice Handicap Index scores.
Following surgery for vocal polyps, post-operative voice therapy can improve patients' vocal discomfort, emotional responses and everyday self-perception.
Recent results of focusing and reflectivity properties of the dispersive double-bent-crystal monochromator have shown that it could be succesfully used in high resolution neutron diffraction experiment. By using a standard polycrystalline sample of α-Fe, the resolution of the diffraction performance in the vicinity of the scattering angle 2θS = 90o for the neutron wavelength λ= 0.162 nm was tested in detail. It has been found that for thin (1.3 mm) bent second crystal the angular resolution represented by FWHM of diffraction profiles was 1x10−3 rad for 211 and 200 reflections and about 3x10−3 rad for 220 reflection.
Δ14C values of leaves of deciduous trees provide a means to map the regional-scale fossil fuel ratio in the atmosphere. We collected a batch of ginkgo (Ginkgo biloba Linnaeus, a deciduous tree) leaf samples from across Korea in the month of July in both 2010 and 2011 to obtain the regional distribution of Δ14C. The Δ14C values of the samples were measured using accelerator mass spectrometry (AMS) at the Korea Institute of Geoscience and Mineral Resources (KIGAM). The average of the Δ14C values from clean air sites in Korea in 2011 measured slightly lower than the average of Δ14C values in 2010. Distribution maps of Δ14C of 2011 and 2010 in Korea were made based on a series of Δ14C values of ginkgo leaf samples from Korea using the Geostatistical and Spatial analyst tools in ESRI's ArcMap software. The distribution maps of Δ14C showed that Δ14C values in the western part of Korea are lower than those in the eastern part of Korea. This is because the western part of Korea is densely populated and contains many industrial complexes, and also because westerly winds from China, containing CO2 from fossil fuel use, blow into Korea. We compared the distribution maps of 2010 and 2011 and tried to find traces of the Fukushima power plant accident in Japan.
Sport-related concussion (SRC) is typically followed by clinical recovery within days, but reports of prolonged symptoms are common. We investigated the incidence of prolonged recovery in a large cohort (n = 18,531) of athlete seasons over a 10-year period. A total of 570 athletes with concussion (3.1%) and 166 controls who underwent pre-injury baseline assessments of symptoms, neurocognitive functioning and balance were re-assessed immediately, 3 hr, and 1, 2, 3, 5, 7, and 45 or 90 days after concussion. Concussed athletes were stratified into typical (within 7 days) or prolonged (> 7 days) recovery groups based on symptom recovery time. Ten percent of athletes (n = 57) had a prolonged symptom recovery, which was also associated with lengthier recovery on neurocognitive testing (p < .001). At 45–90 days post-injury, the prolonged recovery group reported elevated symptoms, without deficits on cognitive or balance testing. Prolonged recovery was associated with unconsciousness [odds ratio (OR), 4.15; 95% confidence interval (CI) 2.12–8.15], posttraumatic amnesia (OR, 1.81; 95% CI, 1.00–3.28), and more severe acute symptoms (p < .0001). These results suggest that a small percentage of athletes may experience symptoms and functional impairments beyond the typical window of recovery after SRC, and that prolonged recovery is associated with acute indicators of more severe injury. (JINS, 2012, 18, 1–12)
Enzyme-Linked Immuno-Sorbent Assay (ELISA), and other methods based on the same principle, are sensitive and specific, but they suffer from several disadvantages, such as their inherent complexity and requirement for multiple reagents, incubation and washing steps and require a relatively large sample size. We have adapted a new carbon nanotube field effect transistors (CNT-FET) based platform to capture Escherichia coli antigens using only the capture anti-body showing good correlation with an established ELISA assay contrived positive and negative specimens were used to test the new CNT-FET platform and results were obtained within three minutes per each sample. The test is easy to perform, rapid, and cost efficient making it a valuable screening tool for E. coli. In this study, we looked at the applicability of using CNT field effect transistor based biosensor as a rapid diagnostic platform for Escherichia coli O157:H7. The CNT-FETs platform detected positive E. coli samples in three minutes using only 2.5 μL of sample volume. This low sample volume required by the CNT-FET platform can be especially advantageous for diagnostic tests constricted by limited amount of samples.