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Background: Ischemic stroke is a major cause of morbidity and mortality in Canada. Since 2015, mechanical thrombectomy has been the standard of care for eligible large vessel occlusions (LVOs), though anesthetic strategies remain variable. Methods: We conducted a single-center retrospective review of patients undergoing mechanical thrombectomy for anterior circulation LVOs between 2021 and 2023. Patients were categorized by anesthetic strategy (general anesthesia vs. conscious sedation), and outcomes, including time to recanalization, angiographic results (mTICI), and 90-day functional status (mRS), were compared. Statistical analyses included Student’s t-test, Mann-Whitney U-test, and Fisher’s exact test. Results: Among 226 patients, 177 (78%) received general anesthesia and 49 (22%) underwent conscious sedation. Baseline characteristics including sex, age, NIHSS, ASPECTS, collaterals, and laterality were similar between groups. Conscious sedation was associated with a statistically significant shorter time from arrival to the angiography suite to groin puncture (p=0.007), but no differences in time to recanalization (p=0.893), angiographic outcomes (p=0.987), or 90-day functional status (p=0.795) were observed. Conclusions: Conscious sedation led to faster procedural initiation, though no difference in clinical or radiographic outcome was observed. Anesthetic choice should be individualized based on patient and physician factors in acute mechanical thrombectomy.
There is a lack of knowledge on deaths related to police use of force across Canada. Tracking (In)Justice is a research project that is trying to make sense of the life and death outcomes of policing through developing a collaborative, interdisciplinary, and open-source database using publicly available sources. With a collaborative data governance approach, which includes communities most impacted and families of those killed by police, we document and analyze 745 cases of police-involved deaths when intentional force is used across Canada from 2000 to 2023. The data indicate a steady rise in deaths, in particular shooting deaths, as well as that Black and Indigenous people are over-represented. We conclude with reflections on the ethical complexities of datafication, knowledge development of what we call death data and the challenges of enumerating deaths, pitfalls of official sources, the data needs of communities, and the living nature of the Tracking (In)Justice project.
In acute ischemic stroke, a longer time from onset to endovascular treatment (EVT) is associated with worse clinical outcome. We investigated the association of clinical outcome with time from last known well to arrival at the EVT hospital and time from hospital arrival to arterial access for anterior circulation large vessel occlusion patients treated > 6 hours from last known well.
Methods:
Retrospective analysis of the prospective, multicenter cohort study ESCAPE-LATE. Patients presenting > 6 hours after last known well with anterior circulation large vessel occlusion undergoing EVT were included. The primary outcome was the modified Rankin Scale (mRS) score at 90 days. Secondary outcomes were good (mRS 0–2) and poor clinical outcomes (mRS 5–6) at 90 days, as well as the National Institutes of Health Stroke Scale at 24 hours. Associations of time intervals with outcomes were assessed with univariable and multivariable logistic regression.
Results:
Two hundred patients were included in the analysis, of whom 85 (43%) were female. 90-day mRS was available for 141 patients. Of the 150 patients, 135 (90%) had moderate-to-good collaterals, and the median Alberta Stroke Program Early CT Score (ASPECTS) was 8 (IQR = 7–10). No association between ordinal mRS and time from last known well to arrival at the EVT hospital (odds ratio [OR] = 1.01, 95% CI = 1.00–1.02) or time from hospital arrival to arterial access (OR = -0.01, 95% CI = -0.02–0.00) was seen in adjusted regression models.
Conclusion:
No relationship was observed between pre-hospital or in-hospital workflow times and clinical outcomes. Baseline ASPECTS and collateral status were favorable in the majority of patients, suggesting that physicians may have chosen to predominantly treat slow progressors in the late time window, in whom prolonged workflow times have less impact on outcomes.
For near-future missions planed for Mars Sample Return (MSR), an international working group organized by the Committee on Space Research (COSPAR) developed the sample safety assessment framework (SSAF). For the SSAF, analytical instruments were selected by taking the practical limitations of hosting them within a facility with the highest level of biosafety precautions (biosafety level 4) and the precious nature of returned samples into account. To prepare for MSR, analytical instruments of high sensitivity need to be tested on effective Mars analogue materials. As an analogue material, we selected a rock core of basalt, a prominent rock type on the Martian surface. Two basalt samples with aqueous alteration cached in Jezero crater by the Perseverance rover are planned to be returned to Earth. Our previously published analytical procedures using destructive but spatially sensitive instruments such as nanoscale secondary ion mass spectrometry (NanoSIMS) and transmission electron microscopy coupled to energy-dispersive spectroscopy revealed microbial colonization at clay-filled fractures. With an aim to test the capability of an analytical instrument listed in SSAF, we now extend that work to conventional Fourier transform infrared (FT-IR) microscopy with a spatial resolution of 10 μm. Although Fe-rich smectite called nontronite was identified after crushing some portion of the rock core sample into powder, the application of conventional FT-IR microscopy is limited to a sample thickness of <30 μm. In order to obtain IR-based spectra without destructive preparation, a new technique called optical-photothermal infrared (O-PTIR) spectroscopy with a spatial resolution of 0.5 μm was applied to a 100 μm thick section of the rock core. By O-PTIR spectroscopic analysis of the clay-filled fracture, we obtained in-situ spectra diagnostic to microbial cells, consistent with our previously published data obtained by NanoSIMS. In addition, nontronite identification was also possible by O-PTIR spectroscopic analysis. From these results, O-PTIR spectroscopy is suggested be superior to deep ultraviolet fluorescence microscopy/μ-Raman spectroscopy, particularly for smectite identification. A simultaneous acquisition of the spatial distribution of structural motifs associated with biomolecules and smectites is critical for distinguishing biological material in samples as well as characterizing an abiotic background.
The One Health High-Level Expert Panel’s definition of One Health includes optimizing the health of people, animals (wild and domestic) and ecosystems. For many One Health practitioners, wildlife that can spread zoonoses are the focus, particularly if they can come in contact with people. However, ecosystem health is often best-indicated by less-encountered species, for instance, amphibians and reptiles. This review highlights how these taxa can benefit human health and well-being, including cultural significance, as well as their impact on plant, animal and environmental health. We highlight current challenges to the health of these species and the need to include them in the One Health Joint Action Plan. We conclude with a call to action for inclusion of amphibians and reptiles in a One Health approach.
Many companion kittens entering shelters are fostered by volunteer community members during the sensitive period for socialisation (~2 to 9 weeks of age) when early experiences are critical to behavioural development. Using a mixed-method survey, we explored current fostering practices relevant to kitten behavioural development and welfare. Foster caretaker participants (n = 487) described their fostering practices and reported providing kittens with a majority of recommended socialisation experiences, such as handling and exposure to various toys and exploratory items. In open-ended text responses, foster caretakers described how they adapted socialisation practices for fearful kittens and the supports and challenges they perceived to impact their ability to properly socialise kittens. Some non-recommended techniques (e.g. flooding) were reported for socialising fearful kittens, with a decreased odds of reporting non-recommended techniques for participants with a higher level of agreeableness personality trait and an increased odds of reporting if fostering practices had been impacted by the COVID-19 pandemic. Foster caretakers reported feeling supported through shelter-supplied resources, personal knowledge, external support, and having access to socialisation opportunities; however, faced personal (e.g. time constraints), shelter-specific (e.g. lack of shelter support), and kitten-specific challenges (e.g. kitten illness). This study highlights the perspectives of foster caretakers as related to optimal socialisation, behavioural development, and welfare. To identify opportunities for improvement it is important to investigate the socialisation guidelines provided to foster caretakers, with the ultimate goal of enhancing kitten behavioural development for improved welfare, long-term adoption, and caretaker satisfaction.
Motor neuron disease (MND) is a progressive, fatal, neurodegenerative condition that affects motor neurons in the brain and spinal cord, resulting in loss of the ability to move, speak, swallow and breathe. Acceptance and commitment therapy (ACT) is an acceptance-based behavioural therapy that may be particularly beneficial for people living with MND (plwMND). This qualitative study aimed to explore plwMND’s experiences of receiving adapted ACT, tailored to their specific needs, and therapists’ experiences of delivering it.
Method:
Semi-structured qualitative interviews were conducted with plwMND who had received up to eight 1:1 sessions of adapted ACT and therapists who had delivered it within an uncontrolled feasibility study. Interviews explored experiences of ACT and how it could be optimised for plwMND. Interviews were audio recorded, transcribed and analysed using framework analysis.
Results:
Participants were 14 plwMND and 11 therapists. Data were coded into four over-arching themes: (i) an appropriate tool to navigate the disease course; (ii) the value of therapy outweighing the challenges; (iii) relevance to the individual; and (iv) involving others. These themes highlighted that ACT was perceived to be acceptable by plwMND and therapists, and many participants reported or anticipated beneficial outcomes in the future, despite some therapeutic challenges. They also highlighted how individual factors can influence experiences of ACT, and the potential benefit of involving others in therapy.
Conclusions:
Qualitative data supported the acceptability of ACT for plwMND. Future research and clinical practice should address expectations and personal relevance of ACT to optimise its delivery to plwMND.
Key learning aims
(1) To understand the views of people living with motor neuron disease (plwMND) and therapists on acceptance and commitment therapy (ACT) for people living with this condition.
(2) To understand the facilitators of and barriers to ACT for plwMND.
(3) To learn whether ACT that has been tailored to meet the specific needs of plwMND needs to be further adapted to potentially increase its acceptability to this population.
Immediate-use steam sterilization (IUSS) shortens the time of sterilization but may increase the risk of surgical site infection (SSI). Among 23,919 procedures with 416 (1.7%) procedures resulting in SSI, IUSS was associated with a 1.52 (95% CI, 1.10–2.11) times higher risk of SSI. IUSS should be minimized.
Studies of extinction typically focus on unintended losses of biodiversity and culture. This study, however, examines an attempt to induce extinction of a parasite: human hookworm (Necator americanus and Ancylostoma duodenale). Our interdisciplinary approach integrates medical history and epidemiology using records created by the Jamaica Hookworm Commission of 1919–1936. We show that the attempt to induce the extinction of hookworms was driven by its perceived effects on labour productivity and consequent status as an ideological and economic threat. We use spatial epidemiology to describe the relationships between parasites, environments and the working conditions of plantation labourers. Using data from 330 locations across Jamaica in which 169,380 individuals were tested for hookworm infection we show that the prevalence of hookworm infection was higher in districts surrounding plantations. Prevalence decreased with the temperature of the coldest month, increased with the amount of rainfall in the driest month, and increased with vegetation quantity (normalised difference vegetation index). Worm burden (and thus pathology) varied greatly between individuals, even those living together; hookworm infection varied between environments, socioeconomic conditions and individuals. Nevertheless, the conditions of labour shaped the distribution of hookworms. Plantations both spread and problematised hookworms, driving efforts to bring it to extinction.
Digital Mental Health Interventions (DMHIs) that meet the definition of a medical device are regulated by the Medicines and Healthcare products Regulatory Agency (MHRA) in the UK. The MHRA uses procedures that were originally developed for pharmaceuticals to assess the safety of DMHIs. There is recognition that this may not be ideal, as is evident by an ongoing consultation for reform led by the MHRA and the National Institute for Health and Care Excellence.
Aims
The aim of this study was to generate an experts’ consensus on how the medical regulatory method used for assessing safety could best be adapted for DMHIs.
Method
An online Delphi study containing three rounds was conducted with an international panel of 20 experts with experience/knowledge in the field of UK digital mental health.
Results
Sixty-four items were generated, of which 41 achieved consensus (64%). Consensus emerged around ten recommendations, falling into five main themes: Enhancing the quality of adverse events data in DMHIs; Re-defining serious adverse events for DMHIs; Reassessing short-term symptom deterioration in psychological interventions as a therapeutic risk; Maximising the benefit of the Yellow Card Scheme; and Developing a harmonised approach for assessing the safety of psychological interventions in general.
Conclusion
The implementation of the recommendations provided by this consensus could improve the assessment of safety of DMHIs, making them more effective in detecting and mitigating risk.
The mineralogy of the clay fraction was studied for soils and saprolite on two Blue Ridge Front mountain slopes. The clay fraction contained the weathering products of primary minerals in the mica gneiss and schist parent rocks. Gibbsite is most abundant in the saprolite and residual soil horizons, where only chemical weathering has been operable. In colluvial soil horizons, where both physical and chemical weathering have occurred, the clay fraction consists largely of comminuted primary phyllosilicates —muscovite, chlorite, and possibly biotite—and their weathering products: vermiculite, interstratified biotite/vermiculite (B/V), and kaolinite. The clay-size chlorite contains Fe2+ as indicated by Mössbauer spectroscopy, and is more resistant to weathering than biotite. The vermiculite and B/V, both weathering products of biotite, contain Fe3+. Vermiculite in colluvial soils and, especially, surface horizons is weakly hydroxy-interlayered. The kaolinite in the clay fraction resulted at least partly from the comminution of kaolinized biotite in coarser fractions.
The hematite content ranged from 0 to 8% of the clay fraction and strongly correlates (r =.95) with dry clay redness, as measured by the redness rating: RR = (10 - YR hue) × (chroma) ÷ (value). The hematite is largely a product of the weathering of almandine; thus, the soil redness is dependent on the amount of almandine in the parent materials and its degree of weathering in the soils. Goethite (13–22% of the clay fraction) imparts a yellow-brown hue to soils derived from almandine-free parent rocks. The release of Fe in relatively low concentrations during the weathering of Fe-bearing primary minerals, particularly biotite, appears to have promoted the formation of goethite.
A green, Lithic Torriorthent soil derived from a celadonite-rich, hydrothermally altered basalt immediately north of the Mojave Desert region in southern California was studied to investigate the fate of the celadonite in a pedogenic weathering environment. Celadonite was found to be disseminated in the highly altered rock matrix with cristobalite, chalcedony, and stilbite. X-ray powder diffraction (XRD) showed the soil material to contain celadonite having a d(060) value of 1.510 Å, indicative of its dioctahedral nature. Very little smectite was detected in the parent material, whereas Fe-rich smectite was found to be abundant in the soil. The Fe-smectite and celadonite were identified as the sole components of the green-colored clay fraction (<2 µm) of all soil horizons. The soil clay showed a single d(060) value of 1.507 Å, indicating that the smectite was also dioctahedral and that its b-dimension was the same as that of the celadonite. Mössbauer spectroscopy showed that the chemical environments of Fe in the rock-matrix celadonite and in the smectite-rich soil clay were also nearly identical. These data strongly suggest a simple transformation of the celadonite to an Fe-rich smectite during soil formation.
Supporting evidence for this transformation was obtained by artificial weathering of celadonite, using sodium tetraphenyl boron to extract interlayer K. The intensity of the 001 XRD peak (at 10.1 Å) of celadonite was greatly reduced after the treatment and a peak at 14.4 Å, absent in the pattern of the untreated material, appeared. On glycolation of the sample, this peak expanded to 17.4 Å, similar to the behavior of the soil smectite. The alteration of celadonite to smectite is a simple transformation requiring only the loss of interlayer K. The transformation is apparently possible under present-day conditions, inasmuch as the erosional landscape position, shallow depth, and lack of significant horizonation indicate that the soil is very young.
The weathering products of primary biotite, chlorite, magnetite, and almandine in mica gneiss and schist in the North Carolina Blue Ridge Front were determined. Sand-size grains of biotite, the most abundant, readily weathered mineral in the parent rock, have altered to interstratified biotite/vermiculite, vermiculite, kaolinite, and gibbsite in the saprolite and soil. Fe2+-chlorite in the parent rock was relatively resistant to chemical weathering, which appears to be confined to the external surfaces of particles. Magnetite grains in the saprolite are essentially unaltered, but those in the soil contain abundant crystallographically controlled etch pits and are coated with oxidation crusts. Almandine altered to goethite, hematite, and gibbsite as the rock weathered to saprolite. Extensively weathered almandine grains were found to contain etch pits and what appeared to be oxide coatings. Apparently, a rapid release of Fe during weathering produced hematite, whereas slower release of Fe favored the formation of goethite.
In this chapter, the subjection of the Israelites in Egypt and their later liberation from oppression is examined with extracts from the Hebrew Torah, and the Greek Septuagint. The vocabulary of servitude of both Hebrew and Greek is discussed through the account of Joseph’s service and disgrace in the house of Potiphar, followed by the suffering of the Israelites, the later descendants of Jacob. The oppression inflicted by the Egyptians and their pharaoh on the Israelites in Egypt is to be seen in their forced labour in making bricks and construction work. Liberation involved leaving the country together, under the leadership of Moses. A final section examines a few further literary texts dating from the Hellenistic and Roman periods that treat related Jewish subjects.