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Consistency in paired comparison data is defined. Two types of inconsistency which may arise are defined. Computational formulas for these types of inconsistency are derived, and examples illustrating the use of these formulas are presented.
Recruiting underrepresented people and communities in research is essential for generalizable findings. Ensuring representative participants can be particularly challenging for practice-level dissemination and implementation trials. Novel use of real-world data about practices and the communities they serve could promote more equitable and inclusive recruitment.
Methods:
We used a comprehensive primary care clinician and practice database, the Virginia All-Payers Claims Database, and the HealthLandscape Virginia mapping tool with community-level socio-ecological information to prospectively inform practice recruitment for a study to help primary care better screen and counsel for unhealthy alcohol use. Throughout recruitment, we measured how similar study practices were to primary care on average, mapped where practices’ patients lived, and iteratively adapted our recruitment strategies.
Results:
In response to practice and community data, we adapted our recruitment strategy three times; first leveraging relationships with residency graduates, then a health system and professional organization approach, followed by a community-targeted approach, and a concluding approach using all three approaches. We enrolled 76 practices whose patients live in 97.3% (1844 of 1907) of Virginia’s census tracts. Our overall patient sample had similar demographics to the state for race (21.7% vs 20.0% Black), ethnicity (9.5% vs 10.2% Hispanic), insurance status (6.4% vs 8.0% uninsured), and education (26.0% vs 32.5% high school graduate or less). Each practice recruitment approach uniquely included different communities and patients.
Discussion:
Data about primary care practices and the communities they serve can prospectively inform research recruitment of practices to yield more representative and inclusive patient cohorts for participation.
This study aimed to determine if pre-operative radiological scoring can reliably predict intra-operative difficulty and final cochlear electrode position in patients with advanced otosclerosis.
Method
A retrospective cohort study of advanced otosclerosis patients who underwent cochlear implantation (n = 48, 52 ears) was compared with a larger cohort of post-lingually deaf adult patients (n = 1414) with bilateral hearing loss and normal cochlear anatomy. Pre-operative imaging for advanced otosclerosis patients and final electrode position were scored and correlated with intra-operative difficulty and speech outcomes.
Results
Advanced otosclerosis patients benefit significantly from cochlear implantation. Mean duration of deafness was longer in the advanced otosclerosis group (19.5 vs 14.3 years; p < 0.05).
Conclusion
Anatomical changes in advanced otosclerosis can result in increased difficulty of surgery. Evidence of pre-operative cochlear luminal changes was associated with intra-operative difficult insertion and final non-scala tympani position. Nearly all electrodes implanted in the advanced otosclerosis cohort were peri-modiolar. No reports of facial nerve stimulation were observed.
Adult sex ratios (ASRs) have proved to correlate with population trends, which make them potential useful indicators of a species’ population trajectory and conservation status. We analysed ASRs and proportion of juveniles in flocks of an endangered steppe bird, the Little Bustard Tetrax tetrax, using surveys made during the non-breeding period in seven areas within its Western European range (one in Portugal, four in Spain, and two in France). We found overall male-biased ASRs, as all the seven surveyed areas showed a male-biased ASR mean value. Five areas were below the threshold median value (female sex ratio = 0.4) considered to be consistent with an increased probability of extinction, according to earlier population viability analyses for the species. We also found a significant positive correlation between female ratio and the proportion of young individuals in the non-breeding flocks surveyed. Our results (strongly male-biased ASRs) support the hypothesis that the viability of Little Bustard populations in Western Europe is threatened by an excess of female mortality, something that should be quantified in the future, and emphasise the value of monitoring sex ratio as a population viability indicator in species where monitoring survival is difficult to achieve.
Adolescents with depression need access to culturally relevant psychological treatment. In many low- and middle-income countries treatments are only accessible to a minority. We adapted group interpersonal therapy (IPT) for adolescents to be delivered through schools in Nepal. Here we report IPT's feasibility, acceptability, and cost.
Methods
We recruited 32 boys and 30 girls (aged 13–19) who screened positive for depression. IPT comprised of two individual and 12 group sessions facilitated by nurses or lay workers. Using a pre-post design we assessed adolescents at baseline, post-treatment (0–2 weeks after IPT), and follow-up (8–10 weeks after IPT). We measured depressive symptoms with the Depression Self-Rating Scale (DSRS), and functional impairment with a local tool. To assess intervention fidelity supervisors rated facilitators' IPT skills across 27/90 sessions using a standardised checklist. We conducted qualitative interviews with 16 adolescents and six facilitators post-intervention, and an activity-based cost analysis from the provider perspective.
Results
Adolescents attended 82.3% (standard deviation 18.9) of group sessions. All were followed up. Depression and functional impairment improved between baseline and follow-up: DSRS score decreased by 81% (95% confidence interval 70–95); functional impairment decreased by 288% (249–351). In total, 95.3% of facilitator IPT skills were rated superior/satisfactory. Adolescents found the intervention useful and acceptable, although some had concerns about privacy in schools. The estimate of intervention unit cost was US $96.9 with facilitators operating at capacity.
Conclusions
School-based group IPT is feasible and acceptable in Nepal. Findings support progression to a randomised controlled trial to assess effectiveness and cost-effectiveness.
The COVID-19 pandemic led to an increased need to conduct research and community engagement using digital methods. Unfortunately, the shift away from in-person research activities can make it difficult to engage and recruit participants from under-resourced communities that lack adequate digital infrastructure. At the beginning of the pandemic, our team recognized that imminent lockdowns would significantly disrupt ongoing engagement with low-income housing resident community partners and that we would ultimately bear responsibility if that occurred. This manuscript outlines the development of methods designed to create capacity for virtual engagement with a community advisory board that were subsequently applied to a longitudinal mixed-methods study. We describe how our experience engaging low-income housing residents during the height of the pandemic influenced the approach and offer guidelines useful for engaging under-resourced communities regardless of setting. Of these, a strong commitment to providing technology, unlimited data connectivity, and basic digital literacy training/technical support is most important. While each of these is essential and failure in any one area will reduce overall effectiveness of the effort, providing adequate technical support while maintaining ongoing relationships with community members is the most important and resource-intensive.
Retrospective self-report is typically used for diagnosing previous pediatric traumatic brain injury (TBI). A new semi-structured interview instrument (New Mexico Assessment of Pediatric TBI; NewMAP TBI) investigated test–retest reliability for TBI characteristics in both the TBI that qualified for study inclusion and for lifetime history of TBI.
Method:
One-hundred and eight-four mTBI (aged 8–18), 156 matched healthy controls (HC), and their parents completed the NewMAP TBI within 11 days (subacute; SA) and 4 months (early chronic; EC) of injury, with a subset returning at 1 year (late chronic; LC).
Results:
The test–retest reliability of common TBI characteristics [loss of consciousness (LOC), post-traumatic amnesia (PTA), retrograde amnesia, confusion/disorientation] and post-concussion symptoms (PCS) were examined across study visits. Aside from PTA, binary reporting (present/absent) for all TBI characteristics exhibited acceptable (≥0.60) test–retest reliability for both Qualifying and Remote TBIs across all three visits. In contrast, reliability for continuous data (exact duration) was generally unacceptable, with LOC and PCS meeting acceptable criteria at only half of the assessments. Transforming continuous self-report ratings into discrete categories based on injury severity resulted in acceptable reliability. Reliability was not strongly affected by the parent completing the NewMAP TBI.
Conclusions:
Categorical reporting of TBI characteristics in children and adolescents can aid clinicians in retrospectively obtaining reliable estimates of TBI severity up to a year post-injury. However, test–retest reliability is strongly impacted by the initial data distribution, selected statistical methods, and potentially by patient difficulty in distinguishing among conceptually similar medical concepts (i.e., PTA vs. confusion).
The PAtient SAtisfaction with Psychotropic (PASAP) scale is a self-completed questionnaire measuring satisfaction with psychotropic medication. The aim of the study was to describe its development in French and its psychometric properties.
Materials and methods:
Scale construction was based on an extensive search of the literature. The item reduction process required semi-structured interviews of psychiatric outpatients (n = 30). The final version of the PASAP is a 9-item, 5-point Likert-type scale, covering the scope of effectiveness and adherence. To assess the psychometric properties of the scale, French patients with an acute manic episode (n = 314) from a large European observational cohort completed the PASAP scale 3 months after psychotropic treatment initiation/change. Internal validity and reliability were assessed using principal component analysis (PCA). Concurrent validity was assessed using comparisons to physician-rated satisfaction with life, illness severity, mood relapse, compliance and side effects.
Results:
Participation rate was 68.4%. PCA was in favour of uni-dimensionality. Cronbach's α coefficient was 0.85 (95%CI 0.83–0.88). All five concurrent measures were significantly associated with the PASAP score.
Conclusion:
The PASAP scale showed good psychometric properties in a large bipolar population and thus seems adequate for evaluating treatment satisfaction. Its short length and good acceptability makes it suitable for clinical research.
Diet modifies the risk of colorectal cancer (CRC), and inconclusive evidence suggests that yogurt may protect against CRC. We analysed the data collected from two separate colonoscopy-based case–control studies. The Tennessee Colorectal Polyp Study (TCPS) and Johns Hopkins Biofilm Study included 5446 and 1061 participants, respectively, diagnosed with hyperplastic polyp (HP), sessile serrated polyp, adenomatous polyp (AP) or without any polyps. Multinomial logistic regression models were used to derive OR and 95 % CI to evaluate comparisons between cases and polyp-free controls and case–case comparisons between different polyp types. We evaluated the association between frequency of yogurt intake and probiotic use with the diagnosis of colorectal polyps. In the TCPS, daily yogurt intake v. no/rare intake was associated with decreased odds of HP (OR 0·54; 95 % CI 0·31, 0·95) and weekly yogurt intake was associated with decreased odds of AP among women (OR 0·73; 95 % CI 0·55, 0·98). In the Biofilm Study, both weekly yogurt intake and probiotic use were associated with a non-significant reduction in odds of overall AP (OR 0·75; 95 % CI 0·54, 1·04) and (OR 0·72; 95 % CI 0·49, 1·06) in comparison with no use, respectively. In summary, yogurt intake may be associated with decreased odds of HP and AP and probiotic use may be associated with decreased odds of AP. Further prospective studies are needed to verify these associations.
While the impact of disasters is strongly felt by those directly affected, they also have significant impact on the mental and physical health of rescue/relief workers and volunteers during the response phase of disaster management.
Method:
Semi-structured interviews were conducted with 11 experts in the field of disaster management from Nepal, inquiring specifically about the impact of the 2015 mega-earthquake on the mental and physical health of rescue/relief workers and volunteers. A thematic approach was used to analyze the results. These were used to assess the applicability of a previously developed conceptual framework which illustrates the hazards and risk factors affecting disaster response workers and the related hazard mitigation approaches.
Results:
The findings suggested a relationship between the type of injuries to responders and the type of disaster, type of responder, and vulnerability of location. The conceptual framework derived from literature was verified for its applicability with a slight revision on analysis of experts’ opinion based on particular context and disaster setting. Technical skills of responders, social stigma, governance, and the socio-economic status of the affected nation were identified as critical influencing factors to heath injuries and could be minimized utilizing some specific or collective measures targeted at the aforementioned variables. Some geographic and weather-specific risks may be challenging to overcome.
Conclusion:
To prevent or minimize the hazards for disaster relief workers, it is vital to understand the variables that contribute to injuries. Risk minimization strategies should address these critical factors.
Disasters cause severe disruption to socio-economic, infrastructural, and environmental aspects of community and nation. While the impact of disasters is strongly felt by those directly affected, they also have significant impacts on the mental and physical health of relief/recovery workers and volunteers. Variations in the nature and scale of disasters necessitate different approaches to risk management and hazard reduction during the response and recovery phases.
Method:
Published articles (2010-2017) on the quantitative and quantitative relationship between disasters and the physical and mental health of relief/recovery workers and volunteers were systematically collected and reviewed. A total of 162 relevant studies were identified. Physical injuries and mental health impacts were categorized into immediate, short-term, and chronic conditions. A systematic review of the literature was undertaken to explore the health risks and injuries encountered by disaster relief workers and volunteers, and to identify the factors contributing to these and relating mitigation strategies.
Results:
There were relatively few studies into this issue. However, the majority of the scrutinized articles highlighted the dependence of nature and scope of injuries with the disaster type and the types of responders, while the living and working environment and socio-economic standing also had significant influence on health outcomes.
Conclusion:
A conceptual framework derived from the literature review clearly illustrated several critical elements that directly or indirectly cause damage to physical and mental health of disaster responders. Pre-disaster and post-disaster risk mitigation approaches may be employed to reduce the vulnerability of both volunteers and workers while understanding the identified stressors and their relationships.
Khatri KC J, Fitzgerald G, Poudyal Chhetri MB. Health risks in disaster responders: a conceptual framework. Prehosp Disaster Med. 2019;34(2):209–216
The composition of Rhassoul clay is controversial regarding the nature of the pure-mineral clay fraction which is claimed to be stevensite rather than saponite. In this study, the raw and mineral fractions were characterized using various techniques including Fourier transform infrared spectroscopy and magic angle spinning nuclear magnetic resonance (MAS NMR). The isolated fine clay mineral fraction contained a larger amount of Al (>1 wt.%) than that reported for other stevensite occurrences. The 27Al MAS NMR technique confirmed that the mineral is stevensite in which the Al is equally split between the tetrahedral and octahedral coordination sites. The 29Si NMR spectrum showed a single unresolved resonance indicating little or no short-range ordering of silicon. The chemical composition of the stevensite from Jbel Rhassoul was determined to be ((Na0.25K0.20)(Mg5.04Al0.37Fe0.20☐0.21)5.61(Si7.76Al0.24)8O20(OH)4). This formula differs from previous compositions described from this locality and shows it to be an Al-bearing lacustrine clay mineral.
The Little Bustard Tetrax tetrax (Linnaeus, 1758) is a medium-sized, ‘Near Threatened’ steppe bird, whose Iberian population has been alarmingly declining over recent decades. Although this population loss has been mainly attributed to agricultural intensification, there is no information on Little Bustard adult mortality levels and their drivers. Based on a joint effort combining all the tracking data on adult Little Bustards collected over a period of 12 years by all research teams working with the species in Iberia, we found that annual anthropogenic mortality is likely to have a critical impact on the species, with values almost as high as the mortality attributed to predation. Collision with power lines was found to be the main anthropogenic threat to the adult population (3.4–3.8%/year), followed by illegal killing (2.4–3%/year), which had a higher impact than initially foreseen. Our work shows how poorly understood and previously unknown threats are affecting the survival of the most important Little Bustard population in Europe.
In order to understand the fundamental parameters governing glacier advance and retreat, and also the spectral properties of fluctuations in glacier length in response to noisy weather, we examine outputs of a numerical flowline model solving the shallow-ice equations with sliding. The numerical results reveal a surprising simplicity: the time evolution and spectral shape of glacier excursions depend on a single parameter, a time constant determined by the geometrical properties of the glacier. Furthermore, the numerical results reveal that perturbations in mass balance over the glacier surface set in motion a sequence of events that can be roughly described as occurring in three overlapping stages: (1) changes in interior thickness drive (2) changes in terminus flux, which in turn drive (3) changes in glacier length. A simple, third-order linear differential equation, which extends previous models in the literature, successfully captures these important features of the glacier flow. This three-stage linear model is readily invertible to recover climate history. It provides clear physical insight and analytical expressions for some important metrics of glacier behavior, such as variance, sensitivity and excursion probabilities. Finally, it facilitates uncertainty analysis. The linear model can also be adapted for arbitrary catchment geometry, and is applied to Nigardsbreen, Norway.
Assessment of Tar Spot Complex (TSC) severity in maize breeding experiments is conducted visually and may sometimes result in inconsistencies due to human interpretation. Disease scoring using remote sensing technologies may help bring more precision to the phenotyping process. An experiment for assessment of grain yield losses due to TSC was conducted at the Aguafria Experimental Station of the International Center for Wheat and Maize Improvement – CIMMYT in Mexico. Twenty-five maize genotypes were planted in spring of 2016 under a fungicide treatment to control TSC development and no fungicide treatment in a square lattice design with three replications. Four flights were carried out using an Unmanned Aerial Vehicle (UAV) equipped with a multispectral (550, 660, 735, 790 nm) and a thermal camera, simultaneously with the visual disease scorings and the yield was measured after harvesting. The preliminary results of the study indicated that the use of remote sensing in disease resistance phenotyping may be as effective as visual disease scoring since both correlate highly with the grain yield. Structural and chlorophyll vegetation indices (VIs) proved to be a good alternative for the estimation of yield losses caused by TSC in experimental field conditions, which may be potentially used for screening for resistance to this disease in maize genotypes, hypothetically reducing the need for visual disease scoring in the field.
A survey was conducted in 2000 across 38 counties in Mississippi on 192 randomly selected soybean fields to assess the most common occurring weeds. Statewide, prickly sida, which was present in 40% of the fields sampled, was the most common. Pitted and entireleaf morningglory were present in 34 and 29% of the soybean fields, respectively. Broadleaf signalgrass and barnyardgrass were the most common annual grasses, and yellow nutsedge was the most common sedge observed. Trumpetcreeper and redvine were the most common perennial vines. In the Mississippi Delta region of Mississippi, prickly sida was present in 45% of the fields sampled. The trend of occurrence of other species in the Delta mirrored statewide results. In eastern Mississippi, prickly sida and broadleaf signalgrass were found in 43% of soybean fields. Sicklepod, common cocklebur, and balloonvine were more prevalent in eastern Mississippi, when compared with the Mississippi Delta. Since 1982, there has been a sevenfold decline in the occurrence of common cocklebur and a fourfold decline in the occurrence of johnsongrass in Mississippi soybean. Also, the occurrences of redroot pigweed, common ragweed, and fall panicum have declined. Conversely, the occurrences of yellow nutsedge and broadleaf signalgrass have increased. The occurrences of barnyardgrass, prickly sida, redvine and trumpetcreeper have been relatively static over the past two decades.
The attribution of past glacier length fluctuations to changes in climate requires characterizing glacier mass-balance variability. Observational records, which are relatively short, are consistent with random fluctuations uncorrelated in time, plus an anthropogenic trend. However, longer records of other climate variables suggest that, in fact, there is a degree of temporal persistence associated with internal (i.e. unforced) climate variability, and that it varies with location and climate. Therefore, it is likely that persistence does exist for mass balance, but records are too short to confirm its presence, or establish its magnitude, with conventional statistical tests. Extending the previous work, we explore the impact of potential climatic persistence on glacier length fluctuations. We use a numerical model and a newly developed analytical model to establish that persistence, even of a degree so small as to be effectively undetectable in the longest mass-balance records, can significantly enhance the resulting glacier length fluctuations. This has a big impact on glacier-excursion probabilities: what was an extremely unlikely event (<1%) can become virtually certain (>99%), when persistence is incorporated. Since the actual degree of climatic persistence that applies to any given glacier is hard to establish, these results complicate the attribution of past glacier changes.