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The therapeutic use of lithium in bipolar disorder is often restricted due to its narrow therapeutic window and adverse drug reactions. Lithium-induced early renal dysfunction is clinically important as it may lead to sodium depletion due to natriuresis leading to lithium retention and lithium toxicity. This is most often seen in the initial phases of therapy, and psychiatrists struggle titrating the dose of lithium and stabilizing the serum lithium level.
Objectives
The present study was conducted to evaluate the effect of add-on sodium chloride on serum lithium levels in bipolar disorder.
Methods
The present randomized controlled trial (NCT04222816) was conducted in 60 patients with type I bipolar disorder who were randomized into the control group who received lithium carbonate with the advice not to take additional salt (at the table) and the test group who received sachets of sodium chloride (1 g/d) as an add-on to lithium carbonate and were advised to restrict their additional salt intake (at the table) to 1 g/d. After baseline assessments, all patients were followed up at 4 weeks, 8 weeks, and 12 weeks when serum lithium, sodium and potassium were estimated. Serum creatinine and aldosterone were repeated at 12 weeks.
Results
In the test group, the fluctuation rate in serum lithium (26.7%) was significantly (p=0.01) lower than in the control group (63.3%). There was a significant difference in serum lithium in the control group at different time points; however, the changes were not significant in the test group. There was a significant difference in serum lithium between the groups at 8 and 12 weeks of follow-up. There were no significant differences in the change in serum sodium, potassium, creatinine, aldosterone, creatinine clearance, and blood pressure within the group and between the groups. A significant positive correlation was found between serum lithium and aldosterone at baseline.
Conclusions
Intake of add-on sodium chloride (1 gm/day) may reduce the fluctuations in serum lithium during the maintenance phase of lithium therapy in type I bipolar disorder.
The ablation zones of debris-covered glaciers in Himalaya exhibit heterogeneous processes and melt patterns. Although sub-debris melt is measured at ablation stakes, the high variability of debris thickness necessitates distributed melt measurements at the glacier scale. Focusing on Annapurna III Glacier, we used uncrewed aerial system (UAS) photogrammetry to estimate total volume loss and slope-perpendicular glacier melt between May and November 2019 using flow-corrected point clouds. Results indicated the average elevation change was −1.10 ± 0.19 m, while the mean melt was −0.87 m w.e., equating to a mean melt rate of −0.47 cm w.e. d−1. However, the spatial pattern was highly variable due to complex local processes necessitating future study over short intervals. The evaluation of specific areas showed the interplay of debris thickness variability, subseasonal debris redistribution, supraglacial channel reconfiguration and the imprint of relict ice cliffs in leading to contemporary melt rates. Ice cliffs had higher melt distances (mean −3.9 ± 0.19 m) compared to non-cliff areas (mean −0.75 ± 0.19 m) and were the predominant control on the spatial patterns of seasonal melt rates. Crucially, the definition of ice cliff areas from thinning data has a profound impact on derived melt rates and melt enhancement. Our study demonstrates the possibility and utility of deriving fully-distributed slope-perpendicular melt measurements.
Suicide is a major global health concern. Bhutanese refugees resettled in the USA are disproportionately affected by suicide, yet little research has been conducted to identify factors contributing to this vulnerability. This study aims to investigate the issue of suicide of Bhutanese refugee communities via an in-depth qualitative, social-ecological approach.
Methods.
Focus groups were conducted with 83 Bhutanese refugees (adults and children), to explore the perceived causes, and risk and protective factors for suicide, at individual, family, community, and societal levels. Audio recordings were translated and transcribed, and inductive thematic analysis conducted.
Results.
Themes identified can be situated across all levels of the social-ecological model. Individual thoughts, feelings, and behaviors are only fully understood when considering past experiences, and stressors at other levels of an individual's social ecology. Shifting dynamics and conflict within the family are pervasive and challenging. Within the community, there is a high prevalence of suicide, yet major barriers to communicating with others about distress and suicidality. At the societal level, difficulties relating to acculturation, citizenship, employment and finances, language, and literacy are influential. Two themes cut across several levels of the ecosystem: loss; and isolation, exclusion, and loneliness.
Conclusions.
This study extends on existing research and highlights the necessity for future intervention models of suicide to move beyond an individual focus, and consider factors at all levels of refugees’ social-ecology. Simply focusing treatment at the individual level is not sufficient. Researchers and practitioners should strive for community-driven, culturally relevant, socio-ecological approaches for prevention and treatment.
In the adult hen, the oviduct receives the ovum from the ovary and provides the biological environment for the formation and potential fertilisation of the egg. During egg formation, albumin, from the magnum is deposited around the yolk, followed by the eggshell membranes from the isthmus, which subsequently surround the egg. As the yolk traverses through the oviduct, calcium is deposited on to it, from the uterus, forming a hardened eggshell. Ovalbumin, avidin and ovomucin secreted from magnum provides content and antimicrobial activity in the egg-white. Collagen X and fibrilin 1 from the isthmus make up the fibrous eggshell membranes. Calbindin 1, ovocleidin-116 and secreted phosphoprotein 1 secreted from the shell gland contribute in calcium ion remodelling for eggshell mineralisation. This review summarises the expression pattern and functional role of genes having a leading role in the egg formation.
Many women experience both vasomotor menopausal symptoms (VMS) and depressed mood at midlife, but little is known regarding the prospective bi-directional relationships between VMS and depressed mood and the role of sleep difficulties in both directions.
Methods
A pooled analysis was conducted using data from 21 312 women (median: 50 years, interquartile range 49−51) in eight studies from the InterLACE consortium. The degree of VMS, sleep difficulties, and depressed mood was self-reported and categorised as never, rarely, sometimes, and often (if reporting frequency) or never, mild, moderate, and severe (if reporting severity). Multivariable logistic regression models were used to examine the bi-directional associations adjusted for within-study correlation.
Results
At baseline, the prevalence of VMS (40%, range 13–62%) and depressed mood (26%, 8–41%) varied substantially across studies, and a strong dose-dependent association between VMS and likelihood of depressed mood was found. Over 3 years of follow-up, women with often/severe VMS at baseline were more likely to have subsequent depressed mood compared with those without VMS (odds ratios (OR) 1.56, 1.27–1.92). Women with often/severe depressed mood at baseline were also more likely to have subsequent VMS than those without depressed mood (OR 1.89, 1.47–2.44). With further adjustment for the degree of sleep difficulties at baseline, the OR of having a subsequent depressed mood associated with often/severe VMS was attenuated and no longer significant (OR 1.13, 0.90–1.40). Conversely, often/severe depressed mood remained significantly associated with subsequent VMS (OR 1.80, 1.38–2.34).
Conclusions
Difficulty in sleeping largely explained the relationship between VMS and subsequent depressed mood, but it had little impact on the relationship between depressed mood and subsequent VMS.
This paper uses Theil's (1979) entropy-based measure of inequality and farm-level data to examine changes in farm business wealth (farm equity) of farm households. The farms associated with farm households are grouped by state into ten regions of the United States. The Theil entropy measure is then calculated and used to decompose total inequality of farm wealth into within-state and across-states (between states) inequalities for each region. Results show that since the enactment of the 1996 Federal Agricultural Improvement and Reform (FAIR) Act, inequality in farm wealth among farms within a state has decreased relative to the number of farms per state, across all regions. Further, most of the reduction in farm wealth inequality is attributed to increased equality in the distribution of real estate assets of the farm households, a major component of farm wealth.
Introduction: The suboptimal management of children’s pain in the emergency department (ED) is well described. Although surveys of physicians show improvements in providing analgesia, institutional audits suggest otherwise. One reason may be patient refusal. Our objectives were to determine the proportion of caregivers that offered analgesia prior to arrival to the ED, accept analgesia in the ED, and identify reasons for withholding analgesia. Our results will inform knowledge translation initiatives to improve analgesic provision to children. Methods: A novel survey was designed to test the hypothesis that a large proportion of caregivers withhold and refuse analgesia. Over a 16-week period across two Canadian paediatric EDs, we surveyed caregivers of children aged 4-17 years with an acutely painful condition (headache, otalgia, sore throat, abdominal pain, or musculoskeletal injury). The primary outcome was the proportion of caregivers who offered analgesia up to 24 hours prior to ED arrival and accepted analgesia in the ED. Results: The response rate was 568/707 (80.3%). The majority of caregivers were female (426/568, 75%), aged 36 years or older (434/568, 76.4%), and had a post-secondary education (448/561, 79.9%). Their children included 320 males and 248 females with a mean age of 10.6 years. Most (514/564, 91.1%) reported being “able to tell when their child was in pain”. On average, children rated their maximal pain at 7.4/10. A total of 382/561 (68.1%) caregivers did not offer any form of analgesia prior to arrival. Common reasons included lack of time (124/561, 22.1%), fear of masking signs and symptoms (74/561, 13.2%) or the seriousness of their child’s condition (72/561, 12.8%), and lack of analgesia at home (71/561, 12.7%). Analgesia was offered to 328/560 (58.6%) children in the ED and 283/328 (72.6%) caregivers accepted. The most common reason for not accepting analgesia was child refusal (20/45, 44.4%). Conclusion: Most caregivers do not offer analgesia to their child prior to arriving in the ED despite high levels of pain and an awareness of it. Despite high rates of acceptance of analgesia in the ED, misconceptions are common. Knowledge translation strategies should dispel caregiver misconceptions, and highlight the impact of pain on children and the importance of analgesia at home.
Juvenile nasopharyngeal angiofibroma often presents with lateral extensions. In countries with limited resources, selection of a cost-effective and least morbid surgical approach for complete excision is challenging.
Methods:
Sixty-three patients with juvenile nasopharyngeal angiofibroma, with lateral extensions, underwent transpalatal, transpalatal-circumaxillary (transpterygopalatine) or transpalatal-circumaxillary-sublabial approaches for resection. Clinico-radiological characteristics, tumour volume and intra-operative bleeding were recorded.
Results:
The transpalatal approach was suitable for extensions involving medial part of pterygopalatine fossa; transpalatal-circumaxillary for extensions involving complete pterygopalatine fossa, with or without partial infratemporal fossa; and transpalatal-circumaxillary-sublabial for extensions involving complete infratemporal fossa, even cheek or temporal fossa up to zygomatic arch. Haemorrhage was greatest with the transpalatal-circumaxillary-sublabial approach, followed by transpalatal approach and transpalatal-circumaxillary approach (1212, 950 and 777 ml respectively). Tumour size (volume) was greatest with the transpalatal-circumaxillary approach, followed by transpalatal-circumaxillary-sublabial approach and transpalatal approach (40, 34 and 29 mm3). There was recurrence in three cases and residual disease in two cases. Long-term morbidity included small palatal perforation (n = 1), trismus (n = 1) and atrophic rhinitis (n = 2).
Conclusion:
These modified techniques, performed with endoscopic assistance under hypotensive anaesthesia, without embolisation, offer a superior option over other open procedures with regard to morbidity and recurrences.
The aluminum doped SrFe12O19 hexaferrite samples were prepared via co-precipitation method using cetyltrimethyl ammonium bromide (CTAB) as a surfactant. The effects of CTAB content (x = 0, 1, 3, 6 and 9 wt. %) on the structure, morphology, and electrocapacitive behavior of the SrFe10Al2O19 nanoparticles were investigated. The use of CTAB was observed to be effective in eliminating α-Fe2O3 phase from samples. Morphological changes including grain and crystallite size was noticed with the increase in the CTAB content. With the increase in CTAB, powder particles grew in size and thickness. A concomitant increase in magnetization due to crystal growth was observed. Electrochemical performance of supercapacitors was evaluated by cyclic voltammetry (CV). Highest power density of 368.09 WKg-1 and energy density of 0.916 WhKg-1 was observed for 3% and 1% CTAB samples, respectively.
Titania nanotubes were prepared by anodic oxidation of Ti. The titania surfaces were partially coated with Zn by reacting zinc acetate with the nanotubes and then annealed. [1] An annealed nanotube cluster was placed carefully on a silicon wafer using tweezers. Secondary electron images were acquired by bombarding with Cs+ and observing the ejected OZn- and OTi- respectively. The SIMS analysis was done in ultra-high vacuum (∼ 10-10 Torr). The location of before and after the SIMS analysis was confirmed by scanning electron microscopy (SEM). Specific areas with various orientations (vertical and horizontal orientations) of the nanotubes were selected for the NanoSIMS 50L analysis. The NanoSIMS 50L is made by Ametek Cameca, Gennevillieres, France and is capable of doing in situ isotopic analysis of surfaces at high spatial resolution (25 nm2). The average ZnO/TiO was ∼1.8%, confirming the actual content of Zn used during synthesis of the nanotubes. Qualitatively, the TiO/ZnO ratio increased with increasing depth implying that ZnO concentration was decreasing as we probed into the nanotubes.
This study examines the return on agricultural assets relative to nonfinancial corporate assets in the general economy using aggregate Bureau of Economic Analysis data. Our results indicate that the rate of return on nonfarm assets dominates the rate of return on agricultural assets. The average rate of return on nonfarm assets is higher than the average rate of return on farm assets, and the variance of the rate of return on nonfarm assets is lower than the variance of the rate of return on farm assets. Furthermore, the rate of return on agricultural assets only exceeds the rate of return in the nonfarm sector in 1992.
The idea of embedded versus peripheral corporate social responsibility (CSR) proposed by Aguinis and Glavas (2013) appears to be very intuitive and functional. After all, who can on face deny the argument that CSR will have the maximum positive outcomes when it is not just an add-on but is thoroughly integrated into the strategies, routines, and operations of the business? However, on closer inspection, there appear to be several problems with the embedded–peripheral dichotomy. Three major ambiguities of the embedded–peripheral dichotomy are focused on in this commentary. The first lies in the potential for significant ambiguity in whether a company falls in one category or the other based on how the totality of the organization's operations and functions are categorized. A company can have CSR built into their operations and strategies for part of their business (embedded) while have them not be built into their operations for different aspects of the operations or product strategies. The second ambiguity area is how CSR actions get defined as peripheral or embedded that does fit well with the actual importance level of the action to the organization. We look at an organization example (TOM Shoes) where peripheral CSR actions have significant impact on organizational success.
In the present study, resource partitioning by natural conspecific size variants (small and large) of ladybird, Menochilus sexmaculatus (Fabricius) females, in response to varying prey densities was assessed using functional and numerical responses as measures of prey density. The prey provided was small (second) and large (fourth) instars of Aphis craccivora Koch. Results revealed that under choice condition, small and large females of M. sexmaculatus consumed higher number of small and large instars, respectively. Small females exhibited a modified Type II functional response on small aphid instars and a Type II functional response on fourth aphid instars. Large females exhibited a Type II functional response when provided either second or fourth aphid instars. Numerical response in terms of numbers of eggs laid by both the females increased with increase in the density of either of the aphid instars. However, in small females, oviposition had a positive correlation with the numbers of small and large aphid instars consumed; being strong for the small aphid instars. While in large females, oviposition was positively correlated with the numbers of large aphid instars consumed and not small aphid instars. It therefore seems that intraspecific resource partitioning in M. sexmaculatus occurs prominently in large females than the small females.
In the present study predation parameters, i.e. consumption rate, conversion efficiency and growth rate, and total developmental duration of immature stages of two congeneric ladybirds, Coccinella septempunctata (L.) and Coccinella transversalis F., have been evaluated in presence of conspecific and heterospecific fourth instar larval and adult female tracks. We hypothesized that the semiochemicals within larval/adult female tracks might act as foraging/feeding deterrent pheromones (FDPs) and would reduce the predation parameters; and would prolong total developmental duration of ladybird predators. Results of the study positively affirmed our hypothesis. The deterrence in prey consumption and reduction in conversion efficiency and growth rate was density dependent with species-specific variations. Consumption rate, conversion efficiency, and growth rate of larval instars decreased and the total developmental duration of immature stages increased when exposed to an increasing density of zero, two, three, and four conspecific/heterospecific larval/adult female tracks. Between ladybird species, C. septempunctata had higher consumption rate, growth rate, and total developmental durations, whereas conversion efficiency was higher in C. transversalis. Despite the presence of semiochemical tracks as foraging barriers, early instars showed higher conversion efficiencies and growth rates, whereas fourth instars had highest consumption rate in all experimental treatments. The present study, therefore, suggests that semiochemical tracks significantly reduce the predation potential and prolong developmental duration of conspecifics and heterospecifics. They, thus behave as FDP.
The infrared (IR) spectra of many evolved carbon-rich stars exhibit two prominent dust emission features peaking around 21μm and 30μm, with the former exclusively seen in proto-planetary nebulae (PPNe), while the latter seen in a much wider range of objects, including AGB stars, PPNe and planetary nebulae (PNe). The 30μm feature is seen in all the 21μm sources, but no correlation is found between these two features. Over a dozen carrier candidates have been proposed for the 21μm feature, but none of them has been widely accepted and the nature of the 21μm feature remains a mystery. The carrier of the 30μm feature also remains unidentified. MgS dust, once widely accepted as a valid carrier, was ruled out because of the sulfur budget problem. In this work we examine nano-sized FeO dust as a carrier for the 21μm feature. We calculate the IR emission spectrum of FeO nanodust which undergoes single-photon heating in PPNe. It is found that the 21μm feature emitted by FeO nanodust is too broad to explain the observed feature. For the 30μm feature, we argue that graphite could be a viable carrier. Graphite, provided its d.c. conductivity σd.c. exceeds ~100ohm−1cm−1, exhibits a pronounced band at 30μm.
Long-term tillage and fertilizer experiments were conducted in rice in kharif followed by lentil in dry subhumid Inceptisols at Varanasi and Faizabad; horse gram at Phulbani and linseed at Ranchi in moist subhumid Alfisols in rabi during 2001 to 2010. The study was conducted to assess the effect of conventional tillage (CT), low tillage + interculture (LT1) and low tillage + herbicide (LT2) together with 100% N (organic) (F1), 50% N (organic) + 50% N (inorganic) (F2) and 100% N (inorganic) (F3) on productivity, profitability, rainwater and energy use efficiencies. The results at Varanasi revealed that CT was superior with mean yield of 2389 kg ha−1, while F1 was superior with 2378 kg ha−1 in rice. At Faizabad, CT was superior with mean rice yield of 1851 kg ha−1 and lentil yield of 977 kg ha−1, while F1 was superior with 1704 and 993 kg ha−1 of rice and lentil, respectively. At Phulbani, F2 was superior with rice yield of 1170 kg ha−1. At Ranchi, F2 with rice yield of 986 kg ha−1 and F3 with linseed yield of 224 kg ha−1 were superior. The regression model of crop seasonal rainfall and yield deviations indicated an increasing trend in rice yield over mean (positive deviation) with increase in rainfall at all locations; while a decreasing trend (negative deviation) was found for lentil at Faizabad, horse gram at Phulbani and linseed at Ranchi. Based on economic analysis, CTF1 at Varanasi and Faizabad, CTF2 at Phulbani and LT2F2 at Ranchi were superior.
In India, rotavirus infections cause the death of 98621 children each year. In urban neighbourhoods in Delhi, children were followed up for 1 year to estimate the incidence of rotavirus gastroenteritis and common genotypes. Infants aged ⩽1 week were enrolled in cohort 1 and infants aged 12 months (up to +14 days) in cohort 2. Fourteen percent (30/210) gastroenteritis episodes were positive for rotavirus. Incidence rates of rotavirus gastroenteritis episodes in the first and second year were 0·18 [95% confidence interval (CI) 0·10–0·27] and 0·14 (95% CI 0·07–0·21) episodes/child-year, respectively. The incidence rate of severe rotavirus gastroenteritis in the first year of life was 0·05 (95% CI 0·01–0·10) episodes/child-year. There were no cases in the second year. The common genotypes detected were G1P[8] (27%) and G9P[4] (23%). That severe rotavirus gastroenteritis is common in the first year of life is relevant for planning efficacy trials.