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Through a series of example research studies, we illustrate processes in translating case report forms to increase language diversity in study populations while simultaneously highlighting implications for data collection and analyses. The Northwestern University Data Analysis and Coordinating Center manages the translation of participant-facing study documents into languages other than English through a process that has been refined over several years, adjusting for changes in technical capabilities in electronic case report forms. This approach to manage, examine for context, and implement certified case report form translations offers an efficient workflow to streamline data capture in multiple languages.
Fifteen years ago, we published an article in Social Science and Medicine seeking to resolve the contentious debate between advocates of two very different frameworks for understanding and addressing the mental health needs of conflict-affected populations. The two approaches, which we labelled trauma-focused and psychosocial, reflect deeply held beliefs about the causes and nature of distress in war-affected communities. Drawing on the burgeoning literature on armed conflict and mental health, the reports of mental health and psychosocial support (MHPSS) staff in the field, and on research on the psychology and psychophysiology of stress, we proposed an integrative model that drew on the strengths of both frameworks and underscored their essential complementarity. Our model includes two primary pathways by which armed conflict impacts mental health: directly, through exposure to war-related violence and loss, and indirectly, through the harsh conditions of everyday life caused or exacerbated by armed conflict. The mediated model we proposed draws attention to the effects of stressors both past (prior exposure to war-related violence and loss) and present (ongoing conflict, daily stressors), at all levels of the social ecology; for that reason, we have termed it an ecological model for understanding the mental health needs of conflict-affected populations.
Methods
In the ensuing 15 years, the model has been rigorously tested in diverse populations and has found robust support. In this paper, we first summarize the development and key tenets of the model and briefly review recent empirical support for it. We then discuss the implications of an ecological framework for interventions aimed at strengthening mental health in conflict-affected populations.
Results
We present preliminary evidence suggesting there has been a gradual shift towards more ecological (i.e., multilevel, multimodal) programming in MHPSS interventions, along the lines suggested by our model as well as other conceptually related frameworks, particularly public health.
Conclusions
We reflect on several gaps in the model, most notably the absence of adverse childhood experiences. We suggest the importance of examining early adversity as both a direct influence on mental health and as a potential moderator of the impact of potentially traumatic war-related experiences of violence and loss.
Clostridium botulinum causes infant botulism by colonising the intestines and producing botulinum neurotoxin in situ. Previous reports have linked infant botulism cases to C. botulinum spores in household dust, yet the baseline incidence of C. botulinum spores in residential households is currently unknown. Vacuum cleaner dust from 963 households in 13 major Canadian cities was tested for C. botulinum using a novel real-time PCR assay directed against all known subtypes of the botulinum neurotoxin gene. None of the samples tested positive for C. botulinum. Analysis of a random subset of samples by MALDI Biotyper revealed that the most common anaerobic bacterial isolates were of the genus Clostridium and the most common species recovered overall was Clostridium perfringens. Dust that was spiked with C. botulinum spores of each toxin type successfully produced positive real-time PCR reactions. These control experiments indicate that this is a viable method for the detection of C. botulinum spores in household dust. We make several recommendations for future work that may help discover a common environmental source of C. botulinum spores that could lead to effective preventative measures for this rare but deadly childhood disease.
System-level change is crucial for solving society's most pressing problems. However, individual-level interventions may be useful for creating behavioral change before system-level change is in place and for increasing necessary public support for system-level solutions. Participating in individual-level solutions may increase support for system-level solutions – especially if the individual-level solutions are internalized as part of one's social identity.
Recent estimates suggest that 40% of dementia cases could be avoided by treating recognised cardiovascular risk factors such as hypertension, diabetes, smoking and physical inactivity. Whether diet is associated with dementia remains largely unknown. We tested if low adherence to established dietary guidelines is associated with elevated lipids and lipoproteins and with increased risk of Alzheimer's disease and non-Alzheimer's dementia – a dementia subtype with a high frequency of cardiovascular risk factors.
Methods
We used the prospective Copenhagen General Population Study including 94 184 individuals with dietary information and free of dementia at baseline. Mean age at study entry was 58 years, and 55% (N = 51 720) were women and 45% (N = 42 464) were men. Adherence to dietary guidelines was grouped into low, intermediate and high adherence based on food frequency questionnaires. Main outcomes were non-Alzheimer's dementia and Alzheimer's disease.
Results
Low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol and plasma triglyceride levels were higher in individuals with intermediate and low adherence to dietary guidelines compared with individuals with high adherence (all p for trends <0.001). Age and sex-adjusted hazard ratios (HRs) for non-Alzheimer's dementia v. individuals with high adherence were 1.19 (95% confidence interval 0.97–1.46) for intermediate adherence, and 1.54 (1.18–2.00) for low adherence. Corresponding HRs in multivariable-adjusted models including APOE genotype were 1.14 (0.92–1.40) and 1.35 (1.03–1.79). These relationships were not observed in individuals on lipid-lowering therapy.
Conclusions
Low adherence to national dietary guidelines is associated with an atherogenic lipid profile and with increased risk of non-Alzheimer's dementia – the subtype of dementia with a high frequency of vascular risk factors. This study suggests that implementation of dietary guidelines associated with an anti-atherogenic lipid profile could be important for prevention of non-Alzheimer's dementia.
Artificial intelligence (AI) is seen as a major disrupting force in the future healthcare system. However, the assessment of the value of AI technologies is still unclear. Therefore, a multidisciplinary group of experts and patients developed a Model for ASsessing the value of AI (MAS-AI) in medical imaging. Medical imaging is chosen due to the maturity of AI in this area, ensuring a robust evidence-based model.
Methods
MAS-AI was developed in three phases. First, a literature review of existing guides, evaluations, and assessments of the value of AI in the field of medical imaging. Next, we interviewed leading researchers in AI in Denmark. The third phase consisted of two workshops where decision makers, patient organizations, and researchers discussed crucial topics for evaluating AI. The multidisciplinary team revised the model between workshops according to comments.
Results
The MAS-AI guideline consists of two steps covering nine domains and five process factors supporting the assessment. Step 1 contains a description of patients, how the AI model was developed, and initial ethical and legal considerations. In step 2, a multidisciplinary assessment of outcomes of the AI application is done for the five remaining domains: safety, clinical aspects, economics, organizational aspects, and patient aspects.
Conclusions
We have developed an health technology assessment-based framework to support the introduction of AI technologies into healthcare in medical imaging. It is essential to ensure informed and valid decisions regarding the adoption of AI with a structured process and tool. MAS-AI can help support decision making and provide greater transparency for all parties.
Due to the complexity of financial products, consumers with low financial literacy are left behind. However, few practical studies investigated the impact of digital advisory systems to improve customer experience. Configuration systems, as the most popular expert systems, have never been applied as a financial tool. In this study, we explore the application of configuration systems to educate consumers in achieving their financial goals. The results highlight multiple benefits from using the configurator, including greater financial literacy and improved individual financial decision-making.
High levels of early emotionality (of either negative or positive valence) are hypothesized to be important precursors to early psychopathology, with attention-deficit/hyperactivity disorder (ADHD) a prime early target. The positive and negative affect domains are prime examples of Research Domain Criteria (RDoC) concepts that may enrich a multilevel mechanistic map of psychopathology risk. Utilizing both variable-centered and person-centered approaches, the current study examined whether levels and trajectories of infant negative and positive emotionality, considered either in isolation or together, predicted children's ADHD symptoms at 4 to 8 years of age. In variable-centered analyses, higher levels of infant negative affect (at as early as 3 months of age) were associated with childhood ADHD symptoms. Findings for positive affect failed to reach statistical threshold. Results from person-centered trajectory analyses suggest that additional information is gained by simultaneously considering the trajectories of positive and negative emotionality. Specifically, only when exhibiting moderate, stable or low levels of positive affect did negative affect and its trajectory relate to child ADHD symptoms. These findings add to a growing literature that suggests that infant negative emotionality is a promising early life marker of future ADHD risk and suggest secondarily that moderation by positive affectivity warrants more consideration.
Adherence to practice guidelines for diagnosing and treating attention-deficit/hyperactivity disorder (ADHD) by primary care providers (PCPs) is important for optimizing care for many children and youth. However, adherence is often low. To address this problem, we implemented an intensive intervention in 2009 aimed at improving diagnosis and management of ADHD among PCPs.
Objectives
The study objective is to assess the sustainability of intervention-attributable outcomes.
Aims
The study aims are to assess the sustained effect of the intervention on PCP intentions to implement, attitudes toward, and obstacles to implement ADHD practice guidelines.
Methods
During November 2009, 48 PCPs from 31 clinical practices completed a 3-day training, 6 months of biweekly telephone peer group reinforcement, and baseline questionnaires; follow-up questionnaires were completed at 12 months. To assess sustainability, we tracked PCPs and administered the questionnaire in 2016.
Results
Intentions to implement ADHD guidelines remained stable over seven years, with all mean values ranging from “probably will” to “definitely will” implement guidelines.
Conclusions
Generally, favorable self-reported intentions (see Exhibits 1 & 2), attitudes and obstacles to implementing ADHD guidelines were sustained seven years after the intensive training and follow-up intervention.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Norovirus (NoV) infections occur very frequently yet are rarely diagnosed. In Denmark, NoV infections are not under surveillance. We aimed to collect and describe existing laboratory-based NoV data. National NoV laboratory data were collected for 2011–2018, including information on patient identification number, age and sex, requesting physician, analysis date and result. We defined positive patient-episodes by using a 30-day time window and performed descriptive and time series analysis. Diagnostic methods used were assessed through a survey. We identified 15 809 patient-episodes (11%) out of 142 648 tested patients with an increasing trend, 9366 in 2011 vs. 32 260 in 2018. This corresponded with a gradual introduction of polymerase chain reaction analysis in laboratories. The highest positivity rate was in patients aged <5 years (15%) or >85 years (17%). There was a large difference in test performance over five Danish geographical regions and a marked seasonal variation with peaks from December to February. This is the first analysis of national NoV laboratory data in Denmark. A future laboratory-based surveillance system may benefit public health measures by describing trend, burden and severity of seasons and possibly pinpoint hospital outbreaks.
The COllaborative project of Development of Anthropometrical measures in Twins (CODATwins) project is a large international collaborative effort to analyze individual-level phenotype data from twins in multiple cohorts from different environments. The main objective is to study factors that modify genetic and environmental variation of height, body mass index (BMI, kg/m2) and size at birth, and additionally to address other research questions such as long-term consequences of birth size. The project started in 2013 and is open to all twin projects in the world having height and weight measures on twins with information on zygosity. Thus far, 54 twin projects from 24 countries have provided individual-level data. The CODATwins database includes 489,981 twin individuals (228,635 complete twin pairs). Since many twin cohorts have collected longitudinal data, there is a total of 1,049,785 height and weight observations. For many cohorts, we also have information on birth weight and length, own smoking behavior and own or parental education. We found that the heritability estimates of height and BMI systematically changed from infancy to old age. Remarkably, only minor differences in the heritability estimates were found across cultural–geographic regions, measurement time and birth cohort for height and BMI. In addition to genetic epidemiological studies, we looked at associations of height and BMI with education, birth weight and smoking status. Within-family analyses examined differences within same-sex and opposite-sex dizygotic twins in birth size and later development. The CODATwins project demonstrates the feasibility and value of international collaboration to address gene-by-exposure interactions that require large sample sizes and address the effects of different exposures across time, geographical regions and socioeconomic status.
The Permian magmatic province of the Oslo rift, south-east Norway, includes large volumes of felsic and silicic rocks. Based on their geochemical character, these rocks may be divided into two main groups. The Larvik larvikites (monzonites) are highly enriched in large ion lithophile elements (LILE) (e.g. 10–32 ppm Th. 8–15 ppm Ta), and have an initial 87Sr/86Sr of 0.70391 ± 5. The syenites and granites have moderate to high concentrations of LILE (e.g. 7–88 ppm Th, 4–25 ppm Ta), and initial 87Sr/86Sr ratios between 0.705 and 0.707. The Larvik larvikites and extrusive equivalents (rhomb porphyry lavas) have similar initial Sr isotope ratios to uncontaminated basalts and gabbros in the rift, and are believed to have a mantle origin. The higher initial 87Sr/86Sr ratios in the silicic than in the felsic rocks reflect a crustal component representing the intermediate or low crust. After intrusion into the upper crust, the major and traceelement concentrations of the silicic magmas were modified through fractional crystallization dominated by removal of alkali feldspar, and transport of elements with a fluid phase. The silicic magmas appear not to have interacted significantly with the side rock at this stage.
The liberal model of the rights-bearing subject, an autonomous, rational being able to make claims on its own behalf, has been a barrier to legal mobilization for some marginalized subjects. Among these liminal subjects, non-human animals have been recognized as property under the law, a status that has limited the capacity of legal activism on their behalf. This chapter explores the novel deployment of the law on behalf of two subjects, Tommy the chimpanzee and Johnny Justice, a pitbull once used in fighting. The arguments used by legal activists focus on the injustice of the suffering endured by the animals rather than focusing on their capacities—or lack thereof—as autonomous subjects. Doing so enables a set of claims about a moral and legal obligation to minimize and compensate for their injuries. However, while the focus on vulnerability does not require the animals to first establish that they are rights-bearing subjects deserving of legal representation, the universalizing gesture of “shared corporeality” obfuscates the ways that new hierarchies are generated in representing some subjects as in need of legal protection. In short, the question becomes: who gets help and who is admitted to privilege?
To examine the trend in social inequality in low intake of vegetables among adolescents in Denmark from 2002 to 2014 using occupational social class (OSC) as socio-economic indicator.
Design
Repeated cross-sectional school surveys including four waves of data collection in 2002–2014. The analyses focused on absolute social inequality (difference between high and low OSC in low vegetable intake) as well as relative social inequality (OR for low vegetable intake by OSC).
Setting
The nationally representative Health Behaviour in School-aged Children (HBSC) study in Denmark.
Subjects
The study population was 11–15-year olds (n 17 243).
Results
Low intake of vegetables was defined as less than weekly intake measured by food frequency items. OSC was measured by student reports of parents’ occupation. The proportion of participants who reported eating vegetables less than once weekly was 8·9 %, with a notable decrease from 11·9 % in 2002 to 5·9 % in 2014. The OR (95 % CI) for less than weekly vegetable intake was 2·28 (1·98, 2·63) in the middle compared with high OSC and 3·12 (2·67, 3·66) in the low compared with high OSC. The absolute social inequality in low vegetable intake decreased from 2002 to 2014 but the relative social inequality remained unchanged.
Conclusions
The study underscores that it is important to address socio-economic factors in future efforts to promote vegetable intake among adolescents. The statistical analyses of social inequality in vegetable intake demonstrate that it is important to address both absolute and relative social inequality as these two phenomena may develop differently.
Whether monozygotic (MZ) and dizygotic (DZ) twins differ from each other in a variety of phenotypes is important for genetic twin modeling and for inferences made from twin studies in general. We analyzed whether there were differences in individual, maternal and paternal education between MZ and DZ twins in a large pooled dataset. Information was gathered on individual education for 218,362 adult twins from 27 twin cohorts (53% females; 39% MZ twins), and on maternal and paternal education for 147,315 and 143,056 twins respectively, from 28 twin cohorts (52% females; 38% MZ twins). Together, we had information on individual or parental education from 42 twin cohorts representing 19 countries. The original education classifications were transformed to education years and analyzed using linear regression models. Overall, MZ males had 0.26 (95% CI [0.21, 0.31]) years and MZ females 0.17 (95% CI [0.12, 0.21]) years longer education than DZ twins. The zygosity difference became smaller in more recent birth cohorts for both males and females. Parental education was somewhat longer for fathers of DZ twins in cohorts born in 1990–1999 (0.16 years, 95% CI [0.08, 0.25]) and 2000 or later (0.11 years, 95% CI [0.00, 0.22]), compared with fathers of MZ twins. The results show that the years of both individual and parental education are largely similar in MZ and DZ twins. We suggest that the socio-economic differences between MZ and DZ twins are so small that inferences based upon genetic modeling of twin data are not affected.
The legend of Tristan and Isolde -- the archetypal narrative about the turbulent effects of all-consuming, passionate love -- achieved its most complete and profound rendering in the German poet Gottfried von Strassburg's verse romance Tristan (ca. 1200-1210). Along with his great literary rival Wolfram von Eschenbach and his versatile predecessor Hartmann von Aue, Gottfried is considered one of three greatest poets produced by medieval Germany, and over the centuries his Tristan has lost none of its ability to attract with the beauty of its poetry and to challenge -- if not provoke -- with its sympathetic depiction of adulterous love. The essays, written by a dozen leading Gottfried specialists in Europe and North America, provide definitive treatments of significant aspectsof this most important and challenging high medieval version of the Tristan legend. They examine aspects of Gottfried's unparalleled narrative artistry; the important connections between Gottfried'sTristan and the socio-cultural situation in which it was composed; and the reception of Gottfried's challenging romance both by later poets in the Middle Ages and by nineteenth- and twentieth-century authors, composers, and artists -- particularly Richard Wagner. The volume also contains new interpretations of significant figures, episodes, and elements (Riwalin and Blanscheflur, Isolde ofthe White Hands, the Love Potion, the performance of love, the female figures) in Gottfried's revolutionary romance, which provocatively elevates a sexual, human love to a summum bonum.
Will Hasty is Professor of German at the University of Florida. He is the editor of Companion to Wolfram's "Parzival," (Camden House, 1999).