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Increasing resources are devoted to osteoarthritis surgical care in Australia annually, with significant expenditure attributed to hip and knee arthroplasties. Safe, efficient, and sustainable models of care are required. This study aimed to determine the impact on healthcare costs of implementing an enhanced short-stay model of care (ESS-MOC) for arthroplasty at a national level.
Methods
Budget impact analysis was conducted for hospitals providing arthroplasty surgery over the years 2023 to 2030. Population-based sample projections obtained from clinical registry and administrative datasets of individuals receiving hip or knee arthroplasty for osteoarthritis were applied. The ESS-MOC assigned 30 percent of eligible patients to a shortened acute-ward-stay pathway and outpatient rehabilitation. The remaining 70 percent received a current practice pathway. The primary outcome was total healthcare cost savings post-implementation of the ESS-MOC, with return on investment (ROI) ratio and hospital bed-days utilized also estimated. Costs are presented in Australian dollars (AUD) and United States dollars (USD), at 2023 prices.
Results
Estimated hospital cost savings for the years 2023 to 2030 from implementing the ESS-MOC were AUD641 million (USD427 million) (95% CI: AUD99 million [USD66 million] to AUD1,250 million) [USD834 million]). This corresponds to a ROI ratio of 8.88 (1.3 to 17.9) dollars returned for each dollar invested in implementing the care model. For the period 2023 to 2030, an estimated 337,000 (261,000 to 412,000) acute surgical ward bed-days, and 721,000 (471,000 to 1,028,000) rehabilitation bed-days could be saved. Total implementation costs for the ESS-MOC were estimated at AUD72 million (USD46 million) over eight years.
Conclusions
Implementation of an ESS-MOC for eligible arthroplasty patients in Australia would generate significant cost and healthcare resource savings. This budget impact analysis demonstrates a best practice approach to comprehensively assessing value, at a national level, of implementing sustainable models of care in high-burden healthcare contexts. Findings are relevant to other settings where hospital stay following joint arthroplasty remains excessively long.
This chapter problematises questions of agency, transformation and motives in the context of the exclusion of young people from school. It addresses the question: in what ways might young people be agentic in processes of school exclusion and how might that agency be strengthened? In order to explore this question, the chapter draws on recent developments in cultural-historical theories of transformative agency by double stimulation and Bernsteinian insights on cultural transmission and pedagogy. Empirical data from an exploratory study of permanent school exclusions in a southern English city are used to illustrate the theoretical considerations on transformative agency that are emerging from a four-year multidisciplinary comparative study of exclusion, in all its forms, across the four jurisdictions of the UK. Data are also used to explore the concept of the categorisation of exclusions and in the context of understanding the possibilities for young people’s agency in exclusion.
Research among non-industrial societies suggests that body kinematics adopted during running vary between groups according to the cultural importance of running. Among groups in which running is common and an important part of cultural identity, runners tend to adopt what exercise scientists and coaches consider to be good technique for avoiding injury and maximising performance. In contrast, among groups in which running is not particularly culturally important, people tend to adopt suboptimal technique. This paper begins by describing key elements of good running technique, including landing with a forefoot or midfoot strike pattern and leg oriented roughly vertically. Next, we review evidence from non-industrial societies that cultural attitudes about running associate with variation in running techniques. Then, we present new data from Tsimane forager–horticulturalists in Bolivia. Our findings suggest that running is neither a common activity among the Tsimane nor is it considered an important part of cultural identity. We also demonstrate that when Tsimane do run, they tend to use suboptimal technique, specifically landing with a rearfoot strike pattern and leg protracted ahead of the knee (called overstriding). Finally, we discuss processes by which culture might influence variation in running techniques among non-industrial societies, including self-optimisation and social learning.
Persistent school absence has a negative effect on academic attainment and puts children and young people at risk of social isolation, dropping out of school, vulnerability to exploitation and exposure to criminality. Pupils are more likely to miss school frequently if they have poor mental health (particularly anxiety and depression), special educational needs and disability (SEND), a long-term health condition, or caring responsibilities, or if they suffer from bullying. Frequent absences can lead to a lack of confidence and anxiety upon returning to school. This chapter argues that schools in England can be hostile environments for children and young people with SEND. Persistent absence for pupils with both identified and unidentified SEND may result from pressure on schools and teachers to perform in academic league tables rather than provide environments for inclusion. The chapter suggests the importance of the cultural, social, physical and emotional factors that lead to absenteeism. These factors are illustrated by vignettes from research on school exclusions; school safety and social networks; school design; and collaboration and emotional wellbeing. What is required is a new focus on school factors related to absence that no longer views the pupil in deficit terms.
Previous results have been mixed regarding the role of the apolipoprotein E e4 (APOE e4) allele in later-life depression: some studies note that carriers experience greater symptoms and increased risk while others find no such association. However, there are few prospective, population-based studies of the APOE e4-depression association and fewer that examine depressive symptom trajectory and depression risk longitudinally. We examined the association between APOE e4 allele status and longitudinal change in depressive symptoms and depression risk in later-life, over a 12-year follow-up period.
Methods
We used data from 690 participants of the Lothian Birth Cohort 1936 who took part in the Scottish Mental Survey 1947 (aged 11) and were followed-up in later-life over five waves from 2004 to 2019 (aged 70–82). We used APOE e4 allele status to predict longitudinal change in depressive symptom scores and risk of depression (defined by a symptom score threshold or use of depression-related medication). Models were adjusted for sex, childhood cognitive ability, childhood social class, education, adult social class, smoking status and functional limitations at baseline.
Results
Depressive symptom scores increased with age. Once adjusted for covariates, APOE e4 allele status did not significantly predict symptom score trajectories or depression risk. Greater functional limitations at baseline significantly predicted poorer symptom score trajectories and increased depression risk (defined by medications). APOE e4 allele status did not significantly moderate the contribution of sex, education or functional limitations.
Conclusions
There was no evidence that APOE e4 carriers experience an increased risk for later-life depression.
Dialysis patients may not have access to conventional renal replacement therapy (RRT) following disasters. We hypothesized that improvised renal replacement therapy (ImpRRT) would be comparable to continuous renal replacement therapy (CRRT) in a porcine acute kidney injury model.
Methods:
Following bilateral nephrectomies and 2 hours of caudal aortic occlusion, 12 pigs were randomized to 4 hours of ImpRRT or CRRT. In the ImpRRT group, blood was circulated through a dialysis filter using a rapid infuser to collect the ultrafiltrate. Improvised replacement fluid, made with stock solutions, was infused pre-pump. In the CRRT group, commercial replacement fluid was used. During RRT, animals received isotonic crystalloids and norepinephrine.
Results:
There were no differences in serum creatinine, calcium, magnesium, or phosphorus concentrations. While there was a difference between groups in serum potassium concentration over time (P < 0.001), significance was lost in pairwise comparison at specific time points. Replacement fluids or ultrafiltrate flows did not differ between groups. There were no differences in lactate concentration, isotonic crystalloid requirement, or norepinephrine doses. No difference was found in electrolyte concentrations between the commercial and improvised replacement solutions.
Conclusion:
The ImpRRT system achieved similar performance to CRRT and may represent a potential option for temporary RRT following disasters.
Substantial clinical heterogeneity of major depressive disorder (MDD) suggests it may group together individuals with diverse aetiologies. Identifying distinct subtypes should lead to more effective diagnosis and treatment, while providing more useful targets for further research. Genetic and clinical overlap between MDD and schizophrenia (SCZ) suggests an MDD subtype may share underlying mechanisms with SCZ.
Methods
The present study investigated whether a neurobiologically distinct subtype of MDD could be identified by SCZ polygenic risk score (PRS). We explored interactive effects between SCZ PRS and MDD case/control status on a range of cortical, subcortical and white matter metrics among 2370 male and 2574 female UK Biobank participants.
Results
There was a significant SCZ PRS by MDD interaction for rostral anterior cingulate cortex (RACC) thickness (β = 0.191, q = 0.043). This was driven by a positive association between SCZ PRS and RACC thickness among MDD cases (β = 0.098, p = 0.026), compared to a negative association among controls (β = −0.087, p = 0.002). MDD cases with low SCZ PRS showed thinner RACC, although the opposite difference for high-SCZ-PRS cases was not significant. There were nominal interactions for other brain metrics, but none remained significant after correcting for multiple comparisons.
Conclusions
Our significant results indicate that MDD case-control differences in RACC thickness vary as a function of SCZ PRS. Although this was not the case for most other brain measures assessed, our specific findings still provide some further evidence that MDD in the presence of high genetic risk for SCZ is subtly neurobiologically distinct from MDD in general.
The role that vitamin D plays in pulmonary function remains uncertain. Epidemiological studies reported mixed findings for serum 25-hydroxyvitamin D (25(OH)D)–pulmonary function association. We conducted the largest cross-sectional meta-analysis of the 25(OH)D–pulmonary function association to date, based on nine European ancestry (EA) cohorts (n 22 838) and five African ancestry (AA) cohorts (n 4290) in the Cohorts for Heart and Aging Research in Genomic Epidemiology Consortium. Data were analysed using linear models by cohort and ancestry. Effect modification by smoking status (current/former/never) was tested. Results were combined using fixed-effects meta-analysis. Mean serum 25(OH)D was 68 (sd 29) nmol/l for EA and 49 (sd 21) nmol/l for AA. For each 1 nmol/l higher 25(OH)D, forced expiratory volume in the 1st second (FEV1) was higher by 1·1 ml in EA (95 % CI 0·9, 1·3; P<0·0001) and 1·8 ml (95 % CI 1·1, 2·5; P<0·0001) in AA (Prace difference=0·06), and forced vital capacity (FVC) was higher by 1·3 ml in EA (95 % CI 1·0, 1·6; P<0·0001) and 1·5 ml (95 % CI 0·8, 2·3; P=0·0001) in AA (Prace difference=0·56). Among EA, the 25(OH)D–FVC association was stronger in smokers: per 1 nmol/l higher 25(OH)D, FVC was higher by 1·7 ml (95 % CI 1·1, 2·3) for current smokers and 1·7 ml (95 % CI 1·2, 2·1) for former smokers, compared with 0·8 ml (95 % CI 0·4, 1·2) for never smokers. In summary, the 25(OH)D associations with FEV1 and FVC were positive in both ancestries. In EA, a stronger association was observed for smokers compared with never smokers, which supports the importance of vitamin D in vulnerable populations.
Eight new species of Pyrenulaceae are described as new to science from Brazil, Guyana and Puerto Rico. Pyrenula sanguineomeandrata Aptroot & Mercado Diaz (with a thallus with red, KOH+ purple pigmentation of lines or a reticulum, simple ascomata with vertical ostioles, a deep red inspersed, KOH+ orange hamathecium, and dark brown 3-septate ascospores 25–29×10–12 μm) and P. sanguineostiolata Aptroot & Mercado Diaz (with a thallus with deeply immersed simple ascomata with vertical ostioles, which are superficial and bright red, and 3-septate ascospores 25–28×9–12 μm) are described from submontane evergreen forests in Puerto Rico. Pyrenula biseptata Aptroot & M. Cáceres (with simple ascomata with vertical ostioles, an inspersed hamathecium and 2-septate ascospores 11–12×4·5–5·0 μm) and P. xanthinspersa Aptroot & M. Cáceres (with an ecorticate thallus containing lichexanthone, simple ascomata with vertical ostioles, not inspersed hamathecium and 3-septate ascospores 14–17×6·0–7·5 μm) are described from rainforest in Amazonian Brazil. Pyrenula subvariabilis Aptroot & Sipman (with fused ascomata with lateral ostioles and submuriform ascospores 17–20(–25)×6–9 μm) and Sulcopyrenula biseriata Aptroot & Sipman (with a thallus containing lichexanthone, simple ascomata with lateral ostioles and lozenge-shaped ascospores with 8 locules, (13–)15–17(–20)×8–10 (width)×6–7 (thickness) μm) are described from savannahs in Guyana. Special attention is paid to the genus Pyrgillus: two new species from the 3-septate core group of this small genus are described from Brazil, viz. P. aurantiacus Aptroot & M. Cáceres (with a corticate thallus containing lichexanthone, mazaedium with orange, KOH+ violet, UV+ red pruina and ascospores of 13–16×6·0–7·5 μm) and P. rufus Aptroot & M. Cáceres (with a corticate thallus containing lichexanthone, mazaedium with dark red, KOH+ orange, UV+ red pruina and ascospores of 15·0–17·5×5·0–6·5 μm). An updated key to the 3-septate species of Pyrgillus is provided.
Four muddy sand sheets occur within a tidal marsh peat at Swantown on the west coast of Whidbey Island, Washington. The two largest sand sheets pinch out about 100 m inland and became thinner and finer-grained landward. All four sand sheets contain marine microfossils and have internal stratification. They record repeated inundation of the marsh over a short time period by distinct pulses of sediment-laden ocean water, consistent with deposition by a tsunami wave train. The layers have been radiocarbon-dated to 1160–1350, 1400–1700, 1810–2060, and 1830–2120 cal yr B.P. The overlap in age between the two youngest layers and inferred great earthquake events at the Cascadia plate boundary, some 250 km to the west, suggests they were emplaced by tsunamis from this source area. The two older layers do not correlate with plate-boundary events. They may be products of tsunamis caused by earthquakes on local faults in the Strait of Juan de Fuca or by submarine landslides in this area.
This paper analyzes the economics of two-tier tariff import quotas (TRQs) and implications of alternative trade liberalization scenarios. The Uruguay Round Agreement on Agriculture had tariffs replace nontariff barriers as the protective mechanism while quotas ensured minimum trade flows. Our framework isolates the effects of changes either in the second-tier tariff, and first-tier tariff, or the quota. We show how market conditions or relative policy instrument levels determine which tariff or quota affects trade and domestic and world prices. Whether or not exporting countries have been allocated export quotas and the procedures for the distribution of the rights to export and import also influences the efficiency of TRQs.
The Uruguay Round Agreement on Agriculture (URAA) put in place a set of rules that may, in the future, have significant effects on the conditions for market access for agricultural products. Bound tariffs replaced non-tariff barriers in most cases, and rules facing exporters are now more transparent. In addition, minimum access commitments were made through the use of import quotas, with a lower tariff for imports within the quota. Although agriculture is now integrated into the multilateral trading system, most commentators agree that the URAA did little actually to liberalize agricultural trade. Bound out-of-quota tariffs remain very high while quotas have resulted in the institutionalization of rents for specific countries and firms or state trading enterprises, thereby potentially increasing resistance by these stakeholders to any trade liberalization initiatives.
Approximately half of the variation in wellbeing measures overlaps with variation in personality traits. Studies of non-human primate pedigrees and human twins suggest that this is due to common genetic influences. We tested whether personality polygenic scores for the NEO Five-Factor Inventory (NEO-FFI) domains and for item response theory (IRT) derived extraversion and neuroticism scores predict variance in wellbeing measures. Polygenic scores were based on published genome-wide association (GWA) results in over 17,000 individuals for the NEO-FFI and in over 63,000 for the IRT extraversion and neuroticism traits. The NEO-FFI polygenic scores were used to predict life satisfaction in 7 cohorts, positive affect in 12 cohorts, and general wellbeing in 1 cohort (maximal N = 46,508). Meta-analysis of these results showed no significant association between NEO-FFI personality polygenic scores and the wellbeing measures. IRT extraversion and neuroticism polygenic scores were used to predict life satisfaction and positive affect in almost 37,000 individuals from UK Biobank. Significant positive associations (effect sizes <0.05%) were observed between the extraversion polygenic score and wellbeing measures, and a negative association was observed between the polygenic neuroticism score and life satisfaction. Furthermore, using GWA data, genetic correlations of -0.49 and -0.55 were estimated between neuroticism with life satisfaction and positive affect, respectively. The moderate genetic correlation between neuroticism and wellbeing is in line with twin research showing that genetic influences on wellbeing are also shared with other independent personality domains.
This article reports on experiences gained in two postgraduate programs in environmental education—one at the University of Canberra and one at Deakin University. The paper draws from the work of several postgraduate students who are exploring environmental issues in their communities as part of their postgraduate studies. The paper addresses some issues associated with community-based environmental education, including:
• research as participation in the critical appraisal of environmental situations
• the need for the research to be responsive to the needs and interests of the community
• the role of the researcher as change agent.
The article concludes that community-based environmental education research is a powerful learning experience for postgraduate students who are at the forefront of the research process and communicating directly with the community.