We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
In the last ten years, the recovery movement has significantly influenced mental health services and workers, psychiatric reform, and the advocacy movement worldwide. Within Brazil’s public mental health care system, operates a cohesive, powerful advocacy coalition empowering recovery-oriented practices. This article aims to highlight successful initiatives spearheaded by individuals with lived experience in Brazil. We will also present some challenges, and discuss possible recovery strategies to strengthen mental health services by empowering people with lived experience and promoting social justice. Efforts and initiatives to implement recovery strategies in Brazil are underway, aiming to improve population mental health and substance misuse both within and outside mental health services. These initiatives include peer support, advocacy, testimonies and empowerment, employment, and social, cultural, and artistic initiatives. Some of the challenges to greater participation of individuals with lived experience in this ongoing process of Brazilian psychiatric reform include the following aspects: barriers to the autonomy and independence of lived experience organizations; the longstanding history of racism in Brazilian society; disparities in social indicators such as education and income, between professionals and people with lived experience in mental health and substance misuse. Although progress in Brazil’s psychiatric reform has advanced through recovery initiatives, challenges remain in ensuring leadership roles for people with lived experience. Ongoing success depends on their active involvement, alongside advocacy movements and involvement of broader society.
Ever since the first discovery of urn burials in eastern Serbia during the 1980s, their dating has been uncertain and based on distant analogies and typological parallels. In this paper, we present radiocarbon dates from five urn cemeteries and three associated settlement sites, showing that the initial dating (Late Bronze Age; 14th–11th BCE) is highly questionable. Instead, radiocarbon dating and modeling presented here connect the urn cemeteries—characterized by a specific grave architecture and associated with settlements that display evidence of copper production—to a period between the 20th and 16th centuries BC. The fact that many of our dates come from cremated bones requires a discussion with regard to the circumstances of carbon exchange during cremation. The absolute dates thus far available for most urn cemeteries from the neighboring regions of the Balkans are all markedly younger (15th–11th century BC) than the data presented here and fall in the frame of the overall expansion of cremation in Europe during the Urnfield period. The new absolute dates from eastern Serbia provide a possibility to change our understanding of the Bronze Age dynamics of the 2nd millennium in the broader area of southeastern Europe and indicate a much earlier acceptance of cremation among certain groups than previously thought.
Animal agriculture employs approximately one-eighth of world’s human population and results in the slaughter of over 160 billion animals annually, representing perhaps the most extensive intertwining of human and animal lives on the planet. In principle, close, intersubjective relationships (involving shared attention and mental states) between humans and the animals in agriculture are possible, though these are infrequently studied and are unlikely to be achieved in farming, given systemic constraints (e.g. housing and management). Much scientific research on human-animal relationships within agriculture has focused upon a fairly restricted range of states (e.g. reducing aversive human-animal interactions within standard systems, toward improving productivity and reducing injuries to workers). Considering human-animal relations along a continuum, we review scholarship supporting the rationale for expanding the range of relationships under consideration in animal welfare research, given the impacts these relationships can have on both animals and stockpersons, increasing consumer demand for humane food products, and the goal of providing animals under our care with good lives. Looking toward traditions that encourage taking the perspective of, and learning from non-humans, we provide entry points to approaches that can enable animal welfare research to expand to investigate a broader range of human-animal relationship states. By showing the potential for close mutually beneficial human-animal relationships, this line of research highlights pathways for understanding and improving the welfare of animals used in agriculture.
To address the global challenge of plastic waste, 175 UN Member States are negotiating a legally binding instrument, the Plastic Treaty, aimed at ending plastic pollution. This ambitious framework, targeting both terrestrial and marine sources, is being developed through Intergovernmental Negotiating Committee meetings scheduled to conclude by 2025. Amidst uncertainties and power dynamics influencing state positions, this research identifies 10 critical, yet unresolved, points within the treaty negotiations (i.e., the scope of the treaty, equity and differentiation, involvement of non-state actors, integration with existing agreements, standards and specifications, trade implications, monitoring and reporting, responsibility and historical contributions, binding vs. non-binding commitments, and financing and technology transfer). The findings suggest potential compromises in the treaty’s environmental provisions, influenced by domestic interests and international power disparities. As negotiations progress, the imperative for cooperation and decisive action against plastic pollution becomes increasingly pressing, challenging member states to prioritize global environmental integrity over national interests.
Background: Neurodegeneration with Brain Iron Accumulation (NBIA) is a heterogenous group of disorders with the common theme of iron accumulation in the basal ganglia. These disorders typically present in childhood with progressive neurodegeneration and neuropsychiatric symptoms. Caring for an individual with NBIAs is intensive, however it is unknown what factors impact caregiver well-being and quality of life. Methods: Common themes were obtained via literature review of quality of life surveys in children with neurological and chronic illnesses. Five domains were addressed: Diagnosis, Communication, Symptom Management, Clinical Experience and Resources/Support. The survey was approved by the Family Advisory Committee at the CHEO Research Institute and the CHEO REB. The survey was distributed via the Rare Connect Platform to Canadian caregivers. Results: Survey responses are being analyzed and will be presented at the CNSF. Within each domain, Likert scales will be analyzed. Domains will be ranked according to the caregiver responses. Conclusions: Results of this survey will assist in developing care management guidelines, resources for families and help with future advocacy for patients and families affected by NBIAs. The results will also help guide future NBIA Canada Family Conferences.
Background: Currently, there are no standardized approaches to care or evaluation for tone dysfunction in Canada. The study authors hypothesize that there is significant practice variation across the country. This environmental scan is aimed to describe the current practice for management of patients with hypertonia across Canada. Methods: A web-based survey was developed by the authors with a multi-disciplinary approach and sent to representative rehabilitation sites in each province. All statistical analyses were performed using the R statistical software version 4.0. Results: CP was found to be the most common diagnosis for tone dysfunction, with 58% (7/12) of sites diagnosing greater than 20 new patients per year. All 12 sites offered oral baclofen and gabapentin, and 92% of sites offered trihexyphenidyl. Botulinum toxin injections were offered at 50% of sites. Upper and lower extremity procedures were offered in 83% of the sites. In 8 of 12 sites (67%), patients were seen within a formal multidisciplinary clinic to manage hypertonia. Conclusions: The information gained from this study provides some insight into the current practice across Canada for children with hypertonia. This study may assist in the development of a national, standardized strategy to tone management, potentially facilitating more equitable access to care for patients.
Background: The Epilepsy Monitoring Unit (EMU) plays a crucial role in a patient’s diagnosis and management for seizures and epilepsy. The duration of stay required to obtain adequate information is not clear, especially in the pediatric population. In this study, we examine whether a one to four day length of stay in the EMU is sufficient to obtain the necessary information. Methods: Retrospective review of 522 admissions (2014-2021). Included any patient admitted to CHEO’s EMU for any length of time. Results: The average admission was 1.75 days with 35.7% of patients requiring repeat EMU visits. Through a binary logistic regression, we show that a previous diagnosis of refractory seizures increases the chance of readmission to the EMU. However, a diagnosis of refractory seizures is also associated with a higher chance of achieving admission goals. While other factors including seizure type, weaning of meds, goals of admission, age, and gender have no influence on likelihood of readmission or achieving admission goals. Conclusions: This study indicates that having a short admission for EMU monitoring is sufficient to capture enough data to achieve admission goals in the pediatric population.
Radiocarbon (14C) data for 2nd millennium BC urban sites in northern Mesopotamia have been lacking until recently. This article presents a preliminary dataset and Bayesian model addressing the Middle and early Late Bronze Age (Old Babylonian and pre/early Mittani) strata of Kurd Qaburstan—one of the largest archaeological sites on the Erbil plain of Iraqi Kurdistan. The results place the large, densely occupied and fortified Middle Bronze Age city in the first part of the 18th century BC, an outcome consistent with the site’s tentative identification as ancient Qabra. A long occupation gap (up to two centuries) probably ensued, before a smaller town confined to the high mound and part of the northeastern lower town resumed in the late 16th and early 15th centuries BC, possibly before this region became part of the Late Bronze Age kingdom of Mittani.
Robots and inertial measurement units (IMUs) are typically calibrated independently. IMUs are placed in purpose-built, expensive automated test rigs. Robot poses are typically measured using highly accurate (and thus expensive) tracking systems. In this paper, we present a quick, easy, and inexpensive new approach to calibrate both simultaneously, simply by attaching the IMU anywhere on the robot’s end-effector and moving the robot continuously through space. Our approach provides a fast and inexpensive alternative to both robot and IMU calibration, without any external measurement systems. We accomplish this using continuous-time batch estimation, providing statistically optimal solutions. Under Gaussian assumptions, we show that this becomes a nonlinear least-squares problem and analyze the structure of the associated Jacobian. Our methods are validated both numerically and experimentally and compared to standard individual robot and IMU calibration methods.
Growing public concern regarding animal welfare and consumer demand for humanely produced products have placed pressure on the meat, wool and dairy industries to improve and confirm the welfare status of their animals. This has increased the need for reliable methods of assessing animal welfare during commercial farm practices. The measurement of the stress caused by commercial farm practices is a major component of animal welfare assessment. However, a major issue for animal welfare science is that many of the techniques used to measure stress involve invasive procedures, such as blood sampling, which may themselves cause a stress response and therefore affect the measurement of interest. To reduce this problem, a number of non-invasive or minimally invasive methods and devices have been developed to measure stress. These include the measurement of cortisol concentrations in saliva and faeces, and remote devices for recording body temperature, heart rate and the collection of blood samples. This review describes the benefits and limitations of some of these methods for measuring stress. In particular, the review focuses on recent advances and current research in the use of infrared thermography (IRT) for measuring stress. Specific applications for IRT in the dairy and beef industries are also described including an automated, non-invasive system for early diagnosis of infection in cattle. It is essential that non-invasive measures of acute and chronic stress are developed for reliable assessment of animal welfare during standard farm management practices and IRT may be a useful tool for this purpose. IRT may offer advantages over many other non-invasive systems as it appears to be capable of measuring different components of the stress axis, including acute sympathetic and hypothalamic-pituitary-adrenocortical responses.
Two experiments were conducted to determine whether maximum eye temperature, measured using infrared thermography (IRT), could be a non-invasive technique for detecting responses of cattle to handling procedures. Experiment one used six crossbred heifers randomly assigned to two groups in a crossover design and subjected to i) being hit with a plastic tube on the rump and ii) being startled by the sudden waving of a plastic bag. Experiment two used 32 crossbred bulls randomly assigned to three treatments: i) control, restraint only; ii) electric prod, two brief applications of an electric prod or, iii) startled, as in experiment one, accompanied by shouting. Exit speed (m s−1) was recorded on release from the restraint. Maximum eye temperature was recorded continuously pre- and post-treatment. In experiment one, eye temperature dropped rapidly between 20 and 40 s following both treatments and returned to baseline between 60 and 80 s following hitting and between 100 and 120 s following startling. In experiment two, eye temperature dropped between 0 and 20 s, following both treatments, and returned to baseline by 180 s, following startling plus shouting, but did not return to baseline for five minutes following electric prod. Exit speed tended to be faster following the electric prod. In conclusion, IRT detected responses that were due possibly to fear and/or pain associated with the procedures and may therefore be a useful, non-invasive method for assessing aversiveness of handling practices to cattle.
There is a need to assess the welfare of dairy cows that live outdoors under cold and wet conditions. This study combined a number of techniques to measure stress and make an assessment of welfare in this situation. Two groups of ten non-pregnant, non-lactating Holstein Friesian cows were exposed to a week of wind and rain (WR) or housed indoors (I) with pre- and post-treatment weeks indoors in a cross-over design. Wind and rain consisted of continual air movement (7.1 kph) using fans, water sprinkling for 15 min (3.0 mm) per hour, a mean temperature of 3.4°C and wind chill of –0.3°C. Internal body temperature was recorded every ten min and behaviour for 16 h per day. Blood, faeces and infrared temperatures were sampled at 0800h each morning during treatment weeks, and three times per week during pre- and post-treatment weeks. All cows were challenged with 2 ml Leptoshield Vaccine (CSL Animal Health, Australia) subcutaneously after 3 days of cold exposure to test immune responses. During WR, cows spent a greater proportion of time standing and less time lying down and eating than during I. Infrared temperatures were lower during WR than I in both dorsal and orbital (eye) regions. There was a distinct diurnal pattern of internal body temperature which had a greater amplitude during WR than I resulting from both a lower minimum and a higher maximum. The time of the minimum was 40 min later for WR than I. The overall mean body temperature was 0.07°C higher in WR than I. There were greater increases in plasma and faecal cortisol during WR than I, respectively. Total T4 was higher during WR than I. Non-esterified fatty acid concentration was higher in the week following WR than I. Total white blood cell numbers were lower during WR than I. No treatment differences were found for creatine kinase or for tumour necrosis factor, heat shock protein 90, interleukin 6 or interferon gamma expression in response to vaccination. In conclusion, this study applied a suite of stress measures to dairy cows exposed to extreme cold and wet conditions. Together, these measures indicated activation of the stress axis, physiological and behavioural adaptations to cold and a reduction in welfare. A number of these measures could be used to assess welfare under cold conditions on farms.
We examined the effects of daily positive or negative human handling on the behaviour of Holstein-Friesian dairy calves (n = 20 calves per treatment, five calves per group). The response to humans and indicators of positive emotions were examined at four weeks of age. Calves that received positive handling approached a familiar handler within 1 min in 50% of the handling sessions compared to 17% of the sessions for negatively handled calves but showed no difference when approaching an unfamiliar person. Calves that received positive handling showed less avoidance behaviour in their home pen to an approaching unfamiliar person (score, positive: 3.7, negative: 2.8) but there was no treatment effect on flight distance when tested outside the home pen. Both treatment groups responded similarly to a novel object and performed the same amount of play behaviour. Calves that received positive handling interacted more with cow brushes than calves that received negative handling (positive: 9.9%, negative: 7.9% of the total time). At three months of age, avoidance behaviour was re-tested, this time including 20 control animals of the same breed and age, reared routinely on-farm. Controls showed more avoidance behaviour (positive: 1.5, negative: 1.0, control: 0.3) and had a greater flight distance (positive: 3.3 m, negative: 3.7 m, control: 4.9 m). The results confirm existing literature demonstrating that the quantity and quality of handling influence the response towards humans. Little evidence was found that the type of early handling influences behaviours indicative of positive emotions.
A 2016 study season and 2017 excavation season at the 95-hectare walled site of Kurd Qaburstan on the Erbil plain have generated a variety of new results. Geophysical survey on the lower town revealed details of the Middle Bronze occupation in the southeast part of the site, including the city wall, a large open area, streets, houses, and a monumental temple comparable to examples from Tell al Rimah, Aššur, and Larsa. Excavations confirmed the Middle Bronze date of the temple and explored further Middle Bronze contexts elsewhere on the lower town. On the High Mound North Slope, Middle Bronze occupation included a fortification wall and large-scale architecture inside it. On the High Mound East, Late Bronze architecture of apparent elite character was documented. Archaeobotanical analyses complementing the excavations reveal the existence of naan-style bread in both Middle and Late Bronze contexts. Given radiocarbon and ceramic results, the Middle Bronze occupation at Kurd Qaburstan is datable to c. 1800 B.C., while the Late Bronze phases on the High Mound East belong to an early LB horizon in the 16–15th centuries B.C., perhaps predating the imposition of Mittani political authority in the region.
To evaluate the effectiveness of an automated hand hygiene compliance system (AHHCS) audible alert and vibration for increasing hand hygiene compliance.
Design:
A nonrandomized, before-and-after, quasi-experimental study of an AHHCS was implemented in several inpatient units. Over a 51-day period, the system’s real-time audible alert was turned on, off, and back on. Overall, hand hygiene compliance was compared between days with activated and deactivated alerts and vibration.
Setting:
This study was conducted at a level 1 trauma center, a regional academic health system with 1,564 beds.
Participants:
The AHHCS was implemented in 9 inpatient units: 3 adult medical-surgical step-down units, and 6 adult intensive care units. The AHHCS badges were assigned to patient care assistants, registered nurses, physical therapists, occupational therapists, speech therapists, respiratory therapists, and physicians.
Intervention:
In the 9 inpatient units, selected healthcare staff were issued wearable badges that detected entry into and exit from a patient room. The audible alert was turned on for 16 days, turned off for 17 days, and then turned back on for 18 days, for a total of 51 days.
Results:
Utilization of the AHHCS real-time audible alert reminder resulted in sustained HH compliance ≥90%. When the alert and vibration were deactivated, HH compliance dropped to an average of 74% (range, 62%–78%). Once the alert resumed, HH compliance returned to ≥90%.
Conclusion:
Utilization of an AHHCS with real-time reminder audible alerts may be an effective method to increase healthcare worker HH compliance to ≥90%. Users of AHHCSs should consider the use of real-time reminders to improve HH compliance.
The COVID-19 pandemic has affected all our lives, not only through the infection itself but also through the measures taken to control the spread of the virus (e.g. lockdown).
Aims
Here, we investigated how the COVID-19 pandemic and unprecedented lockdown affected the mental health of young adults in England and Wales.
Method
We compared the mental health symptoms of up to 4773 twins in their mid-20s in 2018 prior to the COVID-19 pandemic (T1) and during four-wave longitudinal data collection during the pandemic in April, July and October 2020, and in March 2021 (T2–T5) using phenotypic and genetic longitudinal designs.
Results
The average changes in mental health were small to medium and mainly occurred from T1 to T2 (average Cohen d = 0.14). Despite the expectation of catastrophic effects of the pandemic on mental health, we did not observe trends in worsening mental health during the pandemic (T3–T5). Young people with pre-existing mental health problems were disproportionately affected at the beginning of the pandemic, but their increased problems largely subsided as the pandemic persisted. Twin analyses indicated that the aetiology of individual differences in mental health symptoms did not change during the lockdown (average heritability 33%); the average genetic correlation between T1 and T2–T5 was 0.95, indicating that genetic effects before the pandemic were substantially correlated with genetic effects up to a year later.
Conclusions
We conclude that on average the mental health of young adults in England and Wales has been remarkably resilient to the effects of the pandemic and associated lockdown.
This chapter looks at a spectrum of paediatric clinical cases ranging from generalised conditions such as Ehlers– Danlos syndrome to tibial bowing and foot disorders. Skeletal dysplasia and rotational and other malalignments are also covered. The emphasis of the cases shown is to demonstrate how clinical features can contribute to management.
Plans for allocation of scarce life-sustaining resources during the coronavirus disease 2019 (COVID-19) pandemic often include triage teams, but operational details are lacking, including what patient information is needed to make triage decisions.
Methods:
A Delphi study among Washington state disaster preparedness experts was performed to develop a list of patient information items needed for triage team decision-making during the COVID-19 pandemic. Experts proposed and rated their agreement with candidate information items during asynchronous Delphi rounds. Consensus was defined as ≥80% agreement. Qualitative analysis was used to describe considerations arising in this deliberation. A timed simulation was performed to evaluate feasibility of data collection from the electronic health record.
Results:
Over 3 asynchronous Delphi rounds, 50 experts reached consensus on 24 patient information items, including patients’ age, severe or end-stage comorbidities, the reason for and timing of admission, measures of acute respiratory failure, and clinical trajectory. Experts weighed complex considerations around how information items could support effective prognostication, consistency, accuracy, minimizing bias, and operationalizability of the triage process. Data collection took a median of 227 seconds (interquartile range = 205, 298) per patient.
Conclusions:
Experts achieved consensus on patient information items that were necessary and appropriate for informing triage teams during the COVID-19 pandemic.
Background: Clinical guidelines recommend MAP maintenance at 85-90 mmHg to optimize spinal cord perfusion post-SCI. Recently, there has been increased interest in spinal cord perfusion pressure as a surrogate marker for spinal cord blood flow. The study aims to determine the congruency of subdural and intramedullary spinal cord pressure measurements at the site of SCI, both rostral and caudal to the epicenter of injury. Methods: Seven Yucatan pigs underwent a T5 to L1 laminectomy with intramedullary (IM) and subdural (SD) pressure sensors placed 2 mm rostral and 2 mm caudal to the epicenter of SCI. A T10 contusion SCI was performed followed by an 8-hour period of monitoring. Axial ultrasound images were captured at the epicenter of injury pre-SCI, post-SCI, and hourly thereafter. Results: Pigs with pre-SCI cord to dural sac ratio (CDSR) of >0.8 exhibited greater occlusion of the subdural space post-SCI with a positive correlation between IM and SD pressure rostral to the injury and a negative correlation caudal to the epicenter. Pigs with pre-SCI CDSR <0.8 exhibited no correlation between IM and SD pressure. Conclusions: Congruency of IM and SD pressure is dependent on compartmentalization of the spinal cord occurring secondary to swelling that occludes the subdural space.
Oxyurid nematodes (Syphacia spp.) from bank (Myodes glareolus) and field/common (Microtus spp.) voles, from disparate geographical sites in the British Isles, were examined morphologically and genetically. The genetic signatures of 118 new isolates are provided, based primarily on the rDNA internal transcribed spacers (ITS1-5.8S-ITS2) region and for representative isolates also on the small subunit 18S rDNA region and cytochrome c oxidase subunit 1 (cox-1) gene locus. Genetic data on worms recovered from Microtus spp. from the European mainland and from other rodent genera from the Palaearctic, North America and West Africa are also included. We test historical hypotheses indicating that S. nigeriana is a generalist species, infecting a range of different rodent genera. Our results establish that S. nigeriana is a parasite of both bank and field voles in the British Isles. An identical genotype was also recorded from Hubert's multimammate mouse (Mastomys huberti) from Senegal, but Mastomys spp. from West Africa were additionally parasitized by a related, although genetically distinct Syphacia species. We found no evidence for S. petrusewiczi in voles from the British Isles but isolates from Russia and North America were genetically distinct and formed their own separate deep branch in maximum likelihood molecular phylogenetic trees.