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.
Antimicrobial resistance (AMR) poses a significant global health threat, projected to cause 10 million deaths annually by 2050. Addressing AMR requires a coordinated, multidisciplinary approach encompassing infectious disease (ID) clinicians, pharmacists, microbiologists, infection preventionists, and policymakers. The inaugural AMR Summit, hosted by bioMérieux in collaboration with Tampa General Hospital and the University of South Florida Morsani College of Medicine in November 2024, convened experts from various fields to explore innovative strategies for combating AMR. Key topics discussed included the role of multidisciplinary teams in antimicrobial stewardship programs, advancements in rapid diagnostic tests and antimicrobial susceptibility testing, the application of implementation science in AMR, and the integration of next-generation sequencing in ID diagnostics. The summit underscored the importance of diagnostic innovation, interdisciplinary collaboration, policy, advocacy, and public engagement in advancing efforts against AMR.
Historically, it has been proposed that functional neurological symptoms occur more frequently on the left side of the body due to a distinct body representation and emotional processing of the right hemisphere, yet objective imaging data to support this are lacking. We aimed to investigate whether patients with acute left-sided symptoms (right hemisphere) suspected of having a minor stroke are more likely to show negative diffusion-weighted imaging (DWI) compared to those with right-sided symptoms.
Methods:
Data are from the SpecTRA (Spectrometry for Transient Ischemic Attack Rapid Assessment) multicenter prospective cohort study conducted between 2013 and 2017. Patients with mild persistent unilateral hemiparesis and/or hemisensory symptoms (National Institute of Health Stroke Scale ≤ 3) and available DWI were included. The primary outcome was the proportion of patients with a negative DWI.
Results:
Of 1731 patients, 584 (30.8%) were included. Of these, 310 (53.1%) patients presented with left-sided symptoms and 274 (46.9%) with right-sided symptoms. Overall, 214 (36.6%) patients had a negative DWI, 126 (58.9%) with left-sided symptoms and 88 (41.1%) with right-sided symptoms: risk ratio (RR) 1.27 (95% CI = 1.02–1.57). Left-sided hemiparesis was associated with negative DWI (RR 1.42 [95% CI = 1.08–1.87]), while left-sided hemisensory symptoms were not (RR 1.11 [95% CI = 0.87–1.41]). There was no effect modification by age or sex on this association (Pinteraction 0.787 and 0.057, respectively).
Conclusions:
Unilateral left-sided neurological symptoms were more frequently associated with negative DWI compared to right-sided symptoms in suspected minor stroke patients. This observation is exploratory, as the final diagnosis in DWI-negative cases was not established.
Previous observational studies suggested that vitamin D may control the absorption of iron (Fe) by inhibition of hepcidin, but the causal relevance of these associations is uncertain. Using placebo-controlled randomisation, we assessed the effects of supplementation with vitamin D on biochemical markers of Fe status and erythropoiesis in community-dwelling older people living in the UK. The BEST-D trial, designed to establish the optimum dose of vitamin D3 for future trials, had 305 participants, aged 65 years or older, randomly allocated to 4000 IU vitamin D3 (n 102), 2000 IU vitamin D3 (n 102) or matching placebo (n 101). We estimated the effect of vitamin D allocation on plasma levels of hepcidin, soluble transferrin receptor (sTfR), ferritin, Fe, transferrin, saturated transferrin (TSAT%) and the sTfR–ferritin index. Despite increases in 25-hydroxy-vitamin D, neither dose had significant effects on biochemical markers of Fe status or erythropoiesis. Geometric mean concentrations were similar in vitamin D3 arms v. placebo for hepcidin (20·7 [se 0·90] v. 20·5 [1·21] ng/ml), sTfR (0·69 [0·010] v. 0·70 [0·015] µg/ml), ferritin (97·1 [2·81] v. 97·8 [4·10] µg/l) and sTfR–ferritin ratio (0·36 [0·006] v. 0·36 [0·009]), respectively, while arithmetic mean levels were similar for Fe (16·7 [0·38] v. 17·3 [0·54] µmol/l), transferrin (2·56 [0·014] v. 2·60 [0·021] g/dl) and TSAT% (26·5 [0·60] v. 27·5 [0·85]). The proportions of participants with ferritin < 15 µg/l and TSAT < 16 % were unaltered by vitamin D3 suggesting that 12 months of daily supplementation with moderately high doses of vitamin D3 are unlikely to alter the Fe status of older adults.
Seed genebanks must maintain collections of healthy seeds and regenerate accessions before seed viability declines. Seed shelf life is often characterized at the species level; however, large, unexplained variation among genetic lines within a species can and does occur. This variation contributes to unreliable predictions of seed quality decline with storage time. To assess variation of seed longevity and aid in timing regeneration, ten varieties of pea (Pisum sativum L.), chickpea (Cicer arietinum L.) and lentil (Lens culinaris Medikus subsp. culinaris) from the Australian Grains Genebank were stored at moderate temperature (20°C) and moisture (7–11% water, relative humidity [RH] ~30%) and deterioration was assessed by yearly germination tests for 20 years. Decline in germination was fit to a sigmoidal model and the time corresponding to 50% germination (P50) was used to express seed longevity for each genetic line. The feasibility of using RNA fragmentation to assess changed seed health was measured using RNA integrity number (RIN) from RNA extracted from seeds that were stored for 13 and 20 years. Seed lots of legume grains that maintained high survival throughout the 20 years (i.e. they aged slower than other lines) had higher RIN than samples that degraded faster. RIN was lower in embryonic axes compared with cotyledons in the more deteriorated samples, perhaps indicating that axes exhibit symptoms of ageing sooner than cotyledons. Overall, RIN appears to be associated with longevity indicators of germination for these legumes and indicating that RIN decline can be used to assess ageing rate, which is needed to optimize viability monitoring.
People with type 2 diabetes (T2D) are more likely to experience binge eating than the general population, which may interfere with their diabetes management. Guided self-help (GSH) is one of the recommended treatment options for binge eating disorder, but there is currently a lack of evidenced treatment for binge eating in individuals living with T2D. The aims of this pilot study were to test the feasibility and acceptability of recruiting and delivering the adapted, online Working to Overcome Eating Difficulties GSH intervention to adults with T2D and binge eating. The intervention comprises GSH materials presented online in seven sections delivered over 12 weeks, supported by a trained Guide. Twenty-two participants were recruited in a case series design to receive the intervention and we interviewed four Guides and five participants afterwards. We measured binge eating, mental wellbeing, quality of life and weight at pre-post and 12-week follow-up. Results showed a significant reduction in binge eating at the end of the intervention, which continued to improve at follow-up. Before the programme, 92 % of participants scored above cut-off for binge eating. This reduced to 41 % post-intervention and no-one at follow-up. These changes were accompanied by significant improvements in depression, anxiety and small changes in eating disorder symptoms. Participants reported making better lifestyle choices, eating more mindfully and having increased self-confidence. The study shows preliminary evidence for online GSH tailored to the needs of individuals with T2D as a feasible and acceptable approach to improving binge eating, diabetes management and mental wellbeing.
Integrating library instruction into studio art classes can be challenging for art librarians. While some courses have a research component, and thus a clear need for library instruction, many do not, requiring art librarians to creatively engage art students and faculty to demonstrate the value of the library in studio education. One way art librarians can do this is by encouraging students to see the library as a place for artistic inspiration through serendipitous discovery. But how can art librarians foster the idea of the library as a creative place through instruction? From the 1970s to the present day, studies have shown that artists and art students have a marked preference for browsing the stacks as an information seeking strategy. By aligning browsing with chance as an artistic practice and collaborating with studio art professors, art librarians can create dynamic and impactful learning experiences that lead to exciting outcomes in students’ studio courses. One possibility where serendipitous browsing's potential as a learning outcome can be explored is through the creation of book spine poetry, a found poetry technique where books are arranged so their titles create a poem.
Diagnosis of acute ischemia typically relies on evidence of ischemic lesions on magnetic resonance imaging (MRI), a limited diagnostic resource. We aimed to determine associations of clinical variables and acute infarcts on MRI in patients with suspected low-risk transient ischemic attack (TIA) and minor stroke and to assess their predictive ability.
Methods:
We conducted a post-hoc analysis of the Diagnosis of Uncertain-Origin Benign Transient Neurological Symptoms (DOUBT) study, a prospective, multicenter cohort study investigating the frequency of acute infarcts in patients with low-risk neurological symptoms. Primary outcome parameter was defined as diffusion-weighted imaging (DWI)-positive lesions on MRI. Logistic regression analysis was performed to evaluate associations of clinical characteristics with MRI-DWI-positivity. Model performance was evaluated by Harrel’s c-statistic.
Results:
In 1028 patients, age (Odds Ratio (OR) 1.03, 95% Confidence Interval (CI) 1.01–1.05), motor (OR 2.18, 95%CI 1.27–3.65) or speech symptoms (OR 2.53, 95%CI 1.28–4.80), and no previous identical event (OR 1.75, 95%CI 1.07–2.99) were positively associated with MRI-DWI-positivity. Female sex (OR 0.47, 95%CI 0.32–0.68), dizziness and gait instability (OR 0.34, 95%CI 0.14–0.69), normal exam (OR 0.55, 95%CI 0.35–0.85) and resolved symptoms (OR 0.49, 95%CI 0.30–0.78) were negatively associated. Symptom duration and any additional symptoms/symptom combinations were not associated. Predictive ability of the model was moderate (c-statistic 0.72, 95%CI 0.69–0.77).
Conclusion:
Detailed clinical information is helpful in assessing the risk of ischemia in patients with low-risk neurological events, but a predictive model had only moderate discriminative ability. Patients with clinically suspected low-risk TIA or minor stroke require MRI to confirm the diagnosis of cerebral ischemia.
Advance consent could allow individuals at high risk of stroke to provide consent before they might become eligible for enrollment in acute stroke trials. This survey explores the acceptability of this novel technique to Canadian Research Ethics Board (REB) chairs that review acute stroke trials. Responses from 15 REB chairs showed that majority of respondents expressed comfort approving studies that adopt advance consent. There was no clear preference for advance consent over deferral of consent, although respondents expressed significant concern with broad rather than trial-specific advance consent. These findings shed light on the acceptability of advance consent to Canadian ethics regulators.
Schooling transforms child development yet fades into the background in research on prosocial behavior. Mass education, however, was central to the concerns of founding theorists such as Durkheim, Dewey, and Piaget. Putting on a sociological lens makes it easier to see how schools continue to play an active role in prosocial development, and how the concerns of these founding researchers resonate today. To situate the active role of school contexts in prosocial behavior, this chapter first examines schools as social systems, structuring children’s social networks, imposing roles and norms of behavior, and impacting the timing of development. The chapter then examines classroom, pedagogical, and peer prosocial behaviors, and their connection to classic theoretical work in the field. After reviewing these forms of prosocial behavior, the chapter closes by examining the links between prosocial behavior and student outcomes and implications and future directions for theory, research, and practice.
Advance consent presents a potential solution to the challenge of obtaining informed consent for participation in acute stroke trials. Clinicians in stroke prevention clinics are uniquely positioned to identify and seek consent from potential stroke trial participants. To assess the acceptability of advance consent to Canadian stroke clinic physicians, we performed an online survey. We obtained 58 respondents (response rate 35%): the vast majority (82%) expressed comfort with obtaining advance consent and 92% felt that doing so would not be a significant disruption to clinic workflow. These results support further study of advance consent for acute stroke trials.
Scholars, pundits, and politicians use opinion surveys to study citizen beliefs about political facts, such as the current unemployment rate, and more conspiratorial beliefs, such as whether Barack Obama was born abroad. Many studies, however, ignore acquiescence-response bias, the tendency for survey respondents to endorse any assertion made in a survey question regardless of content. With new surveys fielding questions asked in recent scholarship, we show that acquiescence bias inflates estimated incidence of conspiratorial beliefs and political misperceptions in the United States and China by up to 50%. Acquiescence bias is disproportionately prevalent among more ideological respondents, inflating correlations between political ideology such as conservatism and endorsement of conspiracies or misperception of facts. We propose and demonstrate two methods to correct for acquiescence bias.
Little is known about environmental factors that may influence associations between genetic liability to suicidality and suicidal behavior.
Methods
This study examined whether a suicidality polygenic risk score (PRS) derived from a large genome-wide association study (N = 122,935) was associated with suicide attempts in a population-based sample of European-American US military veterans (N = 1664; 92.5% male), and whether cumulative lifetime trauma exposure moderated this association.
Results
Eighty-five veterans (weighted 6.3%) reported a history of suicide attempt. After adjusting for sociodemographic and psychiatric characteristics, suicidality PRS was associated with lifetime suicide attempt (odds ratio 2.65; 95% CI 1.37–5.11). A significant suicidality PRS-by-trauma exposure interaction emerged, such that veterans with higher levels of suicidality PRS and greater trauma burden had the highest probability of lifetime suicide attempt (16.6%), whereas the probability of attempts was substantially lower among those with high suicidality PRS and low trauma exposure (1.4%). The PRS-by-trauma interaction effect was enriched for genes implicated in cellular and developmental processes, and nervous system development, with variants annotated to the DAB2 and SPNS2 genes, which are implicated in inflammatory processes. Drug repurposing analyses revealed upregulation of suicide gene-sets in the context of medrysone, a drug targeting chronic inflammation, and clofibrate, a triacylglyceride level lowering agent.
Conclusion
Results suggest that genetic liability to suicidality is associated with increased risk of suicide attempt among veterans, particularly in the presence of high levels of cumulative trauma exposure. Additional research is warranted to investigate whether incorporation of genomic information may improve suicide prediction models.
Ice streams are warmed by shear strain, both vertical shear near the bed and lateral shear at the margins. Warm ice deforms more easily, establishing a positive feedback loop in an ice stream where fast flow leads to warm ice and then to even faster flow. Here, we use radar attenuation measurements to show that the Siple Coast ice streams are colder than previously thought, which we hypothesize is due to along-flow advection of cold ice from upstream. We interpret the attenuation results within the context of previous ice-temperature measurements from nearby sites where hot-water boreholes were drilled. These in-situ temperatures are notably colder than model predictions, both in the ice streams and in an ice-stream shear margin. We then model ice temperature using a 1.5-dimensional numerical model which includes a parameterization for along-flow advection. Compared to analytical solutions, we find depth-averaged temperatures that are colder by 0.7°C in the Bindschadler Ice Stream, 2.7°C in the Kamb Ice Stream and 6.2–8.2°C in the Dragon Shear Margin of Whillans Ice Stream, closer to the borehole measurements at all locations. Modelled cooling corresponds to shear-margin thermal strengthening by 3–3.5 times compared to the warm-ice case, which must be compensated by some other weakening mechanism such as material damage or ice-crystal fabric anisotropy.
In the scientific analysis of the funeral achievements of Henry V the principal non-invasive techniques used were X-rays and Medical X-ray Computerised Tomography (CT) scanning which, when allied with more traditional methods, revealed new information as well as allowing a different perspective and interpretation of these artefacts. Non-invasive techniques involve some form of imaging or analysis that does not damage or affect the artefact. There are a large number of techniques. Table 11.1 provides a summary of the most commonly used methods. Whilst there is overlap, invasive and non-invasive techniques are complementary as the first gives information about composition at a microscopic level and the second about structure and composition at a more macroscopic level. In practice, the two methods can be combined in that non-invasive imaging may identify areas suitable for invasive sampling.
The examination and understanding of artefacts is becoming increasingly multidisciplinary as the various scientific methods are combined not only with each other but also with more traditional descriptive methods including using contemporary sources to place the artefact in context. A good example would be the analysis of Viking era and early medieval swords. Traditional classification is descriptive based, for example on pommel design as in the Petersen, or Oakeshott simplified classifications, aided by measurements of blade length and geometry as in the Geibig and Oakeshott classifications. To this can be added identification of makers’ marks on a blade. Manuscripts may illustrate or describe the swords. To this descriptive analysis, non-invasive examination by X-rays and CT scans can add precise measurements of blade length and taper, the identification of marks hidden by corrosion, blade structure, particularly pattern welding, evidence of repairs and the method of pommel construction. Non-invasive XRF can identify the presence of gold or other precious metals in areas of decoration, hardness testing helps determine if the blade is made of iron or steel and invasive metallurgical analysis reveals the quality of the steel and indirectly the method of blade manufacture.
In order to produce an X-ray image a detector, formerly film but now digital, is positioned to detect X-rays passing through the object and the image results from differences in attenuation of the X-ray beam by different parts of the object. This shows as grey scale shadows in the image produced by the detector.
We conclude that the extinct polar forests of Antarctica deserve recognition as a distinct biome - the ‘Austral Polar Forest Biome’ - rather than being regarded as analogous to modern rainforest.
Patients presenting to hospital with suspected coronavirus disease 2019 (COVID-19), based on clinical symptoms, are routinely placed in a cohort together until polymerase chain reaction (PCR) test results are available. This procedure leads to delays in transfers to definitive areas and high nosocomial transmission rates. FebriDx is a finger-prick point-of-care test (PoCT) that detects an antiviral host response and has a high negative predictive value for COVID-19. We sought to determine the clinical impact of using FebriDx for COVID-19 triage in the emergency department (ED).
Design:
We undertook a retrospective observational study evaluating the real-world clinical impact of FebriDx as part of an ED COVID-19 triage algorithm.
Setting:
Emergency department of a university teaching hospital.
Patients:
Patients presenting with symptoms suggestive of COVID-19, placed in a cohort in a ‘high-risk’ area, were tested using FebriDx. Patients without a detectable antiviral host response were then moved to a lower-risk area.
Results:
Between September 22, 2020, and January 7, 2021, 1,321 patients were tested using FebriDx, and 1,104 (84%) did not have a detectable antiviral host response. Among 1,104 patients, 865 (78%) were moved to a lower-risk area within the ED. The median times spent in a high-risk area were 52 minutes (interquartile range [IQR], 34–92) for FebriDx-negative patients and 203 minutes (IQR, 142–255) for FebriDx-positive patients (difference of −134 minutes; 95% CI, −144 to −122; P < .0001). The negative predictive value of FebriDx for the identification of COVID-19 was 96% (661 of 690; 95% CI, 94%–97%).
Conclusions:
FebriDx improved the triage of patients with suspected COVID-19 and reduced the time that severe acute respiratory coronavirus virus 2 (SARS-CoV-2) PCR-negative patients spent in a high-risk area alongside SARS-CoV-2–positive patients.
Due to continuing pressures on the UK National Health Service’s mental health services, there has been increased interest in the development of brief psychological interventions (BPIs). These interventions are usually defined as including selected components of established psychological interventions, delivered over fewer sessions, and by staff with less specialised training (paraprofessionals). Cognitive behavioural therapy (CBT)-based BPIs for anxiety and depression have been found to be helpful for clients with mild to moderate mental health problems. This project evaluates the introduction of BPIs for anxiety and depression in a secondary care adult mental health service, with clients experiencing moderate to severe mental health difficulties. The service developed CBT-based manuals for anxiety (anxiety management) and depression (behavioural activation) BPIs. The BPIs were delivered by mental health workers without core therapeutic training, who were offered training and group supervision by psychologists in the team. Measures of anxiety (GAD-7), depression (PHQ-9), wellbeing (SWEMWBS) and functioning (WSAS) were completed at the start and end of treatment. The data reported from a 2-year period suggest that BPIs are associated with reductions in symptoms of anxiety and low mood, and improvements in wellbeing and functioning. Whilst this is a small-scale initial evaluation, the results are promising for the potential benefit of BPIs for clients in secondary care settings. Given that this new way of working has possible additional benefits such as improving access to psychological treatment and cost-effectiveness, further research in the area is warranted and encouraged.
Key learning aims
(1) To overview the current evidence for BPIs.
(2) To outline a possible model for offering BPIs in secondary care.
(3) To illustrate the potential positive effects of BPIs within a secondary care population.
(4) To consider the need for future research and development of BPIs.
The most immediate response of the research community to COVID-19 has been a focus on understanding the effects, treatment and prevention of infection. Of equal and ongoing importance is elucidating the impact of mitigation measures, such as lockdown, on the well-being of societies. Research about mental health and lockdown in the UK has predominately involved large surveys that are likely to encounter self-selection bias. Further, self-reporting does not constitute a clinical judgement.
Aims
To (a) compare the age, gender and ethnicity of patients experiencing mental health emergencies prior compared with during lockdown, (b) determine whether the nature of mental health emergencies has changed during compared with before lockdown, (c) explore the utility of emergency medical service data for identifying vulnerability to mental health emergencies in real time during a pandemic.
Method
A total of 32 401 clinical records of ambulance paramedics attending mental health emergencies in the East Midlands of the UK between 23 March and 31 July 2020 and the same period in 2019 were analysed using binary logistic regression.
Results
People of younger age, male gender and South Asian and Black ethnicity are particularly vulnerable to acute mental health conditions during lockdown. Patients with acute cases of anxiety have increased during lockdown whereas suicide and intentional drug overdose have decreased.
Conclusions
Self-reported data may underrepresent the true impact of lockdown on male mental health and ethnic minority groups. Emergency medical data can be used to identify vulnerable communities in the context of the extraordinary circumstances surrounding the current pandemic, as well as under more ordinary circumstances.