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Ion exchange analyses of the clay-sized fraction of sediments in Lakes Pontchartrain and Maurepas suggest the selective adsorption of Na at the expense of Mg. The literature suggests that Mg should be preferentially adsorbed. As the chlorinity of the lake waters increases from 300 mg/l to 3250mg/l, the percentage of exchangeable Na increases from 13·6 to 30·6 while the percentage of exchangeable Mg decreases from 65·6–36·8. The observed exchangeable Na percentages are higher than the ones calculated from the sodium-adsorption-ratios. The difference is attributed to an increase in the Na exchange constant of the sediment and therefore an increased selectivity for Na. With an increase in chlorinity, montmorillonite increases from 47 to 61 per cent and the total of the exchangeable cations (Na, Mg, Ca, K) increases from 36 to 82 m-equiv./100 g.
Autoimmune encephalitis is increasingly recognized as a neurologic cause of acute mental status changes with similar prevalence to infectious encephalitis. Despite rising awareness, approaches to diagnosis remain inconsistent and evidence for optimal treatment is limited. The following Canadian guidelines represent a consensus and evidence (where available) based approach to both the diagnosis and treatment of adult patients with autoimmune encephalitis. The guidelines were developed using a modified RAND process and included input from specialists in autoimmune neurology, neuropsychiatry and infectious diseases. These guidelines are targeted at front line clinicians and were created to provide a pragmatic and practical approach to managing such patients in the acute setting.
To estimate cost savings after implementation of customized electronic duplicate order alerts.
Design:
Alerts were implemented for microbiology tests at the largest public hospital in Victoria, Australia. These alerts were designed to pop up at the point of test ordering to inform the clinician that the test had previously been ordered and to suggest appropriate reordering time frames and indications.
Results:
In a 6-month audit of urine culture (our most commonly ordered test) after alert implementation, 2,904 duplicate requesters proceeded with the request and 2,549 tests were cancelled, for a 47% reduction in test ordering. For fecal polymerase chain reaction (PCR), our second most common test, there was a 54% reduction in test ordering. For our most commonly ordered expensive test, hepatitis C PCR, there was a 42% reduction in test ordering: 25 tests were cancelled.
Cancelled tests resulted in estimated savings of AU$52,382 (US$33,960) for urine culture, AU$34,914 (US$22,442) for fecal PCR, AU$4,506 (US$2,896) for hepatitis C PCR. For cancelled hepatitis B PCR and Epstein-Barr virus (EBV) and cytomegalovirus (CMV) serology, the cost savings was AU$8,472 (US$5445). The estimated financial cost saving in direct hospital costs for these 6 assays was AU$100,274 (US$67,925) over the 6-month period. Environmental waste cost saving by weight was estimated to be 280 kg. Greenhouse gas footprint, measured in carbon dioxide equivalent emissions for cancelled EBV and CMV serology tests, resulted in a saving of at least 17,711 g, equivalent to driving 115 km in a standard car.
Conclusion:
Customized alerts issued at the time of test ordering can have enormous impacts on reducing cost, waste, and unnecessary testing.
Adverse effects are a common concern when prescribing and reviewing medication, particularly in vulnerable adults such as older people and those with intellectual disability. This paper describes the development of an app giving information on side-effects, called Medichec, and provides a description of the processes involved in its development and how drugs were rated for each side-effect. Medications with central anticholinergic action, dizziness, drowsiness, hyponatraemia, QTc prolongation, bleeding and constipation were identified using the British National Formulary (BNF) and frequency of occurrence of these effects was determined using the BNF, product information and electronic searches, including PubMed.
Results
Medications were rated using a traffic light system according to how commonly the adverse effect was known to occur or the severity of the effect.
Clinical implications
Medichec can facilitate access to side-effects information for multiple medications, aid clinical decision-making, optimise treatment and improve patient safety in vulnerable adults.
Since 2020, the number of asylum-seekers residing in hotels sourced by the UK Home Office, termed Contingency Accommodation, has increased by over 20,000. Reports suggest that the risk of poor mental health in this population is high. The aim of this study was to help inform improvements to mental healthcare provision for UK asylum-seekers living in contingency accommodation by gaining a greater understanding of perceived barriers and facilitators to accessing care.
Methods
Seventeen semi-structured interviews were conducted remotely with Healthcare Service Providers between June and August 2022. Study Participants were recruited using purposive and snowball sampling to include stakeholders from primary care, secondary care, and third sector organisations. Data were analysed initially using deductive analysis based on the Levesque et al Conceptual Framework. Further emergent themes were identified using inductive analysis conducted sequentially on the data.
Results
Twelve themes relating to barriers and three to facilitators to mental healthcare access were identified. The most dominant themes were language barriers and long referral wait times, particularly to access specialist services for torture survivors. Other emergent themes included differing explanatory models of mental distress between Service Users and Providers and fear of authorities and data sharing. Within hotels, there was a lack of standardisation to facilitate mental healthcare access and a reliance on outreach organisations to explain the structure of the health system. Digital exclusion was described in the form of poor reception in hotel rooms and lack of privacy for remote consultations. Perceived mental health complexity was found to act as a barrier to referrals for low intensity psychological therapies such as IAPT being made and accepted. There was a lack of consensus amongst stakeholders about the appropriate time in the asylum journey to refer for trauma-focused therapy. Voluntary and community services (VCS) were described as plugging gaps in mental healthcare, but their role was ill-defined and concerns were expressed about sustainability.
Conclusion
This study identified complex and intersecting barriers at individual, community, health-system, and structural levels which, if addressed, could improve access to mental healthcare. Further work is required to quantify the burden of mental ill health amongst this group and to triangulate findings from this study with views of the asylum-seeking population. Specifically, this study highlights the need to establish exactly how VCS are meeting mental healthcare needs and how they can be better integrated into the healthcare system. Further research exploring the timing of trauma-focused therapy is also warranted.
In this article we consider the Australian Football League Players’ Association (AFLPA) initial fixed percentage of revenue pay request for the 2012–2016 Collective Bargaining Agreement (CBA) with the Australian Football League (AFL) in the context of theoretical predictions of models of player salaries in both settings of profit-maximising and win-maximising clubs. We then explore the AFL data from 2001–2009 and show that the declining share of player salaries as a proportion of revenue is consistent with the predictions from these theoretical models. This poses the question of what the league and the clubs do with the additional revenue if they are not paying it to the players. We explore alternative talent investments (better coaching, improved facilities) as a club strategy and the changing spending on game development as a league strategy.
Patients diagnosed with mental health problems are more predisposed to cardiovascular disease, including cardiac surgery. Nevertheless, health outcomes after cardiac surgery for patients with mental health problems as a discrete group are unknown. This study examined the association between secondary care mental health service use and postoperative health outcomes following cardiac surgery.
Methods
We conducted a retrospective observational research, utilizing data from a large South London mental healthcare supplier linked to national hospitalization data. OPCS-4 codes were applied to classify cardiac surgery. Health results were compared between those individuals with a mental health disorder diagnosis from secondary care and other local residents, including the length of hospital stay (LOS), inpatient mortality, and 30-day emergency hospital readmission.
Results
Twelve thousand three hundred and eighty-four patients received cardiac surgery, including 1,481 with a mental disorder diagnosis. Patients with mental health diagnosis were at greater risk of emergency admissions for cardiac surgery (odds ratio [OR] 1.60; 1.43, 1.79), longer index LOS (incidence rate ratio 1.28; 1.26, 1.30), and at higher risk of 30-day emergency readmission (OR 1.53; 1.31, 1.78). Those who underwent pacemaker insertion and major open surgery had worse postoperative outcomes during index surgery hospital admission while those who had major endovascular surgery had worse health outcomes subsequent 30-day emergency hospital readmission.
Conclusion
People with a mental health disorder diagnosis undertaking cardiac surgery have significantly worse health outcomes. Personalized guidelines and policies to manage preoperative risk factors require consideration and evaluation.
Incorporating theoretic insights from ageing biology could advance the “staying alive” hypothesis. Higher male extrinsic mortality can weaken selection against ageing-related diseases and self-preservation, leading to high male intrinsic mortality. This may incidentally result in female-biased longevity-promoting traits, a possibility that will require rigorous testing in order to disentangle from the adaptive self-preservation hypothesis presented in the target article.
Political and social attitudes have been shown to differ by sex in a way that tracks individual self-interest. We propose that these attitudes also change strategically to serve the best interests of either male or female kin. To test this hypothesis, we developed a measure of gendered fitness interests (GFI) – an index which reflects the sex, relatedness and residual reproductive value of close kin. We predicted that people with male-biased GFI (i.e. people with more male kin of a reproductive age) would have more conservative attitudes towards gender-related issues (e.g. gender roles, women's rights, abortion rights). An online study using an American sample (N = 560) found support for this hypothesis. Further analyses revealed that this relationship was driven not only by people's own sex and reproductive value but also by those of their descendant kin. Exploratory analyses also found a positive association between male-biased GFI and a measure of conformity, as well as a smaller association between male-biased GFI and having voted Republican in the last election. Both of these associations were statistically mediated by gender-related conservatism. These findings are consistent with the hypothesis that GFI influences sociopolitical attitudes.
Although recognized as one of the most significant cultural transformations in North America, the reintroduction of the horse to the continent after AD 1492 has been rarely addressed by archaeological science. A key contributing factor behind this limited study is the apparent absence of equine skeletal remains from early historic archaeological contexts. Here, we present a multidisciplinary analysis of a horse skeleton recovered in Lehi, Utah, originally attributed to the Pleistocene. Reanalysis of stratigraphic context and radiocarbon dating indicates a historic age for this horse (cal AD 1681–1939), linking it with Ute or other Indigenous groups, whereas osteological features demonstrate its use for mounted horseback riding—perhaps with a nonframe saddle. DNA analysis indicates that the animal was a female domestic horse, which was likely cared for as part of a breeding herd despite outliving its usefulness in transport. Finally, sequentially sampled stable carbon, oxygen, and strontium isotope values from tooth enamel (δ13C, δ18O, and 87Sr/86Sr) suggest that the horse was raised locally. These results show the utility of archaeological science as applied to horse remains in understanding Indigenous horse pastoralism, whereas consideration of the broader archaeological record suggests a pattern of misidentification of horse bones from early historic contexts.
Air pollution is linked to mortality and morbidity. Since humans spend nearly all their time indoors, improving indoor air quality (IAQ) is a compelling approach to mitigate air pollutant exposure. To assess interventions, relying on clinical outcomes may require prolonged follow-up, which hinders feasibility. Thus, identifying biomarkers that respond to changes in IAQ may be useful to assess the effectiveness of interventions.
Methods:
We conducted a narrative review by searching several databases to identify studies published over the last decade that measured the response of blood, urine, and/or salivary biomarkers to variations (natural and intervention-induced) of changes in indoor air pollutant exposure.
Results:
Numerous studies reported on associations between IAQ exposures and biomarkers with heterogeneity across study designs and methods. This review summarizes the responses of 113 biomarkers described in 30 articles. The biomarkers which most frequently responded to variations in indoor air pollutant exposures were high sensitivity C-reactive protein (hsCRP), von Willebrand Factor (vWF), 8-hydroxy-2′-deoxyguanosine (8-OHdG), and 1-hydroxypyrene (1-OHP).
Conclusions:
This review will guide the selection of biomarkers for translational studies evaluating the impact of indoor air pollutants on human health.
The diagnosis of anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis relies on the detection of NMDAR IgG autoantibodies in the serum or cerebrospinal fluid (CSF) of symptomatic patients. Commercial kits are available that allow NMDAR IgG autoantibodies to be measured in local laboratories. However, the performance of these tests outside of reference laboratories is unknown.
Objectives:
To report an unexpectedly low rate of NMDAR autoantibody detection in serum from patients with anti-NMDAR encephalitis tested using a commercially available diagnostic kit in an exemplar clinical laboratory.
Methods:
Paired CSF and serum samples from seven patients with definite anti-NMDAR encephalitis were tested for NMDAR IgG autoantibodies using commercially available cell-based assays run according to manufacturer’s recommendations. Rates of autoantibody detection in serum tested at our center were compared with those derived from systematic review and meta-analyses incorporating studies published during or before March 2019.
Results:
NMDAR IgG autoantibodies were detected in the CSF of all patients tested at our clinical laboratory but not in paired serum samples. Rates of the detection were lower than those previously reported. A similar association was recognized through meta-analyses, with lower odds of NMDAR IgG autoantibody detection associated with serum testing performed in nonreference laboratories.
Conclusions:
Commercial kits may yield lower-than-expected rates of NMDAR IgG autoantibody detection in serum when run in exemplar clinical (nonreference) laboratories. Additional studies are needed to decipher the factors that contribute to lower-than-expected rates of serum positivity. CSF testing is recommended in patients with suspected anti-NMDAR encephalitis.
Surface mass balance (SMB) is the net input of mass on a glacier's upper surface, composed of snow deposition, melt and erosion processes, and is a major contributor to the overall mass balance. Pine Island Glacier (PIG) in West Antarctica has been dynamically imbalanced since the early 1990s, indicating that discharge of solid ice into the oceans exceeds snow deposition. However, observations of the SMB pattern on the fast flowing regions are scarce, and are potentially affected by the firn's strain history. Here, we present new observations from radar-derived stratigraphy and a relatively dense network of firn cores, collected along a ~900 km traverse of PIG. Between 1986 and 2014, the SMB along the traverse was 0.505 m w.e. a−1 on average with a gradient of higher snow deposition in the South-West compared with the North-East of the catchment. We show that along ~80% of the traverse the strain history amounts to a misestimation of SMB below the nominal uncertainty, but can exceed it by a factor 5 in places, making it a significant correction to the SMB estimate locally. We find that the strain correction changes the basin-wide SMB by ~0.7 Gt a−1 and thus forms a negligible (1%) correction to the glacier's total SMB.
During the early twenty-first century, school bullying emerged as a social problem of epidemic proportions within academic, news media, and public discourse in the United States. Bullying has been linked to other social problems, such as mass school shootings and youth suicide. In this chapter we trace the evolution of school bullying as a social problem within academia and news media. We identify how this discourse has expanded the conceptualization and domain of school bullying and has stirred public hysteria. We also discuss how conflicting explanations of school bullying have led to confused responses at the individual, institutional, and sociocultural levels. Finally, we argue that efforts to reduce school bullying have criminalized youth behavior. We offer suggestions for a more effective approach to bullying research and prevention.
Water cultures were significantly more sensitive than concurrently collected swab cultures (n=2,147 each) in detecting Legionella pneumophila within a Veterans Affairs healthcare system. Sensitivity for water versus swab cultures was 90% versus 30% overall, 83% versus 48% during a nosocomial Legionnaires’ disease outbreak, and 93% versus 22% post outbreak.
West Antarctic climate and surface mass balance (SMB) records are sparse. To fill this gap, regional atmospheric climate modelling is useful, providing that such models are employed at sufficiently high horizontal resolution and coupled with a snow model. Here we present the results of a high-resolution (5.5 km) regional atmospheric climate model (RACMO2) simulation of coastal West Antarctica for the period 1979–2015. We evaluate the results with available in situ weather observations, remote-sensing estimates of surface melt, and SMB estimates derived from radar and firn cores. Moreover, results are compared with those from a lower-resolution version, to assess the added value of the resolution. The high-resolution model resolves small-scale climate variability invoked by topography, such as the relatively warm conditions over ice-shelf grounding zones, and local wind speed accelerations. Surface melt and SMB are well reproduced by RACMO2. This dataset will prove useful for picking ice core locations, converting elevation changes to mass changes, for driving ocean, ice-sheet and coupled models, and for attributing changes in the West Antarctic Ice Sheet and shelves to changes in atmospheric forcing.
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 Holocene portion of the Siple Dome (Antarctica) ice core was dated by interpreting the electrical, visual and chemical properties of the core. The data were interpreted manually and with a computer algorithm. The algorithm interpretation was adjusted to be consistent with atmospheric methane stratigraphic ties to the GISP2 (Greenland Ice Sheet Project 2) ice core, 10Be stratigraphic ties to the dendrochronology 14 C record and the dated volcanic stratigraphy. The algorithm interpretation is more consistent and better quantified than the tedious and subjective manual interpretation.
We study various measures of irrationality for hypersurfaces of large degree in projective space and other varieties. These include the least degree of a rational covering of projective space, and the minimal gonality of a covering family of curves. The theme is that positivity properties of canonical bundles lead to lower bounds on these invariants. In particular, we prove that if $X\subseteq \mathbf{P}^{n+1}$ is a very general smooth hypersurface of dimension $n$ and degree $d\geqslant 2n+1$, then any dominant rational mapping $f:X{\dashrightarrow}\mathbf{P}^{n}$ must have degree at least $d-1$. We also propose a number of open problems, and we show how our methods lead to simple new proofs of results of Ran and Beheshti–Eisenbud concerning varieties of multi-secant lines.
We argue that the CLASH model makes a number of questionable assumptions about the harshness and unpredictability of low-latitude environments, calling into question the life history strategy approach used, and that it is inconsistent with more nuanced global patterns of violence. We suggest an alternative account for less violence at high latitudes, based on a greater need for cooperation.