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This article describes the Implementation Science (IS) Scholars Program at the University of Arkansas for Medical Sciences (UAMS). The program’s goal is to translate knowledge, approaches, and methods from IS to front-line clinicians in an academic medical center, thereby supporting its goals as a learning health system and promoting a dynamic workforce of IS-informed change leaders. Initiated in 2020, the program is relatively unique in that it attempts to translate concepts and knowledge from IS to clinicians to improve their skills as implementers and change agents. The program is supported by the Translational Research Institute, the UAMS’ awardee of the Clinical and Translational Science Award Program. The two-year program provides 20% salary coverage, bespoke didactics, and close mentoring on a Scholar-initiated project to improve care in their clinical context. The program has trained four cohorts of Scholars over the program’s initial five years. We describe the program, our evaluation of it thus far, and future plans. The program has contributed to numerous healthcare improvements and served as a gateway to future implementation and other research activities among some Scholars.
The COVID-19 pandemic is a disaster event. Exposure to stressors during and after disaster events is associated with negative mental health symptoms. To inform targeted COVID-19 recovery efforts, data are needed to understand which stressors play a key role in this relationship.
Methods
Cross-sectional survey data (demographics, impacts of COVID-19, social determinants of health, depression, and anxiety) were collected online from adults living in New York state between May and June 2020. Differences in the proportion of stressors (COVID-19 and social determinants) experienced by race/ethnicity were assessed using chi-square analyses. Logistic regression was used to assess which factors were associated with increased odds of depression and anxiety.
Results
A majority (n = 258, 62.2%) of the 415 respondents reported being directly impacted by the pandemic. Non-white respondents reported a significantly larger proportion of stressors compared to white respondents. Under half of respondents reported depression (n = 171, 41.2%) and anxiety (n = 164, 39.5%). Healthcare and food concerns were associated with increased odds of depression and anxiety, and economic concerns were associated with increased odds of anxiety.
Conclusions
Findings underscore the need to respond to the COVID-19 mental health crisis by addressing social determinants of health.
The Rare and Atypical DIAbetes NeTwork (RADIANT) aims to discover the underlying pathoetiology of atypical diabetes by conducting both genotyping and non-genetic deep phenotyping. While the return of genetic test results in research settings has been investigated, the return of non-genetic results (RoR-NG) has received less attention. We explore the RoR-NG with RADIANT investigators and participants.
Methods/Study Population:
We conducted one-on-one interviews with 10 adult RADIANT participants and 10 RADIANT investigators. Participants also completed two health literacy screening tools and a survey on perspectives regarding return of results (RoR). Investigators completed one survey on experience and confidence in explaining clinical tests utilized in the RADIANT study and another survey on perspectives regarding RoR.
Results:
Most participants were non-Hispanic White. All participants had high scores on health literacy screens. Both RADIANT participants and investigators expressed strong support for RoR-NG. RADIANT participants and investigators acknowledged the different roles and responsibilities between research and clinical care for interpreting and acting on non-genetic results. However, the lines between clinical care and research in returning and acting on results were often blurred by both participants and investigators.
Discussion/Significance:
Our study provides important insight into how both investigators and participants simultaneously distinguish and blur clinical and research roles and responsibilities when discussing non-genetic research results and the return of these results. Further study should engage individuals from diverse racial and ethnic backgrounds and with varying levels of health literacy to understand how best to support all participants when returning research results.
In this era of spatially resolved observations of planet-forming disks with Atacama Large Millimeter Array (ALMA) and large ground-based telescopes such as the Very Large Telescope (VLT), Keck, and Subaru, we still lack statistically relevant information on the quantity and composition of the material that is building the planets, such as the total disk gas mass, the ice content of dust, and the state of water in planetesimals. SPace Infrared telescope for Cosmology and Astrophysics (SPICA) is an infrared space mission concept developed jointly by Japan Aerospace Exploration Agency (JAXA) and European Space Agency (ESA) to address these questions. The key unique capabilities of SPICA that enable this research are (1) the wide spectral coverage $10{-}220\,\mu\mathrm{m}$, (2) the high line detection sensitivity of $(1{-}2) \times 10^{-19}\,\mathrm{W\,m}^{-2}$ with $R \sim 2\,000{-}5\,000$ in the far-IR (SAFARI), and $10^{-20}\,\mathrm{W\,m}^{-2}$ with $R \sim 29\,000$ in the mid-IR (SPICA Mid-infrared Instrument (SMI), spectrally resolving line profiles), (3) the high far-IR continuum sensitivity of 0.45 mJy (SAFARI), and (4) the observing efficiency for point source surveys. This paper details how mid- to far-IR infrared spectra will be unique in measuring the gas masses and water/ice content of disks and how these quantities evolve during the planet-forming period. These observations will clarify the crucial transition when disks exhaust their primordial gas and further planet formation requires secondary gas produced from planetesimals. The high spectral resolution mid-IR is also unique for determining the location of the snowline dividing the rocky and icy mass reservoirs within the disk and how the divide evolves during the build-up of planetary systems. Infrared spectroscopy (mid- to far-IR) of key solid-state bands is crucial for assessing whether extensive radial mixing, which is part of our Solar System history, is a general process occurring in most planetary systems and whether extrasolar planetesimals are similar to our Solar System comets/asteroids. We demonstrate that the SPICA mission concept would allow us to achieve the above ambitious science goals through large surveys of several hundred disks within $\sim\!2.5$ months of observing time.
Daytime sleepiness is associated with multiple negative outcomes in older adults receiving long-term services and supports (LTSS) including reduced cognitive performance, need for greater assistance with activities of daily living and decreased social engagement. The purpose of this study was to identify predictors of change in subjective daytime sleepiness among older adults during their first 2 years of receiving LTSS.
Design and Setting:
Secondary analysis of data from a prospective longitudinal study of older adults who received LTSS in their homes, assisted living communities or nursing homes interviewed at baseline and every 3 months for 24 months.
Participants:
470 older adults (60 years and older) newly enrolled in LTSS (mean = 81, SD = 8.7; range 60–98; 71% women).
Measurements:
Subjective daytime sleepiness was assessed every 3 months through 2 years using the Epworth Sleepiness Scale. Multiple validated measures were used to capture health-related quality of life characteristics of enrollees and their environment, including symptom status (Symptom Bother Scale), cognition (Mini Mental Status Exam), physical function (Basic Activities of Daily Living), physical and mental general health, quality of life (Dementia Quality of Life, D-QoL), depressive symptoms (Geriatric Depression Scale) and social support (Medical Outcomes Survey-Social Support).
Results:
Longitudinal mixed effects modeling was used to examine the relationship between independent variables and continuous measure of daytime sleepiness. Increased feelings of belonging, subscale of the D-QoL (effect size = −0.006, 95% CI: −0.013 to −0.0001, p = 0.045) and higher number of depressive symptoms (effect size = −0.002, 95% CI: −0.004 to −0.001, p = 0.001) at baseline were associated with slower rates of increase in daytime sleepiness over time.
Conclusions:
Comprehensive baseline and longitudinal screening for changes in daytime sleepiness along with depression and perceived quality of life should be used to inform interventions aimed at reducing daytime sleepiness among older adults receiving LTSS.
Measurements in the infrared wavelength domain allow direct assessment of the physical state and energy balance of cool matter in space, enabling the detailed study of the processes that govern the formation and evolution of stars and planetary systems in galaxies over cosmic time. Previous infrared missions revealed a great deal about the obscured Universe, but were hampered by limited sensitivity.
SPICA takes the next step in infrared observational capability by combining a large 2.5-meter diameter telescope, cooled to below 8 K, with instruments employing ultra-sensitive detectors. A combination of passive cooling and mechanical coolers will be used to cool both the telescope and the instruments. With mechanical coolers the mission lifetime is not limited by the supply of cryogen. With the combination of low telescope background and instruments with state-of-the-art detectors SPICA provides a huge advance on the capabilities of previous missions.
SPICA instruments offer spectral resolving power ranging from R ~50 through 11 000 in the 17–230 μm domain and R ~28.000 spectroscopy between 12 and 18 μm. SPICA will provide efficient 30–37 μm broad band mapping, and small field spectroscopic and polarimetric imaging at 100, 200 and 350 μm. SPICA will provide infrared spectroscopy with an unprecedented sensitivity of ~5 × 10−20 W m−2 (5σ/1 h)—over two orders of magnitude improvement over what earlier missions. This exceptional performance leap, will open entirely new domains in infrared astronomy; galaxy evolution and metal production over cosmic time, dust formation and evolution from very early epochs onwards, the formation history of planetary systems.
Thirty-four women who had vaginal deliveries of live infants completed behavioural ratings and supplied blood and 24-hour urine samples on three occasions during pregnancy and on three occasions after delivery. Approximately one third of the women indicated a distinct upswing in mood between Days 2 and 4 following delivery. These ‘positive mood change’ subjects showed changes in urinary cyclic AMP (adenosine 3′5′ cyclic monophosphate), plasma cyclic AMP, whole blood cell cyclic AMP, whole blood cell ATP (adenosine triphosphate), haematocrit and urinary 11 OHCS (11-hydroxycortisol steroids) following delivery which were different from those observed in the rest of the subjects and comparable with the biochemical changes described during upswings in mood in short-cycle manic-depressive subjects. There was also an indication that the women showing this upswing in mood following delivery were distinct in some respects on both behavioural ratings and biochemical findings during pregnancy.
A double-blind, placebo controlled, crossover trial of carbamazepine in 12 severely and profoundly mentally retarded, overactive adult patients is described. The trial lasted 7 months and those patients in whom overactivity was the dominant problem responded to some degree to carbamazepine with a reduction in overactivity. This was particularly so in patients in whom overactivity was accompanied by some elevation of mood. Patients in whom overactivity was part of a wider spectrum of multiple behaviour disorders showed a scatter of responses. There was no relationship between response to carbamazepine and the presence or absence of epilepsy. The trial identified a small group of mentally retarded patients in whom carbamazepine might be clinically useful.
Erythrocyte sodium concentration, potassium concentration, Na-K ATPase activity, and ouabain sensitive potassium influx were determined in female inpatients suffering from a depressive illness. In most patients the biochemical values were also determined shortly before the patient's discharge from hospital. The Na-K ATPase and the ouabain sensitive potassium influx increased significantly with improvement in the depressive mood rating.
A group of bipolar manic depressive patients attending a routine lithium clinic were investigated. The results suggest that, when on treatment with lithium, manic depressive patients with a good prognosis tend to have a higher erythrocyte Na-K ATPase and higher plasma and erythrocyte lithium concentrations than those with a poor prognosis. There was no evidence to suggest that the erythrocyte: plasma lithium ratio was useful in predicting clinical response to lithium therapy. There was also a positive correlation between plasma lithium concentration and Na–K ATPase activity, confirming that in manic depressive subjects lithium produces a rise in erythrocyte Na–K ATPase activity.
The effect of ascorbic acid and ethylene diamine tetra acetic acid (EDTA) in the treatment of manic-depressive psychosis was compared, using double-blind procedures, with recognized treatment regimes. There was no significant difference between the response of depressed patients to amitriptyline or ascorbic acid and EDTA. Manic patients responded significantly better to lithium than to ascorbic acid and EDTA. These results are in keeping with the suggestion that vanadium may be of aetiological importance in depressive psychosis, but do not support such a suggestion for mania.
Associations between animal behaviour and emissions of methane (CH4) and ammonia (NH3) have been noted in studies of grazing cattle (Lockyer, 1997) and feedlot confined cattle (Harper et al., 1999, Flesch et al., 2007). Methane emissions have been predicted as being greatest during bouts of rumination (Harper et al., 1999) whereas the emissions of the indirect greenhouse gas ammonia tends to be low early in the morning but increasing rapidly in the early afternoon after which a rapid decline until sunset (Flesch et al., 2007). With the exception of Harper et al., (1999) there are few complete data sets that examine the interaction between animal behaviour and greenhouse gas emissions from intensive animal production systems. The current study aimed to investigate the relationship between animal behaviour and emissions of CH4 and NH3 in a beef feedlot system in northern Australia.
Feedlot management systems for beef cattle are becoming a more common practice in Australia reflecting opportunities to ensure quality of product whilst maintaining cost efficiencies within production. However, feedlot systems have been identified as point sources of greenhouse gases emissions (GGE: methane, nitrous oxide and the indirect greenhouse gas ammonia). It has been estimated that feedlot systems contribute 3.5% of total direct methane emissions (Alford et al. 2006), and 30% of total emissions from livestock wastes. Furthermore, approximately 1% of total N2O emissions from agriculture are attributed to livestock. This paper reports methane, N2O and NH3 emissions from an Australian feedlot system managed under summer climatic conditions. It compares actual measured emissions with estimated from three recognised models used by national governments to estimate total GGE per annum from livestock agriculture.
Experiments were conducted in glasshouses at the Agronomy Department, International Rice Research Institute (IRRI), Philippines, in 1987 and 1988 to test the effects of small amounts of additional N applied at different times during the vegetative and reproductive phases of growth on rice yield components and on spikelet differentiation and survival.
The results showed that an additional 10 kg/ha of N fertilizer had the largest effect on maximum spikelet number when applied at growth stage (GS) 1·9 but was too low to sustain the survival of the differentiated spikelets. Applications after panicle initiation did not lead to an increased survival of spikelets. Foliar N application at GS 5·5 did increase spikelet survival.
The results confirm the role of limited N supply in restricting yields of rice. Altering the timing of N inputs seems unlikely to improve spikelet survival.
Experiments were conducted in glasshouses at IRRI, Philippines, during 1987 and 1988 to identify varietal differences in apical development using six rice cultivars having extreme characters; Jirasar 280 (early senescence), Neo-Dunghan 1 (late senescence), Macunting (small seeds), ABB (large seeds), C12474–1 (long culm), and B581–A6–458 (short culm); and five cultivars, IR20, IR22, IR34, IR54, IR64, of the same growth duration.
The length of time from physiological panicle initiation (PI) to flowering varied from 25 to 50 days. The onset of physiological PI occurred when the fourth penultimate leaf was fully exserted. The visual panicle initiation stage (VPI) coincided with spikelet differentiation in all cultivars. Nitrogen top-dressing at 55–57 days before the anticipated maturity date (the present N management recommendation) did not coincide with the actual panicle initiation stage in any of the cultivars and the major yield determinants (i.e. the primary and secondary branches) therefore differentiated in conditions of internal nitrogen shortage. Spikelet abortion took place both before and after flowering. Reduction of pre-flowering abortion is important in increasing rice grain yields and could be achieved by improved N management. It is important to recognise cultivar differences and periods of loss of potential yield in developing efficient N management protocols.
SPIRE, the Spectral and Photometric Imaging Receiver, is Herschel's submillimetre camera and spectrometer. It comprises a three-band imaging photometer operating at 250, 350 and 500 μm, and an imaging Fourier Transform Spectrometer (FTS) covering194–672 μm. The design of SPIRE is described, and the expected scientific performance is summarised, based on modelling and flight instrument test results.
We present three new methods for determining the age of groups of pre-main-sequence stars. The first, creating empirical isochrones allows us to create a robust age ordering, but not to derive actual ages. The second, using the width of the gap in colour-magnitude space between the pre-main-sequence and main-sequence (the radiative convective gap) has promise as a distance and extinction independent measure of age, but is as yet uncalibrated. Finally we discuss τ2 fitting of the main sequence as the stars approach the terminus of the main sequence. This method suggests that there is a factor two difference between these “nuclear” ages, and more conventional pre-main-sequence contraction ages.
When differences are observed between genotypes in their response to low temperatures at germination, it has been generally assumed these are purely genetic. Laboratory experiments were carried out to evaluate the effects of physiological age on the temperature responses of 13 rice genotypes from Bangladesh in order to clarify whether (a) differences in seed germination at low temperature represented genetic differences or differences in the physiological state of the particular seed lot used and (b) whether genotype performance at higher temperatures was indicative of performance at lower temperatures. A higher initial seed moisture content (mc) was associated with lower initial viability (Ki). The base temperature for germination differed by less than 1 °C between genotypes. Seeds remaining ungerminated at low temperatures usually germinated when transferred to 21 °C. The thermal time requirement to reach t50 (θ) differed widely between genotypes. Lower optimum temperatures for germination were associated with lower thermal time requirements. Ageing seeds for 24 hours at 24 % mc and 45 °C significantly reduced final germination on a thermal gradient table at all temperatures below 20.8 °C in genotype BR29 but only below 16.5 °C in BR11. The rates of germination (seeds d−1) of aged seeds were also lower at all temperatures. Germination of high quality seeds of four genotypes were compared at 21 °C and 11 °C both before and after ageing (at 24 % mc and 45 °C). Ageing consistently reduced the rates of germination at both 21 °C and 11 °C. Increased ageing time progressively reduced the rate of germination of all seed lots at both temperatures. The rates of germination at 11 °C and 21 °C were positively and significantly (p < 0.01) related to final germination at the lower temperature of 11 °C. These results demonstrate that seed physiological quality as well as genotype might influence the final germination and rate of germination of rice genotypes at low temperatures. This information will be useful for breeders involved in selection of lines suitable for growing in cooler seasons.
Free radicals and reactive species produced in vivo can trigger cell damage and DNA modifications resulting in carcinogenesis. Dietary antioxidants trap these species limiting their damage. The present study evaluated the role of vitamins C and E in the prevention of potentially premalignant modifications to DNA in the human stomach by supplementing patients who, because of hypochlorhydria and possible depletion of gastric antioxidants, could be at increased risk of gastric cancer. Patients undergoing surveillance for Barrett's oesophagus (n 100), on long-term proton pump inhibitors were randomized into two groups: vitamin C (500 mg twice/d) and vitamin E (100 mg twice/d) for 12 weeks (the supplemented group) or placebo. Those attending for subsequent endoscopy had gastric juice, plasma and mucosal measurements of vitamin levels and markers of DNA damage. Seventy-two patients completed the study. Plasma ascorbic acid, total vitamin C and vitamin E were elevated in the supplemented group consistent with compliance. Gastric juice ascorbic acid and total vitamin C levels were raised significantly in the supplemented group (P=0·01) but supplementation had no effect on the mucosal level of this vitamin. However, gastric juice ascorbic acid and total vitamin C were within normal ranges in the unsupplemented group. Mucosal malondialdehyde, chemiluminescence and DNA damage levels in the comet assay were unaffected by vitamin supplementation. In conclusion, supplementation does not affect DNA damage in this group of patients. This is probably because long-term inhibition of the gastric proton pump alone does not affect gastric juice ascorbate and therefore does not increase the theoretical risk of gastric cancer because of antioxidant depletion.