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Cryptosporidium parvum is a well-established cause of gastrointestinal illness in both humans and animals and often causes outbreaks at animal contact events, despite the availability of a code of practice that provides guidance on the safe management of these events. We describe a large C. parvum outbreak following a lamb-feeding event at a commercial farm in Wales in 2024, alongside findings from a cohort study to identify high-risk exposures. Sixty-seven cases were identified, 57 were laboratory-confirmed C. parvum, with similar genotypes. Environmental investigations found a lack of adherence to established guidance. The cohort study identified 168 individuals with cryptosporidiosis-like illness from 540 exposure questionnaires (distributed via email to 790 lead bookers). Cases were more likely to have had closer contact with lambs (odds ratio (OR) kissed lambs = 2.4, 95% confidence interval (95% CI): 1.2–4.8). A multivariable analysis found cases were more likely to be under 10 years (adjusted OR (aOR) = 4.5, 95% CI: 2.0–10.0) and have had visible faeces on their person (aOR = 3.6, 95% CI: 2.1–6.2). We provide evidence that close contact at lamb-feeding events presents an increased likelihood of illness, suggesting that farms should limit animal contact at these events and that revisions to established codes of practice may be necessary. Enhancing risk awareness among farmers and visitors is needed, particularly regarding children.
Recent changes to US research funding are having far-reaching consequences that imperil the integrity of science and the provision of care to vulnerable populations. Resisting these changes, the BJPsych Portfolio reaffirms its commitment to publishing mental science and advancing psychiatric knowledge that improves the mental health of one and all.
We study the late-time evolution of the compact Type IIb SN 2001ig in the spiral galaxy NGC 7424, with new and unpublished archival data from the Australia Telescope Compact Array and the Australian Square Kilometre Array Pathfinder. More than two decades after the SN explosion, its radio luminosity is showing a substantial re-brightening: it is now two orders of magnitude brighter than expected from the standard model of a shock expanding into a uniform circumstellar wind (i.e. with a density scaling as $R^{-2}$). This suggests that the SN ejecta have reached a denser shell, perhaps compressed by the fast wind of the Wolf–Rayet progenitor or expelled centuries before the final stellar collapse. We model the system parameters (circumstellar density profile, shock velocity, and mass loss rate), finding that the denser layer was encountered when the shock reached a distance of $\approx 0.1$ pc; the mass-loss rate of the progenitor immediately before the explosion was $\dot{M}/v_{w} \sim 10^{-7} {\rm M}_\odot {\mathrm {~yr}}^{-1} {\mathrm {km}}^{-1} {\mathrm {s}}$. We compare SN 2001ig with other SNe that have shown late-time re-brightenings, and highlight the opposite behaviour of some extended Type IIb SNe which show instead a late-time flux cut-off.
The nature and extent of interactions between the distant regions and cultures of Mesoamerica remain open to much debate. Close economic and political ties developed between Teotihuacan and the lowland Maya during the Early Classic period (AD 250–550), yet the relationship between these cultures continues to perplex scholars. This article presents an elaborately painted altar from an elite residential group at the lowland Maya centre of Tikal, Guatemala. Dating to the fifth century AD, the altar is unique in its display of Teotihuacan architectural and artistic forms, adding to evidence not only for cultural influence during this period, but also for an active Teotihuacan presence at Tikal.
The Bali myna Leucopsar rothschildi has long suffered heavy trapping, leading to its near extinction in the wild and categorization as Critically Endangered on the IUCN Red List. Decades of conservation breeding, release of birds and post-release management at Bali Barat National Park have, until recently, failed to secure a viable wild population. However, over the past decade, population increases, expansion into new areas of the National Park and beyond, and successful breeding in both artificial and natural nest sites have occurred. These recent successes are associated with a change in approach by the National Park authority from concentrating efforts on the last refugium of the species (an area protected from trapping but with potentially suboptimal habitat) and towards the human-dominated landscapes around the main road through the National Park. Bali mynas tended to favour areas with extensive shorter grass cover and open canopies and to shun denser woodland. Anthropogenic landscapes such as farmland and plantations presumably mimic the original savannah habitat of the species, but nestbox provision has probably been crucial in these areas in the absence of natural cavities. A potential further factor in the increases in myna numbers and range has been a scheme involving local people in commercial breeding of the species, thereby reducing its market price, and working with communities to reduce trapping pressure. We encourage continuing operation of this management strategy inside the National Park and its further extension into adjacent tourist areas, which appear to have myna-friendly socio-ecological conditions.
Often to the detriment of human decision making, people are prone to an impact bias when making affective forecasts, overestimating the emotional consequences of future events. The cognitive processes underlying the impact bias, and methods for correcting it, have been debated and warrant further exploration. In the present investigation, we examined both individual differences and contextual variables associated with cognitive processing in affective forecasting for an election. Results showed that the perceived importance of the event and working memory capacity were both associated with an increased impact bias for some participants, whereas retrieval interference had no relationship with bias. Additionally, an experimental manipulation effectively reduced biased forecasts, particularly among participants who were most distracted thinking about peripheral life events. These findings have theoretical implications for understanding the impact bias, highlight the importance of individual differences in affective forecasting, and have ramifications for future decision making research. The possible functional role of the impact bias is discussed within the context of evolutionary psychology.
The Royal College Comprehensive Objective Examination in Neurology provides certification for Canadian neurologists and consists of a written examination and the Observed Structured Clinical Encounter (OSCE). The OSCE portion of the certification involves residents visiting several patient stations where they address case scenarios with an examiner. Unfortunately, residents lack exam preparation time due to demanding work hours. In response to resident needs, we created a novel, virtual preparation OSCE program – “prepOSCE” – and evaluated its efficacy. The prepOSCE program employed a proprietary virtual solution from CTC Communications Corp. Ten virtual sessions accommodated 70 residents totally. Seven Canadian physicians and two co-chairs created case scenarios for the stations. On session day, seven residents arrived in a virtual plenary room for briefing followed by assignment to a station by CTC. Residents then moved virtually through prepOSCE stations a different examiner and case scenario in each. Following their session, residents and evaluators were surveyed to capture experiences. The average program rating was 4.22 out of 5 (n = 36 residents of 70 residents who participated in the program) and 4.35 (n = 17 evaluators). Ninety-two percent of residents agreed or strongly agreed that they would recommend this program to their peers; they would like prepOSCE to continue next year; and the program was relevant and added value to their studies. The positive feedback received from prepOSCE participants indicates there is a need for a program like prepOSCE. This model has potential for expansion and it is hoped that specialties outside of neurology could benefit from a similar program.
Background: The estimated economic cost of Clostridioides difficile infection (CDI) is $5.4 billion annually, primarily attributed to acute-care costs. We previously reported data from ECOSPOR III that SER-109, an investigational oral microbiome therapeutic, was superior to placebo in reducing recurrent CDI (rCDI) in adults at 8 weeks after treatment, with a 68% relative risk reduction. Adults with rCDI have more hospitalizations and emergency room (ER) visits (defined herein as healthcare resource utilization, HRU) compared to those without recurrence. Thus, we evaluated incidence of HRU. Methods: Adults with rCDI (≥3 episodes in 12 months) were screened at 56 US and Canadian sites and were randomized 1:1 to SER-109 (4 capsules × 3 days) or placebo following resolution of CDI with standard-of-care CDI antibiotics. The primary end point was rCDI at 8 weeks. Exploratory end points included cumulative incidence of hospitalizations through 24 weeks after treatment. Here, we report cumulative incidence of all-cause HRU through 8 weeks after treatment. Results: In total, 281 patients were screened and 182 were randomized (59.9% female; mean age 65.5 years; 98.9% outpatient). Overall, 31 patients (17%) had 38 hospitalizations or ER visits through week 8 (11 events in 10 SER-109 patients and 27 events in 21 placebo patients) (Table 1). The cumulative incidence of HRU was lower in SER-109–treated patients compared to placebo at both weeks 4 and 8 with most events (65.8%) recorded within 4 weeks after treatment. The adjusted HRU incidence rate (by person time, age, sex, and antibiotic use) was also lower in SER-109–treated patients compared to placebo at weeks 4 and 8 (0.256 [95% CI, 0.096–0.683] versus 0.417 [95% CI, 0.199–0.873], respectively). Conclusions: SER-109–treated patients had less HRU compared to placebo patients through 8 weeks after treatment in this mostly outpatient population. These data suggest a potential benefit of SER-109 in reducing HRU, thus lowering the healthcare burden of rCDI.
Acellular cementum anchors the root to the alveolar socket via the periodontal ligament and grows in layers continuously throughout life, unlike enamel and dentin. Increments are deposited in a biannual light-dark pattern correlated to age and season at death in transmitted light microscopy. This study investigates the still debated structure of individual acellular increments using x-ray fluorescence and x-ray diffraction mapping with synchrotron radiation microbeams on reindeer, red deer, cattle, and human samples. Results show that Ca or Zn x-ray fluorescent intensities and cAp diffracted intensity reveal cementum band structure. Average crystallographic texture (of cAp nanoplatelets’ orientation and collagen fibril orientations) is constant for each specimen. Microtextural variation is also present across individual bands, demonstrating that the overall collagen fibril orientation undergoes subtle changes with season. Patterns of “feast or famine” and concomitant changes in amount and intensity of PDL loading might produce altered collagen (and cAp) orientations between the “good” and the “bad” seasons for ungulates but maybe not for modern human populations.
Internal gravity wave fields are decomposed into temporal modes revealing the hierarchical structure of nonlinear wave–wave interactions. We present a novel fusion of Green's functions for solving the forced internal wave equation with a weakly nonlinear perturbation expansion. Our approach is semi-analytical, based on integration over finite elements with the perturbation expansion ensuring source terms at each order are only dependent on the solutions at lower orders. Thus, the procedure is purely inductive and efficient to compute. To perform a thorough validation of our new method, we diagnose experiments using synthetic Schlieren and apply sophisticated post-processing techniques, including dynamic mode decomposition, to obtain these temporal modes for systems with discrete input frequencies. By decomposing the experimental field and comparing individual constituents against equivalents synthesised by our model, we are able to present the first truly comprehensive, validated, mechanistic picture of wave–wave interactions to arbitrary order. This synergy enables us to identify non-wave oscillatory behaviour at frequencies shared by waves in the hierarchy and leads us to discover an important open question regarding transmission efficiency within individual wave–wave interactions. Although our experiments are generated by boundary displacements, we present equivalences between source terms and boundary displacements so that the class of applicable systems may be broadened. Our technique also generalises to aperiodic and unbounded configurations and to any weakly nonlinear wave-governed system for which there is an available Green's function.
Two introduced carnivores, the European red fox Vulpes vulpes and domestic cat Felis catus, have had extensive impacts on Australian biodiversity. In this study, we collate information on consumption of Australian birds by the fox, paralleling a recent study reporting on birds consumed by cats. We found records of consumption by foxes on 128 native bird species (18% of the non-vagrant bird fauna and 25% of those species within the fox’s range), a smaller tally than for cats (343 species, including 297 within the fox’s Australian range, a subset of that of the cat). Most (81%) bird species eaten by foxes are also eaten by cats, suggesting that predation impacts are compounded. As with consumption by cats, birds that nest or forage on the ground are most likely to be consumed by foxes. However, there is also some partitioning, with records of consumption by foxes but not cats for 25 bird species, indicating that impacts of the two predators may also be complementary. Bird species ≥3.4 kg were more likely to be eaten by foxes, and those <3.4 kg by cats. Our compilation provides an inventory and describes characteristics of Australian bird species known to be consumed by foxes, but we acknowledge that records of predation do not imply population-level impacts. Nonetheless, there is sufficient information from other studies to demonstrate that fox predation has significant impacts on the population viability of some Australian birds, especially larger birds, and those that nest or forage on the ground.
Diagnoses of personality disorder are prevalent among people using community secondary mental health services. Identifying cost-effective community-based interventions is important when working with finite resources.
Aims
To assess the cost-effectiveness of primary or secondary care community-based interventions for people with complex emotional needs who meet criteria for a diagnosis of personality disorder to inform healthcare policy-making.
Method
Systematic review (PROSPERO: CRD42020134068) of databases. We included economic evaluations of interventions for adults with complex emotional needs associated with a diagnosis of personality disorder in community mental health settings published before 18 September 2019. Study quality was assessed using the CHEERS statement.
Results
Eighteen studies were included. The studies mainly evaluated psychotherapeutic interventions. Studies were also identified that evaluated altering the setting in which care was delivered and joint crisis plans. No strong economic evidence to support a single intervention or model of community-based care was identified.
Conclusions
Robust economic evidence to support a single intervention or model of community-based care for people with complex emotional needs is lacking. The strongest evidence was for dialectical behaviour therapy, with all three identified studies indicating that it is likely to be cost-effective in community settings compared with treatment as usual. More robust evidence is required on the cost-effectiveness of community-based interventions on which decision makers can confidently base guidelines or allocate resources. The evidence should be based on consistent measures of costs and outcomes with sufficient sample sizes to demonstrate impacts on these.
Lidar reveals the presence of a precinct at the Classic Maya city of Tikal that probably reproduces the Ciudadela and Temple of the Feathered Serpent at the imperial capital of Teotihuacan.
Overview of needs assessment and application to forensic mental health service users; summary of key research using the CANFOR scales; consideration of broader fit with issues of risk and recovery.