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Individuals with single ventricle physiology who are palliated with superior cavopulmonary anastomosis (Glenn surgery) may develop pulmonary arteriovenous malformations. The traditional tools for pulmonary arteriovenous malformation diagnosis are often of limited diagnostic utility in this patient population. We sought to measure the pulmonary capillary transit time to determine its value as a tool to identify pulmonary arteriovenous malformations in patients with single ventricle physiology.
Methods:
We defined the angiographic pulmonary capillary transit time as the number of cardiac cycles required for transit of contrast from the distal pulmonary arteries to the pulmonary veins. Patients were retrospectively recruited from a single quaternary North American paediatric centre, and angiographic and clinical data were reviewed. Pulmonary capillary transit time was calculated in 20 control patients and compared to 20 single ventricle patients at the pre-Glenn, Glenn, and Fontan surgical stages (which were compared with a linear-mixed model). Correlation (Pearson) between pulmonary capillary transit time and haemodynamic and injection parameters was assessed using angiograms from 84 Glenn patients. Five independent observers calculated pulmonary capillary transit time to measure reproducibility (intraclass correlation coefficient).
Results:
Mean pulmonary capillary transit time was 3.3 cardiac cycles in the control population, and 3.5, 2.4, and 3.5 in the pre-Glenn, Glenn, and Fontan stages, respectively. Pulmonary capillary transit time in the Glenn population did not correlate with injection conditions. Intraclass correlation coefficient was 0.87.
Conclusions:
Pulmonary angiography can be used to calculate the pulmonary capillary transit time, which is reproducible between observers. Pulmonary capillary transit time accelerates in the Glenn stage, correlating with absence of direct hepatopulmonary venous flow.
Case studies have linked SARS-CoV-2 infection to suicidal behaviour. However, conclusive evidence is lacking.
Aims
To examine whether a history of SARS-CoV-2 infection or SARS-CoV-2-related hospital admission was associated with self-harm in the general population and in high-risk groups.
Method
A cohort design was applied to nationwide data on all people aged ≥15 years and living in Denmark between 27 February 2020 and 15 October 2021. Exposure was identified as having had a positive SARS-CoV-2 PCR test, and further assessed as SARS-CoV-2-related hospital admission. Rates of probable self-harm were examined using adjusted incidence rate ratios (aIRRs). The following subgroups were identified: (a) lower educational level, (b) chronic medical conditions, (c) disability pension, (d) mental disorders, (e) substance use disorders, and history of (f) homelessness and (g) imprisonment.
Results
Among 4 412 248 included individuals, 260 663 (5.9%) had tested positive for SARS-CoV-2. Out of 5453 individuals presenting with self-harm, 131 (2.4%) had been infected. Individuals with a history of a positive SARS-CoV-2 test result had an aIRR for self-harm of 0.86 (95% CI 0.72–1.03) compared with those without. High rates were found after a SARS-CoV-2-related hospital admission (aIRR = 7.68; 95% CI 5.61–10.51) or a non-SARS-CoV-2-related admission (aIRR = 10.27; 95% CI 9.65–10.93) versus non-infected and not admitted. In sensitivity analyses with a more restrictive definition of self-harm, a positive PCR test was associated with lower rates of self-harm.
Conclusions
Individuals with a PCR-confirmed SARS-CoV-2 infection did not have higher rates of self-harm than those without. Hospital admission in general, rather than being SARS-CoV-2 positive. seemed to be linked to elevated rates of self-harm.
Childbirth may be a traumatic experience and vulnerability to posttraumatic stress disorder (PTSD) may increase the risk of postpartum depression (PPD). We investigated whether genetic vulnerability to PTSD as measured by polygenic score (PGS) increases the risk of PPD and whether a predisposition to PTSD in PPD cases exceeds that of major depressive disorder (MDD) outside the postpartum period.
Methods
This case-control study included participants from the iPSYCH2015, a case-cohort of all singletons born in Denmark between 1981 and 2008. Restricting to women born between 1981 and 1997 and excluding women with a first diagnosis other than depression (N = 22 613), 333 were identified with PPD. For each PPD case, 999 representing the background population and 993 with MDD outside the postpartum were matched by calendar year at birth, cohort selection, and age. PTSD PGS was calculated from summary statistics from the Psychiatric Genomics Consortium with LDpred2-auto. Odds ratios (ORs) were estimated using conditional logistic regression adjusted for parental psychiatric history and country of origin, PGS for MDD and age at first birth, and the first 10 principal components.
Results
The PTSD PGS was significantly associated with PPD (OR 1.42, 95% CI 1.20–1.68 per standard deviation increase in PTSD PGS) compared to healthy female controls. Genetic PTSD vulnerability in PPD cases did not exceed that of matched female depression cases outside the postpartum period (OR 1.10, 95% CI 0.94–1.30 per standard deviation increase).
Conclusions
Genetic vulnerability to PTSD increased the risk of PPD but did not differ between PPD cases and women with depression at other times.
To understand healthcare providers’ experiences with video recording of patient consultations.
Background:
Video recordings have been recognised to be an effective method to evaluate in situ interactions in clinical practice. The video recordings are often conducted by researchers, but active involvement of healthcare providers into the process of recording is evolving. Still, little is known of how video recordings by healthcare providers may influence daily clinical practice and potentials for direct use to guide practice development.
Methods:
A qualitative design was used, conducting two focus group interviews including 12 healthcare providers representing eight different healthcare services who provide municipal cardiac rehabilitation. Interpretive description was used as the methodological framework, and symbolic interactionism served as the theoretical lens.
Findings:
Three themes were identified reflecting healthcare providers’ experiences with video recording of patient consultations: ‘Concerns of compromising primary work tasks’, ‘Exposing professional and personal skills’ and ‘A new learning dimension’. Overall, the three themes represent the process of video recording own practices attached to patient consultations and the personal investment attached to the video data. Also, how the recordings may provide new insights for practice development in terms of individual and team-based performance in patient consultations.
Conclusion:
Video recordings by healthcaref providers may be a useful source to provide information and learning about patient consultation practice to use in research and supervision, keeping in mind their challenges of implementation into daily clinical practice.
The association between suicide attempts (SAs) in parents and children is unclear, and risk indicators for intergenerational transmission remain undocumented. We aimed to assess this association, considering the child's developmental period at the time of parents' attempted suicide, and the parental relation.
Methods
Using a prospective cohort design, nationwide population data were linked to the Psychiatric Central Register and National Patient Register for all individuals aged 10 years or older living in Denmark between 1980 and 2016. We assessed incidence rate ratios (IRRs) and cumulative hazards for children's first SA.
Results
In a cohort of 4 419 651 children, 163 056 (3.7%) had experienced a parental SA. An SA was recorded among 6996 (4.3%) of the exposed children as opposed to 70112 (1.6%) in unexposed individuals. Higher rates were noted when a parental SA occurred during early childhood (0 ⩽ age < 2) [IRR, 4.7; 95% confidence interval (CI) 4.2–5.4] v. late childhood (6 ⩽ age < 13) (IRR, 3.6; 95% CI 3.4–3.8) when compared to those unexposed. Children exposed prior to age 2 had the highest rates of all sub-groups when reaching age 13–17 (IRR, 6.5; 95% CI 6.0–7.1) and 18–25 years (IRR, 6.8; 95% CI 6.2–7.4). Maternal SA (IRR, 3.4; 95% CI 3.2–3.5) was associated with higher rates than paternal (IRR, 2.8; 95% CI 2.7–2.9).
Conclusion
Parental SA was associated with children's own SA. Exposure during early developmental stages was associated with the highest rates. Early preventive efforts are warranted as is monitoring of suicide risk in the children from age 13.
Antipsychotics are associated with a polymorphic ventricular tachycardia, torsades de pointes, which, in the worst case, can lead to sudden cardiac death. The QT interval corrected for heart rate (QTc) is used as a clinical proxy for torsades de pointes. The QTc interval can be prolonged by antipsychotic monotherapy, but it is unknown if the QTc interval is prolonged further with antipsychotic polypharmaceutical treatment. Therefore, this study investigated the associations between QTc interval and antipsychotic monotherapy and antipsychotic polypharmaceutical treatment in schizophrenia, and measured the frequency of QTc prolongation among patients.
Methods
We carried out an observational cohort study of unselected patients with schizophrenia visiting outpatient facilities in the region of Central Jutland, Denmark. Patients were enrolled from January of 2013 to June of 2015, with follow-up until June of 2015. Data were collected from clinical interviews and clinical case records.
Results
Electrocardiograms were available for 65 patients, and 6% had QTc prolongation. We observed no difference in average QTc interval for the whole sample of patients receiving no antipsychotics, antipsychotic monotherapy, or antipsychotic polypharmaceutical treatment (p=0.29). However, women presented with a longer QTc interval when receiving polypharmacy than when receiving monotherapy (p=0.01). A limitation of this study was its small sample size.
Conclusions
We recommend an increased focus on monitoring the QTc interval in women with schizophrenia receiving antipsychotics as polypharmacy.
Lake Pend Oreille is the largest (36,000 ha or 91,000 ac) freshwater lake in Idaho. Approximately 27% or 10,000 ha of the lake is littoral zone habitat supporting aquatic macrophyte growth. Eurasian watermilfoil has invaded large areas of this littoral zone habitat, with early estimates suggesting approximately 2,000 ha by the mid 2000s. Idaho State Department of Agriculture developed a state-wide eradication program in response to the threats posed by Eurasian watermilfoil, which attempts to quantify Eurasian watermilfoil infestations and its effects on the native plant community. Littoral zone point intercept surveys were conducted in 2007 and 2008 to monitor the trends in aquatic macrophyte community structure and assess management strategies against Eurasian watermilfoil. Lake Pend Oreille has a species-rich aquatic macrophyte community of more than 50 species. Lake-wide, the presence of Eurasian watermilfoil significantly decreased from 2007 (12.5%) to 2008 (7.9%). The native plant community has remained stable from 2007 to 2008 despite lake-wide management activities. In managed areas, the frequency of Eurasian watermilfoil during the 2008 assessment was 23.6% after herbicide applications. This represents a 63% reduction in Eurasian watermilfoil presence from the 2007 (64.5%) survey. When 2,4-D was combined with endothall, the presence of Eurasian watermilfoil declined from 63% (2007) to 36.5% in 2008. Eurasian watermilfoil treated with triclopyr also declined significantly, 64% to 18.2%. When all treatment methods were pooled and compared with areas that were not treated, the presence of Eurasian watermilfoil was significantly greater (52.5%) in untreated areas as opposed to treated areas (23%). The removal of Eurasian watermilfoil resulted in an increase in native species in most areas. Currently, there is as little as 200 ha of Eurasian watermilfoil remaining, which represents an overall reduction of 90% in approximately 7 yr of management.
Physical inactivity and low birth weight (LBW) may lead to an increased risk for developing type 2 diabetes. The extent to which LBW individuals may benefit from physical exercise training when compared with those with normal birth weight (NBW) controls is uncertain. We assessed the impact of an outdoor exercise intervention on body composition, insulin secretion and action in young men born with LBW and NBW in rural India. A total of 61 LBW and 56 NBW healthy young men were recruited into the study. The individuals were instructed to perform outdoor bicycle exercise training for 45 min every day. Fasting blood samples, intravenous glucose tolerance tests and bioimpedance body composition assessment were carried out. Physical activity was measured using combined accelerometry and heart rate monitoring during the first and the last week of the intervention. Following the exercise intervention, the LBW group displayed an increase in physical fitness [55.0 ml (O2)/kg min (52.0−58.0)−57.5 ml (O2)/kg min (54.4−60.5)] level and total fat-free mass [10.9% (8.0−13.4)−11.4% (8.0−14.6)], as well as a corresponding decline in the ratio of total fat mass/fat-free mass. In contrast, an increase in total fat percentage as well as total fat mass was observed in the NBW group. After intervention, fasting plasma insulin levels, homoeostasis model assessments (HOMA) of insulin resistance (HOMA-IR) and insulin secretion (HOMA-IS), improved to the same extent in both the groups. In summary, young men born with LBW in rural India benefit metabolically from exercise training to an extent comparable with NBW controls.
Renewable energy can provide a host of benefits to society. In addition to the reduction of carbon dioxide (CO2) emissions, governments have enacted renewable energy (RE) policies to meet a number of objectives including the creation of local environmental and health benefits; facilitation of energy access, particularly for rural areas; advancement of energy security goals by diversifying the portfolio of energy technologies and resources; and improving social and economic development through potential employment opportunities. Energy access and social and economic development have been the primary drivers in developing countries whereas ensuring a secure energy supply and environmental concerns have been most important in developed countries.
An increasing number and variety of RE policies–motivated by a variety of factors–have driven substantial growth of RE technologies in recent years. Government policies have played a crucial role in accelerating the deployment of RE technologies. At the same time, not all RE policies have proven effective and efficient in rapidly or substantially increasing RE deployment. The focus of policies is broadening from a concentration almost entirely on RE electricity to include RE heating and cooling and transportation.
RE policies have promoted an increase in RE capacity installations by helping to overcome various barriers. Barriers specific to RE policymaking (e.g., a lack of information and awareness), to implementation (e.g., a lack of an educated and trained workforce to match developing RE technologies) and to financing (e.g., market failures) may further impede deployment of RE.
Young snakes are rarely seen in the field and little is known about their habits, mostly because they are too small for radio-telemetry (the primary method for studying snake spatial ecology). However, the offspring of some larger species can be fitted with transmitters and we investigated the spatial ecology and habitat use of ten hatchling water pythons (Liasis fuscus: Pythonidae) in the floodplain of the Adelaide River, tropical Australia. Patterns of habitat use in the late wet season and during the dry season were similar to those of adults tracked in the same vicinity in an earlier study. Soon after release the young snakes moved to the floodplain, avoiding pasture areas. Diurnal refuge sites were typically in the base of grass clumps or below the soil surface, especially in sites with thick vegetation and deep, wide soil cracks. Adult snakes are more sedentary but move longer absolute distances (mean ± SE = 252 ± 50 m wk−1) than hatchlings (66.3 ± 41 m wk−1). However, hatchling snakes moved longer distances relative to body size (84.4 ± 1.1 body lengths wk−1) than did the previously studied adults (66.0 ± 1.1 body lengths wk−1). Mean and minimum body temperatures of the hatchlings were correlated with mean and minimum air temperatures, respectively.
This paper presents a large-scale cross-sectional study of Danish children's early language acquisition based on the Danish adaptation of the MacArthur-Bates Communicative Development Inventories (CDI). Measures of validity and reliability imply that the Danish adaptation of the American CDI has been adjusted linguistically and culturally in appropriate ways which makes it suitable for tapping into Danish children's language acquisition. The study includes 6,112 randomly selected children in the age of 0 ; 8 to 3 ; 0, and results related to the development of early gestures, comprehension and production of words as well as grammatical skills, are presented.
The main objective of this paper is to describe the trajectory of Danish children's early lexical development relative to other languages, by comparing a Danish study based on the Danish adaptation of The MacArthur-Bates Communicative Development Inventories (CDI) to 17 comparable CDI-studies. The second objective is to address the feasibility of cross-linguistic CDI-comparisons. The main finding is that the developmental trend of Danish children's early lexical development is similar to trends observed in other languages, yet the vocabulary comprehension score in the Danish children is the lowest across studies from age 1 ; 0 onwards. We hypothesize that the delay is related to the nature of Danish sound structure, which presents Danish children with a harder task of segmentation. We conclude that CDI-studies are an important resource for cross-language studies, but reporting of studies needs to be standardized and the availability of published data improved in order to make comparisons more straightforward.
Social integration and independence is the ultimate goal of habilitation and social support for patients with cerebral palsy (CP). Having a partner and having children provide support for social integration of adults with or without a disability. We studied 416 participants with CP born between 1965 and 1970 (243 males, 173 females; mean age 32y 2mo [SD 2y]; age range 29–35y) and compared them with 2247 age-matched comparison individuals. Diagnostic subtypes of the 416 participants were: 31% hemiplegia, 49% diplegia, 11% tetraplegia, and 9% other types. The level of motor impairment, estimated in childhood, with regard to walking ability was 65% able to walk without assistance, 22% with assistance, and 12% not able to walk (for 1% of the participants their walking ability was not known). We found no sign of increased social integration over the past two or three decades in Denmark. Sixty-eight per cent lived independently, 13% lived with their parents, and 16% lived at an accommodation facility arranged by the county (institution). Twenty-eight per cent of the participants were cohabiting and 19% had children. The presence of epilepsy and the severity of physical or cognitive impairment as assessed in childhood predicted independent living and physical and cognitive impairment predicted cohabitation, but parents' socioeconomic position and region of living did not. Fifty-five percent of the participants, compared with 4% of the comparison group, had no competitive employment, cohabiting partner, or biological children. The remaining participants had at least one of these types of social contact, but this more optimally socially integrated half of the participants only combined all three types of social contact half as often as the comparison group. This could be due to cognitive difficulties or premature ageing.
The extent, sequence, synchrony and correlates of diel displacements by animals can provide powerful insights into the ecological and social factors that shape an organism's day-to-day activities, but detailed data on spatial ecology are available for very few tropical taxa. Radiotelemetric monitoring of 25 slatey-grey snakes (Stegonotus cucullatus) on a floodplain in the Australian wet-dry tropics for periods of 40 to 355 d (mean=195 d, 136 locations per snake) provided extensive information on habitat use, movement patterns and home range size of these large slender-bodied colubrids. All radio-tracked animals were nocturnal, sheltering by day in soil cracks and beneath tree roots and debris. Snakes did not appear to move between 61% of successive locations and timing of movements was not synchronized among snakes. Most displacements were small (<50m), with males moving further and more often than did females. However, nesting females made occasional long-distance movements, travelling 100–400m to forested areas to oviposit but then returning to their usual home ranges. Snakes of both sexes moved further and more often during the wet-season than the dry-season. Snakes typically moved on a few successive nights then remained sedentary for the next few days, apparently reflecting cessation of activity as soon as a meal was obtained. Home ranges were small (2.9–7.4 ha) and most snakes remained in the same area throughout the year, providing a strong contrast in this respect to the large and seasonally dynamic home ranges of sympatric acrochordid and pythonid snakes.
In the Australian wet–dry tropics, temperatures are high year-round but rainfall is concentrated in a 4-mo wet season. Regular nightly surveys in the Fogg Dam Nature Reserve provided data on temporal (monthly, seasonal) variation in biological attributes of three snake species: water pythons (Liasis fuscus, Pythonidae), keelbacks (Tropidonophis mairii, Colubridae) and slatey-grey snakes (Stegonotus cucullatus, Colubridae). Adults of all three taxa were encountered more frequently during the dry season than the wet season, whereas juveniles were more commonly encountered in the wet season. The sex ratio among adult snakes also shifted seasonally, but in different ways in different species. These sex-ratio shifts probably reflect reproductive activity (mate-searching by males, oviposition migrations by females) and were accompanied by increased encounter rates. Feeding rates and body condition of keelbacks (a frog specialist) were highest during the wet season when frogs were most abundant. Rats migrated away from Fogg Dam during the wet season, and most pythons (rat specialists) left this area to follow their prey. The pythons that remained at Fogg Dam exhibited low feeding rates and poor body condition. Slatey-grey snakes (a generalist predator) showed less seasonal variation in feeding rates or body condition. Our data show that tropical seasonality induces strong fluctuations in many attributes of snake populations, and that patterns of response differ both among and within species.
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