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Our aim was to estimate associations of adolescent dietary patterns and meal habits with hypertensive disorders of pregnancy (HDP) and preterm birth. We used data from a prospective cohort study (Norwegian Young-HUNT1) where dietary information was collected during adolescence and pregnancy outcomes were obtained through record linkage to the Norwegian national birth registry. The outcomes were HDP, hypertension, pre-eclampsia/eclampsia, and preterm birth in the first pregnancy and in any pregnancy. Diet was self-reported from validated questionnaires, and exposures were dietary indexes (healthy; unhealthy; fruit and vegetable; fibre index) and meal habits. Recruitment took place in schools. Eligible participants were females aged 13–19 years at the time of dietary assessment with a subsequent singleton pregnancy (n 3622). Women who reported a higher fibre intake in adolescence had a lower risk of pre-eclampsia in the first pregnancy (Relative Risk: 0·84; 95 % CI 0·7, 1·0), although this was weaker in sensitivity analyses. Regular meal habits in mid-adolescence (aged 13–15 years), particularly breakfast and lunch, were weakly associated with a lower risk of hypertension in pregnancy. Our results are the first to indicate an association between aspects of diet and dietary behaviour in mid-adolescence and subsequent HDP. More evidence is needed from larger studies to replicate the results and from alternative study designs to disentangle causality.
Identifying thrombus formation in Fontan circulation has been highly variable, with reports between 17 and 33%. Initially, thrombus detection was mainly done through echocardiograms. Delayed-enhancement cardiac MRI is emerging as a more effective imaging technique for thrombus identification. This study aims to determine the prevalence of occult cardiac thrombosis in patients undergoing clinically indicated cardiac MRI.
Methods:
A retrospective chart review of children and adults in the Duke University Hospital Fontan registry who underwent delayed-enhancement cardiac MRI. Individuals were excluded if they never received a delayed-enhancement cardiac MRI or had insufficient data. Demographic characteristics, native heart anatomy, cardiac MRI measurements, and thromboembolic events were collected for all patients.
Results:
In total, 119 unique individuals met inclusion criteria with a total of 171 scans. The median age at Fontan procedure was 3 (interquartile range 1, 4) years. The majority of patients had dominant systemic right ventricle. Cardiac function was relatively unchanged from the first cardiac MRI to the third cardiac MRI. While 36.4% had a thrombotic event by history, only 0.5% (1 patient) had an intracardiac thrombus detected by delayed-enhancement cardiac MRI.
Conclusions:
Despite previous echocardiographic reports of high prevalence of occult thrombosis in patients with Fontan circulation, we found very low prevalence using delayed-enhancement cardiac MRI. As more individuals are reaching adulthood after requiring early Fontan procedures in childhood, further work is needed to develop thrombus-screening protocols as a part of anticoagulation management.
Distant glacial areas are interconnected by a complex system of fractures and water channels which run in the glacier interior and characterize the englacial realm. Water can slowly freeze in these channels where the slow freezing excludes air bubbles giving the ice a clear aspect. This ice is uplifted to the surface ablation zone by glacial movements and can therefore be observed in the form of clear surface ice bands. We employed an indirect method to sample englacial water by coring these ice bands. We were able, for the first time, to compare microbial communities sampled from clear (i.e. frozen englacial water bands) and cloudy ice (i.e. meteoric ice) through 16S rRNA gene sequencing. Although microbial communities were primarily shaped and structured by their spatial distribution on the glacier, ice type was a clear secondary factor. One area of the glacier, in particular, presented significant microbial community clear/cloudy ice differences. Although the clear ice and supraglacial communities showed typical cold-adapted glacial communities, the cloudy ice had a less defined glacial community and ubiquitous environmental organisms. These results highlight the role of englacial channels in the microbial dispersion within the glacier and, possibly, in the shaping of glacial microbial communities.
In the first sentence of his Harmonics Ptolemy offers a definition of the science to which his work is devoted, and – rather surprisingly – it contains nothing to indicate that Harmonics is concerned, specifically, with matters to do with music. On the contrary, the definition seems to say that it is concerned with sounds of all sorts, insofar as they differ from one another in pitch. We know, of course, that in fact the work does indeed focus almost exclusively on musical issues, but it turns out that Ptolemy does not narrow his perspective in a way that excludes further treatment of non-musical sounds until the closing stages of his fourth chapter. This chapter discusses the way in which he achieves the transition between the broader and narrower fields of investigation, while still holding fast to the definition from which he began.
Emerging evidence suggests that parents’ nutritional status before and at the time of conception influences the lifelong physical and mental health of their child. Yet little is known about the relationship between diet in adolescence and the health of the next generation at birth. This study examined data from Norwegian cohorts to assess the relationship between dietary patterns in adolescence and neonatal outcomes. Data from adolescents who participated in the Nord-Trøndelag Health Study (Young-HUNT) were merged with birth data for their offspring through the Medical Birth Registry of Norway. Young-HUNT1 collected data from 8980 adolescents between 1995 and 1997. Linear regression was used to assess associations between adolescents’ diet and later neonatal outcomes of their offspring adjusting for sociodemographic factors. Analyses were replicated with data from the Young-HUNT3 cohort (dietary data collected from 2006 to 2008) and combined with Young-HUNT1 for pooled analyses. In Young-HUNT1, there was evidence of associations between dietary choices, meal patterns, and neonatal outcomes, these were similar in the pooled analyses but were attenuated to the point of nonsignificance in the smaller Young-HUNT3 cohort. Overall, energy-dense food products were associated with a small detrimental impact on some neonatal outcomes, whereas healthier food choices appeared protective. Our study suggests that there are causal links between consumption of healthy and unhealthy food and meal patterns in adolescence with neonatal outcomes for offspring some years later. The effects seen are small and will require even larger studies with more state-of-the-art dietary assessment to estimate these robustly.
Anecdotal evidence suggests the use of bolus tube feeding is increasing in the long-term home enteral tube feed (HETF) patients. A cross-sectional survey to assess the prevalence of bolus tube feeding and to characterise these patients was undertaken. Dietitians from ten centres across the UK collected data on all adult HETF patients on the dietetic caseload receiving bolus tube feeding (n 604, 60 % male, age 58 years). Demographic data, reasons for tube and bolus feeding, tube and equipment types, feeding method and patients’ complete tube feeding regimens were recorded. Over a third of patients receiving HETF used bolus feeding (37 %). Patients were long-term tube fed (4·1 years tube feeding, 3·5 years bolus tube feeding), living at home (71 %) and sedentary (70 %). The majority were head and neck cancer patients (22 %) who were significantly more active (79 %) and lived at home (97 %), while those with cerebral palsy (12 %) were typically younger (age 31 years) but sedentary (94 %). Most patients used bolus feeding as their sole feeding method (46 %), because it was quick and easy to use, as a top-up to oral diet or to mimic mealtimes. Importantly, oral nutritional supplements (ONS) were used for bolus feeding in 85 % of patients, with 51 % of these being compact-style ONS (2·4 kcal (10·0 kJ)/ml, 125 ml). This survey shows that bolus tube feeding is common among UK HETF patients, is used by a wide variety of patient groups and can be adapted to meet the needs of a variety of patients, clinical conditions, nutritional requirements and lifestyles.
This chapter explores current research on how young people make judgements about the information they encounter. There will be a discussion on why some young people appear to trust, without question, online information whilst others show remarkable powers of insight and critique. Evidence on how this might affect their physical and mental well-being will be provided. Why this is important both in educational and political terms is discussed. There will then be an exploration of the approaches that can be employed to help young people develop a more discerning approach to engaging with the information they see, hear and read in any context.
The discussion put forward here is based upon a synthesis of research findings involving three groups of young people from the UK – 16–17-year-olds, at a secondary school, 18–19-year-old university students in their first undergraduate year and finally 18–24-year-old men recruited for an experiment, mostly undergraduates – all carried out in the UK. For the first two groups there was a concern voiced by teachers and academic tutors respectively that their students exhibited a noticeable lack of the necessary capabilities to make well-calibrated judgements in order to select good-quality information to support their work for assignments. The 16–17-year-olds were working towards gaining their Extended Project Qualification (EPQ)1 – a mini-dissertation in addition to their A-level study. Walton et al. (2018a) provide a comprehensive reflection of these studies. The 18–19-year-olds were working towards completing their first assignment and had to find good quality information about a sporting issue of their choice (see Walton and Hepworth, 2011; 2013 for a more detailed account). These two groups are quite similar in their context and we will see that their comments and experiences and our analyses align in an encouraging way. How? They both appear to indicate that most (but by no means all) students present with remarkably poor capabilities in making judgements about information, which prevent them from making the most suitable choices. The third group were recruited to find out whether the cognitive process of information discernment has a physiological component. Why? We wanted to find out whether being good at information discernment is related to positive responses to stress.
This paper presents a taxonomy of human wayfinding behaviours. For the purposes of this paper, wayfinding is purposeful navigating in everyday life, in man-made environments, traversing an environment or aiming for an objective with which the individual is unfamiliar. The taxonomy is developed through a review of wayfinding literature from research and practice, user studies conducted specifically for this research and a process of thinking by designing. This taxonomy can also be applied to navigating in documents printed on paper and on-screen, but this paper concentrates on behaviours in environmental space. This taxonomy creates twelve categories of behaviour differentiated by the characteristics of the information that they use. The categories of behaviour are also separated into three groups: social, semantic and spatial. This paper briefly describes and gives examples of each of the categories of behaviour. This is followed by insights into the behaviours from user studies conducted by the author. (This paper borrows its title from Cohen, 2015).
In the more than two hundred years since his death, Cook's reputation has been much discussed, opinion ranging from celebration of his achievement to more subjective assessments of the long-term implications of his voyages in those countries of the Pacific which he visited. The thirteen essays in this book, grouped in four sections, continue the debate. 'The Years in England' cover Cook's Whitby background and the part played by the Royal Society in the Pacific ventures of the period. 'The Pacific Voyages' investigates the clash between the Endeavour's crew and the Aborigines on the banks of the Endeavour River, the process by which Cook and his crews became 'Polynesianised', Cook's visit to the Hawaiian Islands, and his call at Nootka Sound, both on his final voyage. 'Captain Cook and his Contemporaries' views other European explorers in the Pacific, and concludes with an analysis of Russian attitudes towards Cook. 'The Legacy of Captain Cook' compares Cook's death on Hawaii with the later killing of a missionary on Eromanga, examines fluctuations in Cook's reputation, and describes life on board the replica of the Endeavour. GLYNDWR WILLIAMS is Emeritus Professor of History, Queen Mary & Westfield College, University of London. His many books include an edition of Captain Cook's Voyages, 1768-79, from the official accounts derived from Cook's journals.
A few studies have evaluated the impact of clinical trial results on practice in paediatric cardiology. The Infant Single Ventricle (ISV) Trial results published in 2010 did not support routine use of the angiotensin-converting enzyme inhibitor enalapril in infants with single-ventricle physiology. We sought to assess the influence of these findings on clinical practice.
Methods
A web-based survey was distributed via e-mail to over 2000 paediatric cardiologists, intensivists, cardiothoracic surgeons, and cardiac advance practice nurses during three distribution periods. The results were analysed using McNemar’s test for paired data and Fisher’s exact test.
Results
The response rate was 31.5% (69% cardiologists and 65% with >10 years of experience). Among respondents familiar with trial results, 74% reported current practice consistent with trial findings versus 48% before trial publication (p<0.001); 19% used angiotensin-converting enzyme inhibitor in this population “almost always” versus 36% in the past (p<0.001), and 72% reported a change in management or improved confidence in treatment decisions involving this therapy based on the trial results. Respondents familiar with trial results (78%) were marginally more likely to practise consistent with the trial results than those unfamiliar (74 versus 67%, p=0.16). Among all respondents, 28% reported less frequent use of angiotensin-converting enzyme inhibitor over the last 3 years.
Conclusions
Within 5 years of publication, the majority of respondents was familiar with the Infant Single Ventricle Trial results and reported less frequent use of angiotensin-converting enzyme inhibitor in single-ventricle infants; however, 28% reported not adjusting their clinical decisions based on the trial’s findings.
In this paper we consider PDE-constrained optimization problems which incorporate an H1 regularization control term. We focus on a time-dependent PDE, and consider both distributed and boundary control. The problems we consider include bound constraints on the state, and we use a Moreau-Yosida penalty function to handle this. We propose Krylov solvers and Schur complement preconditioning strategies for the different problems and illustrate their performance with numerical examples.
There is now a well-established link between childhood maltreatment and
psychosis. It is, however, unclear what the mechanisms are by which this
occurs. Here, we propose a pathway linking the experience of childhood
maltreatment with biological changes in the brain and suggest a
psychological intervention to ameliorate its effects.
Ptolemaaїs is the only Greek woman on record as a musical theorist. Most writings in Pythagorean harmonics after the fourth century BC were heavily influenced by Plato's Republic, with its rejection of empirical considerations and its insistence on the authority of reason, and especially by the cosmological and psychological implications of his musical construction of the World-Soul in the Timaeus. One of the Pythagorean approaches that Ptolemaїs describes seems nevertheless to preserve a pre-Platonic character, privileging reason over perception but still focused at least in part on the analysis of audible music; and so too do the Pythagoreans discussed by Ptolemy and Porphyry. The principle that a concord's ratio must be either multiple or epimoric has a significant consequence: the interval of an octave plus a fourth (which sense-perception, according to Aristoxenus, Ptolemy and many others, unquestionably recognizes as a concord) cannot really be concordant.
The literary flair of fin-de-siècle Vienna lived on after 1918 in the First Austrian Republic even as writers grappled with the consequences of a lost war and the vanished Habsburg Empire. Reacting to historical and political issues often distinct from those in Weimar Germany, Austrian literary culture, though frequently associated with Jewish writers deeply attached to the concept of an independent Austria, reflected the republic's ever-deepening antisemitism and the growing clamor for political union with Germany. Spanning the two momentous decades between the fall of the empire in 1918 and the Nazi 'Anschluss' in 1938, this book explores work by canonical writers such as Schnitzler, Kraus, Roth, and Werfel and by now-forgotten figures such as the pacifist Andreas Latzko, the arch-Nazi Bruno Brehm, and the fervently Jewish Soma Morgenstern. Also taken into account are Ernst Weiss's 'Hitler' novel 'Der Augenzeuge' and 1930s works about First Republic Austria by the German Communist writers Anna Seghers and Friedrich Wolf. Andrew Barker's book paints a varied and vivid picture of one of the most challenging and underresearched periods in twentieth-century cultural history. Andrew Barker is Emeritus Professor of Austrian Studies at the University of Edinburgh, Scotland.
Autobiographical memories are a key component of our identity. Here, in the light of Cuervo-Lombard and colleagues' paper in this issue, we review impairments in autobiographical memory in schizophrenia and the association between autobiographical memory and outcome in the disorder. We also discuss whether these deficits are specific to schizophrenia and a possible link with traumatic events.
From Trakl's battle-poem “Grodek” (1914) to Kraus's gargantuan drama Die letzten Tage der Menschheit (The Last Days of Mankind, 1919–22), some of the finest works in the Austrian canon were inspired by the trauma of the Great War. For many readers today, however, war fiction in German usually begins and ends with two novels belonging to the Weimar tradition rather than the Austrian tradition – Arnold Zweig's Der Streit um den Sergeanten Grischa (The Argument over Sergeant Grischa, 1927) and E. M. Remarque's Im Westen nichts Neues (All Quiet on the Western Front, 1929). Since both novels appeared some while after the war's end, their authors were at pains to declare them authentic records stemming directly from lived experience of the conflict itself. The two works presented here to illustrate war writing by front-line soldiers in the Austro-Hungarian army required no such retrospective justification.
Unlike Zweig and Remarque, Andreas Latzko and Ernst Weiss felt no need for their experiences to be distilled by the passage of time. Latzko's Menschen im Krieg (Men in War, 1917) appeared while the battles still raged; Weiss's Franta Zlin came out shortly after the ceasefire in 1919. The first created a now-forgotten literary sensation across Europe, but has long been out of print. The other was recently included by Marcel Reich-Ranicki in Robert Musil bis Franz Werfel, the seventh volume of his extended collection provocatively entitled Der Kanon: Die deutsche Literatur (the editor's notion of what constitutes a “German” author may not be shared by all commentators).