We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Effective, continuing professional development opportunities provide veterinarians with the necessary skills to uphold animal welfare standards. In India, surgical neutering is integral in successfully managing the large, free-roaming dog population; the delivery of skills-based, training opportunities which result in long-term behavioural changes remains challenging. Indian veterinarians attending a 12-day, practically focused, training programme on canine surgical neutering, completed a questionnaire prior to the commencement of training and 10–12 months afterwards. Questions explored the programme’s impact on their attitudes, working practices, and retained knowledge. A total of 207 participants completed both questionnaires. Ten to 12 months after attendance, most participants reported increased confidence undertaking common surgical and clinical tasks; they felt both motivated and able to use their newly acquired knowledge and skills in their workplace, with some peer-to-peer skills transfer opportunities. Many reported high levels of employer engagement resulting in improvements in the workplace, including equipment investment. Evidence for sustained improvements in working practices were noted in four key areas: surgical practices, use of perioperative analgesia, use of perioperative antibiotics, and post-operative wound management. Average knowledge scores in four areas (surgical skills, peri-operative analgesia, post-operative antibiotics and post-operative care) increased significantly 10–12 months after the training programme as compared to before, after accounting for other participants’ characteristics. These findings provide evidence for sustained improvements in workplace practices and patient care after attending a skills-based training opportunity, with a concomitant positive impact on standards of animal welfare. Furthermore, it may inform the development and implementation of future, educational, outcomes-focused training initiatives.
Veterinarians are custodians of animal welfare, ensuring practices remain current and effective in the face of the ever-changing demands of the profession. Continuing Professional Development (CPD) is essential for protecting animal welfare, however access to quality CPD is a challenge in many countries. India has one of the fastest growing veterinary industries globally, emphasising the importance of accessible CPD opportunities that are relevant to this setting. This study used focus groups to explore how Indian veterinarians identify relevant CPD, barriers they encounter, and their experiences with CPD. We describe three themes: (1) ‘career vs calling’, where veterinarians’ extrinsic and intrinsic motivational factors were identified, such as their desire to protect animal welfare; (2) being ‘willing to learn but can’t’, with context-specific barriers, such as accessing reliable CPD information; and (3) ‘real interactions matter’, where participants described how pedagogical design influenced their choices, e.g. being able to observe animal welfare improvements through practical teaching. We have three recommendations: firstly, to improve CPD learning opportunities informed by evidence-based methods, to meet knowledge and skills gaps such as the high demand for practically focused training; secondly, the development of a unified accreditation and quality assurance framework to assess content, relevance and delivery standards of available CPD options to veterinarians; and, lastly, improved support from employers to address current barriers and facilitate attendance. These findings contribute to the current knowledge gap of factors that influence Indian veterinarians’ experiences of attaining relevant, accessible CPD and makes suggestions to improve standards of veterinary care and, ultimately, patient welfare.
In the era of cardiovascular-kidney-metabolic syndrome, thorough evaluation of medicines with multiple treatment effects/indications demands a multifaceted modeling philosophy, despite the requirement of health technology assessment (HTA) models to focus on one disease. Using Cardiff, a model previously built for type 2 diabetes (T2D), we illustrate the changes needed to capture contemporary, holistic, patient-centered decision-making, and argue that HTA bodies should revise their approach.
Methods
The upgraded model enables therapy selection and escalation determined by HbA1c thresholds, cardiovascular risk (QRISK3), comorbidities (established cardiovascular or chronic kidney disease), and weight (body mass index ≥35 kg/m2). Risk factor trajectories were updated by incorporating UKPDS-90 equations and other relevant data sources. Clinical outcomes were predicted using new risk equations incorporating cardiovascular outcomes trial data whenever possible. The updated model was applied to assess quality-adjusted life years (QALYs) and lifetime costs in newly diagnosed T2D patients in the UK, modeled via a conventional glycemic-centric approach versus a multifactorial treatment algorithm. Extrapolation to the national level utilized estimates of annual incidence.
Results
The updated treatment algorithm captured and quantified the impact of nuanced comorbidity management called for in guidelines. In a cohort of newly diagnosed T2D patients, 81 percent initiated an SGLT2 inhibitor within five years, predominantly due to increasing cardiovascular risk, versus zero percent when escalation was dictated by HbA1c alone. Broad, early use of SGLT2 inhibitors resulted in an additional 0.73 predicted QALYs and GBP10,757 (USD13,600) in predicted lifetime cost savings per patient versus a “traditional” approach. Cost savings were primarily due to avoided renal events; extrapolation to the national level predicted cost savings to the payer of GBP2.8 billion (USD3.5 billion), which traditional models cannot capture.
Conclusions
The modernized Cardiff model incorporates multifactorial prescribing guidelines and contemporary evidence around cardio-renal protection and is more adept at modeling costs and outcomes of multidimensional antidiabetic treatments; traditional glucose-centric modeling methods may introduce bias. Economic modeling and HTA processes must adapt to follow the complexities of modern disease management and remain relevant as healthcare systems address the cardiovascular-kidney-metabolic syndrome epidemic.
There is limited research into horse slaughter, particularly ante mortem welfare, and the effectiveness of captive-bolt gun (CBG) stunning, despite this being a widely used method worldwide. To address this evidence gap and explore associations between ante and post mortem factors, the welfare of 62 horses was assessed at a commercial Italian abattoir. Animal-based measures were used to identify stress-related behaviours and stunning effectiveness. A sub-sample (44%; 27/62) of heads were assessed for gross brain pathology. All animals in the study showed stress-related behaviours at all stages of the slaughter process. Additionally, 53% (33/62) of horses slipped in the stunning box, with poor floor surface condition and use of force associated with this. At least one sign of an ineffective stun was observed in 22% (14/62) of animals. Six animals were shot twice, with the application of a second shot significantly associated with a higher stress behaviour index score in the stunning box. Damage to critical brainstem structures was found in 85% (23/27) of heads that were assessed with gross pathology. An absence of damage to critical brainstem structures meant that animals were ten times more likely to show signs of ineffective stunning. These results highlight the risks to equine welfare throughout the slaughter process and suggest that mitigating ante mortem stress could improve stunning effectiveness, whilst CBG usage should be refined to ensure that critical brainstem structures are targeted.
This chapter considers how the electric guitar is entwined with ecological issues—materially, culturally, and politically. Its first section discusses the electric guitar’s composite materials—metals, plastics, and especially woods—linking them to upstream impacts, legal and environmental conflicts. Disrupting the industry are environmental problems that interrupt material resource supply, including species endangerments, trade restrictions, and climate change. The second section considers new sustainability initiatives amid growing resource insecurity and a changing climate. Attempts at ecological recuperation encompass diversification of timbers, forest restoration, salvage supply chains, new materials, and urban tree planting schemes. The third section turns to guitar players, asking questions of how, as musicians, we find ourselves entwined within, and in many ways responsible for, the instrument’s ecological dilemmas. Throughout the chapter, we draw upon our long-standing research project tracing the guitar “in rewind” back to forest origins, including interview quotes from wood experts in the guitar industry that we have interviewed across the globe.
The COVID-19 pandemic led to an increased need to conduct research and community engagement using digital methods. Unfortunately, the shift away from in-person research activities can make it difficult to engage and recruit participants from under-resourced communities that lack adequate digital infrastructure. At the beginning of the pandemic, our team recognized that imminent lockdowns would significantly disrupt ongoing engagement with low-income housing resident community partners and that we would ultimately bear responsibility if that occurred. This manuscript outlines the development of methods designed to create capacity for virtual engagement with a community advisory board that were subsequently applied to a longitudinal mixed-methods study. We describe how our experience engaging low-income housing residents during the height of the pandemic influenced the approach and offer guidelines useful for engaging under-resourced communities regardless of setting. Of these, a strong commitment to providing technology, unlimited data connectivity, and basic digital literacy training/technical support is most important. While each of these is essential and failure in any one area will reduce overall effectiveness of the effort, providing adequate technical support while maintaining ongoing relationships with community members is the most important and resource-intensive.
Arising from the 2019 Darwin College Lectures, this book presents essays from seven prominent public intellectuals on the theme of vision. Each author examines this theme through the lens of their own particular area of expertise, making for a lively interdisciplinary volume including chapters on neuroscience, colour perception, biological evolution, astronomy, the future of technology, computer vision, and the visionary core of science. Featuring contributions by professors of neuroscience Paul Fletcher and Anya Hurlbert, professor of zoology Dan-Eric Nilsson, the futurist Sophie Hackford, Microsoft distinguished scientist Andrew Blake, theoretical physicist and author Carlo Rovelli, and Dr Carolin Crawford, the Public Astronomer at the University of Cambridge, this volume will be of interest to anybody curious about how we see the world.
Understanding place-based contributors to health requires geographically and culturally diverse study populations, but sharing location data is a significant challenge to multisite studies. Here, we describe a standardized and reproducible method to perform geospatial analyses for multisite studies. Using census tract-level information, we created software for geocoding and geospatial data linkage that was distributed to a consortium of birth cohorts located throughout the USA. Individual sites performed geospatial linkages and returned tract-level information for 8810 children to a central site for analyses. Our generalizable approach demonstrates the feasibility of geospatial analyses across study sites to promote collaborative translational research.
To determine the usefulness of adjusting antibiotic use (AU) by prevalence of bacterial isolates as an alternative method for risk adjustment beyond hospital characteristics.
AU in days of therapy per 1,000 patient days and microbiologic data from 2015 and 2016 were collected from 26 hospitals. The prevalences of Pseudomonas aeruginosa, extended-spectrum β-lactamase (ESBL)–producing bacteria, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci (VRE) were calculated and compared to the average prevalence of all hospitals in the network. This proportion was used to calculate the adjusted AU (a-AU) for various categories of antimicrobials. For example, a-AU of antipseudomonal β-lactams (APBL) was the AU of APBL divided by (prevalence of P. aeruginosa at that hospital divided by the average prevalence of P. aeruginosa). Hospitals were categorized by bed size and ranked by AU and a-AU, and the rankings were compared.
Results:
Most hospitals in 2015 and 2016, respectively, moved ≥2 positions in the ranking using a-AU of APBL (15 of 24, 63%; 22 of 26, 85%), carbapenems (14 of 23, 61%; 22 of 25; 88%), anti-MRSA agents (13 of 23, 57%; 18 of 26, 69%), and anti-VRE agents (18 of 24, 75%; 15 of 26, 58%). Use of a-AU resulted in a shift in quartile of hospital ranking for 50% of APBL agents, 57% of carbapenems, 35% of anti-MRSA agents, and 75% of anti-VRE agents in 2015 and 50% of APBL agents, 28% of carbapenems, 50% of anti-MRSA agents, and 58% of anti-VRE agents in 2016.
Conclusions:
The a-AU considerably changes how hospitals compare among each other within a network. Adjusting AU by microbiological burden allows for a more balanced comparison among hospitals with variable baseline rates of resistant bacteria.
Substantial clinical heterogeneity of major depressive disorder (MDD) suggests it may group together individuals with diverse aetiologies. Identifying distinct subtypes should lead to more effective diagnosis and treatment, while providing more useful targets for further research. Genetic and clinical overlap between MDD and schizophrenia (SCZ) suggests an MDD subtype may share underlying mechanisms with SCZ.
Methods
The present study investigated whether a neurobiologically distinct subtype of MDD could be identified by SCZ polygenic risk score (PRS). We explored interactive effects between SCZ PRS and MDD case/control status on a range of cortical, subcortical and white matter metrics among 2370 male and 2574 female UK Biobank participants.
Results
There was a significant SCZ PRS by MDD interaction for rostral anterior cingulate cortex (RACC) thickness (β = 0.191, q = 0.043). This was driven by a positive association between SCZ PRS and RACC thickness among MDD cases (β = 0.098, p = 0.026), compared to a negative association among controls (β = −0.087, p = 0.002). MDD cases with low SCZ PRS showed thinner RACC, although the opposite difference for high-SCZ-PRS cases was not significant. There were nominal interactions for other brain metrics, but none remained significant after correcting for multiple comparisons.
Conclusions
Our significant results indicate that MDD case-control differences in RACC thickness vary as a function of SCZ PRS. Although this was not the case for most other brain measures assessed, our specific findings still provide some further evidence that MDD in the presence of high genetic risk for SCZ is subtly neurobiologically distinct from MDD in general.
The paper discusses the Garboldisham macehead: an unusual decorated macehead carved from red deer antler. The macehead was found in the 1960s deposited in a tributary of the river Little Ouse, Norfolk and is decorated with three spirals, making it especially significant. This paper reports on the analysis of the decoration using digital imaging, discusses a new radiocarbon date recently obtained for the artefact, and discusses its significance alongside other dated antler maceheads.