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Major depressive disorder (‘depression’) is significantly more prevalent amongst young adults in Australia relative to older ages. The inefficacy of current treatment options for many individuals(1) warrants investigation of additional approaches to alleviating the burden of this illness. Incidentally, diet often becomes unhealthier during the transition from adolescence to young adulthood(2). This can result in poorer micronutrient consumption, and there is a growing body of evidence indicating that an inverse relationship exists between intake of certain micronutrients and depressive symptoms(3). Given this, diet may be an important modifiable risk factor or adjunctive means of ameliorating depression for young adults. Young adult vegetarians in particular have an increased risk of some micronutrient deficiencies which have been implicated in depression(4). In combination, their age and dietary choice suggest they may be especially vulnerable to depression and therefore benefit from clear guidance to adequately meet their micronutrient requirements. The present study aimed to elucidate the need for such guidance by comparing the proportions of vegetarian and omnivorous young adult participants in the 2011-12 National Nutrition and Physical Activity Survey (NNPAS) who had inadequate intakes of micronutrients implicated in depression. The NNPAS collected the most recent nationally-representative data pertaining to the dietary intake (via two 24-h recalls) of Australians and included 2,397 young adults (18-34 years). Participants who were pregnant, lactating, or who mis-reported intakes according to Goldberg equation-derived cut-off values were excluded (n = 791). The dietary data were used to estimate usual intakes via the Multiple Source Method. Inadequate intakes were identified according to the Estimated Average Requirement (EAR) cut-point method for all micronutrients with an EAR except iron, for which the full-probability method was applied. Survey weights allocated for inference to the total Australian population were implemented throughout the analysis. The final sample was composed of 66 vegetarians (did not report any animal tissue consumption) and 1540 omnivores. The mean intake of long-chain omega-3 fatty acids (EPA, DPA, DHA) from both diet and supplementation was significantly lower in vegetarians compared to omnivores (96.3mg/day vs. 264.5mg/day, p<0.001). A significantly greater proportion of vegetarians compared to omnivores had inadequate total B12 (22.7% vs. 1.4%), iron (58.3% vs. 18.9%), selenium (30.8% vs. 3.5%) and zinc (58.8% vs. 33.3%) intakes (all p<0.05). These results suggest that young adult vegetarians are likely to have significantly lower consumption of long-chain omega-3 fatty acids and an increased risk of inadequately consuming vitamin B12, iron, selenium and zinc compared to their omnivorous counterparts. These findings support the notion that young adult vegetarians may have an increased risk of depression from a nutritional standpoint, and therefore stand to benefit from tailored dietary advice on a public and individual level designed to support their mental health.
The ‘second victim phenomenon’ is a term attributed to the traumatic effect a medical error can have on healthcare professionals. Patient safety incidents have been shown to occur in as many as one in seven patients in hospital. These incidents cause significant, potentially devastating, trauma to patients and their relatives, and can have deep and long-lasting effects on the health professionals involved. These incidents can have a negative impact on doctors’ emotional wellbeing; their professional practice in relation to this impact has not been extensively investigated in surgical trainees.
Method
A survey of UK otolaryngology trainees was conducted to investigate the effects of complications and medical errors on trainees, and examine how these are discussed within departments.
Results and conclusion
The findings suggest that further training is required and would be warmly received by otolaryngology trainees as part of higher surgical training.
Forty years ago, Knut Fladmark (1979) argued that the Pacific Coast offered a viable alternative to the ice-free corridor model for the initial peopling of the Americas—one of the first to support a “coastal migration theory” that remained marginal for decades. Today, the pre-Clovis occupation at the Monte Verde site is widely accepted, several other pre-Clovis sites are well documented, investigations of terminal Pleistocene subaerial and submerged Pacific Coast landscapes have increased, and multiple lines of evidence are helping decode the nature of early human dispersals into the Americas. Misconceptions remain, however, about the state of knowledge, productivity, and deglaciation chronology of Pleistocene coastlines and possible technological connections around the Pacific Rim. We review current evidence for several significant clusters of early Pacific Coast archaeological sites in North and South America that include sites as old or older than Clovis. We argue that stemmed points, foliate points, and crescents (lunates) found around the Pacific Rim may corroborate genomic studies that support an early Pacific Coast dispersal route into the Americas. Still, much remains to be learned about the Pleistocene colonization of the Americas, and multiple working hypotheses are warranted.
Acute tonsillitis represents a significant proportion of admissions to ENT departments nationally. Given current hospital pressures, it is vital to look for safe alternatives to admission. This study explores the safe management of patients in an ambulatory medical unit, without the need for admission.
Methods
A retrospective review of 48 patients’ notes was carried out. Following the development and implementation of a guideline for acute tonsillitis, a prospective re-audit of 41 patients was carried out, measuring length of stay, overnight admissions and re-admissions.
Results
The rate of overnight admission following implementation of the guideline fell from 0.75 to 0.29, and average length of stay dropped from 19.2 to 9.5 hours. There were two re-admissions in each cycle of the audit, which represents a non-significant increase.
Conclusion
The tonsillitis guideline has significantly reduced admissions and length of stay. Re-admissions remain low, demonstrating that this is a safe and cost-effective intervention.
Grommet insertion is a common surgical procedure in children. Long waiting times for grommet insertion are not unusual. This project aimed to streamline the process by introducing a pathway for audiologists to directly schedule children meeting National Institute for Health and Care Excellence Clinical Guideline 60 (‘CG60’) for grommet insertion.
Method and results
A period from June to November 2014 was retrospectively audited. Mean duration between the first audiology appointment and grommet insertion was 294.5 days (median = 310 days). Implementing the direct-listing pathway reduced the duration between first audiology appointment and grommet insertion (mean = 232 days; median = 231 days). There has been a reduction in the time between the first audiology appointment and surgery (mean difference of 62.5 days; p = 0.024), and a reduction in the time between second audiology appointment and surgery (28 days; p = 0.009).
Conclusion
Direct-listing pathways for grommet insertion can reduce waiting times and expedite surgery. Implementation involves a simple alteration of current practice, adhering to National Institute for Health and Care Excellence Clinical Guideline 60. The ultimate decision regarding surgery still rests with ENT specialists.
To investigate the feasibility of a national audit of epistaxis management led and delivered by a multi-region trainee collaborative using a web-based interface to capture patient data.
Methods:
Six trainee collaboratives across England nominated one site each and worked together to carry out this pilot. An encrypted data capture tool was adapted and installed within the infrastructure of a university secure server. Site-lead feedback was assessed through questionnaires.
Results:
Sixty-three patients with epistaxis were admitted over a two-week period. Site leads reported an average of 5 minutes to complete questionnaires and described the tool as easy to use. Data quality was high, with little missing data. Site-lead feedback showed high satisfaction ratings for the project (mean, 4.83 out of 5).
Conclusion:
This pilot showed that trainee collaboratives can work together to deliver an audit using an encrypted data capture tool cost-effectively, whilst maintaining the highest levels of data quality.
Green galenia is a South African woody prostrate perennial that was first
recorded in Australia in the early 1900s and has since become a serious
threat to indigenous temperate grasslands and surrounding agricultural
areas. Laboratory and field based experiments were conducted to examine the
effect of environmental factors on the germination and viability of green
galenia seed. It was shown that green galenia was able to germinate over a
broad range of temperatures, but short bursts (5 min) of high temperatures
(80 C to 120 C replicating possible exposures to a fire) reduced seed
germination. Seed germination was positively favored by light, declined
rapidly in darkness, and decreased by > 80% at a depth of only 0.5 cm in
soil. Water stress greatly reduced seed germination (45% germination at
osmotic potentials below −0.2 MPa). Germination was completely inhibited at
water potentials of −0.4 to −1.0 MPa. This species is moderately tolerant to
salinity, with over 50% of seeds germinating at low levels of salinity (60
mM NaCl), and moderate germination (49%) occurring at 120 mM NaCl, it can
germinate well in both alkaline (pH 10–83%) and acidic (pH 4–80%)
conditions. The results of this study have contributed to our understanding
of the germination and emergence of green galenia, and this will assist in
developing tools and strategies for the long term management of this noxious
weed in Victoria and other parts of Australia.
The objective of this study was to define different terminal sire flock environments, based on a range of environmental factors, and then investigate the presence of genotype by environment interactions (G×E) between the environments identified. Data from 79 different terminal sire flocks (40 Texel, 21 Charollais and 18 Suffolk), were analysed using principal coordinate and non-hierarchical cluster analyses, the results of which identified three distinct environmental cluster groups. The type of grazing, climatic conditions and the use of vitamins and mineral supplements were found to be the most important factors in the clustering of flocks. The presence of G×E was then investigated using data from the Charollais flocks only. Performance data were collected for 12 181 lambs, between 1990 and 2010, sired by 515 different sires. Fifty six of the sires had offspring in at least two of the three different cluster groups and pedigree information was available for a total of 161 431 animals. Traits studied were the 21-week old weight (21WT), ultrasound muscle depth (UMD) and log transformed backfat depth (LogUFD). Heritabilities estimated for each cluster, for each trait, ranged from 0.32 to 0.45. Genetic correlations estimated between Cluster 1 and Cluster 2 were all found to be significantly lower than unity, indicating the presence of G×E. They were 0.31 (±0.17), 0.68 (±0.14) and 0.18 (±0.21) for 21WT, UMD and LogUFD, respectively. Evidence of sires re-ranking across clusters was also observed. Providing a suitable strategy can be identified, there is potential for the optimisation of future breeding programmes, by taking into account the G×E observed. This would enable farmers to identify and select animals with an increased knowledge as to how they will perform in their specific farm environment thus reducing any unexpected differences in performance.
After traumatic injury, the brain undergoes a prolonged period of degenerative change that is paradoxically accompanied by cognitive recovery. The spatiotemporal pattern of atrophy and the specific relationships of atrophy to cognitive changes are ill understood. The present study used tensor-based morphometry and neuropsychological testing to examine brain volume loss in 17 traumatic brain injury (TBI) patients and 13 controls over a 4-year period. Patients were scanned at 2 months, 1 year, and 4 years post-injury. High-dimensional warping procedures were used to create change maps of each subject's brain for each of the two intervals. TBI patients experienced volume loss in both cortical areas and white matter regions during the first interval. We also observed continuing volume loss in extensive regions of white matter during the second interval. Neuropsychological correlations indicated that cognitive tasks were associated with subsequent volume loss in task-relevant regions. The extensive volume loss in brain white matter observed well beyond the first year post-injury suggests that the injured brain remains malleable for an extended period, and the neuropsychological relationships suggest that this volume loss may be associated with subtle cognitive improvements. (JINS, 2012, 18, 1–13)
Aerially sprayed fenitrothion (0.21 kg/ha) caused mortalities from 100% among experimentally caged bees in exposed habitats to 47% in cages placed under dense forest canopy. Bumble bees found foraging in sprayed areas during the days immediately following the spray suffered significantly higher subsequent mortality than those in unsprayed areas.
Long-term effects were investigated by comparing late summer Bombus population densities among sites representing various spray histories. For all species combined, abundances in unsprayed areas averaged 3 times higher than in fenitrothion treated areas. Population recovery appeared to be complete within a few years after discontinuation of spraying.
Foraging performance by laboratory reared colonies was significantly higher in sprayed areas with reduced bee populations than in a control area, possibly because of relaxation of competitive stress. The diversity of plant species used for pollen collection was nearly twice as great in the control as compared with sprayed areas, suggesting that the effect of fenitrothion spraying on cross-pollination may be greatest for plants which are subdominant in the hierarchy of bee preference In one such plant, red clover, reduced seed-set was demonstrated.
Of the many techniques that have been applied to the study of crystal defects, none has contributed more to our understanding of their nature and influence on the physical and chemical properties of crystalline materials than transmission electron microscopy (TEM). TEM is now used extensively by an increasing number of earth scientists for direct observation of defect microstructures in minerals and rocks. Transmission Electron Microscopy of Minerals and Rocks is an introduction to the principles of the technique written specifically for geologists and mineralogists. The first part of the book deals with the essential physics of the transmission electron microscope and presents the basic theoretical background required for the interpretation of images and electron diffraction patterns. A knowledge of elementary crystallography is assumed, and some familiarity with optics and electromagnetic theory is helpful but not essential. The final chapters are concerned with specific applications of TEM in mineralogy and deal with such topics as planar defects, intergrowths, radiation-induced defects, dislocations and deformation-induced microstructures.
Sixty-one serum samples selected on the basis of reactivity in the complement fixation (CF) and latex agglutination (LA) test, were further examined for sensitivity and specificity by indirect haemagglutination (IHA), enzyme linked immunosorbent assay (ELISA) and defined antigen substrate spheres (DASS). Twenty sera from healthy Europeans and 48 samples from patients with either schistosomiasis or trichinosis were also tested. Comparable levels of sensitivity were found between the CF and LA positive sera and IHA, ELISA and DASS. Of the CF positive LA negative group of sera, many were positive by DASS but only a few reacted in IHA and ELISA. Some cross reactivity was also observed in the schistosomiasis sera tested by IHA and ELISA.
Ferrets infected with influenza virus A2/Hong Kong/3/68 responded with a febrile reaction; the temperature was elevated by 1·0°C. or greater to a level of 40°C. or more. In addition, relatively high titres of virus were recovered from nasal washings taken 3 days after virus infection, serum antibody was produced, increased nasal protein was detected and nasal washings contained both HI and neutralizing antibody. Of four ferrets immunized with 400 CCA units of inactivated influenza virus A2/Aichi/2/68 in saline, only one produced detectable serum HI antibody, and none produced detectable nasal antibody. These ferrets were subsequently found to be susceptible to intranasal infection with influenza virus A2/Hong Kong/3/68. Thus, the temperature response, the titre of virus recovered from nasal washings and the serum HI antibody response found after virus infection was similar to that found after infection of non-immunized ferrets. However, the increase in protein concentration and the titre of HI and neutralizing antibody found in nasal washings after virus infection was detectably less than that found after virus infection of non-immunized ferrets.
Four ferrets were immunized with 400 CCA units of inactivated A2/Aichi/2/68 virus in adjuvant 65, and these ferrets produced relatively high titres of serum HI antibody but no detectable nasal antibody. After subsequent virus infection with influenza virus A2/Hong Kong/3/68, these ferrets showed a modified temperature response, reduced titres of virus in nasal washings compared to that found in nasal washings from non-immunized ferrets, no increase in nasal protein and no detectable nasal HI antibody. Thus, immunization with inactivated virus in adjuvant 65 resulted in a significant modification of the response of ferrets to challenge virus; however, the immunity was not complete, and appreciably less than that found after infection with live homologous virus.
Environmental contamination has been shown to be an important aspect of the epidemiology of salmonellosis in calves. Markets and transport vehicles are important links in the calf marketing chain and these were investigated to determine the level of salmonella contamination.
Salmonellas were isolated from 7 of the 14 markets surveyed, with 31 of 838 samples (3.7%) being positive. Nine different salmonella serotypes, of which the commonest was Salmonella typhimurium, were isolated. Four different phage types of S. typhimurium were detected, the commonest being DT204C.
Salmonellas were isolated from 22 of the 107 vehicles (20.6%) examined before washing and from 4 of the 62 vehicles (6.5%) examined after cleaning. Twelve different salmonella serotypes were isolated, of which the most frequent was S. typhimurium. The commonest of the six different S. typhimurium phage types was DT204C.
These results indicate that improved cleaning and disinfection routines both for vehicles and markets are necessary to control salmonellosis in calves.
A group of 23 volunteers were each inoculated with 600 CCA of a new form of influenza virus A/England/42/72 vaccine; this vaccine consisted of purified haemagglutinin and neuraminidase antigens adsorbed to alhydrogel. No significant reactions to the vaccine were reported. Twenty-two volunteers produced increased titres of serum HI antibody, and all showed increased titres of NI antibody after immunization. Thus, for volunteers with no pre-immunization serum HI antibody, the geometric mean titre of serum antibody increased from 1/5 to 1/196 after immunization. Ten volunteers developed local neutralizing antibody after immunization; this antibody response was detected most frequently in volunteers who showed the greater serum antibody response to immunization, and in nasal washings with the higher concentrations of protein and IgA. Ten weeks after immunization, the vaccinees and a group of matched controls were inoculated intranasally with attenuated A/England/42/72 virus. Evidence of infection with the challenge virus was found in 14 of the control subjects and in one of the vaccinees. The results indicate that the surface-antigen-adsorbed vaccine induced high titres of serum antibody, and gave significant protection against challenge infection.
Normal ferrets did not produce serum antibody following immunization with 200 i.u. of inactivated A/Hong Kong/68 influenza virus vaccine and were found to be susceptible to subsequent challenge infection with A/Hong Kong/68 virus. High titres of virus were recovered from nasal washings collected 3 days after infection, serum antibody was produced, increased nasal protein was detected and HI antibody was detected in nasal washings. Ferrets infected with influenza virus A/PR/8/34 7 weeks before immunization with inactivated A/HK/68 virus did, however, produce serum HI antibody to A/HK/68 virus. This antibody conferred partial immunity to challenge infection with A/HK/68 virus, as shown by decreased titres of virus in nasal washings and reduced levels of nasal protein. Previous infection of ferrets with influenza virus B/Ann Arbor/66 did not result in the production of serum antibody to A/HK/68 virus following immunization with A/HK/68 vaccine and the animals were completely susceptible to subsequent challenge infection with A/HK/68 virus. Differences in the amount of nasal protein and nasal antibody produced after A/HK/68 infection were also found in ferrets previously infected with either A/PR/8/34 or B/AA/66 virus, compared with normal ferrets.
The ability of a new, surface-antigen-adsorbed influenza virus vaccine to induce serum antibody in hamsters, and to protect these hamsters against subsequent homologous virus challenge, is reported. In addition, similar studies in hamsters have also been carried out using the surface antigen material prior to adsorption to the aluminium hydroxide carrier. The new, adsorbed vaccine is at least as effective as inactivated saline influenza virus vaccine in inducing serum antibody and protection in hamsters; the unadsorbed surface antigen material, however, did not confer protection to hamsters challenged subsequently with homologous virus.