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The emergence of early cities required new agricultural practices and archaeobotanical crop-processing models have been used to investigate the social and economic organisation of urban ‘consumer’ and non-urban ‘producer’ sites. Archaeobotanical work on the Indus Valley has previously identified various interpretations of labour and subsistence practices. Here, the authors analyse a large archaeobotanical assemblage from Harappa, Pakistan (3700–1300 BC), questioning some of the assumptions of traditional crop-processing models. The ubiquity of small weed seeds, typically removed during the early stages of crop processing, is argued to result from dung burning. This additional taphonomic consideration adds nuance to the understanding of Harappa's labour organisation and food supply with implications for crop-processing models in other contexts.
Achieving equitable healthcare access is a global challenge. Improving whole-population mental health and reducing the global burden of mental disorders is a key recommendation of the 2018 Lancet Global Mental Health Commission, which proposed monitoring national indicators, including the proportion of people with severe mental disorders who are service-users. This study aims to derive an equity indicator from national datasets integrating need, service utilisation and socioeconomic status, and demonstrate its utility in identifying gaps in mental health service use amongst those with the greatest need, thereby guiding equitable healthcare delivery.
Methods
We present a case study of a universal health insurance scheme (Medicare) in Australia. We developed the equity indicator using three national datasets. Geographic areas were linked to an area-based socioeconomic deprivation quintile (Census 2016). Per geographic area, we estimated the number with a mental healthcare need using scores ≥30 on the Kessler-10 (Australian National Health Surveys 2015 and 2018), and obtained the number of services used, defined as mental health-related contacts with general practitioners and mental health professionals (Medicare administrative data 2015–2019). We divided the number of services by the population with an estimated mental healthcare need and averaged these use-rates across each socioeconomic deprivation quintile. The equity indicator is the ratio of the use-rates in the least versus most deprived quintiles.
Results
Those estimated to have the greatest need for mental healthcare in 2019 ranged between 8.2% in the most disadvantaged area quintile (Q1) and 2.4% in the least (Q5), corresponding to a proportional increase of 27.7% in Q1 and 19.5% in Q5 since 2015. Equity-indicator-adjusted service rates of 4.2 (3.8–4.6) and 23.9 (22.4–25.4) showed that individuals with the highest need for care residing in Q1 areas received a stark 6 times fewer services compared to their Q5 counterparts, producing an equity indicator of 6.
Conclusions
As the global prevalence of common mental disorders may be increasing, it is crucial to calculate robust indicators evaluating the equity of mental health service use. In this Australian case study, we developed an equity indicator enabling the direct comparison of geographic areas with different need profiles. The results revealed striking inequities that persisted despite publicly-funded universal healthcare, recent service reforms and being a high-income country. This study demonstrates the importance and feasibility of generating such an indicator to inform and empower communities, healthcare providers and policymakers to pursue equitable service provision.
Studies using the dietary inflammatory index often perform complete case analyses (CCA) to handle missing data, which may reduce the sample size and increase the risk of bias. Furthermore, population-level socio-economic differences in the energy-adjusted dietary inflammatory index (E-DII) have not been recently studied. Therefore, we aimed to describe socio-demographic differences in E-DII scores among American adults and compare the results using two statistical approaches for handling missing data, i.e. CCA and multiple imputation (MI).
Design:
Cross-sectional analysis. E-DII scores were computed using a 24-hour dietary recall. Linear regression was used to compare the E-DII scores by age, sex, race/ethnicity, education and income using both CCA and MI.
Setting:
USA.
Participants:
This study included 34 547 non-Hispanic White, non-Hispanic Black and Hispanic adults aged ≥ 20 years from the 2005–2018 National Health and Nutrition Examination Survey.
Results:
The MI and CCA subpopulations comprised 34 547 and 23 955 participants, respectively. Overall, 57 % of the American adults reported 24-hour dietary intakes associated with inflammation. Both methods showed similar patterns wherein 24-hour dietary intakes associated with high inflammation were commonly reported among males, younger adults, non-Hispanic Black adults and those with lower education or income. Differences in point estimates between CCA and MI were mostly modest at ≤ 20 %.
Conclusions:
The two approaches for handling missing data produced comparable point estimates and 95 % CI. Differences in the E-DII scores by age, sex, race/ethnicity, education and income suggest that socio-economic disparities in health may be partially explained by the inflammatory potential of diet.
In this retrospective cohort study, we evaluated the predictive value of methicillin-resistant Staphylococcus aureus (MRSA) nasal swabs for the development of MRSA infections in patients with left ventricular assist devices. In 106 patients, the MRSA nasal swab had a negative predictive value of 92.9% demonstrating a potential role in antibiotic de-escalation.
The southwestern Cape of South Africa is a particularly dynamic region in terms of long-term climate change. We analysed fossil pollen from a 25,000 year sediment core taken from a near-coastal wetland at Pearly Beach that revealed that distinct changes in vegetation composition occurred along the southwestern Cape coast. From these changes, considerable variability in temperature and moisture availability are inferred. Consistent with indications from elsewhere in southwestern Africa, variability in Atlantic Meridional Overturning Circulation (AMOC) was identified as a strong determinant of regional climate change. At Pearly Beach, this resulted in phases of relatively drier conditions (~24–22.5 cal ka BP and ~22–18 cal ka BP) demarcated by brief phases of increased humidity from ~24.5–24 cal ka BP and 22.5–22 cal ka BP. During glacial Termination I (~19–11.7 ka), a marked increase in coastal thicket pollen from ~18.5 to 15.0 cal ka BP indicates a substantial increase in moisture availability, coincident, and likely associated with, a slowing AMOC and a buildup of heat in the southern Atlantic. With clear links to glacial and deglacial Earth system dynamics and perturbations, the Pearly Beach record represents an important new contribution to a growing body of data, providing insights into the patterns and mechanisms of southwestern African climate change.
Multicentre research databases can provide insights into healthcare processes to improve outcomes and make practice recommendations for novel approaches. Effective audits can establish a framework for reporting research efforts, ensuring accurate reporting, and spearheading quality improvement. Although a variety of data auditing models and standards exist, barriers to effective auditing including costs, regulatory requirements, travel, and design complexity must be considered.
Materials and methods:
The Congenital Cardiac Research Collaborative conducted a virtual data training initiative and remote source data verification audit on a retrospective multicentre dataset. CCRC investigators across nine institutions were trained to extract and enter data into a robust dataset on patients with tetralogy of Fallot who required neonatal intervention. Centres provided de-identified source files for a randomised 10% patient sample audit. Key auditing variables, discrepancy types, and severity levels were analysed across two study groups, primary repair and staged repair.
Results:
Of the total 572 study patients, data from 58 patients (31 staged repairs and 27 primary repairs) were source data verified. Amongst the 1790 variables audited, 45 discrepancies were discovered, resulting in an overall accuracy rate of 97.5%. High accuracy rates were consistent across all CCRC institutions ranging from 94.6% to 99.4% and were reported for both minor (1.5%) and major discrepancies type classifications (1.1%).
Conclusion:
Findings indicate that implementing a virtual multicentre training initiative and remote source data verification audit can identify data quality concerns and produce a reliable, high-quality dataset. Remote auditing capacity is especially important during the current COVID-19 pandemic.
A systematic review and network meta-analysis were conducted to assess the relative efficacy of internal or external teat sealants given at dry-off in dairy cattle. Controlled trials were eligible if they assessed the use of internal or external teat sealants, with or without concurrent antimicrobial therapy, compared to no treatment or an alternative treatment, and measured one or more of the following outcomes: incidence of intramammary infection (IMI) at calving, IMI during the first 30 days in milk (DIM), or clinical mastitis during the first 30 DIM. Risk of bias was based on the Cochrane Risk of Bias 2.0 tool with modified signaling questions. From 2280 initially identified records, 32 trials had data extracted for one or more outcomes. Network meta-analysis was conducted for IMI at calving. Use of an internal teat sealant (bismuth subnitrate) significantly reduced the risk of new IMI at calving compared to non-treated controls (RR = 0.36, 95% CI 0.25–0.72). For comparisons between antimicrobial and teat sealant groups, concerns regarding precision were seen. Synthesis of the primary research identified important challenges related to the comparability of outcomes, replication and connection of interventions, and quality of reporting of study conduct.
A systematic review and meta-analysis were conducted to determine the efficacy of selective dry-cow antimicrobial therapy compared to blanket therapy (all quarters/all cows). Controlled trials were eligible if any of the following were assessed: incidence of clinical mastitis during the first 30 DIM, frequency of intramammary infection (IMI) at calving, or frequency of IMI during the first 30 DIM. From 3480 identified records, nine trials were data extracted for IMI at calving. There was an insufficient number of trials to conduct meta-analysis for the other outcomes. Risk of IMI at calving in selectively treated cows was higher than blanket therapy (RR = 1.34, 95% CI = 1.13, 1.16), but substantial heterogeneity was present (I2 = 58%). Subgroup analysis showed that, for trials using internal teat sealants, there was no difference in IMI risk at calving between groups, and no heterogeneity was present. For trials not using internal teat sealants, there was an increased risk in cows assigned to a selective dry-cow therapy protocol, compared to blanket treatment, with substantial heterogeneity in this subgroup. However, the small number of trials and heterogeneity in the subgroup without internal teat sealants suggests that the relative risk between treatments may differ from the determined point estimates based on other unmeasured factors.
A systematic review and network meta-analysis were conducted to assess the relative efficacy of antimicrobial therapy given to dairy cows at dry-off. Eligible studies were controlled trials assessing the use of antimicrobials compared to no treatment or an alternative treatment, and assessed one or more of the following outcomes: incidence of intramammary infection (IMI) at calving, incidence of IMI during the first 30 days in milk (DIM), or incidence of clinical mastitis during the first 30 DIM. Databases and conference proceedings were searched for relevant articles. The potential for bias was assessed using the Cochrane Risk of Bias 2.0 algorithm. From 3480 initially identified records, 45 trials had data extracted for one or more outcomes. Network meta-analysis was conducted for IMI at calving. The use of cephalosporins, cloxacillin, or penicillin with aminoglycoside significantly reduced the risk of new IMI at calving compared to non-treated controls (cephalosporins, RR = 0.37, 95% CI 0.23–0.65; cloxacillin, RR = 0.55, 95% CI 0.38–0.79; penicillin with aminoglycoside, RR = 0.42, 95% CI 0.26–0.72). Synthesis revealed challenges with a comparability of outcomes, replication of interventions, definitions of outcomes, and quality of reporting. The use of reporting guidelines, replication among interventions, and standardization of outcome definitions would increase the utility of primary research in this area.
Infections due to Campylobacter, Escherichia coli and Salmonella pose a significant health burden in Canada, resulting in major costs to the health care system and economic impacts due to lost productivity resulting from illness. Recent literature suggests that climate may play a role in the prevalence of these pathogens along the food chain. This study used integrated surveillance data to examine associations between weather variables, serving as a proxy for climate, in agricultural areas and Campylobacter, generic E. coli and Salmonella contamination on samples of beef, poultry and swine meat products in Canada. Various temperature metrics (average, maximum and variability) were correlated with Campylobacter prevalence along the food chain. The prevalence of E. coli and Salmonella was correlated with both precipitation and temperatures metrics; however, analysis for E. coli was limited to beef and swine meats at retail settings, because prevalence in other combinations approached 100%, which obviated further analysis. Campylobacter contamination in poultry and swine at abattoir and retail settings demonstrated a seasonal trend, with increased prevalence generally from June or July through November, compared to the baseline month of December. Based on these analyses, Campylobacter is the most likely foodborne bacteria studied whose occurrence in meat products is affected by climatic changes in Canada. An exploratory analysis of data at the provincial scale, using Ontario as an example, revealed similar directional relationships between climate and bacterial prevalence.
The marine reservoir effect is the difference in radiocarbon (14C) between the atmosphere and the marine surface ocean. To overcome the dating errors induced, it is necessary to correct marine 14C ages for this effect. ΔR is the difference between the marine 14C age and the marine calibration curve based on an ocean-atmosphere box diffusion model, which accounts for the time delay in diffusion of carbon into the ocean from the atmosphere and biosphere. This global assessment, however, requires computation of a regional ∆R value for calibration to cater for studies based on a local scale. In this paper the marine reservoir effect is assessed for the southern and eastern coasts of South Africa using 14C dating on pre-1950 marine shells of known age. The resultant ∆R values enable a more complete understanding of the marine reservoir effect along the southern and eastern coastal zone of South Africa. 14C age determinations were conducted on 15 shell samples of known age and the results, combined with previously published values, were used to calculate regional marine reservoir correction values. The east coast has a weighted mean ∆R of 121±16 14C yr, while the south coast has a weighted mean ∆R of 187±18 14C yr.
Presented here are stable nitrogen isotope data from a rock hyrax (Procavia capensis) middens from northwestern Namibia that record a series of rapid aridification events beginning at ca. 3800 cal yr BP, and which mark a progressive decrease in regional humidity across the Holocene. Strong correlations exist between this record and other terrestrial and marine archives from southern Africa, indicating that the observed pattern of climate change is regionally coherent. Combined, these data indicate hemispheric synchrony in tropical African climate change during the Holocene, with similar trends characterising the termination of the ‘African Humid Period’ (AHP) in both the northern and southern tropics. These findings run counter to the widely accepted model of direct low-latitude insolation forcing, which requires an anti-phase relationship to exist between the hemispheres. The combined dataset highlights: 1) the importance of forcing mechanisms influencing the high northern latitudes in effecting low-latitude climate change in Africa, and 2) the potential importance of solar forcing and variations in the Earth's geomagnetic shield in determining both long-term and rapid centennial-scale climate changes, identifying a possible mechanism for the variations marking the AHP termination in both the southern and northern tropics.
This chapter provides a perspective on vegetation changes (as a proxy for overall terrestrial ecosystem changes) within southern Africa’s summer and winter rainfall zones. While climate is a major determinant on southern African ecosystems, topography, geology and fire also play critical roles in ecosystem pattern and processes. Late Quaternary climate changes impacted on southern African ecosystems but did not result in wholesale migration of these biomes. Instead, the palaeoenvironmental record reveals that community dynamics within biomes or at their ecotonal boundaries changed as individual species were favoured or disadvantaged by changing conditions (e.g. climate, fire regimes and/or human impacts) over time.
We describe a versatile infrared camera/spectrograph, IRIS, designed and constructed at the Anglo-Australian Observatory for use on the Anglo-Australian Telescope. A variety of optical configurations can be selected under remote control to provide several direct image scales and a few low-resolution spectroscopic formats. Two cross-dispersed transmission echelles are of novel design, as is the use of a modified Bowen-Burch system to provide a fast f/ratio in the widest-field option. The drive electronics includes a choice of readout schemes for versatility, and continuous display when the array is not taking data, to facilitate field acquisition and focusing.
The linearity of the detector has been studied in detail. Although outwardly good, slight nonlinearities prevent removal of fixed-pattern noise from the data without application of a cubic linearising function.
Specific control and data-reduction software has been written. We describe also a scanning mode developed for spectroscopic imaging.
The recording and analysis of a burnt mound and adjacent palaeochannel deposits on the floodplain of the River Soar in Leicestershire revealed that the burnt mound was in use, possibly for a number of different purposes, at the transition from the Neolithic to the Bronze Age. An extensive radiocarbon dating programme indicated that the site was revisited. Human remains from the palaeochannel comprised the remains of three individuals, two of whom pre-dated the burnt mound by several centuries while the partial remains of a third, dating from the Late Bronze Age, provided evidence that this individual had met a violent death. These finds, along with animal bones dating to the Iron Age, and the remains of a bridge from the early medieval period, suggest that people were drawn to this location over a long period of time.
A postal survey with selected follow-up interviews was conducted on a complete population of females aged 18–22 registered with two group general practices in Leicestershire. The mailing included the Eating Attitudes Test (EAT) and the Crown—Crisp Experiential Index (CCEI). There was a 70% response rate and 411 usable questionnaires were returned. Twenty-eight respondents (6·8%) produced EAT scores of 30 or more. One case of anorexia nervosa and one of bulimia were identified. Interviews of high EAT scoring subjects revealed several subjects with partial syndromes which failed to fulfil diagnostic criteria for either clinical eating disorder.
The distribution, abundance, and types of micro-organisms attached to littoral and sublittoral sand grains have been described. Micro-organisms are present in colonies, ranging from 5 to 150 cells per colony. Many colonies consist of one species. Some colonies are in or surrounded by staining material, others are on flat unstained surfaces. Colonies in staining material often occur in hollows. Large areas of surface between the colonies and staining material are completely bare. Evidence suggests that abrasion may stop micro-organisms colonizing flat or convex surfaces. On grains from the sediment surface, bacteria, blue-green algae (Cyanophyceae), and diatoms (Bacillariaceae) are common. The microbial flora may alter only slightly to depths of 15 cm below the sediment surface, or may change within a few mm. It is sparse towards high water, but differs little between lower littoral and sublittoral sands. The results are discussed in relation to substrate selection by marine invertebrates.