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Although dementia is a terminal condition, palliation can be a challenge for clinical services. As dementia progresses, people frequently develop behavioural and psychological symptoms, sometimes so severe they require care in specialist dementia mental health wards. Although these are often a marker of late disease, there has been little research on the mortality of people admitted to these wards.
Aims
We sought to describe the mortality of this group, both on-ward and after discharge, and to investigate clinical features predicting 1-year mortality.
Method
First, we conducted a retrospective analysis of 576 people with dementia admitted to the Cambridgeshire and Peterborough National Health Service (NHS) Foundation Trust dementia wards over an 8-year period. We attempted to identify predictors of mortality and build predictive machine learning models. To investigate deaths occurring during admission, we conducted a second analysis as a retrospective service evaluation involving mental health wards for people with dementia at four NHS trusts, including 1976 admissions over 7 years.
Results
Survival following admission showed high variability, with a median of 1201 days (3.3 years). We were not able to accurately predict those at high risk of death from clinical data. We found that on-ward mortality remains rare but had increased from 3 deaths per year in 2013 to 13 in 2019.
Conclusions
We suggest that arrangements to ensure effective palliation are available on all such wards. It is not clear where discussions around end-of-life care are best placed in the dementia pathway, but we suggest it should be considered at admission.
Changes in the infrared absorption spectrum of ammonium-saturated rectorite on heating suggest that the ammonium cations are hydrogen bonded to water molecules when the mineral is hydrated. Further spectral changes above 300°C indicate that lattice OH groups are perturbed by protons liberated from the decomposition of ammonium ions giving rise to an absorption doublet at 3500 and 3476 cm-1. The doublet attains maximal intensity when decomposition of ammonium cations and dehydroxylation of the mineral is complete at about 550°C.
The perturbation effect occurs only for swelling dioctahedral minerals which derive their layer charge from Al-for-Si substitution.
A terrestrial (lacustrine and fluvial) palaeoclimate record from Hoxne (Suffolk, UK) shows two temperate phases separated by a cold episode, correlated with MIS 11 subdivisions corresponding to isotopic events 11.3 (Hoxnian interglacial period), 11.24 (Stratum C cold interval), and 11.23 (warm interval with evidence of human presence). A robust, reproducible multiproxy consensus approach validates and combines quantitative palaeotemperature reconstructions from three invertebrate groups (beetles, chironomids, and ostracods) and plant indicator taxa with qualitative implications of molluscs and small vertebrates. Compared with the present, interglacial mean monthly air temperatures were similar or up to 4.0°C higher in summer, but similar or as much as 3.0°C lower in winter; the Stratum C cold interval, following prolonged nondeposition or erosion of the lake bed, experienced summers 2.5°C cooler and winters between 5°C and 10°C cooler than at present. Possible reworking of fossils into Stratum C from underlying interglacial assemblages is taken into account. Oxygen and carbon isotopes from ostracod shells indicate evaporatively enriched lake water during Stratum C deposition. Comparative evaluation shows that proxy-based palaeoclimate reconstruction methods are best tested against each other and, if validated, can be used to generate more refined and robust results through multiproxy consensus.
OBJECTIVES/GOALS: The new CLIC Education & Career Development Gateway aims to be a translational science workforce ecosystem for CTSAs to share learning and training resources and career opportunities. The Gateway also provides individualized assistance to identify and implement TS learning and training resources. METHODS/STUDY POPULATION: The CLIC Education & Career Development Gateway, located on the CLIC website, is an entry way to: 1) the Education Clearinghouse, a platform where CTSA Program hubs can find and share educational resources individually or as part of resource kits; 2) the Opportunities Board, which includes jobs and mini-sabbaticals from CTSA Program hubs; and 3) the Education & Training Navigator, a personalized approach to education and training requests. These approaches help empower and support a cooperative learning and training community that is inclusive and collaborative, facilitating and amplifying opportunities for the sharing of educational resources throughout the translational science workforce. RESULTS/ANTICIPATED RESULTS: Through a person-centered, direct engagement approach, the anticipated outcomes of these efforts are to promote increased collaboration across CTSA Program Hubs and partners, and the amplification of accessible, relevant existing resources. Another anticipated outcome is increased production of educational materials through the reduction of work duplication and identification of gaps in education and training resources. The Gateway also provides an opportunity to communicate the work and efforts that consortium-level special groups (working groups, special interest groups, etc.) produce. Ongoing evaluations and suggestions will help determine future improvements and functionalities. DISCUSSION/SIGNIFICANCE OF IMPACT: CLIC’s education and training ecosystem promotes education as a community space to facilitate opportunities for collaboration and partnerships, amplifying visibility of the work created by members of the CTSA community, and encouraging a transformative career trajectory for trainees and scholars.
To determine the acceptability, internal consistency and test–retest reliability of self-efficacy, motivation and knowledge scales relating to pre-school children’s nutrition, oral health and physical activity.
Design
An online questionnaire was completed twice with an interval of 7–11d.
Setting
Online questionnaires were sent to participants via email from nursery managers. The parent questionnaire was also available on the parenting website www.netmums.com.
Participants
Eighty-two parents and sixty-nine nursery staff from Bristol, UK who had and worked with 2–4-year-olds, respectively.
Results
Response rates were 86·3 and 86·0 % and missing data 15·9 and 14·5 % for the second administration of the parent and nursery staff questionnaires, respectively. Weighted κ coefficients for individual items mostly fell under the ‘moderate’ agreement category for the parental (75·0 %) and nursery staff (55·8 %) items. All self-efficacy and motivation scales had acceptable levels of internal consistency (Cronbach’s α coefficients>0·7). The intraclass correlation coefficients for the self-efficacy, motivation and knowledge scales ranged between 0·48 and 0·82. Paired t tests found an increase between test and retest knowledge scores for the Nutrition Motivation (t=−2·91, df=81, P=0·00) and Knowledge (t=−3·22, df=81, P=0·00) scales in the parent questionnaire.
Conclusions
Our findings demonstrate that the items and scales show good acceptability, internal consistency and test–retest reliability.
Different diagnostic interviews are used as reference standards for major depression classification in research. Semi-structured interviews involve clinical judgement, whereas fully structured interviews are completely scripted. The Mini International Neuropsychiatric Interview (MINI), a brief fully structured interview, is also sometimes used. It is not known whether interview method is associated with probability of major depression classification.
Aims
To evaluate the association between interview method and odds of major depression classification, controlling for depressive symptom scores and participant characteristics.
Method
Data collected for an individual participant data meta-analysis of Patient Health Questionnaire-9 (PHQ-9) diagnostic accuracy were analysed and binomial generalised linear mixed models were fit.
Results
A total of 17 158 participants (2287 with major depression) from 57 primary studies were analysed. Among fully structured interviews, odds of major depression were higher for the MINI compared with the Composite International Diagnostic Interview (CIDI) (odds ratio (OR) = 2.10; 95% CI = 1.15–3.87). Compared with semi-structured interviews, fully structured interviews (MINI excluded) were non-significantly more likely to classify participants with low-level depressive symptoms (PHQ-9 scores ≤6) as having major depression (OR = 3.13; 95% CI = 0.98–10.00), similarly likely for moderate-level symptoms (PHQ-9 scores 7–15) (OR = 0.96; 95% CI = 0.56–1.66) and significantly less likely for high-level symptoms (PHQ-9 scores ≥16) (OR = 0.50; 95% CI = 0.26–0.97).
Conclusions
The MINI may identify more people as depressed than the CIDI, and semi-structured and fully structured interviews may not be interchangeable methods, but these results should be replicated.
Declaration of interest
Drs Jetté and Patten declare that they received a grant, outside the submitted work, from the Hotchkiss Brain Institute, which was jointly funded by the Institute and Pfizer. Pfizer was the original sponsor of the development of the PHQ-9, which is now in the public domain. Dr Chan is a steering committee member or consultant of Astra Zeneca, Bayer, Lilly, MSD and Pfizer. She has received sponsorships and honorarium for giving lectures and providing consultancy and her affiliated institution has received research grants from these companies. Dr Hegerl declares that within the past 3 years, he was an advisory board member for Lundbeck, Servier and Otsuka Pharma; a consultant for Bayer Pharma; and a speaker for Medice Arzneimittel, Novartis, and Roche Pharma, all outside the submitted work. Dr Inagaki declares that he has received grants from Novartis Pharma, lecture fees from Pfizer, Mochida, Shionogi, Sumitomo Dainippon Pharma, Daiichi-Sankyo, Meiji Seika and Takeda, and royalties from Nippon Hyoron Sha, Nanzando, Seiwa Shoten, Igaku-shoin and Technomics, all outside of the submitted work. Dr Yamada reports personal fees from Meiji Seika Pharma Co., Ltd., MSD K.K., Asahi Kasei Pharma Corporation, Seishin Shobo, Seiwa Shoten Co., Ltd., Igaku-shoin Ltd., Chugai Igakusha and Sentan Igakusha, all outside the submitted work. All other authors declare no competing interests. No funder had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.
Sudden cardiac death (SCD) is responsible for 5%-10% of all deaths among children 5-19 years-of-age. The incidence of SCD in youth in Michigan (USA) and nationwide is higher in racial/ethnic minorities and in certain geographic areas. School cardiac emergency response plans (CERPs) increase survival after cardiac arrest. However, school cardiac emergency preparedness remains variable. Studying population-level factors associated with school cardiac emergency preparedness and incidence of SCD in the young may improve understanding of disparities in the incidence of SCD.
Hypothesis/Problem
The objective of this pilot study was to determine the association of elements of high school cardiac emergency preparedness, including Automated External Defibrillator (AED) distribution and the presence of CERPs with county sociodemographic characteristics and county incidence of SCD in the young.
Methods
Surveys were sent to representatives from all public high schools in 30 randomly selected Michigan counties. Counties with greater than 50% response rate were included (n=19). Association of county-level sociodemographic characteristics with incidence of SCD in the young and existence of CERPs were evaluated using Spearman correlation coefficient.
Results
Factors related to the presence of AEDs were similar across counties. Schools in counties of lower socioeconomic status (SES; lower-median income, lower per capita income, and higher population below poverty level) were less likely to have a CERP than those with higher SES (all P<.01). Lack of a CERP was associated with a higher incidence of SCD in youth (r=-0.71; P=.001). Overall incidence of SCD in youth was higher in lower SES counties (r=-0.62 in median income and r=0.51 in population below poverty level; both P<.05).
Conclusion
County SES is associated with the presence of CERPs in schools, suggesting a link between school cardiac emergency preparedness and county financial resources. Additionally, counties of lower SES demonstrated higher incidence of SCD in the young. Statewide and national studies are required to further explore the factors relating to geographic and socioeconomic differences in cardiac emergency preparedness and the incidence of SCD in the young.
WhiteMJ, LoccohEC, GobleMM, YuS, OdetolaFO, RussellMW. High School Cardiac Emergency Response Plans and Sudden Cardiac Death in the Young. Prehosp Disaster Med. 2017;32(3):269–272.
Radiolaria have been recovered in acid residues from late Middle Cambrian strata in western Utah. Although the first Cambrian radiolaria were described by Nazarov (1973) from the Batenevskij Mountains of eastern Kazakhstan in the Soviet Union, radiolaria have not been reported from the Cambrian of North America. Except for the Kazakhstan specimens, the oldest known radiolaria are from the Lower Ordovician of western Spitsbergen (Fortey and Holdsworth, 1971). In North America only two accounts of Ordovician assemblages have been reported from southwestern Newfoundland and eastern Nevada (Bergström, 1974; Dunham and Murphy, 1976).
We present a list of bright (< 17 mag) southern QSOs and bright (< 11 mag) stars that may be suitable for the Hubble Space Telescope link between the Hipparcos astrometric reference frame and the VLBI extragalactic frame. The QSOs have been selected from various lists of radio objects and identifications. The stars have been selected from the Strasbourg (CDS) data base and from the Preliminary Second Cape Photographic Catalogue, and supplemented with stars measured from the SERC IIIa-J Schmidt survey. The list of QSOs and stars have been included in the Hipparcos and HST schedule of observations.
During 1990 we surveyed the southern sky using a multi-beam receiver at frequencies of 4850 and 843 MHz. The half-power beamwidths were 4 and 25 arcmin respectively. The finished surveys cover the declination range between +10 and −90 degrees declination, essentially complete in right ascension, an area of 7.30 steradians. Preliminary analysis of the 4850 MHz data indicates that we will achieve a five sigma flux density limit of about 30 mJy. We estimate that we will find between 80 000 and 90 000 new sources above this limit. This is a revised version of the paper presented at the Regional Meeting by the first four authors; the surveys now have been completed.
We present the results of two 2.3 μm near-infrared (NIR) radial velocity (RV) surveys to detect exoplanets around 36 nearby and young M dwarfs. We use the CSHELL spectrograph (R ~ 46,000) at the NASA InfraRed Telescope Facility (IRTF), combined with an isotopic methane absorption gas cell for common optical path relative wavelength calibration. We have developed a sophisticated RV forward modeling code that accounts for fringing and other instrumental artifacts present in the spectra. With a spectral grasp of only 5 nm, we are able to reach long-term radial velocity dispersions of ~20–30 m s−1 on our survey targets.
Identifying risk factors for insulin resistance in adolescence could provide valuable information for early prevention. The study sought to identify risk factors for changes in insulin resistance and fasting blood glucose levels.
Design
Prospective cohort of girls participating in the National Heart, Lung, and Blood Institute Growth and Health Study.
Setting
USA.
Subjects
Adolescent girls (n 774) assessed at the ages of 16–17 and 18–19 years. Over a 3-year period, measurements of fasting blood glucose and insulin and serum cotinine were taken, and dietary intake (3 d food diary), smoking status and physical activity levels were self-reported.
Results
Improvements in homeostasis model assessment of insulin resistance (HOMA-IR) were associated with increases in the percentage of energy intake from polyunsaturated fats (β = −3·33, 95 % CI −6·28, −0·39, P = 0·03) and grams of soluble fibre (β = −5·20, 95 % CI −9·81, −0·59, P = 0·03) between the ages of 16–17 and 18–19 years; with similar findings for insulin. Transitioning into obesity was associated with an increase in insulin (β = 6·34, 95 % CI 2·78, 9·91, P < 0·001) and HOMA-IR (β = 28·77, 95 % CI 8·13, 49·40, P = 0·006). Serum cotinine concentrations at 16–17 years, indicating exposure to tobacco, were associated with large increases (β = 15·43, 95 % CI 6·09, 24·77, P < 0·001) in fasting blood glucose concentrations.
Conclusions
Increases in the percentage of energy from polyunsaturated fat and fibre, and avoidance of excess weight gain and tobacco exposure, could substantially reduce the risk of insulin resistance in late adolescence.
The paper reports on the fourth (2010) season of fieldwork of the Cyrenaican Prehistory Project, and on further results of analyses of artefacts and organic materials collected in the 2009 season. Ground-based LiDar has provided both an accurate 3D scan of the Haua Fteah cave and information on the cave's morphometry or origins. The excavations in the cave focussed on Middle Palaeolithic or Middle Stone Age ‘Pre-Aurignacian’ layers below the base of the Middle Trench beside the McBurney Deep Sounding (Trench D) and on Final Palaeolithic ‘Oranian’ layers beside the upper part of the Middle Trench (Trench M). Although McBurney referred to the upper part of the Deep Sounding as more or less sterile, the 2010 excavations found evidence for small-scale but regular human presence in the form of stone artefacts and debitage, though given the sedimentary context the latter are unlikely to represent in situ knapping. The excavations of Trench M extended from the basal Capsian layers investigated in 2009 through Oranian layers to the transition with the Dabban Upper Palaeolithic. Some 17,000 lithic pieces have been studied from the Capsian and Oranian layers excavated in Trench M, in an area measuring less than 2 m by 1 m by 1.1 m deep, along with numerous animal bones, molluscs, and macrobotanical remains, as well as occasional shell beads. Preliminary studies of the lithics, bones, molluscs, and plant remains are revealing the changing character of late Pleistocene (Oranian) and early Holocene (Capsian) occupation in the Haua Fteah. Alongside the work in the Haua Fteah, the project continued its assessment of the Quaternary and archaeological sequences of the Cyrenaican coastland and completed a transect survey of surface lithic materials and their landform contexts from the pre-desert across the Gebel Akhdar to the coast, with a new focus on the al-Marj basin. Significant differences are emerging in patterns of Middle Palaeolithic and later hominin occupation and palaeodemography.
The Second Language Studies (SLS) Program was established in 2005 with the express purpose of providing ‘a firm foundation in the field of Second Language Acquisition and its application to current second language research and teaching’ (http://sls.msu.edu). Under the leadership of Professor Susan Gass, the program has grown to include 12 core faculty members and 27 Ph.D. students. As an interdisciplinary program, linkages across the university exist with the Department of Linguistics and Germanic, Slavic, Asian, and African Languages; the Department of French, Classics, and Italian; the Department of Spanish and Portuguese; the Arabic Language Instruction Flagship; the M.A. TESOL Program; the Center for Language Education and Research; the English Language Center; the Center for the Support of Language Teaching; the Department of Psychology; and the College of Education.
Forty-eight approximately 18-month-old Scottish Blackface ewes were used to study the effects of two levels of nutrition during mid-pregnancy (30–98 days of gestation) on the birth weight of lambs from ewes varying in weight, size and condition at first mating. The mean live weight (42–4 kg), size index (31–9) and condition score (2–4) at mating of the 26 ewes from flock A were all less than those of the 22 ewes from flock B (54–5, 39–4 and 2–9 respectively). Mean intakes of the low and high nutritional treatment ewes during mid-pregnancy were 10–6 and 22–0 g/kg/day respectively of a pelleted diet supplying 8–81 MJ metabolizable energy and 125–5 g crude protein/kg. These intakes produced estimated changes in net maternal weight of approximately – 5 and 0 kg respectively.
Mean lamb birth weights from ewes on the low and high nutritional treatments were:flock A, 3–32 and 3–83 kg; flock B, 4–96 and 4–23 kg respectively. Analyses showed intake during mid-pregnancy to have a positive effect on lamb birth weight in the flock A ewes, and a negative effect in flock B ewes. Mating weight accounted for 78% of the variance in birth weight in the low nutritional treatment ewes but had little effect in those on the higher level of feeding.
The practical implications of the results are discussed in relation to levels of juvenile nutrition.
The eight dominant culturable members of an Antarctic fellfield soil bacterial community were four Arthrobacter species, Sanguibacter suarezii, Aureobacterium testaceum, a Bacillus sp., and a Pseudomonas sp.. All of the isolates grew at 2°C, but two of the Arthrobacter spp. were psychrophilic, while the other six bacterial species were psychrotolerant. However, the fastest growing organisms at low temperatures were not the psychrophiles, and the psychrotolerant Bacillus sp. grew fastest at temperatures up to 25°C. When the growth temperature of cultures was altered, the phospholipid content of the two psychrophilic Arthrobacter spp. decreased, whereas the phospholipid contents of the psychrotolerant spp. either increased or did not change. Only one psychrophilic and one psychrotolerant Arthrobacter sp. modified its polar lipid head-group composition in response to a lowering of growth temperature. The change in Arthrobacter sp. CL2-1 was particularly marked and novel in that at low temperatures phosphatidylethanolamine was replaced completely by a phosphoglycolipid and phosphatidylserine, neither of which was present at higher growth temperatures. All eight isolates altered the fatty acyl compositions of their membrane lipids in a manner that was only partially dependent on taxonomic status. In Bacillus sp. C2-1 the changes were opposite to that predicted on the basis of membrane fluidity considerations. The isolates used different combinations of changes in fatty acid branching, unsaturation and chain length. There was no single strategy of thermal adaptation that was employed and the variety of strategies used did not follow phylogenetic boundaries.