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.
Eating disorders, including anorexia nervosa, bulimia nervosa and binge eating disorder, are psychiatric conditions associated with high mortality rates, particularly due to suicide. Although eating disorders are strongly associated with suicidal ideation, attempts, and fatalities, the precise relationship between these conditions remains poorly understood. While substantial genetic influences have been identified for both eating disorders and suicidality, the shared genetics contributing to their co-occurrence remain unclear. In this study, we utilized a multivariate approach to examine the shared genetic architecture of eating disorder symptoms, suicidal thoughts and behaviors in ~20,000 participants from the COVID-19 Psychiatry and Neurological Genetics (COPING) study. We applied individual-level structural equation modeling to explore the factor structure underlying eating disorder symptoms and suicidal ideation, followed by genetic correlation analyses. We modeled the general factor of susceptibility to eating disorders and suicidal ideation that was as strongly genetically influenced as both conditions, with mean SNP heritability of 9%. Importantly, despite the frequent co-occurrence of eating disorders with other psychiatric conditions, our findings highlight the specificity of the relationship between eating disorders and suicidality, independent of other co-occurring psychopathology, such as depression and anxiety. This specificity highlights the need for targeted approaches in understanding the shared susceptibility factors.
The reflection of a shock pulse at a liquid–gas interface occurs in many applications, from lithotripsy to underwater explosions and additive manufacturing. In linear theory, reflection and transmission at an interface depend only on the impedance difference, but this does not hold for a nonlinear pulse. This work develops an analytical framework for computing the reflection and transmission coefficients for an impulsive shock wave at a liquid–gas interface. The problem is treated analytically by considering idealised pulses and solving a series of consecutive Riemann problems. These correspond to the initial interaction with the interface and important subsequent wave interactions that enable a complete description of the process to be obtained. Comparisons with numerical and existing analytical approaches are made for the case of a water–air interface. In the acoustic limit, the method produces results identical to those of linear acoustic theory. As the pulse strength increases, the proposed method agrees well with numerical simulation results, whereas existing analytical methods that consider only the interface fail. We detail how a reflecting pulse can put water into tension without any incident negative pressure. It is further shown that the magnitude of the reflection coefficient decreases with increasing incident shock pressure, and the reflected pulse widens. Reflections of pulses with positive and negative pressures temporarily create negative pressure regions with greater magnitude than the incident pulse. Finally, we consider non-idealised waves. Comparisons with simulations show that the reflection characteristics can be explained qualitatively using the analytical method, and the reflection coefficients are predicted accurately.
Advice from avian influenza experts suggests that there is a high risk that highly pathogenic avian influenza will arrive in the Southern Ocean during the austral summers.
The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery (WCPCCS) will be held in Washington DC, USA, from Saturday, 26 August, 2023 to Friday, 1 September, 2023, inclusive. The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery will be the largest and most comprehensive scientific meeting dedicated to paediatric and congenital cardiac care ever held. At the time of the writing of this manuscript, The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery has 5,037 registered attendees (and rising) from 117 countries, a truly diverse and international faculty of over 925 individuals from 89 countries, over 2,000 individual abstracts and poster presenters from 101 countries, and a Best Abstract Competition featuring 153 oral abstracts from 34 countries. For information about the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery, please visit the following website: [www.WCPCCS2023.org]. The purpose of this manuscript is to review the activities related to global health and advocacy that will occur at the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery.
Acknowledging the need for urgent change, we wanted to take the opportunity to bring a common voice to the global community and issue the Washington DC WCPCCS Call to Action on Addressing the Global Burden of Pediatric and Congenital Heart Diseases. A copy of this Washington DC WCPCCS Call to Action is provided in the Appendix of this manuscript. This Washington DC WCPCCS Call to Action is an initiative aimed at increasing awareness of the global burden, promoting the development of sustainable care systems, and improving access to high quality and equitable healthcare for children with heart disease as well as adults with congenital heart disease worldwide.
The Advancing Mental Health Equality Collaborative is an innovative 3-year quality improvement programme led by the Royal College of Psychiatrists’ National Collaborating Centre for Mental Health (NCCMH). The collaborative was launched in July 2021 and involves 18 organisations across the UK who, with quality improvement support from the NCCMH, are working to understand the needs of their population and identify communities at risk of experiencing inequality to improve access, experience and outcomes of mental health care, support, and treatment for those populations.
Methods
An overarching driver diagram for the Collaborative was developed in collaboration with a wide range of stakeholders through steering group meetings, design workshops and remote consultation. This overarching driver diagram informs the development of population-specific driver diagrams, based on the population segments organisations selected to focus on. Each organisation was allocated an experienced quality improvement coach who supports them to apply a quality improvement approach to plan and deliver their projects, including support to generate insights based on data, staff and community engagement, carry out assets mapping, develop the project's aim and key drivers organisations need to work towards, identify measures, generate change ideas to be tested, and sustain successful changes.
Members of organisations taking part also attend quarterly learning sets where they come together to network, share challenges and ideas, and learn from each other.
Results
Populations identified by organisations include children and young people; Black, Asian and Ethnic minority men aged 18+ years; carer population; neurodivergent individuals with comorbid mental health diagnoses; Muslim women/Black women; refugees and forced migrants; women military veterans in Greater Manchester and Lancashire; Bangladeshi and Pakistani men and women in Oldham; Traveller community in Somerset. A number of initiatives are being tested by teams to improve access, experience and outcomes of mental health care, support, and treatment for these populations, such as offering mental health awareness sessions for refugees in a range of languages.
Conclusion
Addressing inequality in mental health care is a long and complex process. The AMHE collaborative is supporting teams to take an innovative approach to tackle this issue, by ensuring their projects are fully co-produced with those affected by inequality. This includes engaging representatives from the communities they are trying to improve access, experience and outcomes for in all aspects of their quality improvement projects; from design to generating ideas to test, and ensuring they measure what is important to these communities to determine whether improvements have been made.
Understanding the distribution and extent of suitable habitats is critical for the conservation of endangered and endemic taxa. Such knowledge is limited for many Central African species, including the rare and globally threatened Grey-necked Picathartes Picathartes oreas, one of only two species in the family Picathartidae endemic to the forests of Central Africa. Despite growing concerns about land-use change resulting in fragmentation and loss of forest cover in the region, neither the extent of suitable habitat nor the potential species’ distribution is well known. We combine 339 (new and historical) occurrence records of Grey-necked Picathartes with environmental variables to model the potential global distribution. We used a Maximum Entropy modelling approach that accounted for sampling bias. Our model suggests that Grey-necked Picathartes distribution is strongly associated with steeper slopes and high levels of forest cover, while bioclimatic, vegetation health, and habitat condition variables were all excluded from the final model. We predicted 17,327 km2 of suitable habitat for the species, of which only 2,490 km2 (14.4%) are within protected areas where conservation designations are strictly enforced. These findings show a smaller global distribution of predicted suitable habitat forthe Grey-necked Picathartes than previously thought. This work provides evidence to inform a revision of the International Union for Conservation of Nature (IUCN) Red List status, and may warrant upgrading the status of the species from “Near Threatened” to “Vulnerable”.
Supplemental food from anthropogenic sources is a source of conflict with humans for many wildlife species. Food-seeking behaviours by black bears Ursus americanus and brown bears Ursus arctos can lead to property damage, human injury and mortality of the offending bears. Such conflicts are a well-known conservation management issue wherever people live in bear habitats. In contrast, the use of anthropogenic foods by the polar bear Ursus maritimus is less common historically but is a growing conservation and management issue across the Arctic. Here we present six case studies that illustrate how negative food-related interactions between humans and polar bears can become either chronic or ephemeral and unpredictable. Our examination suggests that attractants are an increasing problem, exacerbated by climate change-driven sea-ice losses that cause increased use of terrestrial habitats by bears. Growing human populations and increased human visitation increase the likelihood of human–polar bear conflict. Efforts to reduce food conditioning in polar bears include attractant management, proactive planning and adequate resources for northern communities to reduce conflicts and improve human safety. Permanent removal of unsecured sources of nutrition, to reduce food conditioning, should begin immediately at the local level as this will help to reduce polar bear mortality.
A multi-disciplinary expert group met to discuss vitamin D deficiency in the UK and strategies for improving population intakes and status. Changes to UK Government advice since the 1st Rank Forum on Vitamin D (2009) were discussed, including rationale for setting a reference nutrient intake (10 µg/d; 400 IU/d) for adults and children (4+ years). Current UK data show inadequate intakes among all age groups and high prevalence of low vitamin D status among specific groups (e.g. pregnant women and adolescent males/females). Evidence of widespread deficiency within some minority ethnic groups, resulting in nutritional rickets (particularly among Black and South Asian infants), raised particular concern. Latest data indicate that UK population vitamin D intakes and status reamain relatively unchanged since Government recommendations changed in 2016. Vitamin D food fortification was discussed as a potential strategy to increase population intakes. Data from dose–response and dietary modelling studies indicate dairy products, bread, hens’ eggs and some meats as potential fortification vehicles. Vitamin D3 appears more effective than vitamin D2 for raising serum 25-hydroxyvitamin D concentration, which has implications for choice of fortificant. Other considerations for successful fortification strategies include: (i) need for ‘real-world’ cost information for use in modelling work; (ii) supportive food legislation; (iii) improved consumer and health professional understanding of vitamin D’s importance; (iv) clinical consequences of inadequate vitamin D status and (v) consistent communication of Government advice across health/social care professions, and via the food industry. These areas urgently require further research to enable universal improvement in vitamin D intakes and status in the UK population.
The media and scientific literature are increasingly reporting an escalation of large carnivore attacks on humans, mainly in the so-called developed countries, such as Europe and North America. Although large carnivore populations have generally increased in developed countries, increased numbers are not solely responsible for the observed rise in the number of attacks. Of the eight bear species inhabiting the world, two (i.e. the Andean bear and the giant panda) have never been reported to attack humans, whereas the other six species have: sun bears Helarctos malayanus, sloth bears Melursus ursinus, Asiatic black bears Ursus thibetanus, American black bears Ursus americanus, brown bears Ursus arctos, and polar bears Ursus maritimus. This chapter provides insights into the causes, and as a result the prevention, of bear attacks on people. Prevention and information that can encourage appropriate human behavior when sharing the landscape with bears are of paramount importance to reduce both potentially fatal human–bear encounters and their consequences to bear conservation.
The sparse record of Cretaceous crocodyliforms in Australia comprises only three species, all within the genus Isisfordia. Isisfordia duncani Salisbury et al., 2006 is from the Albian–Turonian Winton Formation of Queensland, and both Isisfordia molnari Hart et al., 2019 and Isisfordia selaslophensis Etheridge, 1917 have been described from opalized material from the Cenomanian Griman Creek Formation of New South Wales. Here, we describe new cranial and postcranial material, including the most complete crocodyliform skeleton from the Cretaceous of New South Wales, which is assigned to Isisfordia cf. I. selaslophensis. We also reappraise previously described crocodyliform material from the same locality. We find that much of this material displays features that are consistent with Isisfordia.
Legal aid, particularly in criminal justice, is a divisive subject. For its most devoted proponents, state funding of legal representation and advice for those accused of crime is a vital public good which helps to uphold values of fairness, justice and equality. For its most virulent critics, criminal legal aid is a wasteful, bloated relic from a bygone era of state intervention, serving primarily to help criminals escape justice. These are perhaps caricatures; but most opinions on criminal legal aid lie nearer to one or other extreme. This chapter examines how, like many areas of criminal justice, criminal legal aid has been subjected to (relatively) modern notions of marketisation, managerialism and competition. We aim to provide some critique of this by both exploring its development and briefly examining two ‘case studies’, which arguably demonstrate the impact of neo-liberal ideology on criminal legal aid.
While criminal legal aid should not be immune to criticism, there has been consensus for decades that the right to legal representation is fundamental and that legal aid is vital to securing this. In England and Wales (E&W), all persons detained in police custody have a right of access to a legally aided lawyer. This is, in theory, universally available and not based on a person's financial circumstances. In contrast, a person may be entitled to a legally aided lawyer if they are charged and brought to court as a defendant. If one is available, a state-funded duty lawyer – that is, a lawyer who works ‘on call’ to provide representation to any accused person without it – may be able to assist a defendant. However, if the duty lawyer is not available, defendants will need to rely on their ‘own’ lawyer. This is subject to a test of both merits and means; if the defendant does not fall below the qualifying threshold for legal aid, they must pay for their own lawyer. If they cannot afford one, the defendant may self-represent before a court or not attend at all.
The importance of legal representation in criminal proceedings – and by extension, legal aid – can be couched in terms of both the procedural benefits (such as the check on police power and adversarial scrutiny of prosecutions) as well as the language of welfarism.
Adverse programming of adult non-communicable disease can be induced by poor maternal nutrition during pregnancy and the periconception period has been identified as a vulnerable period. In the current study, we used a mouse maternal low-protein diet fed either for the duration of pregnancy (LPD) or exclusively during the preimplantation period (Emb-LPD) with control nutrition provided thereafter and postnatally to investigate effects on fetal bone development and quality. This model has been shown previously to induce cardiometabolic and neurological disease phenotypes in offspring. Micro 3D computed tomography examination at fetal stages Embryonic day E14.5 and E17.4, reflecting early and late stages of bone formation, demonstrated LPD treatment caused increased bone formation of relative high mineral density quality in males, but not females, at E14.5, disproportionate to fetal growth, with bone quality maintained at E17.5. In contrast, Emb-LPD caused a late increase in male fetal bone growth, proportionate to fetal growth, at E17.5, affecting central and peripheral skeleton and of reduced mineral density quality relative to controls. These altered dynamics in bone growth coincide with increased placental efficiency indicating compensatory responses to dietary treatments. Overall, our data show fetal bone formation and mineral quality is dependent upon maternal nutritional protein content and is sex-specific. In particular, we find the duration and timing of poor maternal diet to be critical in the outcomes with periconceptional protein restriction leading to male offspring with increased bone growth but of poor mineral density, thereby susceptible to later disease risk.
Nutrition plays a key role in later life health and wellbeing. Older people face a high risk of nutrient deficiencies and malnutrition that can lead to sarcopenia, loss of skeletal muscle mass and strength. A recent review identified that sarcopenia was associated with functional decline, higher rate of falls, higher incidence of hospitalisations and increased mortality (Beaudart et al, 2017). Understandably severe sarcopenia is extremely disabling as it prevents independent living and places an increasing burden on care providers.
Avoiding late life malnutrition is dependent on a number of factors including physical, mental and cognitive health. However, the relative impact of each of these factors and the relationships between them are not well understood. Physical factors, such as problems with chewing, swallowing and impaired mobility, all contribute towards nutritional decline (Hickson, 2006). Mental health status also plays a part, particularly depression, which has been identified as a predictor of poor appetite in older adults (see Engel et al, 2011). Treating depression can be an effective way of increasing appetite and improving nutritional status, but it is commonly under-diagnosed and under-treated among older people (Allan et al, 2014).
There is also growing evidence of associations between diet and cognitive function. Older people with dementia or cognitive decline have a poorer nutritional status than those without (Atti et al, 2008), with increasing dementia severity related to poorer nutritional status (Riccio et al, 2007). The potential for diet to protect against cognitive decline in older people is not currently well understood as much of the epidemiological research has not been supported in trials, and more research is needed to confirm the impact of changing whole diets on cognitive measures (Smith and Blumenthal, 2016).
To explore the associations and interactions between mental and physical health and diet, new intervention and prospective cohort studies are needed (Psaltopoulou et al, 2008). Such research is challenging to complete with older adults, as both ageing itself and the accompanying cognitive and physical decline are progressive and dynamic. Existing tools for measuring diet, cognition and physical activity typically provide snapshots of the situation and cannot identify rate of decline nor readily distinguish cause and effect.
Objectives: This study examines the cost-effectiveness of the OPTI-SCRIPT intervention on potentially inappropriate prescribing in primary care.
Methods: Economic evaluation, using incremental cost-effectiveness and cost utility analyses, conducted alongside a cluster randomized controlled trial of twenty-one general practices and 196 patients, to compare a multifaceted intervention with usual practice in primary care in Ireland. Potentially inappropriate prescriptions (PIPs) were determined by a pharmacist. Incremental costs, PIPs, and quality-adjusted life-years (QALYs) at 12-month follow-up were estimated using multilevel regression. Uncertainty was explored using cost-effectiveness acceptability curves.
Results: The intervention was associated with a nonsignificant mean cost increase of €407 (95 percent CIs, −357–1170), a significant mean reduction in PIPs of 0.379 (95 percent CI, 0.092–0.666), and a nonsignificant mean increase in QALYs of 0.013 (95 percent CIs, −0.016–0.042). The incremental cost per PIP avoided was €1,269 (95 percent CI, −1400–6302) and the incremental cost per QALY gained was €30,535 (95 percent CI, −334,846–289,498). The probability of the intervention being cost-effective was 0.602 at a threshold value of €45,000 per QALY gained and was at least 0.845 at threshold values of €2,500 per PIP avoided and higher.
Conclusions: While the OPTI-SCRIPT intervention was effective in reducing potentially inappropriate prescribing in primary care in Ireland, our findings highlight the uncertainty with respect to its cost-effectiveness. Further studies are required to explore the health and economic implications of interventions targeting potentially inappropriate prescribing.
A number of sea ice automated prediction systems are currently providing operational output to national ice service organizations. The Los Alamos CICE sea ice model is widely used in these systems but there is more variety in other areas, such as ocean forcing and model initialization. RIPS is a regional implementation of CICE that supports the CIS and includes a sophisticated 3DVar data assimilation system and a number of other innovations. GIOPS is a global ice-ocean prediction system that has been developed in close collaboration with Mercator-Ocean and satisfies a growing need in Canada for a multi-purpose global marine core service. TOPAZ is the Arctic regional component of the Copernicus Marine Environment Monitoring Service and uses the HYCOM ocean model and LIM sea ice model with an Ensemble Kalman Filter (EnKF) data assimilation system. The ACNFS/GOFS system supports the NIC and its global mandate using the CICE sea ice model and the HyCom ocean model. CanSIPS targets Canadian marine clients by providing extended range forecasts using of an global ensemble fully coupled atmosphere-ice-ocean model.
Early-onset conduct problems (CP) are a key predictor of adult criminality and poor mental health. While previous studies suggest that both genetic and environmental risks play an important role in the development of early-onset CP, little is known about potential biological processes underlying these associations. In this study, we examined prospective associations between DNA methylation (cord blood at birth) and trajectories of CP (4–13 years), using data drawn from the Avon Longitudinal Study of Parents and Children. Methylomic variation at seven loci across the genome (false discovery rate < 0.05) differentiated children who go on to develop early-onset (n = 174) versus low (n = 86) CP, including sites in the vicinity of the monoglyceride lipase (MGLL) gene (involved in endocannabinoid signaling and pain perception). Subthreshold associations in the vicinity of three candidate genes for CP (monoamine oxidase A [MAOA], brain-derived neurotrophic factor [BDNF], and FK506 binding protein 5 [FKBP5]) were also identified. Within the early-onset CP group, methylation levels of the identified sites did not distinguish children who will go on to persist versus desist in CP behavior over time. Overall, we found that several of the identified sites correlated with prenatal exposures, and none were linked to known genetic methylation quantitative trait loci. Findings contribute to a better understanding of epigenetic patterns associated with early-onset CP.
St Andrews was of tremendous significance in medieval Scotland. Its importance remains readily apparent in the buildings which cluster the rocky promontory jutting out into the North Sea: the towers and walls of cathedral, castle and university provide reminders of the status and wealth of the city in the Middle Ages. As a centre of earthly and spiritual government, as the place of veneration forScotland's patron saint and as an ancient seat of learning, St Andrews was the ecclesiastical capital of Scotland. This volume provides the first full study of this special and multi-faceted centre throughout its golden age. The fourteen chapters use St Andrews as a focus for the discussion of multiple aspects of medieval life in Scotland. They examine church, spirituality, urban society andlearning in a specific context from the seventh to the sixteenth century, allowing for the consideration of St Andrews alongside other great religious and political centres of medieval Europe.
Michael Brown is Professor of Medieval Scottish History, University of St Andrews; Katie Stevenson is Keeper of Scottish History and Archaeology, National Museums Scotland and Senior Lecturer in Late Medieval History, University of St Andrews.
Contributors: Michael Brown, Ian Campbell, David Ditchburn, Elizabeth Ewan, Richard Fawcett, Derek Hall, Matthew Hammond, Julian Luxford, Roger Mason, Norman Reid, Bess Rhodes, Catherine Smith, Katie Stevenson, Simon Taylor, Tom Turpie.