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This study measured the effectiveness of an in-house designed, cast silicone airway model in addressing the lack of easily accessible, validated transoral laser microsurgery simulation models.
Methods
Participants performed resection of two marked vocal fold lesions on the model. The model underwent face, content and construct validation assessment using a five-point Likert scale questionnaire measuring the mean resection time for each lesion and the completeness of lesion excision. Comparative analyses were performed for these measures.
Results
Thirteen otolaryngologists participated in this study. The model achieved validation threshold on all face and content measures (median, ≥4). Construct validation was demonstrated by the improvement in mean resection time between lesions one and two (86 vs 54 seconds, W = 11, p = 0.017). The mean resection time was lower amongst more senior otolaryngologists (61.5 vs 107.1 seconds, W = 11, p = 0.017).
Conclusion
This synthetic silicone model is a low-cost, easily reproducible, high-fidelity synthetic airway model, demonstrating face, content and construct validity.
It is impossible to understand the phenomenon of disinformation without unraveling the more perplexing notion of “truth.” This article explores how a Bulgarian psychic or prophet named Baba Vanga (1911–1996) became one of the most noteworthy mediums of “truth” in twentieth- and twenty-first-century Russian imagination. With Bulgarian-Russian transnational ties as context, we trace how belief in Baba Vanga’s abilities and prophecies was propagated by witnesses via word-of-mouth, newspaper articles, books, TV programming, and the internet. We periodize the ways Vanga secured a place in Russian “truth worlds,” drawing upon both science and religion or a conglomeration of both. We look deeper into the origins and more recent circulation of a purported Vanga prophecy from 1979: namely, that Russia would rise to be the ruler of the world. The dissemination of this message, we argue, is not a Russian state plot to bolster aspirations in Ukraine and its standoff with the West. Instead it has been transmitted in far more fragmented and mediated ways and even countered by the Russian Orthodox Church. A deeper pondering of these mediations of Baba Vanga can help us better understand what we call the “post”-truth world, in which truth is crafted by online “posts.” In contrast to the notion of “post-truth” that posits a dearth of truth, our concept of “post”-truth recognizes that truth is not just in unprecedented excess today but is built through a complex and participatory bricolage that uses science and religion to build shared realities as never before in history.
Do Indigenous peoples in present-day Canada display lower levels of diffuse support than non-Indigenous settlers? Given settler colonial relations (both historic and contemporary) and Indigenous peoples’ own political thought, we can expect that Indigenous peoples would have even lower perceptions of state legitimacy than non-Indigenous peoples. However, there are conflicting expectations regarding whether the descriptive representation of Indigenous peoples in settler institutions is likely to make a difference: on one hand, Indigenous people may see themselves reflected in these institutions and consequently feel better represented; on the other hand, these forms of representation do not challenge the underlying colonial nature of these institutions. Using data from the 2019 and 2021 Canadian Election Studies, our statistical analysis demonstrates that: (1) diffuse support is significantly lower among Indigenous peoples than non-Indigenous peoples, including people of color; (2) Indigenous respondents across multiple peoples have similarly low levels of diffuse support, and (3) being represented by an Indigenous Member of Parliament does not change the levels of diffuse support among Indigenous peoples. Overall, our research highlights the outstanding challenges to achieving reconciliation through the Canadian state and points to ways large-N analyses may be made more robust.
This article discusses sceptical arguments about measurement scales. Measurement scales are part of a promising agenda of openness, transparency and patient and public involvement (PPI) in medical research, but have received critical, sometimes hostile attention from anthropologists. This is because scales repackage localised cultural assumptions about distress as something universal and pan-human and have the capacity to reshape people's interior lives in unhelpful, possibly harmful ways. We take as an example the Patient Health Questionnaire-9 (PHQ-9). Use of the PHQ-9 is currently mandated by major funders. But its history suggests flawed PPI and a lack of openness. The article suggests a constructive role for anthropology in mental health research, using ethnographic evidence and theory to show how, although they have their uses, mental health scales should not be regarded as inert or harmless.
Microvortex generators (MVGs) are a promising solution to control shock wave/turbulent boundary layer interactions (SBLIs), especially in supersonic inlets. In this study, we examine the effects of a microramp vortex generator on an SBLI generated by an oblique shock wave and a turbulent boundary layer using direct numerical simulations (DNSs). Two cases, with and without the presence of a microramp, are compared in terms of their mean and unsteady flow features at free-stream Mach number equal to 2 and friction Reynolds number at the inviscid shock impingement equal to 600. The long integration period allows us to assess how microramps affect the typical low-frequency unsteadiness observed in SBLIs, and the data generated may serve as a reference for simulations of lower fidelity or reduced order models. The analysis shows that the three-dimensional microramp wake alters the interaction region dramatically, inducing a significant spanwise modulation and topology change of the separation. For example, tornado-like structures redistribute the flow in both the spanwise and wall-normal directions inside the recirculation region. The increase in momentum close to the wall by the ramp vortices effectively delays the onset of the separation and, thus, the separation length, but at the same time leads to a significant increase in the intensity of the wall-pressure fluctuations. We then characterise the mutual interaction between the arch-like vortices around the ramp wake and the SBLI. The specific spanwise vorticity shows that these vortices follow the edge of the separation and their intensity, apart from mean compressibility effects, is not affected by the shocks. The shocks, instead, are deformed in shape by the periodic impingement of the vortices, although the spectral analysis did not reveal any significant trace of their shedding frequency in the separation region. These Kelvin–Helmholtz vortices, however, may be relevant in the closure of the separation bubble. Fourier analysis also shows a constant increase, in both value and magnitude, in the low-frequency peak all along the span, suggesting that the motion of the separation shock remains coherent while being disturbed by the arch-like vortices and oscillating at a higher frequency in absolute terms.
This article revisits the mainstream scholarly view that the Greek Hestia is the least anthropomorphic deity among the Olympians, an idea that owes much to a short reference to her in Plato’s Phaedrus. The analysis is based on textual and visual sources from the Archaic period: I first review two references to Hestia in early hexameter poetry, in Hesiod’s Theogony and in the Homeric Hymn to Aphrodite, before turning to the depiction of her in two early Attic black-figure vases, the Sophilos dinos at the British Museum and the François vase, which have been neglected in discussing Hestia’s anthropomorphic nature in early Greek thought. While the study of individual Greek gods has returned to the fore in the field of Greek religion in the last 20 years, it seems that not enough has changed in the current conceptualization of Hestia.
This edited volume by Mark Hauser and Julia Jong Haines aims to bring together local narratives within the context of the Indian Ocean in modern times, from c. AD 1500, and establish how these narratives can inform historical archaeology. As the editors highlight in the introductory chapter, historical archaeology has been greatly informed and inspired by the Atlantic world and its colonial histories. Here, they seek instead to foreground the Indian Ocean as a setting for historical archaeology in its own right. The authors use the long and deep history of interconnectedness and trade in this ocean as a basis for understanding more recent history, not just in light of colonial impact but through bottom-up approaches that focus on the local in the global. The case studies in this book and its overall theme are also part of the ongoing process to decentralise Europe in archaeological discourse. The book consists of 11 chapters, including an introductory chapter by Haines and Hauser and two commentaries. The majority of the case studies are from island East Africa or South India, which naturally limits the scope somewhat.
Since 2006, the Maricopa County Department of Public Health (MCDPH) has conducted routine surveillance of heat-associated deaths in the county. During that time, the number of deaths each year has been on the rise with 2022 numbers showing a 25% increase over 2021. Risk factors such as homelessness and alcohol and drug use have been shown to increase the risk of heat-associated death. During the summer of 2023, record-breaking heat in the metro-Phoenix area was widely reported. The MCDPH heat-associated death surveillance data was widely reported and used by policy makers to address extreme heat as a regional disaster. In this presentation participants will learn how heat-associated death surveillance has evolved over time to inform public health leaders and policy makers to the risk factors associated with poor outcomes from extreme heat. Participants will also understand how the data is shared at the local, national and international levels to inform extreme heat response activities.
Learning Objectives
Participants will learn how heat-associated death surveillance has evolved over time to inform public health leaders and policy makers of the risk factors associated with poor outcomes from extreme heat.
Participants will also understand how the data is shared at the local, national and international levels to inform extreme heat response activities.
This article revisits the question of how the epigraphic culture of the fifth-century BC Athenian Empire impacted on the epigraphic cultures of other communities. Through consideration of the late fifth-century epigraphic cultures of Thasos and Rhodes, it argues that allied communities interacted with the epigraphic manifestations of Athenian authority in different ways, producing diverse epigraphic responses. Further, it argues that the first traces of the shift from the heterogeneity of archaic epigraphic cultures to the epigraphic convergence of the late classical world can be found in the tension between local and Athenian influences in late fifth-century public inscription beyond Athens.
In a horizontally heated melting system, where a solid substance is subject to melting by a warmer liquid beneath, the presence of solute in the liquid introduces a complex interplay between temperature and concentration dynamics. Employing a recently developed sharp interface method (Xue et al., J. Comput. Phys., vol. 491, 2023), we conduct direct numerical simulations to investigate the transient behaviour of the system across a broad range of Rayleigh numbers and solute concentrations. Our observations reveal distinct flow regimes: at low concentrations, the system resembles a temperature-driven melting problem, characterized by vortex rolls beneath the melting interface. As the solute concentration increases, a stably stratified layer emerges beneath the interface, leading to the transition from thermal convection to penetrative convection, which resembles those flow characteristics observed in the double-diffusive convection. This shift results from the competition between the stabilizing effect induced by solute concentration gradient and the destabilizing effect caused by temperature gradient. Otherwise in the diffusion regime, characterized by very high solute concentrations, the flow becomes static due to the complete suppression of convection by the stably stratified layer. This regime further exhibits two distinct patterns: ‘melting’ and ‘dissolution’. Beyond characterizing diverse flow patterns, our study conducts a quantitative analysis, examining heat/mass transfer, melting rates, and the evolution of temperature and concentration at the interface. These insights contribute to a better understanding of the intricate interplay between temperature and solute concentration during phase change, with implications for accurately estimating melting rates in binary fluid systems.
Hypoglossal nerve stimulation has emerged as a promising therapeutic approach for obstructive sleep apnoea patients who are intolerant to continuous positive airway pressure therapy. This paper aimed to explore reasons for hypoglossal nerve stimulation device explantation and associated complications.
Methods
Following Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines, a systematic search across Embase Ovid, PubMed, Scopus, and the Cochrane library yielded 14 articles that met the inclusion criteria. Exclusion criteria were (1) systematic reviews and meta-analyses, conference posters and editorials; (2) non-English studies; and (3) studies published before 2010.
Results
Of the 121 patients identified as having undergone hypoglossal nerve stimulation device explantation, 126 reasons were identified for the procedure. The primary reasons included device malfunction (19.8 per cent), infection (19.0 per cent) and device migration (18.3 per cent). Other reasons included discomfort (9.5 per cent), improper placement (6.3 per cent) and ineffective devices (6.3 per cent). Complications were infrequent (2.48 per cent).
Conclusion
Device malfunction, infection and device migration were prominent reasons for hypoglossal nerve stimulation device explantation. Complications post-explantation were rare but included temporary hypoglossal paresis.
Point-of-care ultrasound is a proven life-saving diagnostic tool that can be easily utilized in remote and austere settings with ever-improving portability. The utility of point-of-care ultrasound in prehospital care as a feasible and valuable tool to assist in prioritizing patients for damage control resuscitation and transport from the field will be highlighted with a focus on resource-limited environments and conflict settings. The session will conclude with a discussion around the successes, challenges, and lessons-learned after the implementation of a point-of-care ultrasound for trauma training program that was deployed to Ukraine in the fall of 2022.
Learning Objectives
Understand the role that point-of-care ultrasound can play in prehospital patient management.
Identify the benefits and pitfalls of point-of-care ultrasound utilization in the prehospital and resource-scarce environment.
Outline successful strategies and identify potential challenges for implementing a point-of-care ultrasound for trauma training program in complex environments.
Rayleigh–Bénard convection in a rotating spherical shell provides a simplified model for convective dynamics of planetary and stellar interiors. Over the past decades, the problem has been studied extensively via numerical simulations, but most previous simulations set the Prandtl number $Pr$ to unity. In this study we build more than 200 numerical models of rotating convection in a spherical shell over a wide range of $Pr$ ($10^{-2}\le Pr \le 10^2$). By increasing the Rayleigh number $Ra$, we characterise four different flow regimes, starting from the linear onset to multiple modes, then transitioning to the geostrophic turbulence and eventually approaching the weakly rotating regime. In the multiple modes regime, we show evidence of triadic resonances in numerical models with different $Pr$, which may provide a generic mechanism for the transition from laminar to turbulence in rotating convection. We analyse scaling behaviours of the heat transfer and convective flow speeds in numerical simulations, paying particular attention to the $Pr$ dependence. We find that the so-called diffusion-free scaling for the heat transfer cannot reconcile all numerical models with different $Pr$ in the geostrophic turbulence regime. However, the characteristic flow speeds at different $Pr$ roughly follow a unified scaling that can be described by visco-Archimedean–Coriolis force balances, though the scaling tends to approach the Coriolis-inertial-Archimedean force balance at low $Pr$. We also show that transition behaviours from rotating to non-rotating convection depend on $Pr$. The transition criteria based on heat transfer and flow morphology would be rather different when $Pr>1$, but the two criteria are consistent for cases with $Pr\le 1$. Both scaling behaviours and transition behaviours suggest that the heat transfer is controlled by the boundary layers while the convective flow speeds are mainly determined by the force balance in the bulk for cases with $Pr>1$, which is in line with recent experimental results with moderate to high $Pr$. For cases with $Pr \le 1$, both the heat transfer and convective velocities are approaching the inviscid dynamics in the bulk. We also briefly analysed the magnitude and scaling of zonal flows at different $Pr$, showing that the zonal flow amplitude rapidly increases as $Pr$ decreases.
Assess the post-operative complications of microscopic parotidectomy and its impact on quality of life.
Methods
Thirty patients were included in this prospective study. Three to six months post-surgery, patients underwent assessments for Frey’s syndrome by Minor test, aesthesiometer test, facial nerve function and Quality of Life questionnaire.
Results
Frey’s syndrome symptom positive in none, Minor test positive in 50 per cent. The preservation rate of the great auricular nerve posterior branch was 90 per cent, but it had no significant impact on the aesthesiometer test. Transient and permanent facial paresis were observed in 13.3 per cent and 3.3 per cent, and salivary fistula in 3.3 per cent. In quality of life, the rating of general health as good/better was seen in 73.3 per cent, nil/minimal pain in 93.3 per cent, bothersome change of facial contour in none, and dry mouth in 23.3 per cent.
Conclusion
Microscopic parotidectomy achieves good surgical outcomes regarding Frey’s syndrome symptoms, greater auricular nerve preservation, facial paresis, salivary fistula and quality of life.
Logical arguments from evil against the existence of God are the strongest form of arguments from evil. They maintain that the all-good, all-powerful God of traditional theism is logically incompatible with the evil in the world. Given that the most well-known logical argument from evil remains the argument put forward by John Mackie over fifty years ago, I begin by setting out Mackie’s argument in detail as well as Alvin Plantinga’s well-regarded critique of it. I then discuss Mackie’s not well-known confusing response to Plantinga’s critique along with attempts by Hugh LaFollette and Quentin Smith to support Mackie’s argument, which fail to take into account Mackie’s own concession to Plantinga’s critique. I then discuss my own attempt in 2019 to provide a Mackie-style logical argument from evil and the reception it has received. I end by suggesting that further discussion might best be pursued by taking up the related question of whether an objective ethics can by adequately supported without appealing to the existence of the God of traditional theism.
Inflammation and infections such as malaria affect micronutrient biomarker concentrations and hence estimates of nutritional status. It is unknown whether correction for C-reactive protein (CRP) and α1-acid glycoprotein (AGP) fully captures the modification in ferritin concentrations during a malaria infection, or whether environmental and sociodemographic factors modify this association. Cross-sectional data from eight surveys in children aged 6–59 months (Cameroon, Cote d’Ivoire, Kenya, Liberia, Malawi, Nigeria and Zambia; n 6653) from the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anaemia (BRINDA) project were pooled. Ferritin was adjusted using the BRINDA adjustment method, with values < 12 μg/l indicating iron deficiency. The association between current or recent malaria infection, detected by microscopy or rapid test kit, and inflammation-adjusted ferritin was estimated using pooled multivariable linear regression. Age, sex, malaria endemicity profile (defined by the Plasmodium falciparum infection prevalence) and malaria diagnostic methods were examined as effect modifiers. Unweighted pooled malaria prevalence was 26·0 % (95 % CI 25·0, 27·1) and unweighted pooled iron deficiency was 41·9 % (95 % CI 40·7, 43·1). Current or recent malaria infection was associated with a 44 % (95 % CI 39·0, 52·0; P < 0·001) increase in inflammation-adjusted ferritin after adjusting for age and study identifier. In children, ferritin increased less with malaria infection as age and malaria endemicity increased. Adjustment for malaria increased the prevalence of iron deficiency, but the effect was small. Additional information would help elucidate the underlying mechanisms of the role of endemicity and age in the association between malaria and ferritin.
This paper brings together several issues in Aquinas’s thought on God’s primary causality, providence, and the reading of scripture. Herein I argue that God’s primary causality is to be understood in terms of His being the source of all actuality. From there I go on to integrate Aquinas’s account of providence with the account of God’s primacy. With God’s primary causality and providence in place, I then go on to address the theme pertinent to this special edition, and that is God’s response to sin in Aquinas’s reading of scripture.