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Dysphagia can lead to morbidity including weight loss and aspiration pneumonia. Effective triage of patients and streamlining of pathways to expedite diagnosis and treatment is therefore imperative.
Objectives
The goals of this research were to measure the referral to treatment time for dysphagia patients in a newly established pathway and compare with existing UK national and local referral to treatment times, and to evaluate patient feedback.
Methods
Speech and language therapy advanced clinical practitioners were trained in nasendoscopy and assessment of swallow. Referral to treatment times were measured and patient satisfaction questionnaires completed.
Results
A decrease in triage to treatment time (from 24 to 6 weeks). Patients reported high understanding of the condition and minimal discomfort during assessments. Radiation exposure was reduced (2 per cent of patients undergoing soluble contrast swallows, previously 100 per cent).
Conclusion
The new pathway expedites treatment and achieves high patient satisfaction. It empowers speech and language therapy in efficiently managing low-complexity cases and supports multidisciplinary care for dysphagia patients.
This essay explores how Iceland, a newly independent state on the northern European periphery, responded to the international agenda for post-war stabilisation set out by economic experts after the turmoil of the First World War. It shows that the government of the so-called Austerity Alliance, led by Jón Þorláksson, adopted austerity policies devised at the international financial conferences in Brussels (1920) and Genoa (1922). To please external experts and creditors, it implemented a comprehensive fiscal and monetary policy of austerity and created a new central bank that was independent of politics. The aim, however, was not to divorce markets from government in a return to a pre-war era of laissez-faire as the scholarly literature suggests. Offering the first analysis of ‘the Icelandic business cycle’, the Þorláksson government enforced austerity by carving out ‘the economy’ – a measurable entity legible to expert management – that greatly expanded the role of the state.
This study presents a new density filter for a pipe-shaped structure and its application to fluid topology optimization. A simple and straight pipe-shaped structure for fluid is preferred for many engineering purposes rather than the perplex manifold structure provided by the topology optimization method. To determine an optimal pipe structure for fluid, we develop a new density filter and apply it to fluid topology optimization. Hence, the original spatially varying design variables of the fluid topology optimization are modified based on the pipe density filter. Subsequently, the filter design variables, including a uniform pipe wall thickness and adjusted cross-section, are used for artificial pseudo-rigid bodies in fluid topology optimization. An additional constraint is imposed to maintain a nearly uniform pipe thickness. Several numerical examples are solved to demonstrate the validity of the present pipe density filter for fluid topology optimization problems minimizing the energy dissipation of the fluid and controlling the particles suspended in the fluid.
One of the most persistent challenges in the study of regional politics in Italy is the lack of systematized data and information about the composition of regional legislatures and governments and the profiles of elected officials. In this paper, we describe the ITREGPARL dataset, a new comprehensive dataset of Italian regional politics comprising 6077 regional politicians from 1993 to 2020. It includes information about regional councillors, regional ministers, presidents and vice-presidents of the regional council, regional presidents and vice-presidents. Along with socio-demographic characteristics – gender, age, previous profession, education – it includes data such as experience and incumbency, number of mandates, length of service and partisanship. It also includes region-level variables, such as geographical area, type of gender quotas and the regional authority index.
By analysing new archival evidence, this article reveals how in the late 1980s, the legal principle of subsidiarity came to be seen as a tool for demobilising opposition to further European integration. At the same time, it also became a projection screen for competing visions for Europe's future: while the European Commission saw subsidiarity as an important foundation for a future European federation and the German government as an essential part of a ‘Europe of the regions’, the British government hoped to use it to achieve a renationalisation of the European Community. The French government was much more sceptical towards subsidiarity, pointing to the paradox that subsidiarity actually required a strong central authority to achieve its decentralising ends. The article concludes by arguing that the debate on subsidiarity reveals how ambitious and yet contested European integration had become by the early 1990s.
Thin airfoil dynamic stall at moderate Reynolds numbers is typically linked to the sudden bursting of a small laminar separation bubble close to the leading edge. Given the strong sensitivity of laminar separation bubbles to external disturbances, the onset of dynamic stall on a NACA0009 airfoil section subject to different levels of low-amplitude free stream disturbances is investigated using direct numerical simulations. The flow is practically indistinguishable from clean inflow simulations in the literature for turbulence intensities at the leading edge of ${Tu} = 0.02\,\%$. At slightly higher turbulence intensities of ${Tu} = 0.05\,\%$, the bursting process is found to be considerably less smooth and strong coherent vortex shedding from the laminar separation bubble is observed prior to the formation of the dynamic stall vortex (DSV). This phenomenon is considered in more detail by analysing its appearance in an ensemble of simulations comprising statistically independent realisations of the flow, thus proving its statistical relevance. In order to extract the transient dynamics of the vortex shedding, the classical proper orthogonal decomposition method is generalised to include time in the energy measure and applied to the time-resolved simulation data of incipient dynamic stall. Using this technique, the dominant transient spatiotemporally correlated features are distilled and the wave train of the vortex shedding prior to the emergence of the main DSV is reconstructed from the flow data exhibiting dynamics of large-scale coherent growth and decay within the turbulent boundary layer.
Oesophageal soft food bolus obstruction is a common presentation to emergency departments. Often these patients are given medication with little evidence of efficacy. Although many cases self-resolve, some require removal of the obstruction. Delay in removal can lead to complications such as oesophageal perforation and mediastinitis. Traditionally, removal was performed by ENT surgeons using rigid oesophagoscopy, but oesophago-gastro duodenoscopy offers a safer alternative that does not require a general anaesthetic.
Method
The current performance, pathways and outcomes of patients attending emergency departments across three health boards in Scotland were reviewed.
Results
In total, 313 patients admitted for oesophageal soft food bolus obstruction were identified. Mixed practice for a single common presentation was observed. In addition, it was found that the majority of patients are already managed by surgery and gastroenterology services with good outcomes and low morbidity.
Conclusion
Patients presenting with soft food bolus obstruction should be referred to local surgery and gastroenterology services in the first instance.
Many people today are concerned about the implications of climate change for their personal reproductive decisions. Some have transformed such concerns into activism by engaging in a “birth strike” and publicly announcing their decision not to procreate because of climate change. This article draws on Hannah Arendt to examine the political meaning and significance of birth strikes. It makes three basic points. First, by highlighting the human condition of being born, what Arendt called natality, birth strikes have illuminated a distinctive set of threats and possibilities for climate politics. Second, due to modern consumerism and instrumentalism, which Arendt saw as the dominance of labor and work over action, birth strikes have been misperceived as advocating a reduction in personal carbon footprints and global population growth. Third, birth strikes have clarified some of the challenges for efforts to link the individual and collective dimensions of climate responsibility.
The parameterization of fluxes associated with representing unresolved dynamics in turbulent flows, especially in the atmosphere and ocean (which have a vast range of scales), remains a challenging task. This is especially true for Earth system models including complex biogeochemistry and requiring very long simulations. The problem of representing the dependence of the mean flux of a passive tracer in terms of the mean has a very long history; in this study, we take a somewhat different approach. We use a formalism showing that the mean flux will be a functional of the mean gradients, a formalism that can be used to calculate the structure of the functional which is non-local in both space and time. Two-dimensional turbulent simulations are used to explore the weight of nearby (in space or time) gradients. We also use stochastic velocities and iterated maps to show that the results are similar. The functional formalism provides an understanding of when non-locality needs to be considered and when a local eddy diffusivity can be a reasonably good approximation. Furthermore, the formalism provides guidance for the development of data-driven parameterizations.
The flow-induced vibrations (FIVs) of two identical tandem square cylinders with mass ratio m* = 3.5 at Reynolds number Re = 150 are investigated through two-dimensional direct numerical simulation (DNS) and linear stability analysis over a parameter range of spacing ratio 1.5 ≤ L* ≤ 5 and reduced velocity 3 ≤ Ur ≤ 34. Three kinds of FIV responses, namely vortex-induced vibration (VIV), biased oscillation (BO) and galloping (GA), are identified. The FIVs are then further classified into the branches of initial VIV (IV), resonant VIV (RV and RV′), flutter-induced VIV (FV), desynchronized VIV (DV), VIV developing from GA (GV), transitional state between VIV and GA (TR), BO and GA based on the characteristics of the vibration responses. The transitions among different FIV branches are examined by combining the DNS with linear stability analysis, where the transition boundaries among the VIV, BO and GA branches over the concerned parameters are identified on the branch maps. The transition from IV to RV or RV′ is found to be related to the unstable wake mode, while the FV, transiting from RV or RV′, is induced by the unstable structural factor in the wake-structure mode. The structural instability is considered as the physical origin of GA, whereas the mode competition between unstable wake and structure leads to DV, GV and TR, and thus delays the appearance of GA. The transition from DV to BO with biased equilibrium position, accompanied by the even-order harmonic frequencies, is essentially induced by the symmetry breaking bifurcation.
The success of tympanoplasty is mainly defined by the post-operative integrity of the tympanic membrane, as well as the absence of any need for further operating. Among the factors affecting the outcome, the surgical grafting technique is still a matter of debate. Our aim is to report the results of the split two-layer cartilage–perichondrium technique.
Methods
We carried out a retrospective study of 108 consecutive adult patients undergoing myringoplasty, assessing both surgical and audiological outcomes of the split two-layer cartilage–perichondrium technique, including primary and revision cases.
Results
Complete perforation closure was observed in 97/108 (89.7 per cent) of the cases; 101/108 (93.5 per cent) had no need for further intervention. Failures were observed only in cases with total perforations without any differences between primary and revision cases. The average air–bone gap improved from 29.75 dB pre-operatively to 5.8 dB post-operatively.
Conclusion
The results indicate high success rates of the technique with failures occurring only in total perforations.
This paper theorizes and defends a process I term “hermeneutical bastardization.” This concept tracks the way in which some hermeneutical injustices arise not from a gap in a shared pool of hermeneutical resources, but from the decontextualization of an advantageous hermeneutical resource into another (typically dominant) hermeneutical domain. This decontextualization bastardizes hermeneutical resources by severing the concept from its original meaning and significance. I focus on the term “trans woman” and examine the way in which dominant epistemic agents rewrite and redefine the concept according to prominent and prevalent pernicious representations. Specifically, once decontextualized, the term “trans woman” denotes an individual who is thoroughly erotic and sexual in nature. Hermeneutical bastardization can illuminate how hermeneutically marginalized groups are reconstructed by other dominant epistemic agents according to these pernicious representations and can be silenced whilst their concepts, or rather their terms, are being utilized in sets of dominant hermeneutical resources in ways that severely diverge from their original intra-communal conceptualization. This type of hermeneutical injustice does not arise from a lacuna in our set of resources, but instead depends on the uptake of a concept's term and its subsequent decontextualization.
‘Anxious scrutiny’ has become one of the most used terms within the lexicon of judicial review throughout the common law world, including Hong Kong, yet surprisingly remains understudied in the scholarly literature. In contrast to the considerable body of literature on substantive review of discretion in relation to proportionality and Wednesbury unreasonableness as rival standards of review, there is still much to explore in relation to the foundation, purpose, and techniques of anxious scrutiny review, including how the concept may have come to depart from its English roots in other common law jurisdictions. Using Hong Kong as a case study, this article examines how anxious scrutiny has been received in an Asian common law jurisdiction, considering both the scope of application and the techniques used by judges under this standard. Through a detailed examination of the case law, it traces the origins and evolution of the standard and its future role within the sliding scale of substantive review within Hong Kong's system of public law.
My first acquaintance with the History of Economics Society (HES) occurred in the summer of 1990 when I attended its seventeenth annual meeting. Organized by the then HES president and now recently deceased Stanley “Todd” Lowry at Washington and Lee University in Lexington, Virginia, it marked the beginning of my experience with US higher education. Later that summer, I began a two-year post-doctoral fellowship at Harvard University. The economics department still hosted a history of economics seminar—the Kress seminar—though its actual connection with the seminar was tenuous.1 Following the Lexington meeting, the paper I presented was accepted for publication in volume 7 of Perspectives on the History of Economic Thought—a book series that published selected papers from the HES conference. It was my first publication in English. From then on, I kept attending the HES annual meeting regularly and with enthusiasm. I met a number of stimulating people and made some good friends there. It was always refreshing to find myself in the United States following nine months of teaching and research in France.
The North East Hill Region (NEHR) of India is home to diverse maize landraces including pigmented accessions rich in antioxidants and nutritional properties. The present study attempted to characterize a representative collection of this mostly unexplored diversity. Altogether eighty-three local maize landraces from the seven hill states of the NEHR were studied with special emphasis on pigmentation diversity. For the morphological traits, a significant ANOVA indicated the presence of substantial genetic variability for which selection would be fruitful. A number of these accessions were found to have traits that help cope with moisture stress, improve stalk strength and optimize photosynthesis. Principal component analysis studies for the yield attributing traits indicated that ear weight was most variable. The bleaching/histological studies confirmed that anthocyanin pigment when present was always restricted to the aleurone layer of the kernels, typical of blue maize. Quantitative analysis for kernel anthocyanin/phlobaphene content also revealed genetic differences among the accessions. Genetic analysis using the model-based STRUCTURE indicated significant population structuring among the accessions. Specifically, for the pigmentation diversity studies both principal coordinate analysis and neighbour joining methods revealed near concurrent population structuring due in part to the high differentiation of seven of the twenty-one pigmentation specific loci studied. The results obtained provide comprehensive evidence of a significant amount of genetic differentiation among the landraces under study. Landraces are valuable reservoirs of favourable alleles for which selection can be made and, as in this study, identify accessions for breeding maize with enhanced levels of beneficial secondary metabolites.