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This study aimed to explore the efficacy of tramadol for neurogenic cough and describe the longitudinal treatment experience.
Methods
A retrospective case series of adults with chronic cough who were treated with tramadol for neurogenic cough. A complete response was defined as no pathologic coughing, and a partial response was defined as 50 per cent or greater reduction in severity or frequency.
Results
Sixty-nine patients were included: 38 per cent of patients reported a complete response with an additional 33 per cent reporting a partial response. The most common successful dosing regimen was 50 mg twice a day. Age, gender and body mass index did not impact treatment response. Patients with a history of laryngeal surgery were less likely to respond (p = 0.04). Sedation (10 per cent) was the most common side effect. Fifty per cent of complete responders (n = 13) were weaned off tramadol after a mean of 39 weeks of treatment.
Conclusion
Tramadol may be effective and is well tolerated in patients with neurogenic cough.
Microswimmers and active colloids often move in confined systems, including those involving interfaces. Such interfaces, especially at the microscale, may deform in response to the stresses of the flow created by the active particle. We develop a theoretical framework to analyse the effect of a nearby membrane on the motion of an active particle whose flow fields are generated by force-free singularities. We demonstrate our results on a particle represented by a combination of a force dipole and a mass dipole, while the membrane resists deformation due to tension and bending rigidities. We find that the deformation either enhances or suppresses the motion of the active particle, depending on its orientation and the relative strengths between the fundamental singularities that describe its flow. Furthermore, the deformation can generate motion in new directions.
Twelve sucking lice, Solenopotes burmeisteri (Fahrenholz) (Psocodea: Linognathidae), were collected from a piece of hide from a female elk, Cervus canadensis (Erxleben) (Artiodactyla: Cervidae), that had been road-killed on the Alaska Highway in the Yukon Territory, Canada (60.78048° N, 136.03328° W), in February 2024. This is the first Canadian record of S. burmeisteri, a species of louse native to Eurasia. One nymph of the winter tick, Dermacentor albipictus (Packard) (Ixodida: Ixodidae), was also collected from this host. No additional lice have been found on 13 subsequently examined elk hides.
The interaction between a coherent vortex ring and an inertial particle is studied through a combination of experimental and numerical methods. The vortex ring is chosen as a model flow ubiquitous in various geophysical and industrial flows. A detailed description of the vortex properties together with the evolution of the particle kinematics during the interaction is addressed thanks to time-resolved particle image velocimetry and three-dimensional shadowgraphy visualisations. Complementary, direct numerical simulations are realised with a one-way coupling model for the particle, allowing for the identification of the elementary forces responsible for the interaction behaviours. The experimental and numerical results unequivocally demonstrate the existence of three distinct interaction regimes in the parameter range of the present study: simple deviation, strong deviation and capture. These regimes are delineated as functions of key controlled dimensionless parameters, namely, the Stokes number and the initial radial position of the particle relative to the vortex ring axis of propagation.
Many of the most significant goods in human life are fleeting, fragile, and subject to loss. But this aspect of such goods, what I call their preciousness, is undertheorized. Here I provide an account of the nature of precious goods, and argue that this category of goods is significant. I argue that while the preciousness of goods is not a consistent contributor to their intrinsic value, preciousness nevertheless calls for a distinct attitudinal response on the part of rational agents: a focused, joyful attention I refer to as cherishing.
In this article, I show that in contexts where the state fails to deliver order and security, criminal organizations can paradoxically facilitate economic development. I consider the case of the Primeiro Comando da Capital [“First Capital Command”] (PCC)—a Brazilian prison gang that has achieved hegemony over the criminal market of a large region and become the de facto regulator of violence and organized crime in São Paulo. Employing a robust difference-in-differences approach on granular administrative employment data, firm creation registries, and satellite-based nighttime luminosity (as a proxy for informal economic activity), I provide causal evidence that the PCC’s stable, rule-based criminal governance significantly increased local economic opportunities. My findings challenge conventional wisdom on the negative economic externalities of crime, demonstrating that hegemonic, institutionalized, and non-extractive criminal governance can generate positive economic externalities by reducing violence and uncertainty.
As electric vertical takeoff and landing (eVTOL) aircraft technology advances, the focus has shifted towards hybrid electric power systems to overcome battery-specific energy limitations. This study introduces a deterministic hybrid power ratio to develop a series gas turbine hybrid electric propulsion system for a generic quad tiltrotor aircraft. First, the failure modes were categorised into two groups based on the primary power component arrangement, and the risks associated with each other were assessed. Three failure modes were identified in typical eVTOL layouts, i.e. one engine inoperative (OEI), one battery pack inoperative (OBI) and one proprotor inoperative (OPI). In addition, for configurations where a single nacelle contained both the battery and motor, a combined OPI+OBI case was considered, thereby acknowledging interconnected risks and extending the scope to four potential failure modes. The study determined the minimum weight of hybrid power systems using tailored deterministic hybrid power ratios based on five proposed sizing rules. In conclusion, the paper proposes an efficient battery layout for lightweight hybrid power systems and an optimal hybrid power system for the eVTOL aircraft, aligned with current battery technology levels.
We study generalised automata (in the sense of Adámek and Trnková) in Joyal’s category of (set-valued) combinatorial species, and as an important preliminary step, we study coalgebras for its derivative endofunctor $\partial$ and for the ‘Euler homogeneity operator’ $L\circ \partial$ arising from the adjunction $L\dashv \partial \dashv R$. The theory is connected with, and in fact provides relatively nontrivial examples of, differential 2-rigs, a notion recently introduced by the author putting combinatorial species on the same relation a generic (differential) semiring $(R,d)$ has with the (differential) semiring $\mathbb{N}[\![ X]\!]$ of power series with natural coefficients. The desire to study categories of ‘state machines’ valued in an ambient monoidal category $(\mathcal{K},\otimes )$ gives a pretext to further develop the abstract theory of differential 2-rigs, proving lifting theorems of a differential 2-rig structure from $(\mathcal{R},\partial )$ to the category of $\partial$-algebras on objects of $\mathcal{R}$ and to categories of Mealy automata valued in $(\mathcal{R},\otimes )$, as well as various constructions inspired by differential algebra such as jet spaces and modules of differential operators. These theorems adapt to various ‘species-like’ categories such as coloured species, $k$-vector species (both used in operad theory), linear species (introduced by Leroux to study combinatorial differential equations), Möbius species and others.
High Reynolds number effects of wall-bounded flows, involving interscale energy transfers between small and large scales of turbulence within and between the inner and outer regions, challenge the classical description of the structure of these flows and the ensuing turbulence models. The two-scale Reynolds stress model recently proposed by Chedevergne et al. (2024, J. Fluid Mech. vol. 1000), was able to reproduce the small- and large-scale contributions in turbulent channel flows that follow the scale separation performed by Lee & Moser (2019, J. Fluid Mech. vol. 860, pp. 886–938), by partitioning energy spectra at a given wavelength. However, the interscale interactions within the inner region were modelled in an ad hoc manner, but without physical relevance, making the two-scale Reynolds stress model less and less accurate for boundary layer applications as the Reynolds number was increased. In this study, by re-analysing direct numerical simulations data from Lee & Moser (2019), with the objective of modelling these scale interactions, crucial observations on energy transfers between large and small scales could be made. In particular, the analysis reveals the important role played by the spanwise component of the Reynolds stress in the logarithmic region. From the analysis undertaken, a revisited version of the two-scale model was thus proposed, focusing efforts on interscale transfer modelling. The resulting model is then successfully tested on high Reynolds number boundary layer configurations without pressure gradient, up to $\textit{Re}_{\tau }=20\,000$. The excellent agreement reflects the good prediction capabilities of the proposed model, and above all, the relevance of the modelling of the energy transfers within and between the inner and outer regions of wall-bounded flows.
Kisspeptin, encoded by Kiss1 gene, regulates reproduction via the hypothalamic-pituitary-gonadal axis. While kisspeptin treatment promotes follicular development in Tan sheep, its direct action on ovarian granulosa cells remains unclear. For this, we first detected the expression of Kiss1 and its receptor Kiss1r in primary ovarian granulosa cells of Tan sheep. Second, the effect of kisspeptin on steroid hormone secretion, proliferation and apoptosis of ovarian granulosa cells was investigated. Third, the signaling pathway of kisspeptin regulating steroid hormone secretion was revealed by western bolting in ovarian granulosa cells. The results showed that the Kiss1 and Kiss1r genes were present in ovarian granulosa cells of Tan-sheep, and 500 nM dose of kisspeptin significantly stimulated steroids hormone secretion (P < 0.05), and up-regulated StAR, HSD17B2, CPY19A1, FSHR, LHR, ERβ, PGR and p-ERK1/2 proteins expression (P < 0.05). Moreover, this treatment significantly promoted cell proliferation and increased the proportion of cells in S phase (P < 0.05), and significantly suppressed granulosa cell apoptosis (P < 0.05). Additionally, the stimulatory effects of kisspeptin on estradiol and progesterone secretion were blocked by inhibitors of the Mitogen-activated Protein Kinase (MAPK) signaling pathway (including PKA inhibitor, PLC inhibitor, PKC inhibitor, and Ca2+inhibitor). Western blot analysis confirmed that kisspeptin regulates steroid hormone secretion primarily through the MAPK-ERK signaling pathway. Our results demonstrate that kisspeptin can directly act on ovarian granulosa cells to promote steroidogenesis, proliferation, and inhibit apoptosis, providing a foundational basis for developing novel kisspeptin-mediated techniques to regulate reproduction in Tan sheep.
Infants with CHD who undergo cardiopulmonary bypass surgery are at risk of impaired growth and neurodevelopment. However, few studies have thoroughly investigated the risk factors for growth and neurodevelopmental impairments, particularly with respect to the timing of the initial surgical intervention.
Methods:
We retrospectively analysed term singleton infants with CHD who underwent cardiopulmonary bypass surgery at a Japanese tertiary centre between 2015 and 2021. Neurodevelopment was assessed at 18–22 months of age using the Kyoto Scale of Psychological Development. We compared outcomes by CHD type (univentricular [UV] vs. biventricular [BV]) and analysed risk factors for growth impairment (weight and height < tenth percentile) and neurodevelopmental impairment (developmental quotient [DQ] < 85), including birth weight, sex, the type of CHD (UV or BV), and timing of the initial cardiopulmonary bypass surgery (<28 days or ≥28 days).
Results:
Of the 108 eligible children, 29 had UV physiology and 79 had BV physiology. Both groups showed impaired growth, with significantly lower body weights in the UV group. Neurodevelopmental scores (total DQ) were significantly lower in the UV group. Neurodevelopmental impairment (total DQ < 85) was observed in 44/108 (40.7%) children, and after adjustment, UV repair was significantly associated with neurodevelopmental impairment (adjusted odds ratio [OR] 3.11, 95% confidence interval [CI] 1.27–7.65). Timing of the initial cardiopulmonary bypass surgery was not associated with outcomes.
Conclusion:
Infants with CHD in Japan exhibit impaired growth and neurodevelopment at 18–22 months following cardiopulmonary bypass surgery, especially those with UV physiology.
The organisation and financing of services dominate long-term care policy and research. This article argues for reorientation towards the social determinants of long-term care and the inequalities they generate. Building on Dahlgren and Whitehead’s influential equivalent for health, the article offers a framework for understanding how inequalities in long-term care need, access and experience are shaped by social networks, living and working conditions, services and policies, social norms, and political, economic and environmental conditions. International evidence on inequalities in need, access and experience is reviewed, and new analysis is presented for England, based on analysis of the Health Survey for England and the Adult Social Care Survey. Socio-economic inequalities are associated with steep gradients in need. Combined with unequal access to formal services, this results in more unmet need among disadvantaged people and a greater weight of responsibility on their family and friends. The final section explores the implications of a social determinants’ perspective for long-term care: addressing ‘upstream’ drivers of need (including social protection, housing and neighbourhood regeneration); inclusion and empowerment agendas; and ensuring that services effectively compensate for, rather than re-enforce, inequalities.
The penetration strategy of hypersonic vehicles in hostile environments is a critical factor in determining their effectiveness in completing reconnaissance or strike missions. Reinforcement learning (RL), as an end-to-end method, exhibits inherent advantages in addressing complex problems. However, existing research indicates that to enhance the efficiency of RL-based strategies, further advancements are necessary to reduce training costs and improve generalisation capabilities. This paper introduces a RL-based cooperative guidance law for multi-hypersonic vehicles, incorporating the estimated remaining time-of-flight and the absolute value of the bank angle obtained through a predictor-corrector method. The observation space and reward function are specifically designed to simplify the complex decision-making problem into a single-value decision problem, thereby reducing computational complexity and training costs. The proposed guidance law integrates the observation space, reward function and action space within the reinforcement learning framework to control flight trajectories, flight time and penetration of no-fly zones, ensuring compliance with multiple constraints. Model training and simulation tests conducted under multiple constraints demonstrate that the proposed approach reduces the training iterations required for the reinforcement learning agent and improves decision-making efficiency. Furthermore, simulations under different no-fly zone distributions confirm the proposed guidance approach’s high generalisation ability.
This essay reflects on my research and teaching on the history of gender and education, specifically with respect to the schooling history of Chinese women in the colonial world. In doing so, it aims to propose an alternate way of seeing the silent and missing figures in the colonial archives: the subordinated, marginalized, feminine colonial subjects. Commonly framed as orphaned, wounded, and diseased bodies in the historical research on the colonial era, these women were rendered as part of the “problem” that the colonial government ought to fix. It was through “them,” the disenfranchised Chinese females, that the missionary and the colonial state found their meaning and purpose. By the early twentieth century, although Chinese women’s education in the colonial context shifted from a discourse of evangelization to one of modernization, the function of women’s schooling remained constant: The feminine figure was still a platform through which the colonial government projected much of its civilizing ambition and desires for modernity. However, if one reads beyond the colonial archives and the paradigm of colonial subject as “recipient” and focuses instead on the archives of everyday life, one can see Chinese feminine figures as the triumphant masters of modern life. This essay traces this paradigm shift and argues that “gender” is an analytical tool capable of unearthing the hidden figures of modernity.
Let $M^{({k})}_{d}(n)$ be the manifold of n-tuples $(x_1,\ldots,x_n)\in(\mathbb{R}^d)^n$ having non-k-equal coordinates. We show that, for $d\geq2$, $M^{({3})}_{d}(n)$ is rationally formal if and only if $n\leq6$. This stands in sharp contrast with the fact that all classical configuration spaces $M^{({2})}_d(n)=\text{Conf}(\mathbb{R}^d,n)$ are rationally formal, just as are all complements of arrangements of arbitrary complex subspaces with geometric lattice of intersections. The rational non-formality of $M^{({3})}_{d}(n)$ for $n \gt 6$ is established via detection of non-trivial triple Massey products, which are assessed geometrically through Poincaré duality.
This study aimed to determine the incidence, location and outcome of incidental avid lesions on positron emission tomography-computed tomography scans for head and neck cancer.
Methods
A retrospective study reviewing digital case notes, performed from a single centre. Clinicopathological information was collected and incidental avid lesions on positron emission tomography-computed tomography reports were recorded. Further investigations were followed up to determine the outcome of the lesions.
Results
A total of 281 patients undergoing staging positron emission tomography-computed tomography (stages T4, N3 or unknown primary) and/or treatment response positron emission tomography-computed tomography scans for head and neck cancer were identified, with 363 incidental avid lesions reported in 369 scans. The most common location was the abdomen (30.0 per cent), followed by thorax (28.9 per cent). A total of 33.1 per cent of lesions had further investigation. The rate of incidental synchronous primary was 3.6 per cent.
Conclusion
The benefit of investigating carefully selected incidental avid lesions outweighs the harm of investigation, as it may alter management. There is a need for a standardised pathway for investigating these lesions in head and neck cancer services.
A 9200-year-long Holocene record of pollen, magnetic susceptibility (MS), and sedimentation rates from Pup Lake, northern Lower Michigan, USA, along with comparative pollen data from regional paleoecological sites and optically stimulated luminescence dates from inland sand dunes across the Great Lakes region, reveals emerging relationships among climate, vegetation, and erosion. Tsuga (hemlock) pollen was used to track local- and regional-scale hydroclimate variability owing to the taxon’s moisture sensitivity and close association with modern lake-effect snowfall gradients. Two periods of elevated MS and Tsuga values, 6800–5200 cal yr BP and 3200–800 cal yr BP, are interpreted as millennial-scale phases of greater effective moisture that drove key changes in forest composition and resulted in accelerated erosion. Overall, the lake’s MS record broadly tracks changes in Tsuga pollen frequencies and sedimentation rates, particularly during the Late Holocene, suggesting the emergence of a well-defined lake-effect climate system between 5200 and 1000 cal yr BP. Additionally, Pup Lake’s MS record exhibits notable connections with widely recognized hemispheric-scale climate deterioration episodes, including the 9.2, 8.2, and 5.2 ka BP events.