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To determine oncological and functional outcomes in patients with T3 and T4 laryngeal carcinoma, in which choice of treatment was based on expected laryngeal function and not T classification.
Methods
Oncological outcomes (disease-specific survival and overall survival) as well as functional outcomes (larynx preservation and functional larynx preservation) were analysed.
Results
In 130 T3 and 59 T4 patients, there was no difference in disease-specific survival or overall survival rates after radiotherapy (RT) (107 patients), chemoradiotherapy (36 patients) and total laryngectomy (46 patients). The five-year disease-specific survival rates were 83 per cent after RT, 78 per cent after chemoradiotherapy and 69 per cent after total laryngectomy, whereas overall survival rates were 62, 54 and 60 per cent, respectively. Five-year larynx preservation and functional larynx preservation rates were comparable for RT (79 and 66 per cent, respectively) and chemoradiotherapy (86 and 62 per cent, respectively).
Conclusion
There is no difference in oncological outcome after (chemo)radiotherapy or total laryngectomy in T3 and T4 laryngeal carcinoma patients whose choice of treatment was based on expected laryngeal function.
What shapes a country’s foreign policy formation in times of crisis? This article explores the factors that were behind the response of Ukrainian decision makers in their relations with Russia and the European Union during the annexation of Crimea between February 21 and March 26, 2014. I view Ukraine’s foreign policy through the lenses of an analytical framework inspired by game theory, where the decision-making process is divided into four parts—information about others’ preferences, trust in interlocutors, everyone’s payoffs, and resources. This article employs a rigorous qualitative thematic analysis of 38 elite interviews, numerous primary documents, and media reports. The core finding suggests that the uncertain times and unpreparedness of Ukrainian decision makers obstructed them from a comprehensive analysis of the environment and formation of the country’s foreign policy strategy, which, consequently, facilitated Russia’s annexation of Crimea.
Despite the salience of corruption in elections in Latin America and beyond, it remains unclear what makes certain candidates attractive to voters as solutions to address corruption. Building on studies about the effect of candidates’ professional affiliation on voting behavior, we hypothesize that police and military officers are perceived to be more competent to address corruption. We test our theoretical expectations through an online survey of Brazilian voters with an image-based factorial experiment that presents respondents with three randomly generated handbills, varying candidates’ professional affiliations and potential confounders, such as economic policy, insider versus outsider status, and demographic features. Our results demonstrate that candidates affiliated with the police or the military are perceived to be more effective at reducing corruption, all else equal. The effect of police or military professions on candidates’ perceived effectiveness to fight corruption varies according to respondents’ ideology and is particularly significant among conservative voters.
Phase three trials of the monoclonal antibodies lecanemab and donanemab, which target brain amyloid, have reported statistically significant differences in clinical end-points in early Alzheimer's disease. These drugs are already in use in some countries and are going through the regulatory approval process for use in the UK. Concerns have been raised about the ability of healthcare systems, including those in the UK, to deliver these treatments, considering the resources required for their administration and monitoring.
Aims
To estimate the scale of real-world demand for monoclonal antibodies for Alzheimer's disease in the UK.
Method
We used anonymised patient record databases from two National Health Service trusts for the year 2019 to collect clinical, demographic, cognitive and neuroimaging data for these cohorts. Eligibility for treatment was assessed using the inclusion criteria from the clinical trials of donanemab and lecanemab, with consideration given to diagnosis, cognitive performance, cerebrovascular disease and willingness to receive treatment.
Results
We examined the records of 82 386 people referred to services covering around 2.2 million people. After applying the trial criteria, we estimate that a maximum of 906 people per year would start treatment with monoclonal antibodies in the two services, equating to 30 200 people if extrapolated nationally.
Conclusions
Monoclonal antibody treatments for Alzheimer's disease are likely to present a significant challenge for healthcare services to deliver in terms of the neuroimaging and treatment delivery. The data provided here allows health services to understand the potential demand and plan accordingly.
Let $\Sigma $ be a nonempty subset of the set of prime numbers which is either equal to the entire set of prime numbers or of cardinality one. In the present paper, we continue our study of the pro-$\Sigma $ fundamental groups of hyperbolic curves and their associated configuration spaces over algebraically closed fields in which the primes of $\Sigma $ are invertible. The present paper focuses on the topic of comparison between the theory developed in earlier papers concerning pro-$\Sigma $ fundamental groups and various discrete versions of this theory. We begin by developing a theory concerning certain combinatorial analogues of the section conjecture and Grothendieck conjecture. This portion of the theory is purely combinatorial and essentially follows from a result concerning the existence of fixed points of actions of finite groups on finite graphs (satisfying certain conditions). We then examine various applications of this purely combinatorial theory to scheme theory. Next, we verify various results in the theory of discrete fundamental groups of hyperbolic topological surfaces to the effect that various properties of (discrete) subgroups of such groups hold if and only if analogous properties hold for the closures of these subgroups in the profinite completions of the discrete fundamental groups under consideration. These results make possible a fairly straightforward translation, into discrete versions, of pro-$\Sigma $ results obtained in previous papers by the authors. Finally, we discuss a construction that was considered previously by M. Boggi in the discrete case from the point of view of the present paper.
We investigated the influence of maternal yellow-pea fiber supplementation in obese pregnancies on offspring metabolic health in adulthood. Sixty newly-weaned female Sprague-Dawley rats were randomized to either a low-calorie control diet (CON) or high calorie obesogenic diet (HC) for 6-weeks. Obese animals were then fed either the HC diet alone or the HC diet supplemented with yellow-pea fiber (HC + FBR) for an additional 4-weeks prior to breeding and throughout gestation and lactation. On postnatal day (PND) 21, 1 male and 1 female offspring from each dam were weaned onto the CON diet until adulthood (PND 120) for metabolic phenotyping. Adult male, but not female, HC offspring demonstrated increased body weight and feed intake vs CON offspring, however no protection was offered by maternal FBR supplementation. HC male and female adult offspring demonstrated increased serum glucose and insulin resistance (HOMA-IR) compared with CON offspring. Maternal FBR supplementation improved glycemic control in male, but not female offspring. Compared with CON offspring, male offspring from HC dams demonstrated marked dyslipidemia (higher serum cholesterol, increased number of TG-rich lipoproteins, and smaller LDL particles) which was largely normalized in offspring from HC + FBR mothers. Male offspring born to obese mothers (HC) had higher hepatic TG, which tended to be lowered (p = 0.07) by maternal FBR supplementation.
Supplementation of a maternal high calorie diet with yellow-pea fiber in prepregnancy and throughout gestation and lactation protects male offspring from metabolic dysfunction in the absence of any change in body weight status in adulthood.
After an intercomparison age experiment carried out in the framework of the first MODIS (MOrtar Dating Inter-comparison Study) project, the results showed general agreement both between optically stimulated luminescence (OSL) dating laboratories and with radiocarbon (14C) dating results. As the needs for the selection of samples convenient for an inter-comparison are not the same between 14C and OSL, for the second running, it has been decided to choose two different sample sets, one to share between the radiocarbon labs and one for the OSL dating ones. The results obtained by applying different experimental protocols (multigrain and single grain techniques) and different statistical models (weighted mean, central age mode, average dose model, minimum age model and exponential exposure dose) are discussed in this work.
Plumbogaidonnayite, ideally PbZrSi3O9⋅2H2O, is a new gaidonnayite-group mineral discovered as a secondary product derived from the alteration of eudialyte from the Saima alkaline complex, China. It occurs as aggregates (up to 1 mm) composed of subhedral to anhedral or platy crystals (individually 5–50 μm), associated closely with microcline, natrolite, aegirine, gaidonnayite, georgechaoite, zircon, bobtraillite and britholite-(Ce) in eudialyte pseudomorphs. The crystals are transparent, colourless or light brown with a vitreous lustre. Plumbogaidonnayite is brittle with conchoidal fracture, and it has a Mohs hardness of ~5 and a calculated density of 3.264 g/cm3. It is optically biaxial (+) with α = 1.61(3), β = 1.63(3) and γ = 1.66(4). The calculated 2V is 80°, with the optical orientations X, Y and Z parallel to the crystallographic a, b and c axes, respectively. The empirical formula is (Pb0.70Ca0.17Ba0.01K0.11Na0.01Y0.01)Σ1.01(Zr1.00Hf0.01Ti0.01)Σ1.02Si3.01O9⋅2H2O calculated on the basis of nine oxygen atoms per formula unit and assuming the occurrence of two H2O groups. Plumbogaidonnayite is orthorhombic, P21nb, a = 11.7690(4) Å, b = 12.9867(3) Å, c = 6.66165(16) Å, V = 1018.17(5) Å3 and Z = 4. The nine strongest lines of its powder XRD pattern [d in Å (I, %) (hkl)] are: 6.489 (36) (020), 5.803 (100) (101), 4.661 (27) (021), 4.336 (29) (121), 3.640 (30) (221), 3.114 (79) (112), 2.947 (27) (400), 2.622 (27) (241) and 2.493 (27) (312). Plumbogaidonnayite has a similar spiral chain framework structure with gaidonnayite and georgechaoite, which is composed of SiO4 tetrahedra and ZrO6 octahedra, but with disordered extra-framework sites (cations and H2O groups) characterised by the substitution of 2Na+ (K+)→Pb2+ (Ca2+) + □ (vacancy). The discovery of plumbogaidonnayite adds a new perspective on the cation ordering and heterovalent substitution mechanism in gaidonnayite-group minerals.
While scholarship on “women's liberation” under historically existing socialism focuses on heroic women making inroads into male-dominated domains, this article explores a previously overlooked group of women in socialist China. Known as jiashu in Chinese, these women are the female dependents (wives, mothers, and in-laws) of both male and female employees in a workplace. Specifically, it centers on the experiences of the jiashu of textile workers in the city of Zhengzhou from 1949 to 1962. It argues that, despite being portrayed as “parasitizing” off formal workers, jiashu performed a wide range of work, both paid and unpaid, inside and outside the household. Similar to their counterparts under capitalism and other state-socialist regimes, these Chinese women's unpaid domestic work sustained the daily and generational reproduction of the labor force and was thus essential to industrial accumulation. Moreover, jiashu also worked on the shopfloor and in collectivized service facilities as paid laborers. Such remunerated work also subsidized accumulation, and the resistance from these women contributed to the eventual collapse of the Great Leap Forward (1958–1962). This research advances the field in two ways. First, it expands theories about the relationship between women's work, social reproduction, and capital accumulation to include work that is both reproductive in nature and remunerated – a previously understudied form of labor. Second, while existing literature focuses on structural analysis and explains why women's work is functional to accumulation, this study gives equal attention to women's agency, showing how interactions between the two shaped historical trajectories.
Following Faber–Pandharipande, we use the virtual localization formula for the moduli space of stable maps to $\mathbb {P}^{1}$ to compute relations between Hodge integrals. We prove that certain generating series of these integrals are polynomials.
Goodstein’s principle is arguably the first purely number-theoretic statement known to be independent of Peano arithmetic. It involves sequences of natural numbers which at first appear to diverge, but eventually decrease to zero. These sequences are defined relative to a notation system based on exponentiation for the natural numbers. In this article, we provide a self-contained and modern analysis of Goodstein’s principle, obtaining some variations and improvements. We explore notions of optimality for notation systems and apply them to the classical Goodstein process and to a weaker variant based on multiplication rather than exponentiation. In particular, we introduce the notion of base-change maximality, and show how it leads to far-reaching extensions of Goodstein’s result. We moreover show that by varying the initial base of the Goodstein process, one readily obtains independence results for each of the fragments $\mathsf {I}\Sigma _n$ of Peano arithmetic.
This article discusses houses on the periphery of Barcelona and in particular in the El Carmel neighbourhood, which were built by poor country-to-city migrants from southern Spain in the post-World War II period. They were constructed following two typologies: barracas (sheds), one-storey huts on an irregular street plan, and coreas (‘Korea houses’), more formally looking one- to three-storey structures lined up on orderly laid-out streets. Based on archival documents, contemporaneous publications and interviews with former autoconstructores (self-builders), the article analyses both social conditions and physical structures. While these buildings were often unauthorized and constructed by informal means, they were just as often built with the landowner’s consent, involving architects and building professionals, and retroactively legalized. The article concludes that in this respect Barcelona’s ‘informal neighbourhoods’ in fact straddled the realms of the formal and the informal, to the extent that the habitual distinction between formal and informal architecture has to be considered inadequate.
Gust response has consistently been a concern in engineering. Critical theories have been proposed in the past to predict the unsteady lift response of an airfoil experiencing vertical gusts by Atassi, and longitudinal gusts by Greenberg. However, their applicability for an airfoil with non-zero angles of attack still needs clarification. Thus, force measurements are conducted to examine these theories’ validity and quasi-steady corrections are applied to compensate potential disparities between the idealised and real flow conditions. Velocity measurements are performed to scrutinise the effect of gusts on the flow around the airfoil, and subsequently to reveal the underlying mechanism governing the airfoil's response to gust-induced perturbations. In the study, two pitching vanes are arranged upstream to generate periodic vertical and longitudinal gusts, whereas a downstream airfoil with angles of attack of 0–12° is subjected to two gust types. It is found that Greenberg's theory demonstrates superior predictive capability in pre-stall regimes, with the potential for its effectiveness to be expanded to post-stall regimes through theoretical refinements. In contrast, Atassi's theory exhibits significant deviations from experimental outcomes across the measured angles of attack. Nevertheless, a modified version of the theory aligns better with experimental results at small angles of attack, whereas substantial discrepancies persist as the angle of attack increases. In the pre-stall regime, the aerodynamic response of the airfoil to vertical gusts displays a linear correlation with the flow angle near the leading edge. In the post-stall regime, the vertical gust induces dynamic stall of the airfoil. The flow angle has an essential effect on the lift coefficient but it alone is inadequate to dictate the trend of the lift coefficient. The vorticity statistics show that negative vortex circulation strongly correlates with the lift coefficient. Thus, further correction of the theory or a new vortex model can be expected to predict the lift variation.
There is concern that junior doctors are not prepared for their post-graduate attachments in ENT. The aims of this study were to capture the learning priorities of those in the ENT first on-call role and facilitate further educational opportunities to address these needs.
Method
Semi-structured interviews were undertaken to explore the learning needs of junior doctors with seven junior and two senior ENT clinicians.
Results
The thematic analysis generated three themes: the role of the ENT Junior; the perceived, expressed and prescribed learning needs; and attitudes towards future learning. These themes explored the misalignment between undergraduate training and post-graduate expectations, the lack of competence in ENT practical skills and the need for focused ENT training prior to commencing on-call shifts.
Conclusion
All interviewees identified the need for greater experience in practical interventional skills prior to their ENT attachments and expressed interest towards a standardised, bootcamp-style induction with simulated emergency experience.
Non-dissolvable nasal packs (Rapid Rhino and Merocel) are widely used in secondary healthcare centres for the control of epistaxis, with some side effects.
Methods
A prospective, observational cohort study was conducted of adults who required Rapid Rhino or Merocel packing for acute epistaxis management in a large healthcare centre between March 2020 and 2021. A validated modified version of the 22-item Sino-Nasal Outcome Test was used.
Results
A total of 80 adults requiring non-dissolvable packs were recruited. Seventy per cent of patients had Rapid Rhino packs inserted. Embarrassment was greater in patients who used Rapid Rhino than Merocel. Merocel packs had a significantly higher mean pain score on removal compared to Rapid Rhino. There was no correlation between rebleed rate and type of nasal pack used.
Conclusion
Non-dissolvable Rapid Rhino and Merocel nasal packs have similar efficacy in controlling epistaxis. Rapid Rhino packs are more embarrassing for patients in comparison to Merocel packs, but are less painful to remove.
U.S. military veterans are an average 20 years older than non-veterans and have elevated rates of certain health conditions. While negative aging stereotypes have been linked to increased risk for various health conditions, little is known about the prevalence and correlates of these stereotypes in this population. Using data from a nationally representative sample of 4,069 U.S. veterans surveyed between 11/19 and 3/20, we examined (1) the current prevalence of negative aging stereotypes related to physical, mental, and cognitive health and (2) sociodemographic, health, and psychosocial factors associated with these stereotypes. Multivariable regression and relative weight analyses were conducted to identify independent correlates of negative aging stereotypes. Results revealed that 82.3%, 71.1%, and 30.0% of veterans endorsed negative aging stereotypes related to physical, cognitive, and emotional health, respectively. Older age (36.6% relative variance explained), grit (23.6%), and optimism (17.5%) explained the majority of the variance in negative age stereotypes related to physical aging; grit (46.6%), openness to experiences (31.5%), and older age (15.1%) in negative age stereotypes related to cognitive aging; and emotional stability (28.8%), purpose in life (28.8%), and grit (25.3%) in negative age stereotypes related to emotional aging. This study provides an up-to-date characterization of the prevalence and correlates of negative aging stereotypes in U.S. veterans. Results underscore the importance of targeting key correlates of negative aging stereotypes, such as lower grit, as part of efforts to promote health and functioning in this population.
Airport emergencies are rare but potentially catastrophic; therefore, system preparedness is crucial. Airport emergency plans include the organization of emergency drills on a regular basis, including full-scale exercises, to train and test the entire rescue organization.
Objective:
This report describes a full-scale simulation at Bologna International Airport, Italy, in October 2022, involving local EMS resources.
Methods:
A full-scale aeroplane crash was simulated on the airport ground, activating the Airport emergency plan, and requiring the intervention of supplementary resources (ambulances, medical cars, and other emergency vehicles).
Results:
Twenty-seven simulated patients were evaluated by EMS: START triage assessment was correct for 81.48% of patients; 11.11% were over-triaged and 7.41% were under-triaged. All patients were transported to the hospitals of the area. The simulation ended 2 hours and 28 minutes after the initial alarm.
Conclusion:
The response time proved a good response. Triage accuracy was correct in more than 80% of simulated patients. The availability of a trauma centre within 6 kilometres allowed the transportation of a quota of patients directly from the event, without affecting transportation times. Areas for improvement were identified in the communication within the different agencies and in moving ambulances within the airport runway without airport personnel guidance.
Transient numerical simulations were conducted to investigate the influence of large amplitude and fast impact backpressure on a shock train. The fundamental problem consists of a shock train within a constant-area channel with a Ma=1.61 inflow and a pulse backpressure applied to the outlet. The pressure disturbance in the isolator has an intense forcing-response lag. From the moment of the backpressure peak appearance, it takes 36 times the backpressure duration for the pressure disturbance to reach the upstream end. It moves upstream with time in the form of a normal shock wave. As time progresses, the normal shock degenerates into a $\lambda $ shock and a compression wave behind due to the action of viscous dissipation in the boundary layer. Eventually, a multi-stage shock train is formed. The maximum backpropagation distance is a quadratic function of both the pulse backpressure peak and duration, and the relationship between these variables was determined by fitting. When the integral value of backpressure to time is fixed, reducing the backpressure peak while increasing the duration will reduce the backpressure pulsation at the isolator outlet, which will be more conducive to shortening the maximum backpropagation distance than reducing the duration and increasing the backpressure peak. The values of backpressure peak and duration are obtained from the detonation combustion case, which ensures the authenticity of backpressure characteristics. The relevant research conclusions can provide a reference for the design of the isolator of pulse detonation ramjet.