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As an effective drag reduction and thermal protection technology, the opposing jet can guarantee the flight safety of the hypersonic vehicle. In this paper, the jet mode transition is realised by controlling the total jet pressure ratio value (PR) with a function. The jet mode transition from the long penetration mode (LPM) to the short penetration mode (SPM) uses an increasing function. However, the jet mode transition from SPM to LPM uses a decreasing function. The flow field reconstruction process of a two-dimensional axisymmetric blunt body model in the hypersonic flow is studied when the jet mode transition between SPM and LPM changes into each other. The flow field structures and wall parameters of the LPM and SPM transition processes are obtained. The results indicate that the drag and Stanton number both decrease in the transition stage from LPM to SPM, and this is beneficial for the improvement of the drag reduction and thermal protection effect. The peak values of drag and Stanton number fall by 36.39% and 46.40%, respectively. When the jet mode transforms from SPM to LPM, the Stanton number increases, and the drag force first increases and then decreases. However, the final drag reduction effect is not obvious. With the increase in the change rate of the total pressure ratio of the two jet transformation modes, the jet mode transition time is advanced, and the flow field changes more violently.
Previous classification systems of pars tensa retractions have not consistently incorporated ossicular erosion or the presence of cholesteatoma.
Objective
This study aimed to illustrate our classification of pars tensa retractions, which is more precise than previous systems, with aided use of the endoscope.
Methods
A retrospective study was carried out on 200 ears of 170 patients whose pars tensa retractions had been documented at a tertiary otological referral centre.
Results
A classification system was developed. Pars tensa retractions were divided into the following subcategories: grade 0, grade 1, grade 2a, grade 2b, grade 3a, grade 3b, grade 3c, grade 4a, grade 4b, grade 4c, grade 5a, grade 5b and grade 5c.
Conclusion
This classification system was able to accommodate all pars tensa retractions. The distribution of grades of pars tensa retractions was based on ossicular status and the presence or absence of cholesteatoma. It is therefore a more applicable, and functionally based system than previous alternatives.
Common postpartum mental health (PMH) disorders such as depression and anxiety are preventable, but determining individual-level risk is difficult.
Aims
To create and internally validate a clinical risk index for common PMH disorders.
Method
Using population-based health administrative data in Ontario, Canada, comprising sociodemographic, clinical and health service variables easily collectible from hospital birth records, we developed and internally validated a predictive model for common PMH disorders and converted the final model into a risk index. We developed the model in 75% of the cohort (n = 152 362), validating it in the remaining 25% (n = 75 772).
Results
The 1-year prevalence of common PMH disorders was 6.0%. Independently associated variables (forming the mnemonic PMH CAREPLAN) that made up the risk index were: (P) prenatal care provider; (M) mental health diagnosis history and medications during pregnancy; (H) psychiatric hospital admissions or emergency department visits; (C) conception type and complications; (A) apprehension of newborn by child services (newborn taken into care); (R) region of maternal origin; (E) extremes of gestational age at birth; (P) primary maternal language; (L) lactation intention; (A) maternal age; (N) number of prenatal visits. In the index (scored 0–39), 1-year common PMH disorder risk ranged from 1.5 to 40.5%. Discrimination (C-statistic) was 0.69 in development and validation samples; the 95% confidence interval of expected risk encompassed observed risk for all scores in development and validation samples, indicating adequate risk index calibration.
Conclusions
Individual-level risk of developing a common postpartum mental health disorder can be estimated with data feasibly collectable from birth records. Next steps are external validation and evaluation of various cut-off scores for their utility in guiding postpartum individuals to interventions that reduce their risk of illness.
Ryoji Ikeda’s sonic composition has often been considered to prioritise a physical, immersive experience of space over temporal musical progression. This article challenges this commonly held view, arguing that the static nature of his work should be understood in terms of complex interactions between space and time rather than in dualistic terms. By analysing a large-scale sonic transformation within his 2005 album Dataplex, the article uncovers complex rhizomatic networks of materials that expand across multiple tracks. The links between the album tracks leads to an unconventional quality of musical time that contains a high degree of statis yet nevertheless presents a non-linear progression, which is created through repetition (loops), variation and re-contextualisation of sounds. The analysis suggests that experiencing the ordered series of tracks in the album means accumulating information and exploring memory within a non-interchangeable process of sonic flow and metamorphosis. Despite the fragmentary nature of these internal continuities, the resulting rhizomatic networks provide a means to understand and even to listen structurally to Ikeda’s sonic composition.
The present study examined if disruption of serial position effects in list recall could serve as an early marker of Alzheimer’s disease (AD) in Spanish–English bilinguals.
Methods:
We tested 20 participants initially diagnosed as cognitively normal or with mild cognitive impairment who declined and eventually received a diagnosis of AD (decliners), and 37 who remained cognitively stable (controls) over at least 2 years. Participants were tested on the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) Word List Learning Test in English or Spanish as part of an annual neuropsychological evaluation.
Results:
Compared to controls, decliners exhibited significantly reduced recall including reduced primacy scores (i.e., items recalled from the first three list items on Trial 1), whereas recency scores (i.e., items recalled from the last 3 list items on Trial 1) were equivalent in decliners and controls. Further analyses suggested that the sensitivity of the primacy effect to preclinical AD was initially stronger in participants tested in Spanish, a surprising finding given that the CERAD was developed for English speakers. However, in the subsequent year of testing, primacy scores declined to the same level regardless of language of testing.
Conclusions:
Several list learning measures may facilitate early diagnosis of AD in Spanish–English bilinguals, possibly including the relatively understudied primacy effect. Additional studies are needed to investigate the possibility that linguistic or demographic variables might modulate sensitivity of list learning tests to preclinical AD, which could lead to broader improvements in their utility for early diagnosis of AD in all populations.
Aortic/arterial stiffness is a reliable, independent predictor and a risk factor for cardiovascular mortality. Arterial stiffness is assessed by pulse wave velocity and echocardiography. The purpose of this study is to analyse aortic/arterial stiffness in patients using echocardiographic and pulse wave velocity techniques.
Materials and Methods:
The participants of this study consisted of 62 patients who presented to the Gazi University Pediatric Endocrinology and Pediatric Cardiology outpatient clinics, including 21 obese, 20 overweight, and 21 normal-weight patients. Echocardiography was performed on all patients, and echocardiographic measurements were compared to pulse wave velocity measurements.
Results:
The mean (min-max) arterial strain measurements were 0.146 ± 0.0 (0.06–0.3) in the obese group and 0.106 ± 0.0 (0.05–0.18) in the overweight group. In comparison to the overweight group, the obese group had greater arterial strain measurements. The pulse wave velocity measurements in the obese and overweight groups were greater than those in the normal weight group (p > 0.05). Elastic modulus and aortic stiffness ß index values were shown to be positively correlated with pulse wave velocity measurements in the obese group (r = 0.56, r = 0.53, respectively; p = 0.008, p = 0.01, respectively). Systolic and diastolic blood pressure measurements were correlated with pulse wave velocity measurements in the obese group (r = 0.98, p = 0.0001, respectively).
Conclusion:
In our study, echocardiographic aortic measurements showing the vessel wall were correlated with pulse wave velocity measurements. Echocardiographic evaluation should be included in the routine follow-up of patients because pulse wave velocity measurement devices are not available in all centres, echocardiography is available in many centres, it is easily applicable, and it facilitates the follow-up of patients.
To investigate changes in neuroregenerative pathways with vocal fold denervation in response to vocal fold augmentation.
Methods
Eighteen Yorkshire crossbreed swine underwent left recurrent laryngeal nerve transection, followed by observation or augmentation with carboxymethylcellulose or calcium hydroxyapatite at two weeks. Polymerase chain reaction expression of genes regulating muscle growth (MyoD1, MyoG and FoxO1) and atrophy (FBXO32) were analysed at 4 and 12 weeks post-injection. Thyroarytenoid neuromuscular junction density was quantified using immunohistochemistry.
Results
Denervated vocal folds demonstrated reduced expression of MyoD1, MyoG, FoxO1 and FBXO32, but overexpression after augmentation. Healthy vocal folds showed increased early and late MyoD1, MyoG, FoxO1 and FBXO32 expression in all animals. Neuromuscular junction density had a slower decline in augmented compared to untreated denervated vocal folds, and was significantly reduced in healthy vocal folds contralateral to augmentation.
Conclusion
Injection augmentation may slow neuromuscular degeneration pathways in denervated vocal folds and reduce compensatory remodelling in contralateral healthy vocal folds.
In this contribution, we exploit machine learning techniques to evaluate whether and how close firms are to become successful exporters. First, we train various algorithms using financial information on both exporters and non-exporters in France in 2010–2018. Thus, we show that it is possible to predict the distance non-exporters are from export status. In particular, we find that a Bayesian Additive Regression Tree with Missingness In Attributes (BART-MIA) performs better than other techniques with an accuracy of up to 0.90. Predictions are robust to changes in definitions of exporters and in the presence of discontinuous exporting activity. Eventually, we discuss how our exporting scores can be helpful for trade promotion, trade credit, and assessing aggregate trade potential. For example, back-of-the-envelope estimates show that a representative firm with just below-average exporting scores needs up to 44% more cash resources and up to 2.5 times more capital to get to foreign markets.
Childhood is a critical period for muscle accumulation. Studies in elders have reported that antioxidant vitamins could improve muscle health. However, limited studies have assessed such associations in children. This study included 243 boys and 183 girls. A seventy-nine-item FFQ was used to investigate dietary nutrients intake. Plasma levels of retinol and α-tocopherol were measured using high-performance liquid chromatography with MS. Dual X-ray absorptiometry was used to assess appendicular skeletal muscle mass (ASM) and total body fat. The ASM index (ASMI) and ASMI Z-score were then calculated. Hand grip strength was measured using a Jamar® Plus+ Hand Dynamometer. Fully adjusted multiple linear regression models showed that for each unit increase in plasma retinol content, ASM, ASMI, left HGS and ASMI Z-score increased by 2·43 × 10−3 kg, 1·33 × 10−3 kg/m2, 3·72 × 10−3 kg and 2·45 × 10−3 in girls, respectively (P < 0·001–0·050). ANCOVA revealed a dose–response relationship between tertiles of plasma retinol level and muscle indicators (Ptrend: 0·001–0·007). The percentage differences between the top and bottom tertiles were 8·38 %, 6·26 %, 13·2 %, 12·1 % and 116 % for ASM, ASMI, left HGS, right HGS and ASMI Z-score in girls, respectively (Pdiff: 0·005–0·020). No such associations were observed in boys. Plasma α-tocopherol levels were not correlated with muscle indicators in either sex. In conclusion, high circulating retinol levels are positively associated with muscle mass and strength in school-age girls.
Perishable artifacts are invaluable tools for reconstructing past lifeways of hunter-gatherers, and when preserved in arid settings, they can inform on dynamic interactions between communities and the environment. Many such materials were recovered from early archaeological surveys in Utah and Nevada but were largely excluded from contemporary analyses because of small sample sizes, their fragmentary nature, and insecure proveniences. This synchronic reanalysis of cordage and coiled basketry from 10 late Holocene sites in the Great Salt Lake Desert utilizes newer approaches to perishables analysis so as to collect data more conducive to statistical comparisons of subsistence and craft traditions absent from earlier Great Basin studies. Regional trends of conformity of fine cordage contrasted with a diversity of basketry manufacture suggest contemporaneous social stressors directing the production of materials and two potentially gendered subclasses of utilitarian objects. Feminine and masculine perishable crafts in the Bonneville Basin follow separate manufacturing traditions, observable despite small sample sizes and poor dating of these curated collections.
This study identifies the link between women's asset ownership and women's empowerment. Women's empowerment is measured by their decision-making role related to their health, large household purchases, and their social interaction. Using Demographic and Health Surveys data for 18 countries from South Asia, the Middle East, and sub-Saharan Africa, we found that the women who owned assets were 14% more likely to be empowered compared with the women who did not own any asset (odds ratio: 1.14, 95% confidence interval: 1.10–1.185). At a disaggregated country level, asset ownership was positively and significantly associated with women's empowerment in nine countries, negatively associated in one country, and had no significant association in the other eight countries. This study provides important insights into the link between women's asset ownership and empowerment and may inform public policy related to gender equality through women's empowerment.
Treatment of seriously ill patients is often complicated by prolonged or complex transfers between hospitals in sub-Saharan Africa. Difficulties or inefficiency in these transfers can lead to poor outcomes for patients. “On-call” triage systems have been utilized to facilitate communication between facilities and to avoid poor outcomes associated with patient transfer. This study attempts to examine the effects of a pilot study to implement such a system in Rwanda.
Methods:
Data collection occurred prospectively in two stages, pre-intervention and intervention, in the emergency department (ED) at Kigali University Teaching Hospital (CHUK). All patients transferred during the pre-determined timeframe were enrolled. Data were collected by ED research staff via a standardized form. Statistical analysis was performed using STATA version 15.0. Differences in characteristics were assessed using χ2 or Fisher’s exact tests for categorical variables and independent sample t-tests for normally distributed continuous variables.
Results:
During the “on call” physician intervention, the indication for transfer was significantly more likely to be for critical care (P <.001), transfer times were faster (P <.001), patients were more likely to be displaying emergency signs (P <.001), and vital signs were more likely to be collected prior to transport (P <.001) when compared to the pre-interventional phase.
Conclusion:
The “[Emergency Medicine] EM Doc On Call” intervention was associated with improved timely interhospital transfer and clinical documentation in Rwanda. While these data are not definitive due to multiple limitations, it is extremely promising and worthy of further study.
Difficulties with emotion regulation are integral to borderline personality disorder (BPD) and its hypothesized developmental pathway. Here, we prospectively assess trajectories of emotion processing across childhood, how BPD symptoms impact these trajectories, and whether developmental changes are transdiagnostic or specific to BPD, as major depressive (MDD) and conduct disorders (CD) are also characterized by emotion regulation difficulties. This study included 187 children enriched for those with early symptoms of depression and disruptive behaviors from a longitudinal study. We created multilevel models of multiple components of emotional processing from mean ages 9.05 to 18.55 years, and assessed the effect of late adolescent BPD, MDD, and CD symptoms on these trajectories. Linear trajectories of coping with sadness and anger, and quadratic trajectories of dysregulated expressions of sadness and anger were transdiagnostic, but also exhibited independent relationships with BPD symptoms. Only inhibition of sadness was related to BPD symptoms. The quadratic trajectories of poor emotional awareness and emotional reluctance were also independently related to BPD. Findings support examining separable components of emotion processing across development as potential precursors to BPD, underscoring the importance of understanding these trajectories as not only a marker of potential risk but also potential targets for prevention and intervention.
This article examines the problem of flooding in colonial Tonkin through two interrelated lenses: the history of disasters as social and political phenomena, and the history of technology and the constraints that shape its use. With a gradient ten times steeper than the Mekong, the Red River (Sông Cái in Vietnamese) is notorious for its huge seasonal fluctuations and violent floods. For centuries, local rulers and cultivators constructed dikes to protect fields and settlements, though breaches and inundations were frequent. French administrators were convinced that they could improve the flooding situation with modern know-how. From the 1890s, colonial engineers carefully studied the river's behavior, examined a range of different schemes to control it, and debated the extent to which the straitjacketing of the river might gradually exacerbate flood risk. Despite their deep-seated misgivings about the problems caused by dikes, they were ultimately forced to work within the parameters of pre-colonial hydraulic works. The result was an intensification of existing dependencies and flood vulnerabilities, which finally came to a head under the combined pressures of extreme weather and war, and which ultimately played an important role in undermining colonial authority in the Red River delta.
This study investigated, and discusses the integration of, the shift-and-persist (SAP) and skin-deep resilience (SDR) theories. The SAP theory states that the combination of shifting (adjusting oneself to stressful situations through strategies like emotion regulation) and persisting (enduring adversity with strength by finding meaning and maintaining optimism) will be beneficial to physical health in children experiencing adversity. The SDR theory states that high striving/self-control will be beneficial to mental health but detrimental to physical health among those confronting adversity. This study investigated 308 children ages 8–17 experiencing the adversity of a chronic illness (asthma). SAP and SDR (striving/self-control) were assessed via questionnaires, and physical health (asthma symptoms, inflammatory profiles), mental health (anxiety/depression, emotional functioning), and behavioral (medication adherence, activity limitations, collaborative relationships with providers) outcomes were measured cross-sectionally. SAP was associated with better physical health, whereas SDR was associated with worse physical health. Both were associated with better mental health. Only SDR was associated with better behavioral outcomes. Implications of findings and discussion of how to integrate these theories are provided. We suggest that future interventions might seek to cultivate both SAP and SDR to promote overall better health and well-being across multiple domains in children experiencing adversity.
This article analyzes the cultural transformation in the self-proclaimed “people’s republics” in the Donbas, characterized by a violent rejection of global postmodernist art and the return to a Soviet, often Stalinist, cultural message and visual language. The author, an art critic and curator, born and previously active in the Donbas, begins by discussing the destruction of unconventional art, even when created by the miners themselves, and the projects associated with the IZOLYATSIA art platform. The second part of the article deals with public art in the early years of the self-proclaimed Donetsk People’s Republic (DNR), in particular, political posters and art exhibits, which employ Soviet or Soviet-like themes and visual imagery. In a notable departure from the Russian model, the “mobilized art” in the separatist-controlled Donbas features positive references to the Bolshevik Revolution. Throughout the article, the concept of violence is used to analyze the mediatized destruction of nonrealist art and the construction of the DNR’s self-image.