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Cases of Fontan failure with normal Fontan pressure have been reported. This study aimed to identify catheterisation-derived haemodynamic predictors of heart transplantation/death, other than Fontan pressure, in late post-Fontan patients.
Methods:
This retrospective study evaluated post-Fontan patients who underwent cardiac catheterisation at age ≥10 years between 1993 and 2018. The predictive effect of cardiac index-systemic vascular resistance index plot and perfusion pressure on freedom from the primary outcome (heart transplantation/death) was evaluated. Patients were categorised into haemodynamic categories A (cardiac index ≥ 3, systemic vascular resistance index ≥ 13), B (cardiac index < 3, systemic vascular resistance index ≥ 13), C (cardiac index ≥ 3, systemic vascular resistance index < 13), and D (cardiac index < 3, systemic vascular resistance index < 13).
Results:
In total, 79 patients (median age: 15.7 [range: 10.1–50.2] years) were included; of them, the primary endpoint occurred in 10 (13%; median follow-up: 1.9 [range: 0.1–18.8] years). Category C patients had significantly shorter freedom from the endpoint than categories A and B patients. Univariate analysis identified significant haemodynamic predictors, including Fontan pressure, pulmonary/systemic vascular resistance index, pulmonary/systemic flow, systemic arterial oxygen saturation, systemic venous oxygen saturation, systemic vascular resistance index, perfusion pressure, perfusion pressure < 53 mmHg, and category C. In multivariable analysis, perfusion pressure < 53 mmHg and category C emerged as predictors of heart transplantation/death alongside Fontan pressure.
Conclusion:
Haemodynamic profiling of late post-Fontan patients using the cardiac index-systemic vascular resistance index plot can aid to comprehend the post-Fontan status and predict clinical prognosis.
Western plainsong studies have typically focused on fully notated manuscripts, which provide the most complete witnesses to the repertories that have interested scholars in the field. Recent work, however, has shown that partially notated manuscripts, fragments, and marginalia can yield different kinds of insights into manuscript culture, as well as the uses and functions of musical notation. This article explores how a partially notated manuscript preserving the Old Hispanic rite, Toledo, Cathedral Archive, MS 35–6 (T6), can expand our knowledge of Old Hispanic chant, its scribal practices, manuscript culture, and notation. We identify the specific palaeographical traits and melodic dialects associated with each scribe. On this basis, we hypothesize that scribes used notation for a variety of reasons: to train in singing and writing, to practise writing, to correct particular melodies and notational forms, to preserve particular versions within a variant melodic tradition, and as an aide-memoire. T6 offers new insights into the various ways that the Old Hispanic oral tradition could be supported by writing.
To evaluate the impact of a mobile-app-based central line-associated bloodstream infection (CLABSI) prevention program in nursing home residents with peripherally inserted central catheters (PICCs).
Design:
Pre-post prospective cohort study with baseline (September 2015–December 2016), phase-in (January 2017–April 2017), and intervention (May 2017–December 2018). Generalized linear mixed models compared intervention with baseline frequency of localized inflammation/infection, dressing peeling, and infection-related hospitalizations. Cox proportional hazards models compared days-to-removal of lines with localized inflammation/infection.
Setting:
Six nursing homes in Orange County, California.
Patients:
Adult nursing home residents with PICCs.
Intervention:
CLABSI prevention program consisting of an actionable scoring system for identifying insertion site infection/inflammation coupled with a mobile-app enabling photo-assessments and automated physician alerting for remote response.
Results:
We completed 8,131 assessments of 817 PICCs in 719 residents (baseline: 4,865 assessments, 422 PICCs, 385 residents; intervention: 4,264 assessments, 395 PICCs, 334 residents). The intervention was associated with 57% lower odds of peeling dressings (OR 0.43, 95% CI 0.28–0.64, P < .001), 73% lower local inflammation/infection (OR = 0.27, 95% CI: 0.13–0.56, P < .001), and 41% lower risk of infection-related hospitalizations (OR = 0.59, 95% CI: 0.42–0.83, P = .002). Physician mobile-app alerting and response enabled 62% lower risk of lines remaining in place after inflammation/infection was identified (HR 0.38, CI: 0.24–0.62, P < .001) and 95% faster removal of infected lines from mean (SD) 19 (20) to 1 (2) days.
Conclusions:
A mobile-app-based CLABSI prevention program decreased the frequency of inflamed/infected central line insertion sites, improved dressing integrity, increased speed of removal when inflammation/infection were found, and reduced infection-related hospitalization risk.
Anxiety symptoms are elevated among people with joint hypermobility. The underlying neural mechanisms are attributed theoretically to effects of variant connective tissue on the precision of interoceptive representations contributing to emotions.
Aim
To investigate the neural correlates of anxiety and hypermobility using functional neuroimaging.
Method
We used functional magnetic resonance neuroimaging to quantify regional brain responses to emotional stimuli (facial expressions) in people with generalised anxiety disorder (GAD) (N = 30) and a non-anxious comparison group (N = 33). All participants were assessed for joint laxity and were classified (using Brighton Criteria) for the presence and absence of hypermobility syndrome (HMS: now considered hypermobility spectrum disorder).
Results
Participants with HMS showed attenuated neural reactivity to emotional faces in specific frontal (inferior frontal gyrus, pre-supplementary motor area), midline (anterior mid and posterior cingulate cortices) and parietal (precuneus and supramarginal gyrus) regions. Notably, interaction between HMS and anxiety was expressed in reactivity of the left amygdala (a region implicated in threat processing) and mid insula (primary interoceptive cortex) where activity was amplified in people with HMS with GAD. Severity of hypermobility in anxious, compared with non-anxious, individuals correlated with activity within the anterior insula (implicated as the neural substrate linking anxious feelings to physiological state). Amygdala-precuneus functional connectivity was stronger in participants with HMS, compared with non-HMS participants.
Conclusions
The predisposition to anxiety in people with variant connective tissue reflects dynamic interactions between neural centres processing threat (amygdala) and representing bodily state (insular and parietal cortices). Correspondingly, interventions to regulate amygdala reactivity while enhancing interoceptive precision may have therapeutic benefit for symptomatic hypermobile individuals.
Amid a new era of disruption spawned by looming climate threats and significant geopolitical tensions, an increasing number of countries have favored a more robust green industrial policy (GIP) to reduce carbon emissions and achieve other economic, political, and geostrategic objectives. The use of multi-purpose GIPs not only raises questions regarding the policies' compatibility with the World Trade Organization (WTO) rules but also, more broadly, profoundly implicates the interface between energy, trade, and the environment. This article selects China, the United States, and the European Union as case studies and provides a thorough analysis of the specific text and context of their GIPs to identify the new trends that deviate from past practices in order to capture the policy transformation. It highlights the disruptively adverse implications of the multi-purpose GIPs on the multilateral trading system. However, the WTO has an opportunity to mitigate such disruptions and avoid a seemingly unavoidable clash by facilitating international cooperation and coordination in the design and implementation of multi-purpose GIPs, particularly among major clean energy producer countries. In doing so, the WTO can strengthen its credibility and stability while also minimizing the misalignment of the diverse objectives and ensuring the decarbonization efforts will not undermined.
In this article, a coupled line diplexer (operating at 2.4 GHz and 3.5 GHz) which can be used as single-band filter with tunable attenuation characteristics in the pass band has been designed. Multilayer graphene (MLG) pads are used to achieve tunable features in this circuit. The graphene pads are placed at each branch of the diplexer. Single-band tunable attenuation characteristics are achieved by applying bias to graphene pads placed at optimum locations on the filter. The proposed tunable coupled line attenuating diplexer is realized on FR-4 glass epoxy substrate of thickness 1.58 mm with a total size of 45 × 75 mm2. By varying the bias voltage (0 V –6 V) of MLG pads the resistance of graphene pad placed in the circuit gets decreases thereby attenuating/controlling the transmission power to the other port in the required band. In lower pass band (2.28–2.55 GHz) the signal is attenuated from 3 to 10.8 dB and in higher pass band (3.2–3.58 GHz) signal is attenuated from 5 to 13 dB. Simulations of the structure with and without graphene pads have been carried out and are in good agreement with measured results.
It is 100 years since the rights of those in ‘actual occupation’ joined the statute book as interests capable of binding transferees of land despite not appearing on the register. This paper seizes the opportunity to investigate and excavate the overlooked and under-examined historical origins of the actual occupation concept and to revisit the oft-touted rationales for the principle’s recognition. In so doing, the paper rejects the commonly-rehearsed justifications for the concept and makes the radical case for abolition of actual occupation.
How does social science insulate police from social movements’ demand for abolition? We explore this through a content analysis of policing social science research funded by Arnold Ventures, the MacArthur Foundation, and the National Institute of Justice published from 2011 to 2022 (N = 143 studies). Our mixed method content analysis revealed what we call “Academic Copaganda,” or studies contesting social movement claims by authors (1) masking their conflicts of interest, or (2) espousing police epistemology. Although Academic Copaganda comprised 20% of studies in the sample, they received most media mentions after the 2020 police killing of George Floyd. We conclude by discussing our contributions to legal scholarship on police legitimacy and empirical critical race theory.
In a collection of Hatt-ı Hümayuns (Imperial Edicts) at the Ottoman Archives in Istanbul, I located the Ottoman translation of the Greek Declaration of Independence. This article examines the terminology that Ottomans used to interpret the language employed by the revolutionary Greeks. The goal of this study is to examine Ottoman attempts to define the rebels and conceptualize the inner motive behind the revolt of their subjects. This article argues that confiscated documents such as the Greek Declaration of Independence contributed to the familiarization of the imperial authorities with the ideological background to the rebellion and the reasons that triggered it.
Direct democratic institutions are often introduced by popular vote, but there is little research on what motivates voters to support these new instruments. Using a unique dataset on the ideological positions of voters and members of parliament, this article examines support for the introduction of the initiative right in a popular vote. We find that voters support the initiative right when they are inadequately represented in parliament. Moreover, the analysis shows that the voting behavior is consistent with voters understanding the strategic implications of adopting the popular initiative. We demonstrate that voters support its adoption if they are ideologically more proximate to the median voter than they are to the median legislator. Finally, the article shows that ideological distance matters for voters of the ruling party as well, which helps explain why a majority of voters support a political institution that limits the ruling party’s room for maneuver.
Kant’s aim in the Transcendental Deduction is to prove that the a priori categories of the understanding necessarily apply to objects of experience. He claims that he will do this simply by explaining how they could so apply. But the idea that a mere explanation of this possibility should provide a defence of the categories’ actual (let alone necessary) applicability is surprising. We argue that it can be understood by attending to the source of the scepticism that the Critique’s Analytic is supposed to overcome: Hume’s inability to explain causal knowledge in the Enquiry.
This paper revisits the role of skill distribution in shaping regional comparative advantage. Theoretically, we show that it is the relative skill dispersion between exporters and importers, rather than the absolute skill dispersion of exporters, that matters for the pattern of international trade. Using industry-level data on Chinese provincial export flows, we demonstrate that regions with a more dispersed skill distribution relative to their trading partners export more goods produced by sectors with lower skill complementarity. Exploring the potential mechanisms, we further find that the trade-promoting effect from relative skill dispersion probably operates through improving product quality and diversity.
In the last decades, it has been well known that low-grade inflammation plays a potential role in the pathogenesis of different cancers. The aim of this systematic review and meta-analysis of observational studies was to evaluate the association between inflammatory potential of diet measured through the Dietary Inflammatory Index (DII), Energy-adjusted DII (E-DII), Empirical Dietary Inflammatory Pattern (EDIP), the Inflammatory Score of Diet (ISD), and risk of colorectal cancer (CRC) and site-specific colon cancer. A systematic electronic search of PubMed/Medline, Scopus, the Web of Sciences and reference lists up to 21 November 2023 was performed. Data were pooled by the generic inverse variance method using random effect model. To assess the heterogeneity of included studies, the I2 index was used. A total of twenty-eight original studies, comprising 2 287 836 participants, were selected to include in this meta-analysis. Pooled results showed a significant association between higher adherence to pro-inflammatory diet and increased risk of CRC (effect size (ES): 1·39; 95 % CI 1·29, 1·51; I2 = 82·9 %), colon (ES: 1·40; 95 % CI 1·26, 1·55; I² = 73·3 %, P< 0·01), proximal colon (ES: 1·28; 95 % CI 1·17, 1·40; I² = 29·1 %), distal (ES: 1·50; 95 % CI 1·30, 1·74; I² = 63·5 %) and rectal (ES: 1·46; 95 % CI 1·23, 1·74; I² = 80 %). Stratified analysis by type of dietary indices noted that greater adherence to the DII, E-DII and EDIP were related to significant increase in the risk of overall CRC and site-specific colon cancers. Our results highlighted the proposed role of inflammatory potential of diet as important risk factor for CRC. Adherence to an anti-inflammatory dietary pattern should be recommended to reduce incidence of CRC, globally.
To assess the feasibility of transcatheter closure in patients with dextrocardia and isolated atrial septal defect or ventricular septal defect.
Methods:
A retrospective analysis was performed on the clinical data of 10 patients with dextrocardia and atrial septal defect or ventricular septal defect from June 2013 to January 2023 and successfully underwent transcatheter closure. Patient data were meticulously collected.
Results:
The study cohort comprised 10 patients, with three males, aged between 3 and 38 years. Intraoperative right heart catheterisation revealed the following measurements: the mean pulmonary arterial pressure of 20.5(18,24,3) mmHg, and a pulmonary-to-systemic flow ratio of 1.80(1.58,2.15). There were five atrial septal defects, with defect diameters of 26(20,30) mm, comprising three dextroversion and two mirror-image dextrocardia. Intraoperative echocardiography confirmed the absence of any residual shunt. Among them, a patient with mirror-image dextrocardia, atrial septal defects, and interrupted inferior vena cava required an alternative approach due to femoral vein limitations. The right internal jugular vein was punctured, and a 22 mm atrial septal occluder was successfully deployed via this route. The study identified five ventricular septal defects, with defect diameters of 4(3.5,5.5) mm, including two dextroversion and three mirror-image dextrocardia. Upon post-operative repeat left ventriculography, no residual shunt was detected in all but one case, which exhibited a minimal residual shunt. Throughout the perioperative period and subsequent post-operative follow-up, no severe complications were observed.
Conclusion:
For patients with dextrocardia accompanied by simple CHD, transcatheter closure is a viable option when interventional treatment is indicated. Although transcatheter closure of atrial septal defects or ventricular septal defect in patients with dextrocardia presents unique challenges, it is safe and effective when the anatomical nuances of dextrocardia are thoroughly understood.
My contribution to this Forum highlights the ways that Michael Willrich’s story of early-twentieth-century anarchism intersects with and complicates existing scholarly accounts of the development of the American “surveillance state.” My essay reflects on the way the subjects of Willrich’s history—immigrant radicals, those who sought to subdue and deport them, and those who defended them—shine a new light on ongoing struggles over the boundaries of modern social regulation.
The objectives of the study were to determine somatic cell count (SCC) and evaluate the presence of pathogens (IMI – intramammary infection) in late lactation (LL), followed by the start (colostrum, CL) and approximate peak (established lactation, EL) of the next lactation, as well as to assess the possible transmission of IMI from lactation to lactation. The study was performed on a dairy farm in northern Slovakia. A total of 489 half udder milk samples (242, 80 and 167 in LL, CL and EL, respectively) were collected. Pathogens were identified using MALDI-TOF MS and PathoProof (the latter only in LL). SCC was determined only in LL and EL. Samples were divided according to SCC in four groups from lowest (SCC1 < 500 × 103 cells mL−1) to highest (SCC4 ≥ 2000 × 103 cells mL−1). SCC was higher in LL than in EL. The prevalence of pathogens identified using MALDI-TOF MS was 16.5, 38.8 and 12.6% in LL, CL and EL, respectively. Non-aureus staphylococci and mammaliicocci (NASM) were the most common isolated pathogens in goat milk and colostrum. Staphylococcus (S.) caprae and S. epidermidis species tended to cause persistent IMI in the next lactation. The identification of pathogens using PathoProof was higher than with MALDI-TOF MS. Of all the pathogens (n = 262) identified using PathoProof, the most common were Staphylococcus spp. (86.7%) of which 65.8% exhibited the β-lactamase gene. Additionally, Escherichia coli (4.2%), S. aureus (2.7%), Enterococcus spp. (2.3%), Streptococcus uberis (1.9%), Mycoplasma spp., Protetheca spp. (0.8% each), Arconabacterium pyogenes/Peptoniphilus indolicus and yeast (0.4% each) were also detected using PathoProof. Better identification of pathogen presence in samples with high SCC could contribute to the discussion about SCC as an indicator of subclinical mastitis in goats.
Using newspaper coverage of women's and girl's property offences in minor English and Irish courts, I analyze courts’ use of Catholic convent institutions between 1930 and 1959. Coverage of minor local hearings offers access to everyday cases, where boundaries between moral and legal transgression were blurred. I explore three interlocking themes in newspaper reports. First, those courts sent to convents were punished, at least in part, for breaching prevailing gendered moral norms. Second, judges represented convents as sites of moral reform; justifying convent detention by reinforcing gendered notions of damaged female agency. Finally, judges sent women and girls to convents even when they publicly resisted. In these ways, courts reinforced reliance on convents for gendered “moral reclamation.” In the conclusion, I explore the argument's implications for state reckoning with historical abuses in institutions like Ireland's Magdalene laundries, showing how abolition feminist legal histories can pose new questions about relationships between law and the experience of mass incarceration.
The linear arithmetic fundamental lemma (AFL) is a conjectural identity of intersection numbers on Lubin–Tate deformation spaces and derivatives of orbital integrals. It was introduced for elliptic orbits by Li, and Howard and Li. For elliptic orbits, the relevant intersection problem is formulated for the basic isogeny class. In the present article, we extend the conjecture to all orbits and all isogeny classes. Our main result is a reduction of the non-basic cases of the AFL to the basic ones, which relies on an analysis of the connected-étale sequence. Our results will be relevant in the global setting, where also locally non-elliptic orbits may contribute in a non-trivial way.