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A previous study of the altitudes of the lowest part of the Upper Cretaceous–Eocene stratigraphic ensemble evidenced for the first time the existence of an east-west elongated dome between N53° and N54° Lat. on the western slope of the Southern Urals. This ridge which is superimposed on the remnants of the Sernovodsk–Abdullino Aulacogen and with the Belaya tear fault was the result of the rejuvenation of these deep basement features; it has been interpreted as a positive flower structure. Slightly to the north, the Southern Urals display a clear bend towards the East. In front of it, detailed microstructural studies show that this curvature was associated with a stress pattern typical of an indentation. Field studies concentrating on the intersection between the flower structure and the Belaya River Valley show (1) that there are two riverbeds more or less superimposed in the same valley, (2) that the older watercourse is offset by small east-west shear zones, (3) that the shear zones are in continuity with the flower structure and (4) that the recent riverbed is not affected by similar offsets. The vertical movements recorded along the Belaya River by geodetic measurements don’t support the existence of a recent activity of the indenter because they are always of a limited extent and associated with karst collapses. This conclusion is supported by the stratigraphic evolution of the fluvial sediments and confirms that the indentation of the Southern Urals did not continue after 10 ka.
There is a tendency today to substitute the affirmation of the absolute value of peace for an earlier, fully-formulated ideal of universal peace. This formula, if I am not mistaken, bears the mark of a new exigency: how to maintain the philosophical task, that is, give a basis to the idea of peace that does not arise solely from circumstantial considerations—however imperious they may be, since they come from the knowledge of the danger that a new world war would bring to entire populations—without again falling under Utopian illusions that have fed the projects of perpetual peace. However, some of the difficulties with which the present consideration will deal give a glimpse of the definition of peace as an absolute value. I think it would be wise to examine this definition briefly in order to clear a way for myself.
Disaster Medicine (DM) is the clinical specialty whose expertise includes the care and management of patients and populations outside conventional care protocols. While traditional standards of care assume the availability of adequate resources, DM practitioners operate in situations where resources are not adequate, necessitating a modification in practice. While prior academic efforts have succeeded in developing a list of core disaster competencies for emergency medicine residency programs, international fellowships, and affiliated health care providers, no official standardized curriculum or consensus has yet been published to date for DM fellowship programs based in the United States.
Study Objective:
The objective of this work is to define the core curriculum for DM physician fellowships in the United States, drawing consensus among existing DM fellowship directors.
Methods:
A panel of DM experts was created from the members of the Council of Disaster Medicine Fellowship Directors. This council is an independent group of DM fellowship directors in the United States that have met annually at the American College of Emergency Physicians (ACEP)’s Scientific Assembly for the last eight years with meeting support from the Disaster Preparedness and Response Committee. Using a modified Delphi technique, the panel members revised and expanded on the existing Society of Academic Emergency Medicine (SAEM) DM fellowship curriculum, with the final draft being ratified by an anonymous vote. Multiple publications were reviewed during the process to ensure all potential topics were identified.
Results:
The results of this effort produced the foundational curriculum, the 2023 Model Core Content of Disaster Medicine.
Conclusion:
Members from the Council of Disaster Medicine Fellowship Directors have developed the 2023 Model Core Content for Disaster Medicine in the United States. This living document defines the foundational curriculum for DM fellowships, providing the basis of a standardized experience, contributing to the development of a board-certified subspecialty, and informing fellowship directors and DM practitioners of content and topics that may appear on future certification examinations.
As disasters increase globally in both frequency and intensity, the vulnerability of children during disasters has become obvious. Pediatricians are often left to manage the resulting physical and mental repercussions. With minimal to no disaster medicine training offered at most U.S. pediatric residencies, the need for an easily accessible pediatric disaster medicine curriculum has been exacerbated. While this need has been highlighted in the literature, material to include or methods to sustainably incorporate disaster medicine into training programs has not been established.
Method:
From a thorough literature review, 19 topics were selected as potentially necessary to include in a disaster medicine curriculum for pediatric residents. Utilizing the Delphi method, subject matter experts were asked to rank these topics with an option to add others. Two independent surveys separated by time were administered with the goal of identifying ten critical core concepts for pediatric resident disaster medicine education. A virtual roundtable discussion then took place to finalize the ten core concepts, discuss objectives, and consider realistic methods of incorporating the curriculum into the residency timeline.
Results:
The ten core concepts identified were 1) introduction to disaster medicine, 2) patient triage, 3) surge capability, 4) mental health effects of a disaster, 5) preparedness for children with special healthcare needs, 6) communicating personal/family disaster preparedness, 7) hospital disaster mitigation, 8) reunification, 9) drills and training, and 10) disaster ethics and crisis standards of care.
Experts agreed upon a longitudinal multi-modal approach with inclusion of short didactics, case scenarios, questions/answers, games, and links to further educational activities and opportunities focused on individualized needs.
Conclusion:
The Delphi method was a successful approach to gathering expert consensus to establish core concepts for a pediatric resident disaster medicine curriculum.
The long-term prospective multi-centre nationwide (French) observational study FRANCISCO will provide new information on perimembranous ventricular septal defect with left ventricular overload but no pulmonary hypertension in children older than 1 year. Outcomes will be compared according to treatment strategy (watchful waiting, surgical closure, or percutaneous closure) and anatomic features of the defect. The results are expected to provide additional guidance about the optimal treatment of this specific population, which is unclear at present.
Enrichment of tissues with ≥20-carbon n-3 PUFA like EPA is associated with positive cardiovascular outcomes. Stearidonic acid (SDA; 18 : 4n-3) and α-linolenic acid (ALA; 18 : 3n-3) are plant-derived dietary n-3 PUFA; however, direct comparisons of their impact on tissue n-3 PUFA content are lacking. Ahiflower® oil extracted from Buglossoides arvensis seeds is the richest known non-genetically modified source of dietary SDA. To investigate the safety and efficacy of dietary Ahiflower oil, a parallel-group, randomised, double-blind, comparator-controlled phase I clinical trial was performed. Diets of healthy subjects (n 40) were supplemented for 28 d with 9·1 g/d of Ahiflower (46 % ALA, 20 % SDA) or flax seed oil (59 % ALA). Blood and urine chemistries, blood lipid profiles, hepatic and renal function tests and haematology were measured as safety parameters. The fatty acid composition of fasting plasma, erythrocytes, polymorphonuclear cells and mononuclear cells were measured at baseline and after 14 and 28 d of supplementation. No clinically significant changes in safety parameters were measured in either group. Tissue ALA and EPA content increased in both groups compared with baseline, but EPA accrual in plasma and in all cell types was greater in the Ahiflower group (time × treatment interactions, P ≤ 0·01). Plasma and mononuclear cell eicosatetraenoic acid (20 : 4n-3) and docosapentaenoic acid (22 : 5n-3) content also increased significantly in the Ahiflower group compared with the flax group. In conclusion, the consumption of Ahiflower oil is safe and is more effective for the enrichment of tissues with 20- and 22-carbon n-3 PUFA than flax seed oil.
The majority of maxillofacial gunshot wounds are caused by suicide attempts. Young men are affected most often. When the lower one-third of the face is involved, airway patency (1.6% of the cases) and hemorrhage control (1.9% of the cases) are the two most urgent complications to monitor and prevent. Spinal fractures are observed with 10% of maxillary injuries and in 20% of orbital injuries. Actions to treat the facial gunshot victim need to be performed, keeping in mind spine immobilization until radiographic imaging is complete and any required spinal stabilization accomplished. Patients should be transported to a trauma center equipped to deal with maxillofacial and neurosurgery because 40% require emergency surgery. The mortality rate of maxillofacial injuries shortly after arrival at a hospital varies from 2.8% to 11.0%. Complications such as hemiparesis or cranial nerve paralysis occur in 20% of survivors. This case has been reported on a victim of four gunshot injuries. One of the gunshots was to the left mandibular ramus and became lodged in the C4 vertebral bone.
A thick Ordovician intra-rhyolitic palaeosol was studied to investigate the peculiarities of early Palaeozoic continental environments, shortly before the development of vascular plants, and to compare its pedogenic patterns with those of previously studied intra-basaltic profiles from the same succession. Well-defined K-eluviation from the top of the palaeosol is proportionally met by K-illuviation at the base of the profile, a pedogenic behaviour that was masked in the underlying intra-basaltic profiles due to subsequent eodiagenetic K-enrichment associated with rhyolite emplacement. Greater stability of K (and eventually Mg) than Si in the intra-rhyolitic profile suggests high pH soil water at the time of pedogenesis despite the low base contents of the acidic host rock, and despite evidence for humid weathering conditions. We also observe that, at the base and at the top of the profile, Al2O3/Zr ratios are substantially lower than those of the host rock, suggesting Al-leaching and therefore extreme weathering conditions, whereas the middle portion of the profile shows Al2O3/Zr ratios that are similar to those of the host rock, suggesting Al stability and therefore less extreme conditions. We interpret these variations in Al2O3/Zr ratios as signatures of a cyclic change from sub-humid periods during which Al was stable throughout the profile, to more humid periods with a well-defined seasonality, during which only the juvenile zone of weathering at the base of the profile could have developed sufficiently high pH during dry seasons for Al to be leached, leaving the Al2O3/Zr signatures from previous stages untouched higher in the profile.
To explore the specificities of Escherichia coli bacteraemia in the elderly, the demographic, clinical and bacteriological characteristics and in-hospital mortality rate of ‘young’ (18–64 years, n = 395), ‘old’ (65–79 years, n = 372) and ‘very old’ (⩾80 years, n = 284) adult patients of the multicentre COLIBAFI cohort study were compared. Clinical and bacteriological risk factors for death were jointly identified by logistic regression and multivariate analysis within each group. ‘Young’ and ‘old’ patients had more comorbidities than ‘very old’ patients (comorbidity score: 1·5 ± 1·3 and 1·6 ± 1·2 vs. 1·2 ± 1·2, respectively; P < 0·001), and were more frequently nosocomially infected (22·3% and 23·8% vs. 8·8%, respectively; P < 0·001). ‘Old’ patients had the poorest prognosis (death rate: 16·4% vs.10·4% for ‘young’ and 12·0% for ‘very old’ patients, respectively; P = 0·039). Risk factors for death were age group-specific, suggesting a host–pathogen relationship evolving with age.
Ethiopia's development strategy rests on the promotion of a market economy, driven by ‘new entrepreneurs’, both urban and rural, while, to bring it to ‘maturity’ and to compensate for its present ‘failures’, the resolute intervention of a ‘developmental state’ is essential. Simultaneously, the ruling party aims to sustain its political hegemony by enrolling massively among those at the top of the social pyramid, to which most of these ‘new entrepreneurs’ belong, so as to build its new constituency on them. In the rural areas (83% of the population), the merger of these two objectives leads to the mobilisation of the upper group of smallholder farmers, recruited both as ‘model farmers’ to become the engine for the growth, notably with the support of a massive public Agricultural Extension Programme, and also as members of the ruling party. However, the subordination of the regime's economic objectives to its political agenda undermines the implementation of its development strategy at the field level. This raises questions about the efficiency of the programme and the room left for entrepreneurship, even though this is a mainstay of the market economy that the regime sees as ‘vital’ for Ethiopia's ‘survival’ (Meles 2006).
The composition of the soluble organic matter of the Oxfordian–Kimmeridgian Flodigarry Shale Member (Isle of Skye, Scotland) is presented for the first time. A continuous succession of silty clays and nodular limestone beds is exposed on a rocky shore to the north of Staffin Bay. This succession is proposed as a potential stratotype of the boundary between the Oxfordian and Kimmeridgian stages. This paper points out the exceptional preservation and very low thermal degradation of the organic matter. Indeed, the molecular composition is characterized by the abundance of unsaturated biomarkers (hopenes and diasterenes) as well as undamaged bioterpenoids (ferruginol and sugiol). The abundance of long-chain n-alkanes characterized by an odd-over-even predominance reveals a dominant continental contribution. This is also attested to by the relatively high amounts of plant biomarkers (e.g. ferruginol, sugiol, cadalene and retene), which suggest a palaeovegetation largely composed of pinophytes, especially Cupressaceae, Taxodiaceae and Cheirolepidiaceae, on the nearest emerged lands. The water column of the depositional environment was oxic in its upper part and rather dysoxic in its lower part. The composition of the organic matter does not significantly change along the Flodigarry Shale Member. In other words, no evolutionary events or drastic change in palaeoenvironments can be deduced from the molecular content of these sedimentary rocks, and it does not allow us to support a precise location for the Oxfordian/Kimmeridgian boundary in the succession.
Mafic flows of the Middle to Upper Ordovician Dunn Point Formation of eastern Canada were deeply weathered under warm and relatively humid conditions before being buried by subsequent flows. In the absence of superior plants, and in the context of relatively low atmospheric carbon levels, the soils developed alkaline groundwater conditions through mineral–water interactions, which resulted in an enhanced mobility of Al relative to Si in most palaeosols of that formation. Although the vegetation cover was volumetrically insignificant compared with that of subsequent geological times, it was apparently producing very efficient chelates, which, for most palaeosols of the succession, generated a well-defined cheluviation pattern for not only Al and Fe, but also and mainly Ti, which is typically immobile in modern soils. The resulting soils developed an Al–Fe–Ti-depleted upper horizon that was enriched in Si, probably through periodic ground saturation. Long-term climatic variations related to orbital cycles are inferred to have accounted for a second type of soil in the succession, which contrasts with the former by showing a Si-depleted and less Al–Fe–Ti-depleted upper horizon. Some soil material was substantially reworked by surface runoff, but such occurrences can be easily differentiated from in situ soil material in terms of texture, structure and composition. A thick overlying rhyolite flow is thought to be responsible for providing abundant K in solution, which was incorporated in the underlying basalt palaeosols as exchangeable cations within a probably montmorillonitic clay precursor to the Fe–Mg-rich phengite that later developed during deep burial and orogenic compression.
Antibiotic prescription is frequently inappropriate in hospitals. Our objective was to evaluate whether the quality of antibiotic prescription could be measured using case vignettes to assess physicians' knowledge.
Methods.
The study was conducted in 2 public teaching hospitals, where 33/41 units and 206/412 physicians regularly prescribing antibiotics to inpatients agreed to participate. A cross-sectional survey of knowledge was performed using 4 randomly assigned case vignette sets. Curative antibiotic prescriptions were then evaluated using standard criteria for appropriateness at initiation (day 0), after 2–3 days of treatment (days 2–3), and at treatment completion. We compared knowledge of the physicians with their observed prescriptions in the subset of 106 physicians who completed the case vignettes and prescribed antibiotics at least once.
Results.
The median global case vignette score was 11.4/20 (interquartile range, 8.92-314.3). Of the 483 antibiotic prescriptions, 314 (65%) were deemed appropriate at day 0, 324 (72%) on days 2–3, and 227 (69%) at treatment completion. Prescriptions were appropriate at all 3 time points in only 43% of patients. Appropriate prescription was positively and independently associated with emergency prescription on day 0, documented infection on days 2–3, and 1 of the 2 hospitals at treatment completion. In addition, appropriateness at the 3 evaluation times was positively associated with prescription in anesthesiology or the intensive care unit. Case vignette scores above the median were significantly and independently associated with appropriate antibiotic prescription on days 2–3 and at treatment completion.
Conclusions.
Case vignettes are effective for identifying physicians or hospitals whose knowledge and practice regarding antibiotic prescription require improvement.
Simple NMR techniques can provide an absolute quantification of the quality of the orientational order of discotic columnar phases, provided the anisotropic local magnetic interactions are thoroughly characterized. For the prototypical discotic liquid crystal hexapentoxy-triphenylene, we measure the 13C chemical shift anisotropy of the triphenylene carbons, and use this result to analyze the orientational order, that occurs through a first order phase transition from the high temperature liquid phase, and is almost saturated (order parameter close to 0.85).
Most of the reports about the reaction of the Ethiopian regime to the blow that it suffered in the 2005 elections focus on its institutional evolution, and conclude that it took a turn towards even stronger authoritarianism. Observations made in a rural community in south-east Amhara State reveal that it reacted first, until the end of 2009, by a whole range of the deepest reforms since its takeover in 1991. These combined a stronger grip of the ruling party in all areas with a ‘liberalisation’ of the rural development strategy and first steps towards local ‘good governance’. They were embodied in the rise of the traditional rural elite which had been ostracised for years, as if the regime was trying to build its new constituency on it. But at the end of 2009 the local authorities suddenly returned to the all-encompassing authoritarian attitude characteristic of the pre-2005 period. This ‘liberalisation’ could thus be seen as merely a tactical interlude, conceded by a ruling party still driven by its Leninist legacy and the Abyssinian ‘culture of power’.
Two simulation methods of the energy transmitted by the arc roots to the electrode material are described and their results are compared together and with these found by other authors. About a copper electrode the time phase evolutions are given when a constant energy flux is applied to the contact surface. The obtained results are better for vacuum and small current. The cathode and anode result discussions lead to propositions to improve arc root models.
Observation of the 2005 Ethiopian elections in two rural communities in south-east Amhara State reveals a picture very different from that presented in national-level analyses derived largely from urban areas. Deeply entrenched attitudes to power and government in the study area make the idea of peaceful electoral competition inconceivable. Peasants are first and foremost concerned to vote for the winning side, since to do otherwise carries intense risks to their welfare and even survival. The freedom with which the main opposition party was able to campaign until a few weeks before the election convinced many peasants that the government had abdicated, and that they should vote for the opposition as the likely winners. Belated mobilisation of the ruling party and state apparatus challenged this perception and created great uncertainty. This peasantry's political, economic and cultural alienation, allied to authoritarian rule and a lack of voter information placed genuinely ‘free and fair’ elections out of reach.
The purpose of this paper is to show some examples of phase transformations induced by grinding molecular materials. These materials are considered because they are extremely sensitive to external disturbances and are generally very good glass formers. This allows investigating more easily a broad range of the parameters which are open to influence the nature of the end product namely the temperature and intensity of grinding. Such an investigation has also a practical interest in pharmaceutical science. It is shown that the position of the grinding temperature with regard to the glass transition temperature of the compound is a key parameter. Comparison of the effects of temperature and intensity of grinding demonstrates that the driven material concept offers a framework to rationalize all the observed transformations.