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We present a re-discovery of G278.94+1.35a as possibly one of the largest known Galactic supernova remnants (SNRs) – that we name Diprotodon. While previously established as a Galactic SNR, Diprotodon is visible in our new Evolutionary Map of the Universe (EMU) and GaLactic and Extragalactic All-sky MWA (GLEAM) radio continuum images at an angular size of $3{{{{.\!^\circ}}}}33\times3{{{{.\!^\circ}}}}23$, much larger than previously measured. At the previously suggested distance of 2.7 kpc, this implies a diameter of 157$\times$152 pc. This size would qualify Diprotodon as the largest known SNR and pushes our estimates of SNR sizes to the upper limits. We investigate the environment in which the SNR is located and examine various scenarios that might explain such a large and relatively bright SNR appearance. We find that Diprotodon is most likely at a much closer distance of $\sim$1 kpc, implying its diameter is 58$\times$56 pc and it is in the radiative evolutionary phase. We also present a new Fermi-LAT data analysis that confirms the angular extent of the SNR in gamma rays. The origin of the high-energy emission remains somewhat puzzling, and the scenarios we explore reveal new puzzles, given this unexpected and unique observation of a seemingly evolved SNR having a hard GeV spectrum with no breaks. We explore both leptonic and hadronic scenarios, as well as the possibility that the high-energy emission arises from the leftover particle population of a historic pulsar wind nebula.
People with lived experience of incarceration have higher rates of morbidity and mortality compared to people without history of incarceration. Research conducted unethically in prisons and jails led to increased scrutiny of research to ensure the needs of those studied are protected. One consequence of increased restrictions on research with criminal-legal involved populations is reluctance to engage in research evaluations of healthcare for people who are incarcerated and people who have lived experience of incarceration. Ethical research can be done in partnership with people with lived experience of incarceration and other key stakeholders and should be encouraged. In this article, we describe how stakeholder engagement can be accomplished in this setting, and further, how such engagement leads to impactful research that can be disseminated and implemented across disciplines and communities. The goal is to build trust across the spectrum of people who work, live in, or are impacted by the criminal-legal system, with the purpose of moving toward health equity.
Our study analysed evolving regional commitments on food policy in the Pacific. Our aim was to understand regional priorities and the context of policy development, to identify opportunities for progress.
Design:
We analysed documentation from a decade of regional meetings in order to map regional policy commitments relevant to healthy diets. We focused on agriculture, education, finance, health, and trade sectors, and Heads of State forums. Drawing on relevant political science methodologies, we looked at how these sectors ‘frame’ the drivers of and solutions to non-communicable diseases (NCD), their policy priorities, and identified areas of coherence and tension.
Setting:
The Pacific has among the highest rates of non-communicable diseases in the world, but also boasts an innovative and proactive response. Heads of State have declared NCD a ‘crisis’ and countries have committed to specific prevention activities set out in a regional ‘Roadmap’. Yet, diet-related NCD risk-factors remain stubbornly high and many countries face challenges in establishing a healthy food environment.
Results:
Policies to improve food environments and prevent NCD are a stated priority across regional policy forums, with clear agreement on the need for a multi-sectoral response. However, we identified challenges in sustaining these priorities as political attention fluctuated. We found examples of inconsistencies and tension in sectoral responses to the NCD epidemic that may restrict implementation of the multi-sectoral action.
Conclusion:
Understanding the priorities and positions underpinning sectoral responses can help drive a more coherent NCD response, and lessons from the Pacific are relevant to public health nutrition policy and practice globally.
The number of pediatric antimicrobial stewardship programs (ASPs) is increasing and program evaluation is a key component to improve efficiency and enhance stewardship strategies.
OBJECTIVE
To determine the antimicrobials and diagnoses most strongly associated with a recommendation provided by a well-established pediatric ASP.
DESIGN AND SETTING
Retrospective cohort study from March 3, 2008, to March 2, 2013, of all ASP reviews performed at a free-standing pediatric hospital.
METHODS
ASP recommendations were classified as follows: stop therapy, modify therapy, optimize therapy, or consult infectious diseases. A multinomial distribution model to determine the probability of each ASP recommendation category was performed on the basis of the specific antimicrobial agent or disease category. A logistic model was used to determine the odds of recommendation disagreement by the prescribing clinician.
RESULTS
The ASP made 2,317 recommendations: stop therapy (45%), modify therapy (26%), optimize therapy (19%), or consult infectious diseases (10%). Third-generation cephalosporins (0.20) were the antimicrobials with the highest predictive probability of an ASP recommendation whereas linezolid (0.05) had the lowest probability. Community-acquired pneumonia (0.26) was the diagnosis with the highest predictive probability of an ASP recommendation whereas fever/neutropenia (0.04) had the lowest probability. Disagreement with ASP recommendations by the prescribing clinician occurred 22% of the time, most commonly involving community-acquired pneumonia and ear/nose/throat infections.
CONCLUSIONS
Evaluation of our pediatric ASP identified specific clinical diagnoses and antimicrobials associated with an increased likelihood of an ASP recommendation. Focused interventions targeting these high-yield areas may result in increased program efficiency and efficacy.
To determine the association between contact precautions and depression or anxiety as well as feelings of anger, sadness, worry, happiness, or confusion.
Design.
Prospective frequency-matched cohort study.
Setting.
The University of Maryland Medical Center, a 662-bed tertiary care hospital in Baltimore, Maryland.
Participants.
A total of 1,876 medical and surgical patients over the age of 18 years were approached; 528 patients were enrolled from January through November 2010, and 296 patients, frequency matched by hospital unit, completed follow-up on hospital day 3.
Results.
The primary outcome was Hospital Anxiety and Depression Scale (HADS) scores on hospital day 3, controlling for baseline HADS scores. Secondary moods were measured with visual analog mood scale diaries. Patients under contact precautions had baseline symptoms of depression 1.3 points higher (P < .01) and anxiety 0.8 points higher (P = .08) at hospital admission using HADS. Exposure to contact precautions was not associated with increased depression (P = .42) or anxiety (P = .25) on hospital day 3. On hospital day 3, patients under contact precautions were no more likely than unexposed patients to be angry (20% vs 20%; P = .99), sad (33% vs 38%; P = .45), worried (51% vs 46%; P = .41), happy (58% vs 67%; P = .14), or confused (23% vs 24%; P = .95).
Conclusions.
Patients under contact precautions have more symptoms of depression and anxiety at hospital admission but do not appear to be more likely to develop depression, anxiety, or negative moods while under contact precautions. The use of contact precautions should not be restricted by the belief that contact precautions will produce more depression or anxiety.
To investigate the relationship between contact precautions and delirium among inpatients, adjusting for other factors.
Design.
Retrospective cohort study.
Setting.
A 662-bed tertiary care center.
Patients.
All nonpyschiatric adult patients admitted to a tertiary care center from 2007 through 2009.
Methods.
Generalized estimating equations were used to estimate the association between contact precautions and delirium in a retrospective cohort of 2 years of admissions to a tertiary care center.
Results.
During the 2-year period, 60,151 admissions occurred in 45,266 unique nonpsychiatric patients. After adjusting for comorbid conditions, age, sex, intensive care unit status, and length of hospitalization, contact precautions were significantly associated with delirium (as denned by International Classification of Diseases, Ninth Revision), medication, or restraint exposure (adjusted odds ratio [OR], 1.40 [95% confidence interval {CI}, 1.24–1.51]). The association between contact precautions and delirium was seen only in patients who were newly placed under contact precautions during the course of their stay (adjusted OR, 1.75 [95% CI, 1.60–1.92]; P< .01) and was not seen in patients who were already under contact precautions at admission (adjusted OR, 0.97 [95% CI, 0.86–1.09]; P = .60).
Conclusions.
Although delirium was more common in patients who were newly placed under contact precautions during the course of their hospital admission, delirium was not associated with contact precautions started at hospital admission. Patients newly placed under contact precautions after admission but during hospitalization appear to be at a higher risk and may benefit from proven delirium-prevention strategies.
Animal studies and one large cross-sectional study of 752 healthy Chinese men and women suggest that monosodium glutamate (MSG) may be associated with overweight/obesity, and these findings raise public concern over the use of MSG as a flavour enhancer in many commercial foods. The aim of this analysis was to investigate a possible association between MSG intake and obesity, and determine whether a greater MSG intake is associated with a clinically significant weight gain over 5 years. Data from 1282 Chinese men and women who participated in the Jiangsu Nutrition Study were analysed. In the present study, MSG intake and body weight were quantitatively assessed in 2002 and followed up in 2007. MSG intake was not associated with significant weight gain after adjusting for age, sex, multiple lifestyle factors and energy intake. When total glutamate intake was added to the model, an inverse association between MSG intake and 5 % weight gain was found (P = 0·028), but when the model was adjusted for either rice intake or food patterns, this association was abolished. These findings indicate that when other food items or dietary patterns are accounted for, no association exists between MSG intake and weight gain.
An experiment to measure the variation in the phenological and apical development ofwinter wheat (cv. Avalon) in England and Scotland is described. Ten sites which ranged from Aberdeen (57·2° N), the most northerly, to Newton Abbot (50·6° N), the most southerly, were included in the survey, and at each site seed was hand-sown in mid-September, October and November 1983. Developmental stages and sampling procedures were precisely defined to ensure uniformity in scoring by the observers at each site. Temperatures during the growing season were in line with the long-term means, though spring was cooler at all sites and summer warmer at most. The range of monthly-mean temperatures between sites was about the same as the difference between consecutive months. The method of analysis of development rates and durations was in terms of thermal time, modified by sensitivity to photoperiod and a vernalization requirement that slowed early development until a number of days of low temperatures had been experienced. In general, crops at northern sites developed more slowly than those in the south and particularly the south-west of England. There was less variation in the timing of apical stages for later sowings. Developmental rates responded linearly to temperature and photoperiod, with the base temperature increasing for later phases of development. The effect of photoperiod in modifying the rate of development was apparent for all developmental phases from emergence to anthesis, longer days accelerating development, but there was no effect on the duration of the grain-filling period. Vernalization exerted its effect solely within the phase from emergence to double ridge, and had a major influence on the variation between sites only for the first sowing.
The initiation of leaf and spikelet primordia was studied at sites ranging in latitude from Newton Abbot (50·6°N) to Aberdeen (57·2°N) in crops sown in the middle of September, October and November 1983. The rate of primordium initiation tended to decrease from south to north but there were also marked differences between quite close sites.
The rate of leaf initiation increased with temperature but photoperiod had little effect; the rate of spikelet initiation was affected both by temperature and by photoperiod. There were differences in the total number of leaves initiated which were only partlyexplained by differences in vernalization.
Expressing leaf and spikelet initiation rates in terms of thermal and photo-thermal time respectively showed a constant rate of leaf initiation and a constant and more rapid rate of spikelet initiation.
Clinical supervision is of growing importance professionally, but instruments to measure its effectiveness are scarce. Based on the observational instrument Teachers' PETS, two complementary levels of outcome measurement were used to analyse supervisory effectiveness, namely momentary time sampling (i.e. a micro-analysis of frequencies) and the more molar “change episodes”. Ten audio-taped sessions of routine (baseline; N = 5) and CBT supervision (N = 5; i.e. the intervention phase) were coded with both measures, to assess their relative sensitivity to this manipulation. Improved supervisee learning was detected during the intervention phase by both measures. However, a retrospective comparison between the data within these change episodes and the accompanying non-episode data indicated that the micro level of analysis provided a more sensitive measure of supervisory effectiveness. Technical and conceptual issues arise.
Multiwalled carbon nanotubes (MWNTs) were continuously synthesized by hot wire chemical vapor deposition (HWCVD) using a methane source catalyzed by metal-organic ferrocene. The microstructure of the MWNTs and the catalyst particles were subsequently characterized with transmission electron microscopy which identified three different phases, i.e., bcc α-Fe, fcc γ-Fe and orthorhombic Fe3C. The hydrogen storage capacity of MWNTs was determined with temperature-programmed desorption (TPD) technique. Hydrogen adsorption at near ambient conditions was observed only in as-synthesized MWNTs containing iron particles and was dramatically increased after hydrogen reducing treatment. Possible adsorption mechanism was also discussed.
Petitioning as a method of expressing grievances in British history was not peculiar to any particular set of individuals, but was widely used by all sections of society for a range of issues. Given its origins, however, it became ritualized as the means of labour negotiation for workers who were employed by the state, and, by the nineteenth century, by municipal authorities. This was before the institutionalization of trade unions and their recognition as representative agencies for industrial bargaining. One of these groups of workers in the state sector were naval dockyard employees, engaged in the construction, repair, and maintenance of British naval ships. For these workers, the nature of labour relations, and the importance of petitioning as an instrument of negotiation between employees and employer, was both complex and dynamic.
It was the state as employer which characterized the context of work in the Royal Dockyards. Although it is the case that the yards never had a monopoly on the building of the nation's ships – commissioning in private yards was always an element, particularly in times of impending conflict – it was the unique nature of the employment relationship in these yards which set them aside from private shipbuilding concerns and gave the petitioning system a particular set of meanings. This system, tying workers into “the service of the state”, contributed, therefore, to forms of bargaining which were peculiar to national and local government employment.
Petitioning as a method of expressing grievances in British history was not peculiar to any particular set of individuals, but was widely used by all sections of society for a range of issues. Given its origins, however, it became ritualized as the means of labour negotiation for workers who were employed by the state, and, by the nineteenth century, by municipal authorities. This was before the institutionalization of trade unions and their recognition as representative agencies for industrial bargaining. One of these groups of workers in the state sector were naval dockyard employees, engaged in the construction, repair, and maintenance of British naval ships. For these workers, the nature of labour relations, and the importance of petitioning as an instrument of negotiation between employees and employer, was both complex and dynamic.