We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Adaptive radiotherapy (ART) is commonly used to mitigate effects of anatomical change during head and neck (H&N) radiotherapy. The process of identifying patients for ART can be subjective and resource-intensive. This feasibility project aims to design and validate a pipeline to automate the process and use it to assess the current clinical pathway for H&N treatments.
Methods:
The pipeline analysed patients’ on-set cone-beam CT (CBCT) scans to identify inter-fractional anatomical changes. CBCTs were converted into synthetic CTs, contours were automatically generated, and the original plan was recomputed. Each synthetic CT was evaluated against a set of dosimetric goals, with failed goals causing an ART recommendation.
To validate pipeline performance, a ‘gold standard’ was synthesised by recomputing patients’ original plans on a rescan-CT acquired during treatment and identifying failed clinical goals. The pipeline sensitivity and specificity compared to this ‘gold standard’ were calculated for 12 ART patients. The pipeline was then run on a cohort of 12 ART and 14 non-ART patients, and its sensitivity and specificity were instead calculated against the clinical decision made.
Results:
The pipeline showed good agreement with the synthesised ‘gold standard’ with an optimum sensitivity of 0·83 and specificity of 0·67. When run over a cohort containing both ART and non-ART patients and assessed against the subjective clinical decision made, the pipeline showed no predictive power (sensitivity: 0·58, specificity: 0·47).
Conclusions:
Good agreement with the ‘gold standard’ gives confidence in pipeline performance and disagreement with clinical decisions implies implementation could help standardise the current clinical pathway.
This article begins by critiquing Kathryn Tanner’s Christianity and the New Spirit of Capitalism on two fronts. It suggests that her presentation of ‘Financially Dominated Capitalism’ (FDC) is problematically one-dimensional, and it takes issue with her theological construal of time. The article then argues for an alternative temporal vision which both makes better sense of Christian experience and finds resonance with economic policy proposals that undercut FDC.
Molecular dynamics simulations were performed of the adsorption of methylene blue (MB) on model beidellite, montmorillonite, and muscovite mica surfaces, using a previously determined empirical force field developed for dioctahedral clays. The simulations show that the adsorption of MB on mineral surfaces can result in a variety of configurations, including single and double layers of MB parallel to the basal surface, and irregular clusters. The d(001) values of ~12.3 and ~15.7 Å are assigned to dry phases with parallel single and double layers of MB, respectively, in agreement with X-ray studies. At intermediate MB loadings, stacks inclined to basal surfaces are formed. The stacks of MB ions inclined by 65–70° relative to the (001) plane of muscovite are not found on dry surfaces, in contrast to previous studies. Configurations similar to those proposed by others form spontaneously in the presence of H2O, but the ions in the model systems are not quite as ordered and not ordered in exactly the same way as the ones previously described, and they display a mobility that is not compatible with strict atomic order. The formation of a triple layer of H2O interspersed with ions may occur in the interlayer. Overall, the results of the simulations confirm that the MB-ion method must be used with great caution in surface-area determinations, because of the multiplicity of possible configurations. At the same time, the ability for adsorption to occur as either single or multiple MB layers is useful to determine cation-exchange capacity over a wide range of surface-charge densities.
The Western Regional Alliance for Pediatric Emergency Medicine (WRAP-EM) is a multi-state, Administration for Strategic Preparedness and Response (ASPR) funded pediatric disaster center of excellence. WRAP-EM set out to determine the impact of health disparities on its 11 core areas.
Methods:
We conducted 11 focus groups during April 2021. Discussions were led by an experienced facilitator, and participants could also include their thoughts on a Padlet throughout the discussion. Data were analyzed to determine overarching themes.
Results:
Responses focused on health literacy, health disparities, resource opportunities, addressing obstacles, and resilience building. Health literacy data highlighted the need for development of readiness and preparedness plans, community engagement in cultural and language appropriate means, and increasing diversity in training. Obstacles faced included funding; inequitable distribution of research, resources, and supplies; lack of prioritization of pediatric needs; and fear of retribution from the system. Multiple already existing resources and programs were referenced highlighting the importance of best practice sharing and networking. A stronger commitment to mental health-care delivery, empowerment of individuals and communities, use of telemedicine, and ongoing cultural and diverse education were recurring themes.
Conclusions:
Results of the focus groups can be used to prioritize efforts to address and improve health disparities in pediatric disaster preparedness.
Facial injuries are common and can involve both soft tissue injury and bony injury. These often occur because of motor vehicle collisions, secondary to direct impact against the windshield, steering wheel, or dashboard, as well as from broken glass fragments, causing lacerations and eye injuries. Many facial injuries also occur because of physical assault or because of falls to the head and face, especially in the elderly, who are less able to protect their face while falling.
Firms with high levels of organization capital (OK), a firm-specific production factor provided by key employees, are known to be risky and earn high stock returns. We argue that fragility of OK (i.e., its sensitivity to potential disruptions) is an independently important dimension of this risk. We proxy for fragility by the size of the top management team and show that firms with small teams outperform firms with big teams by 5% annually. The return spread increases in the level of OK and correlates with the outside options of top executives. Further supporting our interpretation, shocks to team composition from unexpected deaths of chief executive officers cause larger value losses in smaller teams.
This study aimed to explore barriers and facilitators of the provision of dairy and plant-based dairy alternatives (PBDA) by parents of preschool-age children, a previously unexplored area of research.
Design:
Five focus groups of parents were conducted and audio-recorded. Verbatim transcripts were analysed using thematic analysis.
Setting:
University of Guelph, in Guelph, ON, Canada in 2019.
Participants:
Thirty-two (n 19 mothers, 13 fathers) parents of preschool-age children. Most (59 %) were university or college educated.
Results:
Facilitators common to both dairy and PBDA provision included perceived nutritional benefits, such as dairy’s Ca, protein and fat content, and PBDA’s protein content, and the perception that PBDA adds variety to the diet. Facilitators unique to dairy v. PBDA provision included the taste of, familiarity with, and greater variety and accessibility of dairy products, specifically child-friendly products. A facilitator unique to PBDA v. dairy provision was ethical concerns regarding dairy farming practices. Barriers common to both dairy and PBDA provision included perceived cost, concerns regarding the environmental impact of production, and high sugar content. Barriers specific to dairy included use of antibiotics and hormones in dairy production. A barrier specific to PBDA was the use of pesticides.
Conclusion:
Behaviour change messages targeting parents of preschoolers can emphasise the nutrition non-equivalence of dairy and some PBDA and can educate parents on sources of affordable, unsweetened dairy and PBDA.
Despite advances in the treatment of pulmonary hypertension and improvements in obstetric care, pulmonary hypertension (PH) remains a leading cause of cardiac maternal death in the developed world. The last three decades have seen the development of effective therapies for specific forms of PH, improving patients’ symptoms and more than doubling survival in some forms of PH. Consequently there are an increasing number of women of childbearing potential with PH. Women may present for the first time, with PH in pregnancy, in the early post-partum period or patients with PH may consider pregnancy despite counselling regarding the high risks.
The archaeological site of Saruq al-Hadid, Dubai, United Arab Emirates, presents a long sequence of persistent temporary human occupation on the northern edge of the Rub’ al-Khali desert. The site is located in active dune fields, and evidence for human activity is stratified within a deep sequence of natural dune deposits that reflect complex taphonomic processes of deposition, erosion and reworking. This study presents the results of a program of radiocarbon (14C) and thermoluminescence dating on deposits from Saruq al-Hadid, allied with studies of material remains, which are amalgamated with the results of earlier absolute dating studies provide a robust chronology for the use of the site from the Bronze Age to the Islamic period. The results of the dating program allow the various expressions of human activity at the site—ranging from subsistence activities such as hunting and herding, to multi-community ritual activities and large scale metallurgical extraction—to be better situated chronologically, and thus in relation to current debates regarding the development of late prehistoric and early historic societies in southeastern Arabia.
In-patients in crisis report poor experiences of mental healthcare not conducive to recovery. Concerns include coercion by staff, fear of assault from other patients, lack of therapeutic opportunities and limited support. There is little high-quality evidence on what is important to patients to inform recovery-focused care.
Aims
To conduct a systematic review of published literature, identifying key themes for improving experiences of in-patient mental healthcare.
Method
A systematic search of online databases (MEDLINE, PsycINFO and CINAHL) for primary research published between January 2000 and January 2016. All study designs from all countries were eligible. A qualitative analysis was undertaken and study quality was appraised. A patient and public reference group contributed to the review.
Results
Studies (72) from 16 countries found four dimensions were consistently related to significantly influencing in-patients' experiences of crisis and recovery-focused care: the importance of high-quality relationships; averting negative experiences of coercion; a healthy, safe and enabling physical and social environment; and authentic experiences of patient-centred care. Critical elements for patients were trust, respect, safe wards, information and explanation about clinical decisions, therapeutic activities, and family inclusion in care.
Conclusions
A number of experiences hinder recovery-focused care and must be addressed with the involvement of staff to provide high-quality in-patient services. Future evaluations of service quality and development of practice guidance should embed these four dimensions.
Declaration of interest
K.B. is editor of British Journal of Psychiatry and leads a national programme (Synergi Collaborative Centre) on patient experiences driving change in services and inequalities.
In this review article, we discuss selected developments regarding the role of the equation of state in simulations of core-collapse supernovae. There are no first-principle calculations of the state of matter under supernova conditions since a wide range of conditions is covered, in terms of density, temperature, and isospin asymmetry. Instead, model equation of state are commonly employed in supernova studies. These can be divided into regimes with intrinsically different degrees of freedom: heavy nuclei at low temperatures, inhomogeneous nuclear matter where light and heavy nuclei coexist together with unbound nucleons, and the transition to homogeneous matter at high densities and temperatures. In this article, we discuss each of these phases with particular view on their role in supernova simulations.
Retreat of Mendenhall Glacier nearJuneau, Alaska, U.S.A., has exposed a bedrock ridge spotted with “siltskins”, patchy coatings of calcite-cemented clay-to sandsized lithic grains. Coatings 0.5–20 mm thick occur in two distinct morphologies. Thin, striated siltskins coat mainly stoss faces. Thicker, corrugated siltskins on lee faces consist of parallel micro-ridges elongated downslope. Thin-section analysis shows that siltskins consist of a basal, calcite-rich layer overlain by microlaminated layers of calcite-cemented lithic grains. Scanning electron microscope (SEM) energy-dispersive spectrometer (EDS) analysis of laminae and surfaces shows laterally persistent Ca/Si differences. Isotopic values for δO18 and δO13 ranged from −19.52‰ to −12.74‰ and −6.18‰ to −3.44‰, respectively, consistent with deposition from subglacial waters of varying isotopic composition and with derivation of carbon from inorganic sources. Corrugated siltskins are complex depositional features modified by erosional processes. Parallel micro-ridges spaced 1–10 mm apparently formed as sediment-rich water dripped down lee-slope rock faces. Ice–rock separation, flow energy and the transported sediment controlled the layering and depositional forms. Siltskins probably formed when a subglacial cavity system was active on the rock ridge and provide clues about how microscale hydrologic processes interact with larger-scale subglacial systems.
Early Norian silicified bivalves from Hells Canyon in the Wallowa terrane of northeastern Oregon are part of a rich molluscan biota associated with a tropical island arc. The Hells Canyon locality preserves lenses of silicified shells formed as tempestites in a shallow subtidal carbonate environment. These shell assemblages are parautochthonous and reflect local, rather than long-distance, transport. Silicification at this locality involved small-scale replacement of original calcareous microstructures, or small-scale replacement of neomorphosed shells, without an intervening phase of moldic porosity. This incremental replacement of carbonate by silica contrasts markedly with void-filling silicification textures reported previously from silicified Permian bivalve assemblages.
The bivalve paleoecology of this site indicates a suspension feeding biota existing on and within the interstices of coral-spongiomorph thickets, and inhabiting laterally adjacent substrates of peloidal carbonate sand. The bivalve fauna is ecologically congruent with the reef-dwelling molluscs associated with Middle Triassic sponge-coral buildups in the Cassian Formation of the Dolomites (Fuersich and Wendt, 1977). Hells Canyon is a particularly important early Norian locality because of the diversity of substrate types and because the site includes many first occurrences of bivalves in the North American Cordillera. These first occurrences include the first documentation of the important epifaunal families Pectinidae and Terquemiidae in Triassic rocks of the North American Cordillera.
The large number of biogeographic and geochronologic range extensions discovered in this single tropical Norian biota indicates that use of literature-based range data for Late Triassic bivalves may be very hazardous. Many bivalve taxa formerly thought to have gone extinct in Karnian time have now been documented from Norian strata in this arc terrane. These range extensions, coupled with the high bivalve species richness of the Hells Canyon site, suggest that the Karnian mass extinction in several literature-based compilations may be an artifact of incomplete sampling. Even for the Norian, present compilations of molluscan extinction may have an unacceptably large artifactual component.
Thirty-five bivalve taxa from the Hells Canyon locality are discussed. Of these, seven are new: the mytilid Mysidiella cordillerana n. sp., the limacean Antiquilima vallieri n. sp., the true oyster Liostrea newelli n. sp., the pectinacean Crenamussium concentricum n. gen. and sp., the unioid Cardinioides josephus n. sp., the trigoniacean Erugonia canyonensis n. gen. and sp., and the carditacean Palaeocardita silberlingi n. sp.
Growth of Douglas fir [Pseudotsuga menziesii (Mirb.) Franco] was increased by controlling grasses and broadleaf herbs with eight herbicide regimes during the first 3 yr after planting on a well-drained moist site in the Oregon Coast Range. The greatest growth occurred if weeds were controlled in the same growing season that tree seedlings were transplanted to the field; smaller increments came from second- and third-year weed control. Growth increases attributable to early weed control continued through the fifth year, indicating that conditions during establishment strongly influenced later growth. Plots with no herbaceous vegetation had more available soil water than those with competing vegetation, and tree seedlings on these plots experienced less water stress. Irrigation in the third year increased stem diameter of seedlings in that year but had no effect thereafter. Increases in average seedling stem volume at 5 yr after transplanting were linearly related (r2 = 0.77) to the difference in observed xylem potential during the first three growing seasons after transplanting and the xylem potential at which photosynthesis ceased, −2 MPa.
In North America, terrestrial records of biodiversity and climate change that span Marine Oxygen Isotope Stage (MIS) 5 are rare. Where found, they provide insight into how the coupling of the ocean–atmosphere system is manifested in biotic and environmental records and how the biosphere responds to climate change. In 2010–2011, construction at Ziegler Reservoir near Snowmass Village, Colorado (USA) revealed a nearly continuous, lacustrine/wetland sedimentary sequence that preserved evidence of past plant communities between ~140 and 55 ka, including all of MIS 5. At an elevation of 2705 m, the Ziegler Reservoir fossil site also contained thousands of well-preserved bones of late Pleistocene megafauna, including mastodons, mammoths, ground sloths, horses, camels, deer, bison, black bear, coyotes, and bighorn sheep. In addition, the site contained more than 26,000 bones from at least 30 species of small animals including salamanders, otters, muskrats, minks, rabbits, beavers, frogs, lizards, snakes, fish, and birds. The combination of macro- and micro-vertebrates, invertebrates, terrestrial and aquatic plant macrofossils, a detailed pollen record, and a robust, directly dated stratigraphic framework shows that high-elevation ecosystems in the Rocky Mountains of Colorado are climatically sensitive and varied dramatically throughout MIS 5.
Field stars provide important constraints for the late stages of stars' angular momentum evolution. We measured rotation periods ranging from 0.1 to 150 days for approximately 450 mid-to-late M dwarfs using photometry from the MEarth transiting planet survey. We use parallaxes, proper motions, and radial velocities to calculate galactic kinematics for these solar neighborhood M dwarfs. The velocity dispersions increase towards longer rotation periods, indicating that there is a relationship between rotation and age for these stars.
DSM-5 contains substantial changes to eating disorder diagnoses. We examinedrelative prevalence rates of DSM-IV and DSM-5 eating disorder diagnosesusing Eating Disorder Examination–Questionnaire diagnostic algorithms in 117community out-patients. DSM-5 criteria produced a reduction in combined‘other specified feeding or eating disorder’ and ‘unspecified feeding oreating disorder’ diagnoses from 46% to 29%, an increase in anorexia nervosadiagnoses from 35% to 47%, the same number of bulimia nervosa diagnoses anda 5% rate of binge eating disorder diagnoses.
To describe pediatric emergency medicine (PEM) physicians' reported pain management practices across Canada and explore factors that facilitate or hinder pain management.
Methods:
This study was a prospective survey of Canadian pediatric emergency physicians. The Pediatric Emergency Research Canada physician database was used to identify participants, and a modified Dillman's Total Design Survey Method was used for recruitment.
Results:
The survey response rate was 68% (139 of 206). Most physicians were 31 to 50 years old (82%) with PEM training (56%) and had been in practice for less than 10 years (55%). Almost all pain screening in emergency departments (EDs) occurred at triage (97%). Twenty-four percent of physicians noted institutionally mandated pain score documentation. Ibuprofen and acetaminophen were commonly prescribed in the ED for mild to moderate pain (88% and 83%, respectively). Over half of urinary catheterizations (60%) and intravenous (53%) starts were performed without any analgesia. The most common nonpharmacologic interventions used for infants and children were pacifiers and distraction, respectively. Training background and gender of physicians affected the likelihood of using nonpharmacologic interventions. Physicians noted time restraints to be the greatest barrier to optimal pain management (55%) and desired improved access to pain medications (32%), better policies and procedures (30%), and further education (25%).
Conclusions:
When analgesia was reported as provided, ibuprofen and acetaminophen were most commonly used. Both procedural and presenting pain remained suboptimally managed. There is a substantial evidence practice gap in children's ED pain management, highlighting the need for further knowledge translation strategies and policies to support optimal treatment.
To investigate the simultaneous occurrence of more than 1 Clostridium difficile ribotype in patients' stool samples at the time of diagnostic testing.
Methods.
Stool samples submitted for diagnostic testing for the presence of toxigenic C. difficile were obtained for 102 unique patients. A total of 95 single colonies of C. difficile per stool sample were isolated on selective media, subcultured alongside negative (uninoculated) controls, and polymerase chain reaction (PCR) ribotyped using capillary gel electrophoresis.
Results.
Capillary-based PCR ribotyping was successful for 9,335 C. difficile isolates, yielding a median of 93 characterized isolates per stool sample (range, 69-95). More than 1 C. difficile ribotype was present in 16 of 102 (16%) C. difficile infection (CDI) cases; 2 of the 16 mixtures were composed of at least 3 ribotypes, while the remaining 14 were composed of at least 2.
Conclusions.
Deep sampling of patient stool samples coupled with capillary-based PCR ribotyping identified a high rate of mixed CDI cases compared with previous estimates. Studies seeking to quantify the clinical significance of particular C. difficile ribotypes should account for mixed cases of disease.