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.
Delayed presentation to the emergency department influences acute stroke care and can result in worse outcomes. Despite public health messaging, many young adults consider stroke as a disease of older people. We determined the differences in ambulance utilization and delays to hospital presentation between women and men as well as younger (18–44 years) versus older (≥45 years) patients with stroke.
Methods:
We conducted a population-based retrospective study using national administrative health data from the Canadian Institute of Health Information databases and examined data between 2003 and 2016 to compare ambulance utilization and time to hospital presentation across sex and age.
Results:
Young adults account for 3.9% of 463,310 stroke/transient ischemic attack/hemorrhage admissions. They have a higher proportion of hemorrhage (37% vs. 15%) and fewer ischemic events (50% vs. 68%) compared with older patients. Younger patients are less likely to arrive by ambulance (62% vs. 66%, p < 0.001), with younger women least likely to use ambulance services (61%) and older women most likely (68%). Median stroke onset to hospital arrival times were 7 h for older patients and younger men, but 9 h in younger women. There has been no improvement among young women in ambulance utilization since 2003, whereas ambulance use increased in all other groups.
Conclusions:
Younger adults, especially younger women, are less likely to use ambulance services, take longer to get to hospital, and have not improved in utilization of emergency services for stroke over 13 years. Targeted public health messaging is required to ensure younger adults seek emergency stroke care.
Limited evidence supports primary care paramedic (PCP) direct transport of ST-segment elevation myocardial infarction (STEMI) patients for percutaneous coronary intervention (PCI). The goal of this study was to evaluate an urban-based PCP STEMI bypass guideline.
Methods
We reviewed consecutive Toronto Paramedic Services call reports between April 7, 2015, and May 31, 2016, regarding STEMI patients identified by PCPs. The primary outcome was patient assignment (stable versus unstable) according to guideline criteria. Secondary outcomes were the proportion of PCP-transported patients who had an indication for an advanced care intervention (ACI) or who received an ACI when PCPs rendezvoused with an advanced care paramedic (ACP). Lastly, we reviewed prehospital outcomes of cardiac arrest patients and calculated the difference in transport intervals between direct PCP bypass and a PCI-centre and predicted transport interval to the closest emergency department (ED).
Results
Of 361 patients, 232 were PCP transports and 129 were ACP-rendezvous transports. There was a significant difference in the distribution of stable and unstable patients between PCPs and ACPs (p<0.001). For PCP patients, 21/232 (9.1%) had indications for an ACI, whereas 34/129 (26.4%) ACP patients received an ACI. Eleven patients experienced cardiac arrest; 10 were successfully resuscitated (5 of these by PCPs). The median difference between direct PCP bypass and a PCI-centre versus transport to the closest ED was 5.53 minutes (IQR=6.71).
Conclusions
We found a significant difference in the distribution of stable and unstable patients and fewer patients with indications for an ACI in PCP patients. This PCP STEMI bypass guideline appears feasible.
In the mid-1990s, excellent results from the GRIP and GISP2 deep drilling projects in Greenland opened up funding for continued ice-coring efforts in Antarctica (EPICA) and Greenland (NorthGRIP). The Glaciology Group of the Niels Bohr Institute, University of Copenhagen, was assigned the task of providing drilling capability for these projects, as it had done for the GRIP project. The group decided to further simplify existing deep drill designs for better reliability and ease of handling. The drill design decided upon was successfully tested on Hans Tausen Ice Cap, Peary Land, Greenland, in 1995. The 5.0m long Hans Tausen (HT) drill was a prototype for the ~11m long EPICA and NorthGRIP versions of the drill which were mechanically identical to the HT drill except for a much longer core barrel and chips chamber. These drills could deliver up to 4m long ice cores after some design improvements had been introduced. The Berkner Island (Antarctica) drill is also an extended HT drill capable of drilling 2 m long cores. The success of the mechanical design of the HT drill is manifested by over 12 km of good-quality ice cores drilled by the HT drill and its derivatives since 1995.
Continuous good-quality deep ice cores provide excellent scientific data with which to reconstruct a past climate record for >800 ka. At depths starting from ∼100m using an electromechanical drill, a drilling liquid is essential for successful recovery of the very high-quality ice cores demanded by modern scientific analysis techniques (e.g. continuous flow analysis). Finding a suitable drill fluid for use at deep ice-coring drill sites is not an easy task. Temperatures vary greatly not just from site to site, but also at a site where the average mean temperature from surface to bedrock can vary from –55°C to –2.75°C. In the past 60 years, many fluids have been used, with varying degrees of success, but for various reasons are either unavailable, are now considered unsafe and dangerous or are too environmentally damaging to be permitted. Here we report on our pre-season investigation into possible candidate drill fluids, with specific information concerning ESTISOL™ 240 and COASOL™, the rationale behind the redesign of our drill successfully used at NorthGRIP, Greenland, and EPICA DML, Antarctica, the knock-on effect of those changes, and our field experience in Greenland at Flade Isblink in 2006 and at NEEM in 2009–10.
A drill liquid is essential for the purpose of recovering good-quality scientifically useful ice cores at intermediate to deep depths, i.e. >∼100 m. The pressure produced by the liquid helps to eliminate the detrimental effects of the abrupt release of isostatic pressure in the ice during the drilling process, prevents consequential fractures within the ice core, and is essential to produce an even distribution of hydrostatic pressure to balance the ice isostatic pressure and so minimize borehole deformation. To perform these tasks, while minimizing risks to health and the environment, the liquid needs to exhibit specific physical, chemical and biological characteristics. Here we report on two promising candidate drill liquids, ESTISOL™ 140 and ESTISOL™ 165, for use in the extreme conditions found within the ice sheets of Greenland and Antarctica, where the temperature can range from close to 0°C to below −57°C and pressures can exceed 40 MPa. From both the manufacturer’s data and our laboratory tests and observations we report on the physical, chemical and biological characteristics that both liquids exhibit. We also report on how one of the candidates was field-tested on the Greenland ice sheet and the East Antarctic high plateau.
The Numeniini is a tribe of 13 wader species (Scolopacidae, Charadriiformes) of which seven are Near Threatened or globally threatened, including two Critically Endangered. To help inform conservation management and policy responses, we present the results of an expert assessment of the threats that members of this taxonomic group face across migratory flyways. Most threats are increasing in intensity, particularly in non-breeding areas, where habitat loss resulting from residential and commercial development, aquaculture, mining, transport, disturbance, problematic invasive species, pollution and climate change were regarded as having the greatest detrimental impact. Fewer threats (mining, disturbance, problematic native species and climate change) were identified as widely affecting breeding areas. Numeniini populations face the greatest number of non-breeding threats in the East Asian-Australasian Flyway, especially those associated with coastal reclamation; related threats were also identified across the Central and Atlantic Americas, and East Atlantic flyways. Threats on the breeding grounds were greatest in Central and Atlantic Americas, East Atlantic and West Asian flyways. Three priority actions were associated with monitoring and research: to monitor breeding population trends (which for species breeding in remote areas may best be achieved through surveys at key non-breeding sites), to deploy tracking technologies to identify migratory connectivity, and to monitor land-cover change across breeding and non-breeding areas. Two priority actions were focused on conservation and policy responses: to identify and effectively protect key non-breeding sites across all flyways (particularly in the East Asian- Australasian Flyway), and to implement successful conservation interventions at a sufficient scale across human-dominated landscapes for species’ recovery to be achieved. If implemented urgently, these measures in combination have the potential to alter the current population declines of many Numeniini species and provide a template for the conservation of other groups of threatened species.
Illegal killing/taking of birds is a growing concern across the Mediterranean. However, there are few quantitative data on the species and countries involved. We assessed numbers of individual birds of each species killed/taken illegally in each Mediterranean country per year, using a diverse range of data sources and incorporating expert knowledge. We estimated that 11–36 million individuals per year may be killed/taken illegally in the region, many of them on migration. In each of Cyprus, Egypt, Italy, Lebanon and Syria, more than two million birds may be killed/taken on average each year. For species such as Blackcap Sylvia atricapilla, Common Quail Coturnix coturnix, Eurasian Chaffinch Fringilla coelebs, House Sparrow Passer domesticus and Song Thrush Turdus philomelos, more than one million individuals of each species are estimated to be killed/taken illegally on average every year. Several species of global conservation concern are also reported to be killed/taken illegally in substantial numbers: Eurasian Curlew Numenius arquata, Ferruginous Duck Aythya nyroca and Rock Partridge Alectoris graeca. Birds in the Mediterranean are illegally killed/taken primarily for food, sport and for use as cage-birds or decoys. At the 20 worst locations with the highest reported numbers, 7.9 million individuals may be illegally killed/taken per year, representing 34% of the mean estimated annual regional total number of birds illegally killed/taken for all species combined. Our study highlighted the paucity of data on illegal killing/taking of birds. Monitoring schemes which use systematic sampling protocols are needed to generate increasingly robust data on trends in illegal killing/taking over time and help stakeholders prioritise conservation actions to address this international conservation problem. Large numbers of birds are also hunted legally in the region, but specific totals are generally unavailable. Such data, in combination with improved estimates for illegal killing/taking, are needed for robustly assessing the sustainability of exploitation of birds.
Peer drinking norms are arguably one of the strongest correlates of adolescent drinking. Prospective studies indicate that adolescents tend to select peers based on drinking (peer selection) and their peers' drinking is associated with changes in adolescent drinking over time (peer socialization). The present study investigated whether the peer selection and socialization processes in adolescent drinking differed as a function of the dopamine receptor D4 (DRD4) variable number tandem repeat genotype in two independent prospective data sets. The first sample was 174 high school students drawn from a two-wave 6-month prospective study. The second sample was 237 college students drawn from a three-wave annual prospective study. Multigroup cross-lagged panel analyses of the high school student sample indicated stronger socialization via peer drinking norms among carriers, whereas analyses of the college student sample indicated stronger drinking-based peer selection in the junior year among carriers, compared to noncarriers. Although replication and meta-analytic synthesis are needed, these findings suggest that in part genetically determined peer selection (carriers of the DRD4 seven-repeat allele tend to associate with peers who have more favorable attitudes toward drinking and greater alcohol use) and peer socialization (carriers' subsequent drinking behaviors are more strongly associated with their peer drinking norms) may differ across adolescent developmental stages.
In Mozambique and Cape Verde, writing in Portuguese by African women has directly engaged political reconstruction by denouncing colonial oppression and embracing national freedom. This article addresses the recent history of Lusophone African women's fiction, which has been pivotal in inscribing the intimate arena of sexuality and motherhood into power relations and has also revealed ways in which the domain of violence intersects with private lives. By focusing on two novels that exemplify this trend, this article demonstrates links between the political and the intimate. It also shows how Lusophone African authors contribute to healing social conflict through their narratives, and draws some conclusions about gender relations in the Lusophone African experience and across the continent.
The purpose of this investigation was to test the hypothesis that maternal exercise training during pregnancy enhances endothelial function in offspring at birth. Six-month-old gilts (n = 8) were artificially inseminated and randomized into exercise-trained (n = 4) and sedentary groups (n = 4). Exercise training consisted of 15 weeks of treadmill exercise. The thoracic aorta of offspring were harvested within 48 h after birth and vascular responsiveness to cumulative doses of endothelium-dependent (bradykinin: 10−11–10−6 M) and independent (sodium nitroprusside: 10−10–10−4 M) vasodilators were assessed using in vitro wire myography. Female offspring from the exercised-trained gilts had a significantly greater endothelium-dependent relaxation response in the thoracic aorta when compared with the male offspring and female offspring from the sedentary gilts. The results of this investigation demonstrate for the first time that maternal exercise during pregnancy produces an enhanced endothelium-dependent vasorelaxation response in the thoracic aortas of female offspring at birth.
Fission-track dating of zircons and apatites from tuffs and bentonites has produced the first isotopic ages for the type sections of the Ordovician and Silurian Systems. In the Ordovician the following ages have been determined: lower Arenig 493 Ma, lower Llanvirn 487 Ma, lower Llandeilo 477 Ma, upper Caradoc 463 Ma and upper Ashgill 434 Ma. In the Silurian, the following: lower Llandovery 437 Ma, lower Wenlock 422 Ma, upper Wenlock 414 Ma and Ludlow 407 Ma. The Ordovician-Silurian boundary is interpreted as occurring at about 436 Ma. Three North American Rocklandian bentonites yielded zircons whose ages average 453 Ma. This is about 10 Ma younger than supposedly correlative units in the British type sections.
When an organic calcareous soil was air-dried for 2 days and re-wetted to a wide range of moisture contents, well below saturation, nitrite accumulated within 1–2 days. At the same time much nitrate was formed and more carbon dioxide was released than from soil kept moist. On further incubation of re-wetted soil for 3–5 days, the nitrite concentration decreased rapidly. Since 15N-labelled nitrate was reduced to nitrite after air-drying and re-wetting, and no nitrite was formed in autoclaved soil, nitrate was microbially reduced.
Eighty-three per cent of added 15N tracer was recovered from the soil 2 days after re-wetting to 70 % moisture, indicating that 58 ppm N had been lost; 10 ppm N of this was released as nitrous oxide. Autoclaved soil to which nitrite was added did not evolve nitrous oxide, suggesting that nitrite was reduced biologically rather than decomposed chemically.
Three other soils were treated similarly; two, which were non-calcareous, accumulated no nitrite. Fresh calcareous soils with high respiration rates and good capacities to denitrify when waterlogged are most likely to form nitrite after drying and moderate re-wetting.
In the four-month period following the Rethinking the Preparation for Calculus conference in October 2001, there were three other invited conferences regarding the undergraduate mathematics curriculum.
CRAFTY's Curriculum Foundations Summary Workshop (November 2001), organized by Bill Barker and Susan Ganter and supported by the NSF and the Calculus Consortium for Higher Education [1]. CRAFTY (the MAA committee on Curriculum Renewal Across the First Two Years) had previously organized a series of 11 workshops in which leading educators from 17 different quantitative disciplines came together to discuss and inform the mathematics community of the mathematical needs of their students today. The summary workshop was held to unify the suggestions from the individual workshops.
The Forum on Quantitative Literacy (December 2001), organized by Bernard Madison, sponsored by the Woodrow Wilson Foundation and funded by the Pew Charitable Trusts [2].
Reforming College Algebra (February 2002), organized by Don Small on behalf of the MAA Task Force on the First College Level Mathematics Course and supported by the Consortium of Historically Black Colleges and Universities [3].
Each of these conferences focused on the mathematical needs of students in courses below calculus. Although the CRAFTY Curriculum Foundations Workshop did not look at these courses specifically, the recommendations from most of the quantitative disciplines were directed at courses such as college algebra and precalculus, because these are the courses that provide the mathematical foundation for students in most other disciplines.