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Bloodstream infections (BSIs) are a frequent cause of morbidity in patients with acute myeloid leukemia (AML), due in part to the presence of central venous access devices (CVADs) required to deliver therapy.
Objective:
To determine the differential risk of bacterial BSI during neutropenia by CVAD type in pediatric patients with AML.
Methods:
We performed a secondary analysis in a cohort of 560 pediatric patients (1,828 chemotherapy courses) receiving frontline AML chemotherapy at 17 US centers. The exposure was CVAD type at course start: tunneled externalized catheter (TEC), peripherally inserted central catheter (PICC), or totally implanted catheter (TIC). The primary outcome was course-specific incident bacterial BSI; secondary outcomes included mucosal barrier injury (MBI)-BSI and non-MBI BSI. Poisson regression was used to compute adjusted rate ratios comparing BSI occurrence during neutropenia by line type, controlling for demographic, clinical, and hospital-level characteristics.
Results:
The rate of BSI did not differ by CVAD type: 11 BSIs per 1,000 neutropenic days for TECs, 13.7 for PICCs, and 10.7 for TICs. After adjustment, there was no statistically significant association between CVAD type and BSI: PICC incident rate ratio [IRR] = 1.00 (95% confidence interval [CI], 0.75–1.32) and TIC IRR = 0.83 (95% CI, 0.49–1.41) compared to TEC. When MBI and non-MBI were examined separately, results were similar.
Conclusions:
In this large, multicenter cohort of pediatric AML patients, we found no difference in the rate of BSI during neutropenia by CVAD type. This may be due to a risk-profile for BSI that is unique to AML patients.
The UK legal community has in recent years experienced growing concern about the wellbeing and mental health of lawyers.This is an interest reflected across an array of practical and policy initiatives, reports, research studies, articles and books on the topic, as well as substantial media coverage. Much of the wider legal wellness literature in the UK context, as elsewhere, has tended to focus on the areas of legal professional practice and law students within legal education and training. There are tentative signs, however, of a heightened focus within UK legal studies on the wellbeing and mental health of university legal academics (see below).This chapter seeks to connect up this emerging discussion of legal academic wellbeing with the more established wellbeing debates taking place across the UK legal services sector. By unpacking selected themes within a rapidly expanding interdisciplinary literature on academic wellbeing in UK universities, the chapter explores shared concerns and themes, as well as significant points of difference, in how wellbeing is conceptualised across these discrete legal fields.
A closer look at what is shared across law schools and the legal professions, it is argued here, can shed considerable light on our understandings of the place and purpose of university legal education itself at the present moment; and how, with regard to wellbeing, specific legal‘ communities … act as containers for their own experiences, doubts, joys and frustrations‘. In moving‘ beyond silos‘, this chapter suggests, research and theory about learning the law and legal education has much to gain from a closer engagement with the legal wellbeing debates. At the same time, the emergence of wellbeing as a distinctive kind of problem to be addressed by discrete legal communities must be set in the context of structural and cultural changes productive of new ideas of legal professionalism, enmeshed with the law‘s current‘ wellbeing problem‘– a development impacting on lawyers, law students and legal academics alike, albeit in different and frequently contradictory ways.
This paper reframes debates about gender equality in the legal professions by interrogating the practices of men and interconnections between fatherhood, gender and parenting within the specific context of large corporate law firms. Drawing on interviews with male lawyer-fathers, it argues that closer exploration of fatherhood reveals much about the gendered dynamics of identity formation as a legal professional in this sector. A set of ideas about fatherhood, the paper suggests, shape how men's work can define a distinctive gender identity as a ‘family man’ and good lawyer. Political-economic and cultural shifts around fatherhood, however, are reconfiguring and adapting gender relations in law in a number of contradictory ways with implications for understanding the place of men in relation to gender-equality agendas. Ideas about fatherhood, family, work and career, I argue, are mobilised and enmeshed within the reproduction of distinctive law-firm cultures and gendered ideas of organisational commitment. What, in short, might it mean to be both a ‘good father’ and a ‘good lawyer’?
Maternal mental health during pregnancy has been linked to health outcomes in progeny. Mounting evidence implicates fetal “programming” in this process, possibly via epigenetic disruption. Maternal mental health has been associated with glucocorticoid receptor methylation (nuclear receptor subfamily 3, group C, member 1 [NR3C1]) in the neonate; however, most studies have been small (n < 100) and have failed to control for multiple testing in the statistical analysis. The Barwon Infant Study is a population-derived birth cohort with antenatal recruitment. Maternal depression and anxiety were assessed using the Edinburgh Postnatal Depression Scale and psychological distress using the Perceived Stress Scale. NR3C1 cord blood methylation levels were determined using Sequenom MassArray for 481 participants. Maternal psychological distress and anxiety were associated with a small increase in neonate NR3C1 methylation at specific CpG sites, thus replicating some previous findings. However, associations were only nominally significant and did not remain after correction for the number of CpG sites and exposures investigated. As the largest study to explore the relationship between maternal well-being and offspring NR3C1 cord blood methylation, our results highlight the need for caution when interpreting previous findings in this area. Future studies must ensure they are adequately powered to detect the likely small effect sizes while controlling for multiple testing.
This paper, by Richard Collier, reviews the dominant methodological and theoretical approaches that have shaped socio-legal scholarship on masculinities and law to date. It presents a flavour of contemporary work in the field and, looking specifically to the concerns of the ALS/British Library/SLSA socio-legal training day on sources and methods in Law, Gender and Sexuality, considers selected issues around methods and sources involved in analysing masculinities and law. The paper suggests work in this area has drawn on a diverse range of archives and content and that there is considerable variation in how legal scholarship has sought to approach the topic of masculinity.
At the end of 2013 the real yields that the UK government had to pay on its debt were negative over the whole curve. Several possible explanations are available for this phenomenon – central bank action, regulatory changes, demographic developments and economic conditions. The first two can result from deliberate interaction by the state into the financial markets and can be labelled as financial repression. We explain the historic precedents for Governments to use financial repression to manage their debt, look into the influence of regulation on asset allocation for insurers and pension funds, and introduce the concept of a balance-sheet recession.
The use of transmission lines has increased considerably since the author began his lectures on them at the University of Kent at Canterbury in October 1968. Now the mighty internet involves huge lengths of optical fibres, estimated at over 750 million miles, and similar lengths of copper cables. The ubiquitous mobile phones and personal computers contain circuits using microstrip, coplanar waveguide and stripline. However, despite all these widespread modern applications of transmission lines, the basic principles have remained the same. So much so, that the many classic textbooks on this subject have been essential reading for nearly a hundred years. It is not the purpose of this book to repeat the content of these standard works but to present the material in a form which students may find more digestible. Also this is an age where mathematical calculations are relatively simple to perform on modern personal computers and so there is less need for much of the advanced mathematics of earlier years. The aim of this book is to introduce the reader to a wide range of transmission line topics using a straightforward mathematical treatment which is linked to a large number of graphs illustrating the text. Although the professional worker in this field would use a computer program to solve most transmission line problems, the value of this book is that it provides exact solutions to many simple problems which can be used to verify the more sophisticated computer solutions. The treatment of the material will also encourage ‘back-of-envelope’ calculations which may save hours of computer usage. The author is aware of the hundreds of books published on every aspect of transmission lines and the myriads of scientific publications which appear in an ever increasing number of journals. To help the reader get started on exploring any topic in greater depth, this book contains comments on many of these specialist books at the end of each chapter. Following this will be the reader's daunting task to search through the scientific literature for even more information. It is the author's hope that this book will establish some of the basic principles of this extensive subject which make the use of some of these scientific papers more profitable.
In the preceding five chapters the topic of attenuation has been largely omitted. One reason for this was to simplify the text as the ‘loss-less’ or ‘loss-free’ theory is much easier than that for ‘lossy’ lines. Another reason is that attenuation in many transmission lines is not the major characteristic, particularly for short lengths of line. This means that the discussions in the previous five chapters are sufficient if the losses are small. However, no account of transmission lines would be complete without a discussion of the main causes and effects of attenuation. The chapter will begin with a return to the equivalent circuit method as this enables the two main mechanisms for attenuation to be introduced in a straightforward manner. After that, the concepts will be extended to those transmission lines that require electromagnetic waves for their solutions. Finally, some other aspects of attenuation will be discussed, including dispersion and pulse distortion.
Attenuation in two conductor transmission lines
At the beginning of Chapter 1, an equivalent circuit for a short length of loss-less transmission line was shown in Figure 1.1. In order to introduce the two main sources of attenuation, this diagram now needs amending. Firstly, any conductors will have some electrical resistance (curiously even for superconducting wires at microwave frequencies there will be some resistance, if there are still some unpaired electrons!) and this resistance can be represented as a series distributed resistance, R, which will have the units of Ωm−1. The other source of attenuation is the loss that occurs due to a dielectric having a small conductance. This can be represented by a parallel distributed conductance G with units of Sm−1. The effect of both of these resistive elements is to remove energy from the wave in proportion to the square of its amplitude. Not surprisingly, this results in an exponential decay of a sine wave.
This chapter will complete the discussion about photons on transmission lines. In the first three chapters, the equivalent circuit technique was used to develop many aspects of transmission lines. This involved a one dimensional analysis which has stood the test of time and still produces a useful, although incomplete, picture. However, in the second section, the analysis using electromagnetic waves was given, revealing the three dimensional nature of transmission lines. This showed features that the first section was not able to do; in particular, the velocity and the characteristic impedance of the waves as well as the propagation of higher order modes and the causes of attenuation. The electromagnetic wave approach is outstanding in its accurate prediction of the complex nature of transmission lines. In Chapter 7, a third method was considered using only plane waves travelling at the velocity of light. It was assumed that these plane waves were made up of linearly polarised photons. In this chapter, some more aspects of photons will be considered to see what other properties of transmission lines can be revealed. The use of photons is sufficiently new to be less well established and accepted as the other two approaches to transmission lines used so far. One problem lies in the separation between classical and quantum electrodynamics. The classical theory can be used quite satisfactorily for large numbers of photons. However, if individual photons are being considered, only the quantum theory will describe the phenomena adequately. The full treatment of photons using quantum mechanics is beyond the scope of this book but, where appropriate, the results of such a treatment will be quoted. The other problem lies in the somewhat conflicting theories that currently exist. This chapter should therefore be read with some caution as the picture presented may well change in the near future. Fortunately, the contents of the first seven chapters are sufficiently uncontroversial to not need changing within the lifetime of this book.