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.
This is the 2nd edition of the popular comprehensive and results-based review study guide, presenting educational content for the Anesthesiology BASIC exam in an easily digestible format. Updated alongside the content of the exam, this new edition continues to provide an essential resource for residents. Reviewing all exam topics, the chapters cover clinical anesthetic practice, pharmacology, physiology, anatomy, anesthesia equipment, and monitoring methods. Information is presented in a clear and focused style, and the use of bullet points and concise paragraphs throughout enable effective learning and efficient exam revision. Figures and illustrations supplement the text and additional margin space provides room for annotations and further notes. The user-friendly format ensures that all exam preparation, including notes from question banks, can be kept in this 'one-stop' review book. Written by residents for residents in a comprehensive and easily digestible format, this book is a valuable resource for effective and successful exam preparation.
Develop a Staphylococcus aureus wound antibiogram among patients who use fentanyl (PWUF) presenting with acute S. aureus skin and soft tissue infections (SSTIs) in Philadelphia, Pennsylvania.
Design:
Retrospective, multisite cohort study.
Patients and Setting:
Individuals presenting to emergency departments or admitted to inpatient units of four Penn Medicine hospitals with an acute S. aureus SSTI and illicit fentanyl use within the previous year.
Methods:
We described susceptibilities of S. aureus isolated from wound cultures among the PWUF cohort and compared these to the health system’s wound antibiogram. We compared frequency of in-hospital medication treatment for opioid use disorder among patients who left the hospital prior to vs after the availability of S. aureus susceptibilities.
Results:
Among 131 S. aureus isolates from 131 PWUF, 35/131 (26.7%) were susceptible to oxacillin, 73/121 (60.3%) were susceptible to clindamycin, 77/122 (63.1%) were susceptible to tetracycline, and 119/126 (94.4%) were susceptible to trimethoprim-sulfamethoxazole. PWUF displayed significantly reduced susceptibility to oxacillin and tetracycline compared to the health system’s outpatient wound S. aureus antibiogram. Compared to patients discharged prior to susceptibility availability, more patients discharged after the reporting of susceptibilities were administered buprenorphine or methadone in the hospital (82.0% vs 51.4%, P < 0.001).
Conclusion:
High nonsusceptibility to clindamycin and tetracycline suggests these agents should not be prescribed as empiric therapy for acute S. aureus SSTI in PWUF in Philadelphia. PWUF would benefit from joint management by infectious diseases and addiction medicine experts to ensure prescription of active therapy. Additional study is needed of PWUF in other regions.
To understand caregivers’ perceptions about their children’s mealtime social experiences at school, and how they believe these social experiences impact their children’s consumption of meals at school (both meals brought from home and school meals).
Design:
Qualitative data were originally collected as part of a larger mixed methods study using an embedded-QUAN dominant research design.
Setting:
Semi-structured interviews were conducted with United States (U.S.) caregivers over ZoomTM in English and Spanish during the 2021-2022 school year. The interview guide contained 14 questions on caregivers’ perceptions about their children’s experiences with school meals.
Participants:
Caregivers of students in elementary, middle, and high schools in rural, suburban, and urban communities in California (n=46) and Maine (n=20) were interviewed. Most (60.6%) were caregivers of children who were eligible for free or reduced-price meals.
Results:
Caregivers reported that an important benefit of eating meals at school is their child’s opportunity to socialize with their peers. Caregivers also stated that their child’s favorite aspect of school lunch is socializing with friends. However, some caregivers reported the cafeteria environment caused their children to feel anxious and not eat. Other caregivers reported that their children sometimes skipped lunch and chose to socialize with friends rather than wait in long lunch lines.
Conclusions:
Socializing during school meals is important to both caregivers and students. Policies such as increasing lunch period lengths and holding recess before lunch have been found to promote school meal consumption and could reinforce the positive social aspects of mealtime for students.
Paleoproterozoic granitoids of the lesser Himalayan belt are keys to understanding the evolution of the northern Indian continental margin and its position in the Columbia supercontinent assembly. We present whole-rock chemistry and zircon U-Pb geochronological data for Gwaldam Biotite Granite (GBGr) from the Baijnath Klippe (BK) in Kumaun Himalaya to elucidate their petrogenesis and geodynamic implications. Granites are characterized by ferroan, weakly peraluminous nature with high SiO2 and K2O contents, enrichment in LILE (Rb, Th, K and Pb), and depletion in Ba, Nb, P, Hf and Ti. Granites show enrichment in light rare earth element relative to heavy rare earth elements and pronounced negative Eu anomalies. Such chemistry suggests typical A-type granite with high Y/Nb >2 values that characterize it as A2-type granite. Zircon U-Pb ages for the granite yield upper intercept at 1900 ± 3 Ma (core) and 1854 ± 2 Ma (rim). Integrating the chemical and geochronological data, we propose a two-stage evolution model for the area. In the GBGr, the ∼1900 Ma date of zircon core is likely the date of crystallization of the melts presumably formed during the first extensional stage at uppermost mantle – lower crust levels caused by slab break-off/rollback, which followed a post-collisional setting. The second incipient rifting stage produced melt that entrained the zircon cores (∼1900 Ma) during its ascendance and crystallized as the GBGr at ∼1854 Ma when the zircon rims crystallized. It is further proposed that the Paleoproterozoic Northern Indian continental margin later underwent at least two crustal extensions during the Columbia supercontinent agglomeration.
For an integer $k \geq 2$, let $P_{n}^{(k)}$ be the k-generalised Pell sequence, which starts with $0, \ldots ,0,1$ (k terms), and each term thereafter is given by the recurrence $P_{n}^{(k)} = 2 P_{n-1}^{(k)} +P_{n-2}^{(k)} +\cdots +P_{n-k}^{(k)}$. We search for perfect powers, which are sums or differences of two k-generalised Pell numbers.
Patient involvement in psychiatry education struggles to be representative of the patients that doctors will treat once qualified. The issues of mental health stigma, cultural perspectives of mental health and the unique role of teaching, required exploring to establish the barriers and facilitators to increasing the diversity of patients involved in psychiatry education. To explore the causes of this lack of representation, a roundtable event with 34 delegates composed of people with lived experience of mental health issues, people from underserved communities, academics, mental health professionals and charity representatives met to discuss the barriers to involvement in psychiatry education and possible solutions. Themes were further developed in a context expert focus group. Notes from the roundtable and focus group were analysed and developed into recommendations for medical schools and mental health professional teaching departments.
Among 572,314 people who met inclusion criteria, the mean observed TD diagnosis rate across 341 MSAs was 3.10 per 1000 patients with an AP prescription; 86 (25.2%) MSAs had no patients with a TD diagnosis. Over 50% of MSAs and states had an underdiagnosis of TD. MSAs with the highest expected TD diagnosis rates were Missoula, MT (5.47), Billings, MT (5.39), and Madison, WI (5.16). MSAs with the highest observed TD rates were Chambersburg-Waynesboro, PA (18.52), Napa, CA (13.70), and San Angelo, TX (13.07). MSAs with the largest negative differences between observed and expected TD diagnosis rates (ie, highest underdiagnosis rates) were Missoula, MT (−5.47), Billings, MT (−5.39), and Gainesville, FL (−4.39). States with the highest expected TD rates were Montana (5.28), Idaho (4.52), and Alaska (4.32). States with the highest observed TD rates were North Dakota (7.09), Idaho (5.85), and New Mexico (5.67). States with the highest underdiagnosis rates were South Dakota (−3.72), Vermont (−3.57), and Montana (−3.21).
Conclusions
Overall, this study showed that TD was underdiagnosed in >50% of US geographic regions. This research highlights opportunities for improved TD recognition in areas with TD underdiagnosis.
The efficacy and safety of aripiprazole once-monthly 400 mg (AOM 400) as maintenance monotherapy treatment for bipolar I disorder (BP-I) were demonstrated in a double-blind, placebo-controlled, 52-week randomized withdrawal trial (NCT01567527). This post hoc analysis of data from NCT01567527 evaluated the efficacy of AOM 400 in the earlier BP-I population.
Methods
Patients within the first quartile of the dataset according to age (18–32 years: AOM 400, n=36; placebo, n=34) or disease duration (≤4.6 years: AOM 400, n=33; placebo, n=34) were considered to be in the earlier stages of BP-I, and were included. The primary outcome was time from randomization to recurrence of any mood episode, defined as meeting any one of several predetermined criteria, including Young Mania Rating Scale (YMRS) total score ≥15 or clinical worsening.
Results
Time to recurrence of any mood episode was significantly delayed with AOM 400 versus placebo in patients aged 18–32 years (hazard ratio [HR]: 2.462 [95% confidence interval (CI): 1.092, 5.547]; p<0.05) and in patients with a disease duration ≤4.6 years (HR: 3.207 [95% CI: 1.346, 7.645]; p<0.01). Further analysis suggested that the benefit of AOM 400 versus placebo was driven by a significantly lower proportion of patients experiencing a YMRS total score ≥15 (18–32 years: 5.60% versus 44.10%, p<0.001; disease duration ≤4.6 years: 6.10% versus 41.20%, p<0.01) or clinical worsening (18–32 years: 8.30% versus 38.20%, p<0.01; disease duration ≤4.6 years: 6.10% versus 38.20%, p<0.01).
Conclusion
The efficacy of AOM 400 was demonstrated in the earlier BP-I population.
Study registration number: NCT01567527 (ClinicalTrials.gov)
The data in this poster were originally presented at Psych Congress, held on 6–10th September 2023 in Nashville, TN, USA.
Funding
Otsuka Pharmaceutical Development & Commercialization Inc. (Princeton, NJ, USA) and Lundbeck LLC (Deerfield, IL, USA).
A quasi-linear reduced transport model is developed from a database of high-$\beta$ electromagnetic nonlinear gyrokinetic simulations performed with spherical tokamak for energy production (STEP) relevant parameters. The quasi-linear model is fully electromagnetic and accounts for the effect of equilibrium flow shear using a novel approach. Its flux predictions are shown to agree quantitatively with predictions from local nonlinear gyrokinetic simulations across a broad range of STEP-relevant local equilibria. This reduced transport model is implemented in the T3D transport solver that is used to perform the first flux-driven simulations for STEP to account for transport from hybrid kinetic ballooning mode turbulence, which dominates over a wide region of the core plasma. Nonlinear gyrokinetic simulations of the final transport steady state from T3D return turbulent fluxes that are consistent with the reduced model, indicating that the quasi-linear model may also be appropriate for describing the transport steady state. Within the assumption considered here, our simulations support the existence of a transport steady state in STEP with a fusion power comparable to that in the burning flat top of the conceptual design, but do not demonstrate how this state can be accessed.
Glacier and snow melt are the primary sources of water for streams, and rivers in upper Indus region of the western Himalaya. However, the magnitude of runoff from this glacierized basin is expected to vary with the available energy in the catchment. Here, we used a physically based energy balance model to estimate the surface energy and surface mass balance (SMB) of the upper Chandra Basin glaciers for 7 hydrological years from 2015 to 2022. A strong seasonality is observed, with net radiation being the dominant energy flux in the summer, while latent and sensible heat flux dominated in the winter. The estimated mean annual SMB of the upper Chandra Basin glaciers is −0.51 ± 0.28 m w.e. a−1, with a cumulative SMB of −3.54 m w.e during 7 years from 2015 to 2022. We find that the geographical factors like aspect, slope, size and elevation of the glacier contribute towards the spatial variability of SMB within the study region. The findings reveal that a 42% increase in precipitation is necessary to counteract the additional mass loss resulting from a 1°C increase in air temperature for the upper Chandra Basin glaciers.
A diverse range of services often supplements procedures that involve medical technologies and adds value along patient care pathways. However, these novel elements of value are often not captured in traditional assessment frameworks. ExpertLink is one such example. ExpertLink uses digital solutions to connect clinical experts worldwide, enabling remote training and collaboration, while maintaining the highest standard of patient care.
Methods
Rezum™ is a minimally invasive therapy for patients with symptomatic benign prostatic hyperplasia (BPH). It is a quick day procedure with proven safety, effectiveness, and durability in clinical outcomes. Leveraging ExpertLink, an expert in Sydney, Australia, remotely proctored 11 Rezum™ procedures in Malaysia in November 2022, supporting five urologists in five hospitals across five states within five hours. Efficient and straightforward procedures such as Rezum™ are well suited to remote proctorship. Through this case study, we quantify the sustainability, equity, and access benefits, illustrating the additional value ExpertLink brings across the healthcare continuum and beyond.
Results
For a proctor traveling from Australia to Malaysia, over 6,500 kilometers and 17 hours travel time is saved, equating to an estimated 1,700-kilogram reduction in CO₂ emissions. Without ExpertLink, a proctor may be away from practice for up to a week. ExpertLink allows for continuity of practice, including consultations and procedures, during this time. For five doctors traveling from Malaysia to Australia for training, an estimated 7,400-kilogram reduction in CO₂ emissions and approximately 85 hours travel time is saved. ExpertLink provided 11 geographically dispersed patients with timely access to treatment and expedited the physician learning curve.
Conclusions
This case study illustrates the value for just one technology on one day. ExpertLink embodies novel elements of value that are not captured in traditional value assessment frameworks. Collaborative effort between stakeholders is needed to broaden the view of value in healthcare, incorporate additional elements of value in existing assessment frameworks, and appropriately recognize this often-uncounted value in decision-making.
In 2022, a group of health technology assessment (HTA) bodies from Australia, Canada, and the UK announced a collaboration to identify solutions to common challenges. This collaboration was later expanded to include agencies from New Zealand and Quebec, Canada. Since one possible activity of the consortium is joint assessments, we compared the methodologies of the agencies on 11 topics to assess the feasibility of this.
Methods
We reviewed the methodological guidelines of the Canadian Agency for Drugs and Technologies in Health (CADTH), L’Institut national d’excellence en santé et services sociaux (INESSS), the National Institute for Health and Care Excellence (NICE), the Pharmaceutical Benefits Advisory Committee (PBAC), the Pharmaceutical Management Agency (Pharmac), and the Scottish Medicines Consortium (SMC). The topics considered were real-world evidence, consideration of health effects, economic reference case, survival analysis, surrogate endpoints, patient involvement, uncertainty, orphan pathways, clinical evidence requirements, carer perspective, and decision modifiers. We analyzed the level of alignment across the collaborating agencies using information from the guidelines, supplemented by published literature where necessary.
Results
Three topics exhibited high alignment: consideration of health effects, clinical evidence requirements and surrogate endpoints. The topics of orphan pathways and carer perspective had low alignment. The remaining topics had moderate alignment. Regarding orphan pathways, NICE and the SMC had separate processes for ultra-orphan drugs, CADTH and INESSS implicitly consider rarity, and PBAC and Pharmac do not appear to consider rarity. Since carer perspective is not commonly accepted in HTA, NICE was the only agency with relevant guidance on this topic. INESSS required the societal perspective as standard, while the PBAC and Pharmac explicitly excluded it. CADTH may consider carer perspective in some circumstances, whereas the SMC guidance was ambiguous.
Conclusions
While there is good alignment on most topics, there are several areas where agencies would need to resolve divergences in preferred methodology if joint assessments are going to be carried out in the future. All relevant stakeholders should be part of this process, including patient groups and industry.
The use of real-world evidence (RWE) by health technology assessments to evaluate emerging technologies has increased. Although traditionally recognized as the gold standard of evidence, randomized controlled trials (RCTs) may be challenging to conduct, especially in surgical settings. The aim of this analysis is to synthesize and compare results from RWE with those from RCTs for robotic-assisted surgery (RAS).
Methods
A systematic review was performed according to PRISMA methods. RWE and RCT studies published between 1 January 2010 and 31 December 2022 and comparing RAS, laparoscopic, or open surgery across seven procedures were included. Perioperative outcomes of interest were operative time, length of stay (LOS), conversion to an open procedure, estimated blood loss (EBL), blood transfusions, readmissions, reoperations, postoperative complications, and mortality. A meta-analysis was performed using R software.
Results
Thirty-three RCTs and 121 RWE studies were included. For RAS versus laparoscopy, RCTs and RWE were concordant for conversions (RCT:OR=0.56 [0.42, 0.74], p<0.01; RWE:OR = 0.41 [0.36, 0.47], p<0.01) and LOS in favor of RAS (RCT:WMD = −0.66 [−1.12, −0.20], p<0.01; RWE:WMD = −0.50 [−0.63, −0.36], p<0.01), while operative time was longer for RAS (RCT:WMD = 27.89 [12.66, 43.12], p<0.01; RWE:WMD = 28.89 [15.56, 42.22], p<0.01). RWE complemented RCTs on blood transfusions and mortality, showing RAS favored over laparoscopy. For RAS versus open surgery, RCTs and RWE agreed RAS had significantly lower EBL (RCT:WMD = −260.42 [−515.16, −5.67], p = 0.05; RWE: WMD = −328.27 [−474.08, −182.47], p<0.01), lower postoperative complications (RCT:OR = 0.70 [0.50, 0.97], p = 0.03; RWE:OR = 0.56 [0.50, 0.62], p<0.01), shorter LOS (RCT:WMD = −1.88 [−3.12, −0.64], p<0.01; RWE:WMD = −1.95 [−2.20, −1.70], p<0.01), and longer operative time (RCT:WMD = 35.38 [2.14, 68.61], p=0.04; RWE:WMD = 38.80 [24.62, 52.97], p<0.01). For the remaining outcomes, RCTs showed no difference, while RWE provided complementary results in favor of RAS.
Conclusions
RWE confirmed many of the results shown in RCTs and complemented findings for perioperative outcomes. Based on these results, RWE can supplement the findings from RCTs in the literature, provide more generalizability, and offer a more comprehensive landscape of the evidence on robotic-assisted surgery.
This article addresses a critical gap in international research concerning digital literacies and empowerment among adults who are English as an additional language (EAL) learners. In the Australian context, where digital communication and services are embedded in all aspects of life and work, proficiency in digital literacies, including advanced technologies like generative artificial intelligence (AI), is vital for working and living in Australia. Despite the increasing prevalence and significance of generative AI platforms such as ChatGPT, there is a notable absence of dedicated programs to assist EAL learners in understanding and utilising generative AI, potentially impacting their employability and everyday life. This article presents findings from a larger study conducted within training providers, spanning adult educational institutions nationwide. Through analysis of data gathered from surveys and focus groups, the article investigates the knowledge and attitudes of students, educators, and leaders regarding integrating generative AI into the learning program for adult EAL learners. The results reveal a hesitance among educators, particularly concerning beginning language learners, in incorporating generative AI into educational programs. Conversely, many adult learners demonstrate enthusiasm for learning about its potential benefits despite having limited understanding. These disparities underscore the pressing need for comprehensive professional development for educators and program leaders. The findings also highlight the need to develop the AI literacy of learners to foster their understanding and digital empowerment. The article concludes by advocating for a systemic approach to include generative AI as an important part of learning programs with students often from adult migrant and refugee backgrounds.
Galaxy Zoo is an online project to classify morphological features in extra-galactic imaging surveys with public voting. In this paper, we compare the classifications made for two different surveys, the Dark Energy Spectroscopic Instrument (DESI) imaging survey and a part of the Kilo-Degree Survey (KiDS), in the equatorial fields of the Galaxy And Mass Assembly (GAMA) survey. Our aim is to cross-validate and compare the classifications based on different imaging quality and depth. We find that generally the voting agrees globally but with substantial scatter, that is, substantial differences for individual galaxies. There is a notable higher voting fraction in favour of ‘smooth’ galaxies in the DESI+zoobot classifications, most likely due to the difference between imaging depth. DESI imaging is shallower and slightly lower resolution than KiDS and the Galaxy Zoo images do not reveal details such as disc features and thus are missed in the zoobot training sample. We check against expert visual classifications and find good agreement with KiDS-based Galaxy Zoo voting. We reproduce the results from Porter-Temple+ (2022), on the dependence of stellar mass, star formation, and specific star formation on the number of spiral arms. This shows that once corrected for redshift, the DESI Galaxy Zoo and KiDS Galaxy Zoo classifications agree well on population properties. The zoobot cross-validation increases confidence in its ability to compliment Galaxy Zoo classifications and its ability for transfer learning across surveys.
There is no clear evidence about how to support people with borderline personality disorder (BPD) during the perinatal period. Perinatal emotional skills groups (ESGs) may be helpful, but their efficacy has not been tested.
Aims
To test the feasibility of conducting a randomised controlled trial (RCT) of perinatal ESGs for women and birthing people with BPD.
Method
Two-arm parallel-group feasibility RCT. We recruited people from two centres, aged over 18 years, meeting DSM-5 diagnostic criteria for BPD, who were pregnant or within 12 months of a live birth. Eligible individuals were randomly allocated on a 1:1 ratio to ESGs + treatment as usual (TAU), or to TAU. Outcomes were assessed at 4 months post randomisation.
Results
A total of 100% of the pre-specified sample (n = 48) was recruited over 6 months, and we obtained 4-month outcome data on 92% of randomised participants. In all, 54% of participants allocated to perinatal ESGs attended 75% of the full group treatment (median number of sessions: 9 (interquartile range 6–11). At 4 months, levels of BPD symptoms (adjusted coefficient −2.0, 95% CI −6.2 to 2.1) and emotional distress (−2.4, 95% CI −6.2 to 1.5) were lower among those allocated to perinatal ESGs. The directionality of effect on well-being and social functioning also favoured the intervention. The cost of delivering perinatal ESGs was estimated to be £918 per person.
Conclusions
Perinatal ESGs may represent an effective intervention for perinatal women and birthing people with BPD. Their efficacy should be tested in a fully powered RCT, and this is a feasible undertaking.
In this research, a novel polarization reconfigurable fractal antenna with high gain is proposed for wideband applications. This antenna consists of a Koch curve based hexagonal ring patch, two Positive-Intrinsic-Negative (PIN) diodes, and partial ground. The patch is positioned on a Rogers RT/Duroid 5880 substrate (ϵr = 2.2) with overall dimensions 33 × 30 × 1.6 mm3. It has three frequency bands with three different cases i.e., case I, 3–7.91 (90%); case II, 3–7.73 (88.16%); and case III, 3.54–6.7 GHz (61.7%). As a result, the proposed antenna’s impedance bandwidth (IBW) offers constant wideband coverage ranging from 3–7.91 GHz (90%). The axial ratio bandwidth (ARBW) is below 3 dB over 3.6–6.9 (62.86%) and 3.33–7.14 GHz (72.78%) for LHCP (Case I) and RHCP modes (Case II), respectively. The value for LP mode (Case III) is 3.54–6.7 GHz (61.7%). A peak realized gains of 4.75, 5.07, and 3.8 dBi are achieved at 6.2, 6.3, and 6 GHz for Case I, Case II, and Case III, respectively. Both linear and circular polarization prototype was developed and the performance was verified through measurements. The design confirms good polarization-reconfigurable characteristics within the band of 3.91 – 7.91 GHz.