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Embedding climate resilient development principles in planning, urban design, and architecture means ensuring that transformation of the built environment helps achieve carbon neutrality, effective adaptation, and well-being for people and nature. Planners, urban designers, and architects are called to bridge the domains of research and practice and evolve their agency and capacity, developing methods and tools consistent across spatial scales to ensure the convergence of outcomes towards targets. Shaping change necessitates an innovative action-driven framework with multi-scale analysis of urban climate factors and co-mapping, co-design, and co-evaluation with city stakeholders and communities. This Element provides analysis on how urban climate factors, system efficiency, form and layout, building envelope and surface materials, and green/blue infrastructure affect key metrics and indicators related to complementary aspects like greenhouse gas emissions, impacts of extreme weather events, spatial and environmental justice, and human comfort. This title is also available as open access on Cambridge Core.
Leadership emergence is fraught with pervasive gender stereotypes, and women remain underrepresented in senior leadership roles, particularly in healthcare organisations. We apply ecological systems theory to explain how environmental factors enable or inhibit women’s leadership emergence in healthcare settings. We interviewed 17 senior female leaders in the Australian healthcare sector to explore how gender-related perceptions affected their leadership journeys. Five themes emerged that challenge existing narratives: men supported women’s advancement; women impeded other women’s progress; vulnerability was a leadership strength; ambitious women were ostracised; and women were ‘given’ leadership opportunities rather than actively pursuing them. By situating these findings within the ecological systems theory framework, we highlight the interplay of individual and contextual influences across ecosystem levels. Our study offers a novel perspective on gender stereotypes in leadership emergence, advancing ecological systems theory by extending it into a new field. We provide recommendations at individual, organisational, community, and societal levels to empower women leaders.
This meta-analytic study aims to assess the relationship between innovation and organizational performance. Examining studies published from 2012 to 2021 using a specific protocol resulted in selecting 180 effect sizes from 143 studies. Comprehensive Meta-Analysis Software (CMA2) (2.2.064) software facilitated data analysis. Findings reveal a positive and significant relationship between innovation and organizational performance. Moderating analysis identifies country, continent, year of publication, and innovation type as moderating variables. Additionally, recent years exhibit a noteworthy convergence in the relationship trend between innovation and organizational performance. Enhancing organizational performance remains a critical concern. The study’s outcomes offer valuable insights for managers, especially in international organizations to improve the planning and management of innovation and performance in their various branches and projects in different continents and countries.
The present systematic review and meta-analysis sought to evaluate the effects of conjugated linoleic acid (CLA) supplementation on cardiovascular risk factors in patients at risk of CVD. Relevant studies were obtained by searching the PubMed, SCOPUS and Web of Science databases (from inception to January 2023). Weighted mean differences (WMD) and 95% CI were pooled using a random-effects model. Heterogeneity, sensitivity analysis and publication bias were reported using standard methods. A pooled analysis of 14 randomised controlled trials (RCT) with 17 effect sizes revealed that CLA supplementation led to significant reductions in body weight (WMD: −0·72 kg, 95% CI: −1·11, −0·33, P < 0·001), BMI (WMD: −0·22 kg/m2, 95% CI: −0·44, −0·00, P = 0·037) and body fat percentage (BFP) (WMD: −1·32 %, 95% CI: −2·24, −0·40, P = 0·005). However, there was no effect on lipid profile and blood pressure in comparison with the control group. In conclusion, CLA supplementation may yield a small but significant beneficial effect on anthropometric indices in patients at risk of CVD. Moreover, CLA seems not to have adverse effects on lipid profiles and blood pressure in patients at risk of CVD. It should be noted that the favourable effects of CLA supplementation on anthropometric variables were small and may not reach clinical importance.
Several meta-analyses have suggested the beneficial effect of vitamin D on patients infected with severe acute respiratory syndrome coronavirus-2. This umbrella meta-analysis aims to evaluate influence of vitamin D supplementation on clinical outcomes and the mortality rate of COVID-19 patients.
Design:
Present study was designed as an umbrella meta-analysis. The following international databases were systematically searched till March 2023: Web of Science, PubMed, Scopus, and Embase.
Settings:
Random-effects model was employed to perform meta-analysis. Using AMSTAR critical evaluation tools, the methodological quality of the included meta-analyses was evaluated.
Participants:
Adult patients suffering from COVID-19 were studied.
Results:
Overall, 13 meta-analyses summarising data from 4 randomised controlled trial and 9 observational studies were identified in this umbrella review. Our findings revealed that vitamin D supplementation and status significantly reduced mortality of COVID-19 [Interventional studies: (ES = 0·42; 95 % CI: 0·10, 0·75, P < 0·001; I2 = 20·4 %, P = 0·285) and observational studies (ES = 1·99; 95 % CI: 1·37, 2·62, P < 0·001; I2 = 00·0 %, P = 0·944). Also, vitamin D deficiency increased the risk of infection and disease severity among patients.
Conclusion:
Overall, vitamin D status is a critical factor influencing the mortality rate, disease severity, admission to intensive care unit and being detached from mechanical ventilation. It is vital to monitor the vitamin D status in all patients with critical conditions including COVID patients.
Public health laws and policies are uniquely able to mitigate the adverse and inequitable health impacts of climate change. This article summarizes some key considerations in developing such laws and policies and a variety of approaches local public health departments are using to increase climate resilience and health equity.
Effective climate change resilience in local communities must center each community’s unique challenges and essential role in developing climate resilience strategies. This article will discuss recent developments by the federal government that align with a community-centered approach, and how Community Health Workers can influence the outcomes.
The main goal of radiation therapy is to eradicate all cancer cells and minimize the damage to healthy tissues around the tumour. Treatment planning systems are used to predict the outcome of the treatment in terms of dose distribution prior to the treatment. One of the most reliable dose calculation algorithms is Monte Carlo. The aim of this study is to evaluate the performance of automated external contouring tool on dose calculation using Monte Carlo algorithm.
Materials and methods
The external contour of thorax phantom was created by automated tools of Monaco treatment planning system, and then, the IAEA-TECDOC-1583 quality assurance tests were created. Then, the treatment plans were delivered to the phantom, and the dose was measured by the Farmer ionization chamber at specific points. The external contour was corrected according to the source surface distances (SSD) which are mentioned in TECDOC-1583, and the dose was re-calculated. Finally, a comparison was made between the results.
Results
Dosimetric tests of TECDOC-1583 showed the errors ranged from −2·8% to +2·5%. In case of editing external contour and omitting fluctuations, the errors were decreased. The comparisons indicated that the most significant variation occurred in test 4 and the least changes were related to the tests 1 and 3.
Conclusions
The results of the study showed that the fluctuations of the external contour affect the calculated volume of the phantom and thus the dose. In order to obtain correct results, automated external contouring tools should be used with the correct instructions and re-checked before treatment planning.
Increasing attention has been paid in recent scholarship on Bertolt Brecht to his engagement with Georg Wilhelm Friedrich Hegel beyond the ideological coordinates of orthodox Marxism, to which Brecht's relationship was far from straightforward. Unlike most of his left-wing peers among the German exiles who spent World War II in California, Brecht did not resettle in the Federal Republic. Instead, he returned home as socialist Germany's favorite son, even penning a national anthem for the nascent German Democratic Republic. Brecht received a full government subsidy from the governing Socialist Unity Party and, in 1954, the Stalin Peace Prize, remaining a cultural icon of the GDR long after his death two years later. David Bathrick recounts a 1968 symposium commemorating what would have been Brecht's seventieth birthday:
Once maligned for his formalist tendencies within the socialist camp, Brecht was now recognized in Werner Mittenzwei's words as “the great model for the theater life of the GDR.” But it was Alexander Abusch, representing the Council of Ministers who paid the greatest tribute: “It is altogether fitting that we celebrate Brecht's 70th birthday together with the 120th anniversary of the appearance of the Communist Manifesto, for Brecht's life work is the manifesto made poetry and theatrical practice.”
The paradox of Brecht's accession to Stalinist royalty is that the man whose “life work is the manifesto made poetry and theatrical practice” could only be a deeply unorthodox Marxist. He never joined the German Communist Party in the Weimar Republic; nevertheless, he was rumored to be number five on Hitler's death list when he fled the Third Reich to Scandinavia. Years later, in 1947, his exile in America was in turn cut short after he was called before the House Un-American Activities Committee (HUAC), where he was able to answer honestly (in between a tour de force of playful guile) that he had never been a member of a communist party. In their study of Brecht, Jan Needle and Peter Thomson sum up what might be called the “problem” of Brecht: “[E]ven at his most apparently straightforward, Brecht's inability to see only one side of any question was absolute. Irony and ambiguity” mark even the most didactically communist of Brecht's works, ensuring that by and large, “for his fellow Marxists, he was too dialectical by half.”
The cardioprotective effects of nuts are well established. However, the positive impacts of nuts in preventing CVD at a younger age, a condition known as premature coronary artery disease (PCAD), is still debated. Therefore, we aim to determine the association between nuts and PCAD occurrence and its severity in different Iranian ethnicities.
Design:
This case–control study was conducted within the framework of the Iran-premature coronary artery disease (I-PAD) study, an ongoing multi-centric study on Iranian patients of different ethnicities.
Setting:
This multi-centric case–control study was conducted in among 3253 persons under the age of 70 years in women and 60 years in men from different ethnicities in Iran.
Participants:
Information on nut consumption was collected using a validated FFQ. Subjects were selected from among the candidates for angiography. Cases were those whose coronary angiography showed stenosis of more than 75 % in at least one vessel or more than 50 % of the left main artery, while the control group participants had normal angiography results.
Results:
In the crude model, compared to the first quartile, the highest quartile of nut consumption was significantly associated with a lower risk of PCAD (OR = 0·26, 95 % CI (0·21, 0·32); Pfor trend = 0·001). In the top quartile of nut intake, a substantial decrease in PCAD was observed after controlling for putative confounders (OR = 0·32; 95 % CI (0·24, 0·43); Pfor trend = 0·001). Additionally, a 75 % decrease in the risk of severe PCAD was observed in the participants in the highest quartile of nut intake.
Conclusion:
A significant inverse association was observed between nut intake and the risk and severity of PCAD in the Iranian population. Large-scale clinical trials are required to confirm these findings.
Healthcare personnel (HCP) may encounter unfamiliar personal protective equipment (PPE) during clinical duties, yet we know little about their doffing strategies in such situations.
Objective:
To better understand how HCP navigate encounters with unfamiliar PPE and the factors that influence their doffing strategies.
Setting:
The study was conducted at 2 Midwestern academic hospitals.
Participants:
The study included 70 HCP: 24 physicians and resident physicians, 31 nurses, 5 medical or nursing students, and 10 other staff. Among them, 20 had special isolation unit training.
Methods:
Participants completed 1 of 4 doffing simulation scenarios involving 3 mask designs, 2 gown designs, 2 glove designs, and a full PPE ensemble. Doffing simulations were video-recorded and reviewed with participants during think-aloud interviews. Interviews were audio-recorded and analyzed using thematic analysis.
Results:
Participants identified familiarity with PPE items and designs as an important factor in doffing. When encountering unfamiliar PPE, participants cited aspects of their routine practices such as designs typically used, donning and doffing frequency, and design cues, and their training as impacting their doffing strategies. Furthermore, they identified nonintuitive design and lack of training as barriers to doffing unfamiliar PPE appropriately.
Conclusion:
PPE designs may not be interchangeable, and their use may not be intuitive. HCP drew on routine practices, experiences with familiar PPE, and training to adapt doffing strategies for unfamiliar PPE. In doing so, HCP sometimes deviated from best practices meant to prevent self-contamination. Hospital policies and procedures should include ongoing and/or just-in-time training to ensure HCP are equipped to doff different PPE designs encountered during clinical care.
Several studies have examined the association between CD36 rs1761667 polymorphism with cardiometabolic risk factors and metabolic syndrome (MetS). This study aimed to investigate the interactions between rs1761667 polymorphism and dietary patterns on the cardiometabolic risk factors and the risk of MetS in apparently healthy individuals aged 20–70 years. Food consumption data were acquired using a validated semi-quantitative FFQ. Dietary patterns were identified by factor analysis. CD36 rs1761667 was genotyped by PCR-restriction fragment length polymorphism. The gene–diet interaction was detected by the general linear model or logistic regression. Significant or marginally significant interactions were observed between healthy dietary pattern (HDP) and CD36 rs1761667 on weight (P = 0·006), BMI (P = 0·009), waist circumference (P = 0·005), hip circumference (P = 0·06), body muscle percentage (P = 0·02), body fat percentage (P = 0·09), TAG-glucose index (P = 0·057), atherogenic index of plasma (P = 0·07), the risk of MetS (P = 0·02), risk of abdominal obesity (P = 0·02) and elevated blood pressure (P = 0·07). Besides, a gene–diet interaction was detected between the traditional dietary pattern and rs1761667 variants on odds of hypertriglyceridaemia (P = 0·02). The adherence to HDP was associated with a lower weight, BMI and higher odds of HDL-cholesterol only in A-allele carriers. In conclusion, adherence to HDP (a diet with high fibre, fish and dairy products) can be more effective on some cardiometabolic risk factors and risk of MetS components in the A-allele carrier than the GG genotype of rs1761667 polymorphism. However, future studies are required to shed light on this issue.
The Pliocene–Quaternary volcanic rocks which outcrop between Qorveh and Bijar are part of post-collisional within-plate volcanic activity in northern Iran. These mafic alkaline rocks form part of the northern arm of the Sanandaj–Sirjan (Hamedan–Tabriz) zone. Thermobarometry on equilibrium clinopyroxene – whole-rock pairs yields pressures and temperatures of 4–6 (±1.8) kbar and 1182–1213 (±27) °C, respectively; olivine – whole-rock (melt) equilibrium thermometry yields crystallization temperatures of 1212–1264 (±27) °C. Field relationships, including the presence of pyroxenitic xenoliths, and geochemical evidence (e.g. high FeO/MnO, and low CaO compared to lavas derived from peridotite sources) suggest a pyroxenitic mantle source for the studied rocks. Variation of trace elements and isotopic ratios (i.e. Ce/Pb, Ba/La, 87Sr/86Sr) indicate that this pyroxenite mantle source was generated by interaction between melted sediments of the subducted Neo-Tethys slab with ambient peridotitic lithospheric mantle. The resulting metasomatized lithosphere is denser and has a lower viscosity than the peridotitic mantle, and tectonic disturbance can cause it to fall into the depths of the mantle. The descending volatile-rich material starts to melt with increasing temperature. Modelling of rare earth element (REE) abundances suggests that <1 % partial melting of the descending pyroxenite could create the Plio-Quaternary alkali basaltic magma of the Qorveh–Bijar. The geochemical evidence for lithospheric foundering, and hence drip magmatism, in the Qorveh–Bijar volcanic belt is supported by seismographic studies indicating thinned lithosphere beneath the study area.
During the early Bajocian, a conspicuous coal-bearing siliciclastic succession was deposited in the northern Tabas Bock, which is important for understanding the regional geodynamics of the Central-East Iranian Microcontinent (CEIM) as well as for the Jurassic coal genesis in this part of Laurasia. Sedimentary facies analysis in a well-exposed section of the lower Bajocian Hojedk Formation (Kalshaneh area, northern Tabas Block) led to the recognition of ten characteristic sedimentary facies and three facies associations, representing channels with point bars and floodplains of a Bajocian meandering river system. Modal analysis indicates that the mature quartz arenites and quartzo-lithic sandstones of the Hojedk Formation originated from the erosion and recycling of older, supracrustal sedimentary rocks on the Yazd Block to the west. The coal petrography and maturity show an advanced maturation stage, whereas the great thickness of these continental strata points to a pronounced extension-related subsidence in the northern Tabas Block. The rapid rate of differential subsidence can be explained by accelerated normal block-faulting in the back-arc extensional basin of the CEIM, facing the Neotethys to the south. Compared to the thick Jurassic, the post-Jurassic strata are relatively thin and played a limited role in the thermal history of the coal in the northern Tabas Block. A relatively high geothermal gradient in the tectonically highly mobile area of the northern Tabas Block and/or heating by regionally widespread Palaeogene intrusions were most probably the key drivers of the thermal maturation of the Middle Jurassic coals.
Over the last several decades, there has been an increase in chronic diseases such as neurodegenerative, inflammatory, cardiovascular disease (CVD) and cancer. Two eating patterns, a low-carbohydrate diet (LCD) and fasting, have been researched independently over this period and found to be beneficial in reducing many of these chronic diseases’ detrimental effects. However, there have been limited studies about the synergy of these eating patterns. This current scoping review aims to explore the evidence of the health outcomes of using a LCD in conjunction with fasting. Four databases were searched, and fifteen articles were found that fit the inclusion criteria. The articles reported positive effects of combining the two eating patterns for type 2 diabetes, CVD, inflammatory conditions and weight reduction and maintenance. LCD and fasting together provide synergy in decreasing metabolic syndrome (as the key causes of chronic illnesses), such as insulin levels, fasting glucose, blood pressure, TAG and regulating lipid profile. Due to the paucity of research, further high-quality studies are needed to substantiate this evidence.
Untethered small-scale robots can accomplish tasks which are not feasible by conventional macro robots. In the current research, we have designed and fabricated a miniature magnetic robot actuated by an external magnetic field. The proposed robot has two coaxial wheels and one magnetic dipole which is capable of rolling and moving on the surface by variation in the direction of magnetic field. To generate the desired magnetic field, a Helmholtz electromagnetic coil is manufactured. To steer the robot to the desired position, at first the robot dynamics is investigated, and subsequently a controller based on a neuro-fuzzy network has been designed. Finally, the proposed controller is implemented experimentally and the performance of the control system is demonstrated.
Adipocyte expansion through adipogenesis can offset the adverse metabolic effects of obesity. Nigella sativa (NS) (black seed) oil is shown to have therapeutic features in the management of obesity. NS oil might have beneficial changes in obese populations through mediating serum levels of adipogenesis-related parameters and relative transcriptional gene–diet interactions (nutrigenomics), though no previous studies assessed this mechanism in overweight/obese participants. This study assessed the effects of NS oil supplements on blood concentration and mRNA expression levels of TNF-α, PPAR-γ and serum adiponectin and expression of AdipoR1, as major adipogenesis and obesity-related parameters, in overweight/obese women using a cross-over design. Eligible women were randomised to receive either NS oil supplements (2000 mg/d) or placebo. Two periods of interventions (8 weeks in each) were cross-changed by a 4-week washout period. An individualised diet plan without calorie deficits was given to participants to match their energy/macronutrient intakes. The Pkcross procedure and intention-to-treat analysis were performed using Stata. Cohen’s d(d) was estimated to measure the magnitude of the effects. Forty-six participants were included. NS oil capsules reduced transcription levels ((d = –2·31), P < 0·001) and blood concentrations of TNF-α ((d = –0·29), P < 0·001). AdipoR1 expression (d = 2·24, P < 0·001) and serum adiponectin (d = 0·88, P < 0·001) showed a significant augmentation with a medium-high effect size, as did gene expression (d = 0·69, P < 0·001) and serum levels of PPAR-γ (d = 0·97, P < 0·001). There was a moderate but significant decrease in body weight (d = 0·6, P < 0·001). The present beneficial findings would provide strong information for future nutrigenomics/clinical trial studies assessing the role of NS in the management of obesity and other comorbidities.
OBJECTIVES/GOALS: In this study we sought to determine the role of glucagon-like peptide-1 (GLP-1), one of the main gut hormones in regulating glucose metabolism, after protein ingestion in patients with a history of Roux-en-Y gastric bypass (GB) and sleeve gastrectomy (SG). METHODS/STUDY POPULATION: We examined the glucose and islet-cell secretory responses to 50 g protein ingestion with and without a potent GLP-1 receptor antagonist, exendin-(9-39) [Ex-9], in 10 GB-treated subjects, 9 SG-treated, and 7 non-operated controls (CN). The groups were matched for age, BMI, fat-free mass, fasting glucose and insulin, and HbA1c. The surgical groups also were matched for weight loss and time post-surgery. No subjects had diabetes. RESULTS/ANTICIPATED RESULTS: Protein ingestion resulted in an early rise in glycemia (AUCGlucose1hr) in GB and SG, whereas CN had minimal change in glucose (p<0.05). Protein ingestion enhanced C-peptide responses in all groups, but to a larger extent in GB and SG when compared to CN (p<0.05). Early glucagon response to protein ingestion (AUCGlucagon1hr) tended to be larger in GB and SG subjects when compared to CN (p=0.07). Ex-9 increased premeal and prandial glycemia in all groups (p<0.05), but increase in early glycemia (AUCGlucose1hr) was most notable in GB (p=0.1, interaction). This glycemic effect of Ex-9 was associated with a ~25% reduction in prandial C-peptide secretion in GB and SG and ~8% increase in CN (p<0.05, interaction). Early prandial glucagon responses were larger during studies with Ex-9 compared to those without (p<0.05). DISCUSSION/SIGNIFICANCE: Our findings indicate that glucose metabolism after protein ingestion is altered after GB and SG. To our knowledge, this is the first report to demonstrate that endogenous GLP-1 contributes to glucose and islet-cell secretory response to protein ingestion, and that GB and SG exaggerate GLP-1 contribution to insulin secretion after protein ingestion.
Background: Assessment of patients for temporal lobe epilepsy (TLE) surgery requires multimodality input, including EEG to ensure optimal surgical planning. Often EEG demonstrates abnormal foci not detected on clinical MRI. 7T MRI provides improved resolution and we investigated its utility to detect potential abnormalities associated with EEG. Methods: Images were acquired on 7T MRI scanner (N=13) in oatients with TLE. Evaluation of 7T imaging for focal abnormalities was performed. Correlation of 7T MRI findings with EEG of focal slowing or interictal epileptic spikes (IEDs) and seizures was performed. Results: Assessment of 7T MRI demonstrated concordance with TLE in 8/13 cases. Three cases exhibited abnormal 7T MRI abnormalities not detected by 1.5 T MRI. Eleven out of 13 cases had EEG findings without anatomic correlates on MRI, with IEDs localizing to contralateral temporal, frontal, and parieto-occipital lobes. 7T images did not reveal focal anatomical abnormalities to account for the EEG findings in these patients. Conclusions: To our knowledge, this is the first study to investigate the role of 7T MRI in relation to EEG abnormalities. 7T RI findings show concordance with clinical data. 7T MRI did not reveal anatomical findings to account for EEG abnormalities, suggesting that such changes may be functional rather than anatomical.