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OBJECTIVES/GOALS: Bronchiolitis is a major cause of PICU admission, yet identifying best practices is limited by the lack of existing databases containing the needed demographic and clinical variables. We used probabilistic linkage to join the Virtual Pediatric System (VPS) and Pediatric Health Information Systems (PHIS) databases to overcome this data barrier. METHODS/STUDY POPULATION: We performed a single site study joining VPS and PHIS data. These national databases contain clinical (VPS) and billing and resource use (PHIS) data. Limits on the use of patient identifiers (PI) for multi-center research, makes direct linkage techniques impossible. To demonstrate that probabilistic linkage can accurately link VPS and PHIS records, we obtained our single site VPS and PHIS records and linked them using probabilistic linkage without PI and compared this to a gold standard linkage created with PI. We also compared demographic features of linked and unlinked records to assess the ability of probabilistic linkage to create a representative sample. RESULTS/ANTICIPATED RESULTS: We obtained 920 VPS records of patients with bronchiolitis and linked 91% (839/920) to a PHIS record with 4 (0.5%) false-positive matches. Characteristics of linked and unlinked records are compared in Table 1. Comparison of probabilistically linked and unlinked records showed no difference in median age in years (0.7 [Interquartile range (IQR) 0.3-1.5] v 0.7 [IQR 0.2-1.5], p = 0.76), median number of complex chronic conditions (0 [IQR 0-1] v 0 [IQR 0-1], p = 0.16), median Pediatric Index of Mortality 3 severity of illness scores (-4.6 [IQR -4.7 – 4.4] v -4.6 [IQR -4.7 – 4.4], p = 0.44), median days of PICU stay (4 [IQR 3-6] v 4 [IQR 2-6], p = 0.36), proportion female ( 44% v 46%, p = 0.82), or proportion of patients intubated (28% v 24%, p = 0.41). DISCUSSION/SIGNIFICANCE: Probabilistic linkage creates an accurate combined VPS-PHIS database. Extending our methodology to join data from all 38 hospitals contributing to VPS and PHIS will allow creation of a large database containing the demographic, treatment, and outcome data needed to enable Comparative Effectiveness Research of bronchiolitis care.
Adult patients who triggered an electronic sepsis alert in the emergency department (ED), received ≥2 doses of vancomycin or an antipseudomonal beta-lactam, and were discharged with an ICD-10 sepsis code.
Methods:
We assessed the prevalence of delays in second doses of antibiotics by ≥25% of the recommended dose interval and conducted multivariate regression analyses to assess for risk factors for delays and in-hospital mortality.
Results:
The cohort included 449 patients, of whom 123 (27.4%) had delays in second doses. In-hospital death occurred in 31 patients (25.2%) in the delayed group and 71 (21.8%) in the non-delayed group (p = 0.44). On multivariate analysis, only location in a non-ED unit at the time second doses were due was associated with delays (OR 2.75, 95% CI 1.20–6.32). In the mortality model, significant risk factors included malignant tumor, respiratory infection, and elevated Sequential Organ Failure Assessment (SOFA) score but not delayed second antibiotic doses (OR 1.19, 95% CI 0.69–2.05). In a subgroup analysis, delayed second doses were associated with higher mortality in patients admitted to non-intensive care units (ICUs) (OR 4.10, 95% CI 1.32–12.79).
Conclusions:
Over a quarter of patients with sepsis experienced delays in second doses of antibiotics. Delays in second antibiotic doses were not associated with higher mortality overall, but an association was observed among patients admitted to non-ICUs.
Wild rabbits in Australia developed genetic resistance to the myxoma virus, which was introduced as a biological control agent. However, little is known about the rate at which this evolutionary change occurred. We collated data from challenge trials that estimated rabbit resistance to myxomatosis in Australia and expressed resistance on a continuous scale, enabling trends in its development to be assessed over 45 years up to 1995. Resistance initially increased rapidly, followed by a plateau lasting ten years, before a second rapid increase occurred associated with the introduction of European rabbit fleas as myxoma virus vectors. By contrast, in the United Kingdom, where rabbit flea vectors were already present when the myxoma virus initially spread, resistance developed more slowly. No estimates of rabbit resistance to myxomatosis have been made for almost 30 years, despite other highly lethal rabbit pathogens becoming established worldwide. Continued testing of wild-caught rabbits in Australia to determine current levels of resistance to myxomatosis is recommended to assess its current effectiveness for managing pest rabbits. Given the economic and environmental significance of invasive rabbits, it would be remiss to manage such biological resources and ecosystem services poorly.
We prove discrete restriction estimates for a broad class of hypersurfaces arising in seminal work of Birch. To do so, we use a variant of Bourgain’s arithmetic version of the Tomas–Stein method and Magyar’s decomposition of the Fourier transform of the indicator function of the integer points on a hypersurface.
Compare rates, clinical characteristics, and outcomes of paediatric palliative care consultation in children supported on extracorporeal membrane oxygenation admitted to a single-centre 16-bed cardiac or a 28-bed paediatric ICU.
Methods:
Retrospective review of clinical characteristics and outcomes of children (aged 0–21 years) supported on extracorporeal membrane oxygenation between January, 2017 and December, 2019 compared by palliative care consultation.
Measurements and results:
One hundred children (N = 100) were supported with extracorporeal membrane oxygenation; 19% received a palliative care consult. Compared to non-consulted children, consulted children had higher disease severity measured by higher complex chronic conditions at the end of extracorporeal membrane oxygenation hospitalisation (5 versus. 3; p < 0.001), longer hospital length of stay (92 days versus 19 days; p < 0.001), and higher use of life-sustaining therapies after decannulation (79% versus 23%; p < 0.001). Consultations occurred mainly for longitudinal psychosocial-spiritual support after patient survived device deployment with a median of 27 days after cannulation. Most children died in the ICU after withdrawal of life-sustaining therapies regardless of consultation status. Over two-thirds of the 44 deaths (84%; n = 37) occurred during extracorporeal membrane oxygenation hospitalisation.
Conclusions:
Palliative care consultation was rare showing that palliative care consultation was not viewed as an acute need and only considered when the clinical course became protracted. As a result, there are missed opportunities to involve palliative care earlier and more frequently in the care of extracorporeal membrane survivors and non-survivors and their families.
A major threat to the Scotch whisky industry is the sale of counterfeit single malt whiskies with purported distillation years in the 19th and early- to mid-20th centuries. However, these are often much more recent spirits, distilled in the latter part of the 20th or first part of the 21st centuries. These sales impinge upon the reputation of auction houses, retailers, brand owners and distillers. The atmospheric testing of nuclear weapons in the 1950s and early 1960s has enabled a precise calibration curve to be created, however, there are several reasons why this may not be appropriate for establishing the year of whisky distillation. We have created a 14C calibration curve derived from known-age, single malt whiskies for the period 1950–2015 that enables whisky distilled during the period from 1955 onwards to have the distillation year determined to within 1–3 years for certain periods. However, because of the shape of the curve, two possible age ranges are often possible. The correct range can often be determined from a further plot of δ13C values against distillation year, which shows a trend of decreasing values through time. Several examples are given of the determination of both genuine and fake products.
The concept of food addiction is currently a highly debated subject within both the general public and the scientific communities. The term food addiction suggests that individuals may experience addictive-like responses to food, similar to those seen with classic substances of abuse. An increasing number of studies have established the prevalence and correlates of food addiction. Moreover, food addiction may be associated with obesity and disordered eating. Thus, intervening on food addiction may be helpful in the prevention and therapy of obesity and eating disorders. However, controversy exists about if this phenomenon is best defined through paradigms reflective of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) substance-related disorders (e.g. food addiction) or non-substance-related disorders (e.g. eating addiction) criteria. This review paper will give a brief summarisation of the current state of research on food addiction, a more precise definition of its classification, its differentiation from eating addiction and an overview on potential overlaps with eating disorders. Based on this review, there is evidence that food addiction may represent a distinct phenomenon from established eating disorders such as bulimia nervosa or binge-eating disorder. Future studies are needed to further examine and establish orthogonal diagnostic criteria specific to food addiction. Such criteria must differentiate the patterns of eating and symptoms that may be similar to those of eating disorders to further characterise food addiction and develop therapy options. To date, it is too premature to draw conclusions about the clinical significance of the concept of food addiction.
Brian Cook provides a clearheaded overview of the complications of text, transmission, and provenance evidenced in a major medieval Icelandic chronicle of northwest European politics, the Orkneyinga saga. Cook focuses on the connivances of the legendary queen Ragnhild and their impact upon North Sea islands and kingdoms. Is she a Norse reflex or importation of the Irish sovereignty figure? And, as deadly as it might be, does sexual association with such a figure endow her lovers with legendary cachet? These are among the questions Cook attempts to answer.
In a series of narrative events that William P.L. Thomson suggests read more like folktale than history, the sons of Earl Thorfinn successively take both the Earldom of Orkney and Ragnhild Eiríksdóttir as wife. As I shall argue, the murder plots and serial marriages described in chapter 9 of Orkneyinga saga bear a striking resemblance to medieval Irish tales of a sovereignty goddess representing the land. In what follows, my intention is not to claim a genetic relationship between the two—that the sovereignty figure of medieval Irish literature is direct source for Ragnhild—but rather that chapter 9 of Orkneyinga saga has a narrative problem to solve concerning the succession of the earldom, and that the solution is reminiscent of the well-known sovereignty goddess motif.
A number of scholars have argued for the influence of medieval Irish literary culture on that of their insular neighbors, the Anglo-Saxons and the Norse. While degree and channels of influence generally require consideration on a case-by-case basis, William Sayers points out that
[w]hatever stand one takes on oral-traditional/literary influence from Celtic to Norse, no one disputes the overall historicity of the individual entries in Landnámabók (The Book of Settlements) that ascribe birth or residence, and ties of kinship, marriage, fosterage or bondage originating in Ireland, the Hebrides and parts of mainland Scotland to about a fourth of the original settlers, and Norwegian origins to the remainder.
It is generally assumed by scholars that the Celtic settlers—however they made their way to Iceland—would have brought with them oral tales that influenced neighboring literary traditions by the time those traditions came to be recorded.
In this note we give a characterization of $\ell ^{p}\times \cdots \times \ell ^{p}\rightarrow \ell ^{q}$ boundedness of maximal operators associated with multilinear convolution averages over spheres in $\mathbb{Z}^{n}$.
Radiocarbon (14C) wiggle-match dating is a technique with a substantial potential to improve the precision of dating timbers in situations where dendrochronology is not tenable. However, one of the key reasons why obtaining a dendrochronological determination might be difficult is the short-lived nature of timbers on a range of archaeological sites, something that also affects the efficiency of the wiggle-match dating technique. Combined with the potential for high expense that the technique presents, it is paramount that wiggle-match dating research design has a good empirical basis. To this end we dated 50 consecutive, individual rings from a timber that grew during the Hallstatt radiocarbon calibration plateau (ca. 750–400 cal BC) in southwest Scotland. The results indicate that (1) the precision and accuracy of wiggle-match dates carried out on short-lived sequences during the Hallstatt plateau may suffer due to insufficient resolution of the calibration data, (2) sampling time-frames roughly equivalent to the underpinning calibration data are recommended (for the period in question this means decadal blocks), and (3) short-lived sequences are at risk of losing accuracy if the actual past trend of radiocarbon diverges from the mean of the radiocarbon calibration curve.
From 1994 onwards, radiocarbon discharges from the Sellafield nuclear fuel reprocessing plant have been made largely to the northeast Irish Sea. They represent the largest contributor to UK and European populations of the collective dose commitment derived from the entire nuclear industry discharges. Consequently, it is important to understand the long-term fate of 14C in the marine environment. Research undertaken in 2000 suggested that the carbonate component of northeast Irish Sea sediments would increase in 14C activity as mollusk shells, which have become enriched in Sellafield-derived 14C, are broken down by physical processes including wave action and incorporated into intertidal and subtidal sediments. The current study, undertaken in 2011, tested this hypothesis. The results demonstrate significant increases in 14C enrichments found in whole mussel shells compared to those measured in 2000. Additionally, in 2000, there was an enrichment above ambient background within only the largest size fraction (>500 μm) of the intertidal inorganic sediment at Nethertown and Flimby (north of Sellafield). In comparison, the present study has demonstrated 14C enrichments above ambient background in most size fractions at sites up to 40 km north of Sellafield, confirming the hypothesis set out more than a decade ago.
The SUERC Radiocarbon Dating Laboratory has recently replaced its spreadsheet-based record keeping with a new database program, custom designed to help laboratory staff manage the high throughput of nearly 5000 cathodes in the past year. The system can accept data from a variety of sources in addition to manual entry; experimental results can be uploaded from spreadsheets, while integration with graphitization lines means that graphite yields are automatically recorded. The system is able to pass 14C results directly to OxCal v 4 for calibration, with the resulting plots incorporated into the dating certificates issued to submitters. There are also benefits to submitters, with electronic sample submission both eliminating transcription errors and speeding up the logging-in process, which keeps turnaround times down. For bone samples, data on collagen yields are now stored electronically and are more readily obtainable from the laboratory. The new SUERC Radiocarbon Dating Laboratory database will make a significant contribution to maintaining the high quality of results produced by the laboratory, aiding staff in tracking sample progress, and monitoring quality assurance (QA) samples going through the laboratory, eliminating transcription errors, and making communication easier between laboratory staff and sample submitters.
Purpose: The aim of this study was to compare associations between generic versus disease-specific functional health status assessments and patient and clinical characteristics for patients with severe congenital heart disease. Methods: This was a cross-sectional observational study involving 325 single ventricle patients, aged 10–18 years, after Fontan procedure. Enrolled patients underwent a medical history review, laboratory testing, and assessment of the functional health status by completion of the generic Child Report Child Health Questionnaire and the disease-specific Congenital Heart Adolescent and Teenage questionnaire. Correlated conceptually equivalent domains from both questionnaires were identified and their associations with patient and clinical variables were compared. Results: From the generic assessment, patients perceived marginally lower physical functioning (p = 0.05) but greater freedom from bodily pain compared with a normal population (p < 0.001). The equivalent physical functioning/limitations domain of the generic instrument, compared with the disease-specific instrument, had similar associations (higher multi-variable model R2) with medical history variables (R2 = 0.14 versus R2 = 0.12, respectively) and stronger associations with exercise testing variables (R2 = 0.22 versus R2 = 0.06). Similarly, the corresponding freedom from bodily pain/symptoms domains from both questionnaires showed a greater association for the generic instrument with medical history variables (R2 = 0.15 versus R2 = 0.09, respectively) and non-cardiac conditions (R2 = 0.13 versus R2 = 0.06). The associations of each questionnaire with echocardiographic results, cardiac magnetic resonance imaging results, and serum brain natriuretic peptide levels were uniformly weak (R2 range <0.01 to 0.04). Conclusions: Assessment of the physical functional health status using generic and disease-specific instruments yields few differences with regard to associations between conceptually similar domains and patient and clinical characteristics for adolescents after Fontan procedure.