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In response to the COVID-19 pandemic, we rapidly implemented a plasma coordination center, within two months, to support transfusion for two outpatient randomized controlled trials. The center design was based on an investigational drug services model and a Food and Drug Administration-compliant database to manage blood product inventory and trial safety.
Methods:
A core investigational team adapted a cloud-based platform to randomize patient assignments and track inventory distribution of control plasma and high-titer COVID-19 convalescent plasma of different blood groups from 29 donor collection centers directly to blood banks serving 26 transfusion sites.
Results:
We performed 1,351 transfusions in 16 months. The transparency of the digital inventory at each site was critical to facilitate qualification, randomization, and overnight shipments of blood group-compatible plasma for transfusions into trial participants. While inventory challenges were heightened with COVID-19 convalescent plasma, the cloud-based system, and the flexible approach of the plasma coordination center staff across the blood bank network enabled decentralized procurement and distribution of investigational products to maintain inventory thresholds and overcome local supply chain restraints at the sites.
Conclusion:
The rapid creation of a plasma coordination center for outpatient transfusions is infrequent in the academic setting. Distributing more than 3,100 plasma units to blood banks charged with managing investigational inventory across the U.S. in a decentralized manner posed operational and regulatory challenges while providing opportunities for the plasma coordination center to contribute to research of global importance. This program can serve as a template in subsequent public health emergencies.
This article is a clinical guide which discusses the “state-of-the-art” usage of the classic monoamine oxidase inhibitor (MAOI) antidepressants (phenelzine, tranylcypromine, and isocarboxazid) in modern psychiatric practice. The guide is for all clinicians, including those who may not be experienced MAOI prescribers. It discusses indications, drug-drug interactions, side-effect management, and the safety of various augmentation strategies. There is a clear and broad consensus (more than 70 international expert endorsers), based on 6 decades of experience, for the recommendations herein exposited. They are based on empirical evidence and expert opinion—this guide is presented as a new specialist-consensus standard. The guide provides practical clinical advice, and is the basis for the rational use of these drugs, particularly because it improves and updates knowledge, and corrects the various misconceptions that have hitherto been prominent in the literature, partly due to insufficient knowledge of pharmacology. The guide suggests that MAOIs should always be considered in cases of treatment-resistant depression (including those melancholic in nature), and prior to electroconvulsive therapy—while taking into account of patient preference. In selected cases, they may be considered earlier in the treatment algorithm than has previously been customary, and should not be regarded as drugs of last resort; they may prove decisively effective when many other treatments have failed. The guide clarifies key points on the concomitant use of incorrectly proscribed drugs such as methylphenidate and some tricyclic antidepressants. It also illustrates the straightforward “bridging” methods that may be used to transition simply and safely from other antidepressants to MAOIs.
We apply two methods to estimate the 21-cm bispectrum from data taken within the Epoch of Reionisation (EoR) project of the Murchison Widefield Array (MWA). Using data acquired with the Phase II compact array allows a direct bispectrum estimate to be undertaken on the multiple redundantly spaced triangles of antenna tiles, as well as an estimate based on data gridded to the uv-plane. The direct and gridded bispectrum estimators are applied to 21 h of high-band (167–197 MHz; z = 6.2–7.5) data from the 2016 and 2017 observing seasons. Analytic predictions for the bispectrum bias and variance for point-source foregrounds are derived. We compare the output of these approaches, the foreground contribution to the signal, and future prospects for measuring the bispectra with redundant and non-redundant arrays. We find that some triangle configurations yield bispectrum estimates that are consistent with the expected noise level after 10 h, while equilateral configurations are strongly foreground-dominated. Careful choice of triangle configurations may be made to reduce foreground bias that hinders power spectrum estimators, and the 21-cm bispectrum may be accessible in less time than the 21-cm power spectrum for some wave modes, with detections in hundreds of hours.
The Protectorate is arguably the Cinderella of Interregnum studies: it lacks the immediate drama of the Regicide, the Republic or the Restoration, and is often dismissed as a 'retreat from revolution', a short period of conservative rule before the inevitable return of the Stuarts. The essays in this volume present new research that challenges this view. They argue instead that the Protectorate was dynamic and progressive, even if the policies put forward were not always successful, and often created further tensions within the government and between Whitehall and the localities. Particular topics include studies of Oliver Cromwell and his relationship with Parliament, and the awkward position inherited by his son, Richard; the role of art and architecture in creating a splendid protectoral court; and the important part played by the council, as a law-making body, as a political cockpit, and as part of a hierarchy of government covering not just England but also Ireland and Scotland. There are also investigations of the reactions to Cromwellian rule in Wales, in the towns and cities of the Severn/Avon basin, and in the local communities of England faced with a far-reaching programme of religious reform. PATRICK LITTLE is Senior Research Fellow at the History of Parliament Trust. Contributors: BARRY COWARD, DAVID L. SMITH, JASON PEACEY, PAUL HUNNEYBALL, BLAIR WORDEN, PETER GAUNT, LLOYD BOWEN, STEPHEN K. ROBERTS, CHRISTOPHER DURSTON.
Spring snow melt over the Beaufort and East Siberian seas is examined using visible-band DMSP imagery, SMMR brightness temperatures, and surface air temperatures for the years 1979, 1980 and 1984–86. Regional melt onset, as identified from the SMMR data, typically begins in early June, but can vary by up to two weeks between years. The subsequent pace of melt, estimated from the difference in days between the SMMR signal and visual identification of melt features in the DMSP data, exhibits a similar range. Interannual differences in snow melt are examined with respect to variations in cloud cover and geostrophic meridional winds. While over the Beaufort Sea, early melt onset and rapid melt progression may be favored by a combination of limited cloud cover and, as inferred from the wind data, strong northward air advection, no firm conclusions can be drawn from the available data. Presumably, potential relationships between melt and atmospheric forcings tend to be masked by additional factors, such as variations in initial snow depth and uncertainties in the data sets.
Data from a rawinsonde network are used to provide aerological estimates of monthly precipitation minus evaporation (P – E) averaged over the region north of 70° N. Using published climatological estimates of E, area-averaged P is obtained for each month and year as a residual. Using surface temperatures from the rawinsonde network, the fraction of precipitation falling as snow is then estimated. Over the 1974–91 study period, precipitation and snowfall (water equivalent) have annual means of 26.6 and 19.0 cm. respectively. Assuming a representative aged snowpack density of 330 kg m−3 yields a total snow depth of 57.5 cm. The mean annual cycles of both variables display an autumn maximum, but because of the temperature dependency, nearly all precipitation falls as rain during July and August. Composite analyses reveal that increased precipitation for all seasons and increased snowfall for winter and autumn are favored by a “winter-type” circulation pattern, characterized by stronger troughs over the Atlantic and Eurasian sectors of the Arctic, associated with increased cyclonic activity over the Arctic peripheral seas.
Benghal dayflower is an exotic weed species in the United States that is a challenge to manage in agricultural fields. Research was conducted in North Carolina, Georgia, and Florida to evaluate the longevity of buried Benghal dayflower seeds. Seeds were buried in the field for 2 to 60 mo at a depth of 20 cm in mesh bags containing soil native to each area. In North Carolina, decline of Benghal dayflower seed viability was described by a sigmoidal regression model, with seed size having no effect on viability. Seed viability at the initiation of the study was 81%. After burial, viability declined to 51% after 24 mo, 27% after 36 mo, and < 1% after 42 mo. In Georgia, initial seed viability averaged 86% and declined to 63 and 33% at 12 and 24 mo, respectively. Burial of 36 mo or longer reduced seed viability to < 2%. The relationship between Benghal dayflower seed viability and burial time was described by a sigmoidal regression model. In Florida, there was greater variability in Benghal dayflower seed viability than there was at the other locations. Seed viability at the first sampling date after 2 mo of burial was 63%. Although there were fluctuations during the first 24 mo, the regression model indicated approximately 60% of seed remained viable. After 34 mo of burial, seed viability was reduced to 46% and then rapidly fell to 7% at 39 mo, which was consistent with the decrease in seed viability at the other locations. Although there is a physical dormancy imposed by the seed coat of Benghal dayflower, which has been detected in previous studies, it appears that a decline in buried seed viability to minimal levels occurs within 39 to 48 mo in the southeastern United States, suggesting that management programs must prevent seed production for at least four growing seasons to severely reduce the Benghal dayflower soil seedbank.
Herbicide soil/solution distribution coefficients (Kd) are used in mathematical models to predict the movement of herbicides in soil and groundwater. Herbicides bind to various soil constituents to differing degrees. The universal soil colloid that binds most herbicides is organic matter (OM), however clay minerals (CM) and metallic hydrous oxides are more retentive for cationic, phosphoric, and arsenic acid compounds. Weakly basic herbicides bind to both organic and inorganic soil colloids. The soil organic carbon (OC) affinity coefficient (Koc) has become a common parameter for comparing herbicide binding in soil; however, because OM and OC determinations vary greatly between methods and laboratories, Koc values may vary greatly. This proposal discusses this issue and offers suggestions for obtaining the most accurate Kd, Freundlich constant (Kf), and Koc values for herbicides listed in the WSSA Herbicide Handbook and Supplement.
Because individuals develop dementia as a manifestation of neurodegenerative or neurovascular disorder, there is a need to develop reliable approaches to their identification. We are undertaking an observational study (Ontario Neurodegenerative Disease Research Initiative [ONDRI]) that includes genomics, neuroimaging, and assessments of cognition as well as language, speech, gait, retinal imaging, and eye tracking. Disorders studied include Alzheimer’s disease, amyotrophic lateral sclerosis, frontotemporal dementia, Parkinson’s disease, and vascular cognitive impairment. Data from ONDRI will be collected into the Brain-CODE database to facilitate correlative analysis. ONDRI will provide a repertoire of endophenotyped individuals that will be a unique, publicly available resource.
This article examines the relationship between shame and police court media trial reports. It explores the social and cultural mores that underpinned the construction of shaming practices in trial coverage and assesses the ways in which the media functioned as a judicial and extrajudicial shaming resource. Far from disappearing with changing sensibilities, as has been argued elsewhere, premodern religious and judicial shaming methods shifted into areas of modernity, being relayed, supported, and influenced by new forms of modern print culture. The media, this article contends, served as an extension of the disciplinary apparatus, with editors applying their own assumptions about the guilt of the accused regardless of judicial verdicts and in line with their own notion of “common-sense” lay justice. The use of shame, though, was discriminatory—mirroring, and even helping to define, middle-class notions of shameful behavior and masculine and feminine conduct—which would, crucially, expose the social and cultural confines of media censure.
Active surveillance to identify asymptomatic carriers of carbapenem-resistant Enterobacteriaceae (CRE) is a recommended strategy for CRE control in healthcare facilities. Active surveillance using stool specimens tested for Clostridium difficile is a relatively low-cost strategy to detect CRE carriers. Further evaluation of this and other risk factor-based active surveillance strategies is warranted.