To send 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 sending content to .
To send content items to your Kindle, first ensure email@example.com
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 sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent 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.
Malnutrition is common in children with CHD and is likely to place them at an increased risk for adverse surgical outcomes. We sought to evaluate the impact of preoperative malnutrition on outcomes after paediatric cardiac surgery.
We conducted a retrospective analysis of patients from age 0 to 5 years undergoing cardiac surgery at Seattle Children’s Hospital from 2006 to 2015. We used regression modelling to examine the impact of malnutrition on surgical outcomes.
We found a non-linear relationship between low height-for-age and weight-for-age z-scores and mortality after surgery. In the range of z-score ⩽−2, each additional unit decrease in height-for-age or weight-for-age z-score was associated with a 2.9 or 2.1% increased risk for mortality, respectively. Each unit decrease in height-for-age z-score was associated with a 1.2% increased risk for cardiac arrest, 1.1% increased risk for infection, and an average of 1.7 additional hours of mechanical ventilation, 6 hours longer ICU stay, and 13 hours longer hospital stay. Each unit decrease in weight-for-age z-score was associated with a 0.7% increased risk for cardiac arrest, 0.8% increased risk for infection, and an average of 1.9 additional hours of mechanical ventilation and 5.3 additional hours of ICU stay.
This study is unique in demonstrating a significant association between malnutrition and 30-day mortality and other adverse outcomes after paediatric cardiac surgery in a mixed population of CHD patients. By evaluating nutritional status as a continuous variable, we were able to clearly distinguish the point at which malnutrition begins to affect mortality.
Organisational culture of institutions providing care for older people is increasingly recognised as influential in the quality of care provided. There is little research, however, that specifically examines the processes of care home culture and how these may be associated with quality of care. In this paper we draw from an empirical study carried out in the United Kingdom (UK) investigating the relationship between care home culture and residents' experience of care. Eleven UK care homes were included in an in-depth comparative case study design using extensive observation and interviews. Our analysis indicates how organisational cultures of care homes impact on the quality of care residents receive. Seven inter-related cultural elements were of key importance to quality of care. Applying Schein's conceptualisation of organisational culture, we examine the dynamic relationship between these elements to show how organisational culture is locally produced and shifting. A particular organisational culture in a care home cannot be achieved simply by importing a set of organisational values or the ‘right’ leader or staff. Rather, it is necessary to find ways of resolving the everyday demands of practice in ways that are consistent with espoused values. It is through this everyday practice that assumptions continuously evolve, either consistent with or divergent from, espoused values. Implications for policy makers, providers and practitioners are discussed.
Some features of interest for divalent polymer electrolytes are described. Attention is focussed on two contrasting roles for cations: providing chemical cross-links within the polymer matrix and offering a source of mobile charge carriers. The possible merits of using mixtures of two types of cation, one type for each role, is discussed. Alternative mixed salt systems containing two anions with a common cation are considered. Another class of mixed polymer electrolyte systems involving two divalent cations in conjunction with two monovalent anions is also examined in the context of illustrating competitive anion-cation interactions within the polymer matrix by EXAFS local structure techniques. Results for the systems PE015:ZnI2/Mg(CIO4)2, PEO15:ZnI2/Mg(CF3SO3)2, PEO15:CaI2/ZnI2 and PEO15:CaI2/CaBr2 are discussed.
In 1958, only one year after his country gained independence from Britain, the Ghanaian prime minister, Kwame Nkrumah, delivered a speech before the Council on Foreign Relations in New York. In addition to a resolute anti-imperialism, he emphasized that two related imperatives would play a crucial role in shaping the orientation of Africa toward the wider world. First, the tremendous “industrial and military power concentrated behind the two great powers in the Cold War” demanded that the new states of Africa pursue a policy of non-alignment. In Africa, Nkrumah insisted, “the opportunities of health and education and a wider vision which other nations take for granted are barely within reach of our people.” To preserve their impoverished continent from devastating violence, African nations would have to remain apart from the Cold War’s military alliances, rivalries, and strife. Second, Africa would have to seek dramatically accelerated development. Colonial overlords had failed to deliver promised advances, but “now comes our response. We cannot tell our peoples that material benefits and growth and modern progress are not for them. If we do, they will throw us out and seek other leaders who promise more. And they will abandon us, too, if we do not in reasonable measure respond to their hopes. We have modernize.”
In 1979, Immanuel Wallerstein proclaimed the death of modernization theory. The concept of modernization, he argued, had finally been recognized as a “cul-de-sac,” an intellectual obstruction that had confined decades of social scientific inquiry. Drawing scholars away from questions about the essential nature, historical construction, and lasting power of a capitalist world system, it had only encouraged “comparative measurements of non-comparable and non-autonomous entities.” As social scientists invoked objectivity, employed structural-functional indices, and ordered nation-states in terms of relative “progress,” they ignored the power that structured global flows of resources. The concept had been, perhaps, a “worthy parable” for its time. By inventing “development” and the “Third World,” well-intentioned liberal social scientists had offered “new hope” that destitute peoples might emerge into twentieth-century light. If the “underdeveloped were clever enough to invent an indigenous version of Calvinism … or if transistors were placed in remote villages, or if farsighted elites mobilized benighted masses with the aid of altruistic outsiders,” then the “underdeveloped too would cross the river Jordan and come into a land flowing with milk and honey.” The time had come, however, to reject modernization, “to put away childish things, and look reality in its face.”
While perhaps the most striking, Wallerstein’s was not the only unflattering epitaph for modernization theory. Starting in the mid-1960s and continuing on through the 1970s, a broad range of scholars generated a massive literature criticizing the idea that all of the world’s nations followed the same essential trajectory of growth, a pattern most clearly identified in the history of Western accomplishment.
Production of embryos that are free of tough outer coats facilitates studies that are not possible with embryos surrounded by impenetrable envelopes. This report describes a new procedure for preventing formation of fertilisation membranes in the sea urchin (Lytechinus pictus) model. This procedure involves treating unfertilised eggs with the enzyme alpha-amylase, which cleaves alpha-1,4 glucosidic bonds in the vitelline layer. A major advantage of this method is that it is very well defined and completely controllable with alpha-amylase inhibitor. The results suggest that intact alpha-1,4 glucosidic bonds are essential for vitelline layer integrity required for formation of the fertilisation membrane. Eggs treated with alpha-amylase possessed the same surface lectin receptors as untreated eggs and, as shown by light and transmission electron microscopy, produced healthy, cleaving embryos that were free of fertilisation envelopes.
Email your librarian or administrator to recommend adding this to your organisation's collection.