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This chapter is about the struggle over the future of work on the edge of the global economy. It traces the history of conflict in an industry that is not widely known, but sits at the epicenter of the global supply chain: short-haul trucking responsible for moving the mass of imports from enormous cargo ships to warehouses and retailers around the country. The chapter’s specific focus is on the nation’s largest and most important port complex – America’s port – which straddles the border of Los Angeles and Long Beach, California, and includes the ports in both cities. Here, for nearly two decades, labor and environmental groups – bound together in a pivotal “blue–green” alliance – carried forward a monumental campaign to transform working conditions for drivers and environmental conditions for communities.
In this work we consider a new class of oscillatory instabilities that pertain to thermocapillary destabilization of a liquid film heated by a solid substrate. We assume the substrate thickness and substrate–film thermal conductivity ratio are large so that the effect of substrate thermal diffusion is retained at leading order in the long-wave approximation. As a result, the system dynamics is described by a nonlinear partial differential equation for the film thickness that is non-locally coupled to the full substrate heat equation. Perturbing about a steady quiescent state, we find that its stability is described by a non-self-adjoint eigenvalue problem. We show that, under appropriate model parameters, the linearized eigenvalue problem admits complex eigenvalues that physically correspond to oscillatory (in time) instabilities of the thin-film height. As the principal results of our work, we provide a complete picture of the susceptibility to oscillatory instabilities for different model parameters. Using this description, we conclude that oscillatory instabilities are more relevant experimentally for films heated by insulating substrates. Furthermore, we show that oscillatory instability where the fastest-growing (most unstable) wavenumber is complex, arises only for systems with sufficiently large substrate thicknesses. Finally, we discuss adaptation of our model to a practical setting and make predictions of conditions at which the reported instabilities can be observed.
We compared the fluorescent gel removal rate using fewer high-touch surfaces (HTSs) and rooms and determined the optimum number of HTSs and rooms needed to ensure accuracy using 2,942 HTSs in 228 rooms on 13 units. Randomly selecting 3 HTS in 2 rooms predicted the optimal removal rate.
Re-planning mid-treatment, with the adjustment of target volumes, has been performed as part of the normal workflow at our institution. We sought to quantify the benefit of this approach and identify factors to optimise plan adaptive strategies.
Materials and methods:
Patients with locally advanced oropharyngeal cancer treated to 70 Gy with concurrent chemoradiation (CCRT) on TomoTherapy® who underwent re-planning during the treatment were eligible. Survival and prognostic factors were evaluated with Kaplan–Meier and Cox proportional hazards, two-side p-value <0·05 significant.
Forty-two patients were identified with Stage III (n = 5), IVA (n = 34) and IVB (n = 3) [AJCC 7th] disease. Median re-planning dose was 40 Gy (14–60 Gy). Median change in mean total parotid dose was reduction of 1 Gy (range –7·5 Gy to +13·9 Gy). The volume of PTV70 and PTV60 receiving 99% of the prescribed (V99) dose was increased by 2·2% (–3·3 to +16·6%) and 1·9% (–11·5 to +12·6%) by re-planning. As a continuous variable, increasing per cent nodal regression was associated with the improved disease control in a multivariate model including stage, pack years smoking and human papilloma viral (HPV) status (HR: 0·85, 0·71–0·99, p = 0·05).
Adaptive planning generates a superior plan for the majority of patients, but there is modest overall parotid gland sparing.
In community settings, negative symptoms and cognitive deficits are the primary barriers to independent living, stable relationships, and employment for individuals suffering from schizophrenia-spectrum disorders. In contrast, however, positive psychotic symptoms (e.g., command hallucinations and persecutory delusions) often drive behavior which serves as the gateway to arrest and criminalization. Historically, the keystone of treatment for positive psychotic symptoms has been antagonism of dopamine D2 receptors in the mesolimbic tract. In this article, we review and explore the principles underlying dopamine antagonism for the treatment of psychosis; optimization of dopamine antagonists in treating positive psychotic symptoms; the advantages of depot dopamine antagonist antipsychotics in forensic settings; the concepts of pharmacokinetic and pharmacodynamic treatment failures; and the role of medication plasma concentrations in optimizing and managing treatment.
This study tested whether the association between interparental conflict and adolescent externalizing symptoms was moderated by a polygenic composite indexing low dopamine activity (i.e., 7-repeat allele of DRD4; Val alleles of COMT; 10-repeat variants of DAT1) in a sample of seventh-grade adolescents (Mean age = 13.0 years) and their parents. Using a longitudinal, autoregressive design, observational assessments of interparental conflict at Wave 1 predicted increases in a multi-informant measurement of youth externalizing symptoms 2 years later at Wave 3 only for children who were high on the hypodopaminergic composite. Moderation was expressed in a “for better” or “for worse” form hypothesized by differential susceptibility theory. Thus, children high on the dopaminergic composite experienced more externalizing problems than their peers when faced with more destructive conflicts but also fewer externalizing problems when exposed to more constructive interparental conflicts. Mediated moderation findings indicated that adolescent reports of their emotional insecurity in the interparental relationship partially explained the greater genetic susceptibility experienced by these children. More specifically, the dopamine composite moderated the association between Wave 1 interparental conflict and emotional insecurity 1 year later at Wave 2 in the same “for better” or “for worse” pattern as externalizing symptoms. Adolescent insecurity at Wave 2, in turn, predicted their greater externalizing symptoms 1 year later at Wave 3. Post hoc analyses further revealed that the 7-repeat allele of the dopamine receptor D4 (DRD4) gene was the primary source of plasticity in the polygenic composite. Results are discussed as to how they advance process-oriented Gene x Environment models of emotion regulation.
Introduction: Patients with concussion often present to the emergency department (ED). Although sports and recreation (SR) activities account for less than half of all adult concussions, guidelines developed for management of SR-related concussions (SRC) are widely used for all concussion patients. This study aimed to identify whether there are clinically relevant differences in patient and injury characteristics between SRC and those occurring outside of SR activities. Methods: Adults ( >17 years) presenting from April 2013 to April 2015 with a concussion to one of three EDs with Glasgow coma scale score ≥13 were recruited by on-site research assistants. Data on patient characteristics (i.e., age, sex, employment, lifestyle, relevant medical history), ED presentation (i.e., EMS arrival, hours since injury, CTAS, Glasgow Coma Scale score) and injury characteristics (i.e., activity leading to injury, loss of consciousness [LOC], signs and symptoms [scored using the Rivermead Post-Concussion Questionnaire], and health-related quality of life [from the 12-Item Short Form Health Survey [SF-12]) were collected from structured interviews and the ED chart. Dichotomous and categorical variables were compared using Fisher's exact test; continuous variables were compared using t-tests or Mann-Whitney tests, as appropriate. Results: In total, 248 patients were enrolled (47% male, median [IQR] age: 35 [23, 49]). Patients with SRC were younger (median: 23.5 years vs 35 years; p < 0.001), more likely to be a student (31% vs 8%; p > 0.001), and more likely to exercise regularly (89% vs 66%; p = 0.001). Patients with SRC were less likely to present during the daytime (66% vs. 77%; p = 0.022), less likely to have a history of mental health issues (18% vs 33%; p = 0.011) and had significantly higher median SF-12 physical components scores (55.5 [IQR: 51.4 to 57.8] vs. 53.5 [IQR: 45.5 to 56.7]; p = 0.025). All other characteristics were similar between the two groups. Conclusion: Although differences in demographics and lifestyle have been identified between patients sustaining a SRC and those concussed during other activities, injury characteristics, such as presentation acuity, proxies for severity, and signs and symptoms, were similar in both groups. Further analysis to assess whether the demographic and lifestyle differences affect clinical outcomes, such as time to symptom resolution, between these two groups is required to assess if sport-based treatment guidelines are appropriate for all patients.
Introduction: Patients with concussion often present to the emergency department (ED). Current guidelines recommend graded return to work and physical activity (i.e., sport, recreation and exercise activities); however, whether emergency physicians target this advice based on patient-reported activities is unknown. This study aimed to assess mismatches between physicians’ rest and return-to-activity advice and self-reported pre-injury work and physical activity of adult concussion patients. Methods: Adults (>17 years) presenting with a concussion from April 2013 to April 2015 to a study ED with Glasgow coma scale score ≥13 were recruited by on-site research assistants. Data on patient characteristics (i.e., age, sex, employment, and physical activity level) and activity leading to injury were collected from structured patient interviews. A structured questionnaire collected data from the treating physician about discharge advice provided. “Working” was defined as employed or enrolled in any level of school at the time of injury. “Physically active” was defined by reporting regular exercise (≥2 times a week) or concussed during a sports-related activity. Proportions or medians (interquartile range [IQR]) are reported, as appropriate. Results: Physician questionnaires were completed for 198/248 enrolled patients (median age: 37 years [IQR: 23, 49]; 46% male). Overall, 89% (177/198) were working; 110/177 (62%) received return-to-work advice, while 10/21 (48%) patients also received return-to-work advice, despite not working. Mentally strenuous work/school duties were reported by 143 patients, of which 85 (60%) were recommended cognitive rest. Overall, 148 patients were physically active and 115 (78%) of these were recommended physical rest while 124 (82%) were advised on safe return to physical activity. On the other hand, 35/50 (70%) patients who were not physically active received advice on safe return to physical activity. Sustaining a sports-related injury significantly increased the likelihood of safe return to physical activity advice among physically active patients (Fisher's exact p = 0.001). Conclusion: There is a mismatch between concussed patients’ pre-injury activities, and the rest and return-to-activity (i.e., work and physical activity) advice provided by emergency physicians. The possible effect of this mismatch on patient outcomes should be assessed in future research, as should strategies to improve emergency physician-patient communications around concussion management.
This study examined the interplay between a polygenic composite and cortisol activity as moderators of the mediational pathway among family adversity, youth negative emotional reactivity to family conflict, and their psychological problems. The longitudinal design contained three annual measurement occasions with 279 adolescents (Mean age = 13.0 years) and their parents. Latent difference score analyses indicated that observational ratings of adversity in interparental and parent–child interactions at Wave 1 predicted increases in a multimethod, multi-informant assessment of youth negative emotional reactivity to family conflict from Waves 1 to 2. Changes in youth negative emotional reactivity, in turn, predicted increases in a multi-informant (i.e., parents, adolescent, and teacher) assessment of psychological problems from Waves 1 to 3. Consistent with differential susceptibility theory, the association between family adversity and negative emotional reactivity was stronger for adolescents who carried more sensitivity alleles in a polygenic composite consisting of 5-HTTLPR, DRD4 VNTR, and BDNF polymorphisms. Analyses of adolescent cortisol in the period surrounding a family disagreement task at Wave 1 revealed that overall cortisol output, rather than cortisol reactivity, served as an endophenotype of the polygenic composite. Overall cortisol output was specifically associated with polygenic plasticity and moderated the association between family adversity and youth negative emotional reactivity in the same for better or for worse manner as the genetic composite. Finally, moderator-mediated-moderation analyses indicated that the moderating role of the polygenic plasticity composite was mediated by the moderating role of adolescent cortisol output in the association between family adversity and their emotional reactivity.
This paper presents new excavation data on the Chinchihuapi I (CH-I) locality within the Monte Verde site complex, located along Chinchihuapi Creek in the cool, temperate Valdivian rain forest of south-central Chile. The 2017 and 2018 archaeological excavations carried out in this open-air locality reveal further that CH-I is an intermittently occupied site dating from the Early Holocene (~10,000 cal yr BP) to the late Pleistocene (at least ~14,500 cal yr BP) and probably earlier. A new series of radiocarbon dates refines the chronology of human use of the site during this period. In this paper, we describe the archaeological and stratigraphic contexts of the recent excavations and analyze the recovered artifact assemblages. A fragmented Monte Verde II point type on an exotic quartz newly recovered from excavations at CH-I indicates that this biface design existed in at least two areas of the wider site complex ~14,500 cal yr BP. In addition, associated with the early Holocene component at CH-I are later Paijan-like points recovered with lithic tools and debris and other materials. We discuss the geographic distribution of diagnostic artifacts from the site and their probable relationship to other early sites in South America.
Registered nurses (RNs) and licensed practical nurses (LPNs) provide the skilled component of nursing care in Canadian residential long-term care facilities, yet we know little about this important workforce. We surveyed 309 RNs and 448 LPNs from 91 nursing homes across Western Canada and report descriptively on their demographics and work and health-related outcomes. LPNs were significantly younger than RNs, worked more hours, and had less nursing experience. LPNs also experienced significantly more dementia-related responsive behaviours from residents compared to RNs. Younger LPNs and RNs reported significantly worse burnout (emotional exhaustion) and poorer mental health compared to older age groups. Significant differences in demographics and work- and health-related outcomes were also found within the LPN and RN samples by province, region, and owner-operator model. These findings can be used to inform important policy decisions and workplace planning to improve quality of work life for nurses in residential long-term care facilities.
Irradiation effects that have been observed in the structures of a number of ceramic materials are reviewed. Results of X-ray diffraction studies indicate that, to a great extent, the magnitudes of the crystallographic changes depend upon the type of crystal structure. However, the nature of the atomic bonding and the type of radiation can be the predominant factor in radiation stability in some materials. Damage mechanisms that have been investigated include: (1) fast-neutron and high-energy garnma-ray effects, (2) transmutation effects in high-neutron crosssection materials, and (3) lire effects of the (n, α) reaction in various bolide-containing structures. Some crystallographic changes observed include lattice parameter changes and structure damage of various magnitudes, the appearance of a transmutat. on product structure, and changes from the crystalline to the amorphous state.
Many materials, both fissionable and non-fissionable, become very radioactive when subjected to nuclear radiations. This radioactivity results in a high background level in X-ray diffraction studies and becomes a limiting factor in an analysis of radiation damage. A description is given of special techniques that are used to minimize this background and produce optimum diffraction conditions. The radioactive intensity of irradiated X-ray specimens varies from levels that are only mildly troublesome to levels that are extremely hazardous to personnel. The diffraction methods employed at the various levels are explained. An example of the radioactive energy spectrum of a specimen is given to show the method of selecting the best operating conditions and techniques.
Excavations at the Pre-Pottery Neolithic B ritual site of Naḥal Roded 110 in the Southern Negev, Israel, have revealed evidence—unique to this region—for on-site flint knapping and abundant raptor remains.
Tricalcium phosphate (TCP) is a promising candidate in bone and dental tissue engineering applications. Though osteoconductive, its low osteoinductivity is a major concern. Trace elements addition at low concentrations are known for their impact on not only the osteoinductivity, but also physical and mechanical properties of TCP. Copper (Cu) is known for its role in vascularization and angiogenesis in biological systems. Here, we studied the effects of Cu addition on phase composition, porosity, microstructure and in vitro interaction with osteoblast (OB) cells. Our results showed that Cu stabilized the TCP structure, while no significant effect of microstructure and porosity was found. Cu at concentrations less than 1 wt.% did not have any cytotoxic effect while decreased proliferation of OBs were observed at 1 wt.% Cu doped TCP. Addition of Cu upregulated collagen type I and vascular endothelial growth factor expression in a dose dependent manner at early time-point. Furthermore, Cu reduced inflammatory gene expression by human osteoblasts. These findings show that addition of Cu to TCP may provide a therapeutic strategy that can be applied in bone tissue engineering applications.
The rise of social movements in US legal scholarship is a current response to an age-old problem in progressive legal thought: harnessing law for social change while maintaining a distinction between law and politics. This problem erupted in controversy around the civil rights–era concept of legal liberalism defined by activist courts and lawyers pursuing political reform through law. Contemporary legal scholars have responded by building on social science to develop a new concept—movement liberalism—that assigns leadership of transformative change to social movements to preserve conventional roles for courts and lawyers. Movement liberalism aims to achieve the lost promise of progressive reform, while avoiding critiques of legal activism that have divided scholars for a half-century. Yet rather than resolving the law-politics problem, movement liberalism reproduces long-standing debates, carrying forward critical visions of law that it seeks to transcend.