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.
Capacity legislation in Ireland is evolving. The Assisted Decision-Making (Capacity) Act 2015 has been passed into law, but its main provisions are yet to be commenced. This paper compares the law and its practical implications currently and under the new legislation. Quick reference algorithms for frontline clinicians are proposed.
A growing number of studies have tested the association between intimate partner violence (IPV) and the unintendedness of pregnancy or birth, and most have suggested that unintendedness of pregnancy is a cause of IPV. However, about nine in every ten women face violence after delivering their first baby. This study examined the effects of the intendedness of births on physical IPV using data from the National Family Health Survey (2015–16). The multivariate logistic regression model analysis found that, compared with women with no unwanted births (2.9%), physical IPV was higher among those women who had unwanted births (6.9%, p<0.001), followed by those who had mistimed births (4.4 %, p<0.001), even after adjusting for several women’s individual and socioeconomic characteristics. Thus, the reduction of women with mistimed and unwanted births could reduce physical IPV in India. The study highlights the unfinished agenda of family planning in the country and argues for the need to integrate family planning and Reproductive, Maternal and Child Health Care (RMNCH) services to yield multi-sectoral outcomes, including the elimination of IPV.
Prematurity impacts myocardial development and may determine long-term outcomes. The objective of this study was to test the hypothesis that preterm neonates develop right ventricle dysfunction and adaptive remodelling by 32 weeks post-menstrual age that persists through 1 year corrected age.
Materials and Methods:
A subset of 80 preterm infants (born <29 weeks) was selected retrospectively from a prospectively enrolled cohort and measures of right ventricle systolic function and morphology by two-dimensional echocardiography were assessed at 32 weeks post-menstrual age and at 1 year of corrected age. Comparisons were made to 50 term infants at 1 month and 1 year of age. Sub-analyses were performed in preterm-born infants with bronchopulmonary dysplasia and/or pulmonary hypertension.
In both term and preterm infants, right ventricle function and morphology increased over the first year (p < 0.01). The magnitudes of right ventricle function measures were lower in preterm-born infants at each time period (p < 0.01 for all) and right ventricle morphology indices were wider in all preterm infants by 1 year corrected age, irrespective of lung disease. Measures of a) right ventricle function were further decreased and b) morphology increased through 1 year in preterm infants with bronchopulmonary dysplasia and/or pulmonary hypertension (p < 0.01).
Preterm infants exhibit abnormal right ventricle performance with remodelling at 32 weeks post-menstrual age that persists through 1 year corrected age, suggesting a less developed intrinsic myocardial function response following preterm birth. The development of bronchopulmonary dysplasia and pulmonary hypertension leave a further negative impact on right ventricle mechanics over the first year of age.
An ancient yoga technique called sutra neti, which is extensively used in India to keep the sinuses healthy, led to complete velopharyngeal stenosis in a 67-year-old male patient who presented with bilateral nasal obstruction, mouth breathing, anosmia and a change in voice.
The patient was diagnosed by nasal endoscopy using a zero-degree Hopkins rod endoscope, and adhesions were released using coblation.
The patient had post-operative alleviation of symptoms and a patent velopharyngeal inlet on examination.
Vigorous sutra neti can lead to velopharyngeal stenosis. Release of the stenosis is then required to cure the nasal blockade.
This article studies the conditions that lead peripheral minorities to identify with the state, their ethnic group, or neighboring countries. We contribute to research on separatism and irredentism by examining how violence, psychological distance, and national status determine identification. The analysis uses data from a novel experiment that randomized videos of actual violence in a large, representative survey of the Kashmir Valley region in the Indian state of Jammu and Kashmir, an enduring site of separatist and irredentist conflict. We find that a strong regional identity is a counterweight to irredentism, but violent repression by the state can push members of the minority to identify with an irredentist neighbor. Violence increases perceived distance from the nation and reduces national identification. There is suggestive evidence that these effects are concentrated among individuals with attributes that otherwise predict higher levels of identification with the state. Information about integrative institutions and increased national status brought about by economic growth is insufficient to induce national identification in a context where psychological distance from the nation is large.
The partial coalescence dynamics of a compound drop in a liquid pool is numerically investigated. We study the effect of the ratio of the inner to outer radii
of the compound drop while maintaining a constant liquid volume in the outer shell of the compound droplet. It is observed that for small values of the radius ratio, the coalescence dynamics is similar to that of a ‘simple’ drop, but the partial coalescence is suppressed for large values of
. Increasing the value of
decreases the distance migrated by the inner bubble in the downward direction inside the pool. The location of the bubble after coalescence is found to play an important role in the pinch-off process of the satellite drop. The influence of the governing dimensionless parameters on the coalescence dynamics has also been investigated.
OBJECTIVES/SPECIFIC AIMS: While the role of antiphospholipid antibodies in activating endothelial cells has been extensively studied, the impact of these antibodies on the adhesive potential of leukocytes has received considerably less attention. Mac-1 is a heterodimeric beta-2 integrin primarily expressed by myeloid-lineage cells. In its activated state, Mac-1 mediates cell-cell interactions by engaging a variety of surface molecules, including the endothelium-expressed glycoprotein ICAM-1. Here, our goals were (1) to determine the extent to which APS neutrophils adhere to healthy, resting endothelial cells under physiologic flow conditions, and (2) to identify potential therapeutic targets by elucidating the molecules required for that adhesion. METHODS/STUDY POPULATION: Primary APS patients (meeting Sydney criteria) and non-autoimmune controls were matched for age and gender. Freshly isolated human umbilical vein endothelial cells (HUVECs) were utilized within five passages. Samples were introduced into a flow channel via a programmable syringe pump, and perfused across a resting HUVEC monolayer. After 15 minutes of perfusion, the chamber was flushed, and the remaining adherent cells were quantified. Flow cytometry was used to identify differentially-expressed molecules on the surface of APS neutrophils. Neutrophil extracellular trap (NET) release was assessed in static neutrophil-HUVEC cultures. RESULTS/ANTICIPATED RESULTS: Pre-treating control neutrophils with APS plasma resulted in increased adhesion as compared with control plasma (>2.5-fold for n = 12 plasma samples; p < 0.05). This was true under both venous conditions (low shear) and conditions representative of the microvasculature (pulsatile flow and higher shear). Control neutrophils treated with APS plasma demonstrated upregulation of CD64, CEACAM-1, beta-2 glycoprotein I, and activated Mac-1 on the neutrophil surface, as well as shedding of L-selectin. Upregulation of activated Mac-1 and shedding of L-selectin were also triggered by IgG purified from APS plasma. For these changes to be meaningful clinically, we reasoned that they should be present on neutrophils in the peripheral blood of APS patients. Indeed, perfusion of anticoagulated blood through the flow chamber resulted in increased adhesion of patient neutrophils as compared with controls (>5-fold for n = 18 patients; p < 0.05). Similarly, patient neutrophils demonstrated upregulation of CD64, CEACAM-1, beta-2 glycoprotein I, and activated Mac-1 on the neutrophil surface. A monoclonal antibody specific for activated Mac-1 reduced the adhesion of APS neutrophils to HUVECs in the flow-chamber assay (>2-fold reduction for n = 5 patients; p < 0.05). Importantly, the same monoclonal antibody reduced NET release in neutrophil-HUVEC co-cultures. DISCUSSION/SIGNIFICANCE OF IMPACT: APS neutrophils have an increased adhesive potential, which is dependent upon the activated form of Mac-1. This may lower the threshold for both neutrophil-endothelium engagement and NET release in patients, and thereby have implications for events such as venous thrombosis. Studies are underway to determine the extent to which Mac-1 is a viable therapeutic target in preclinical models of APS.
The implementation of stable, accurate, and wideband second-order microwave integrators (SOMIs) is presented in this paper. These designs of SOMIs are obtained by using different combinations of transmission line sections and shunt stubs in cascading. Particle swarm optimization (PSO), cuckoo search algorithm (CSA), and gravitational search algorithm (GSA) are applied to obtain the optimal values of the characteristic impedances of these line elements to approximate the magnitude response of ideal second-order integrator (SOI). The performance measure criteria for the proposed SOMIs are carried out based on magnitude response, absolute magnitude error, phase response, convergence rate, pole-zero plot, and improvement graph. The simulation results and statistical analysis demonstrate that GSA surpasses the PSO and CSA to approximate the ideal SOI in all state-of-the-art, that is eligible for wide-band microwave integrator. The designed SOMI is compact in size and suitable to cover microwave applications. The magnitude errors for the proposed SOMIs GSA based are as low as 4.9954 and 3.6573, respectively. The structure of the designed SOMI is implemented in the form of microstrip line on RT/Duroid substrate with dielectric constant 2.2 and having height 0.762 mm. The simulated and measured magnitude result agrees well with the ideal one in the frequency range of 3–15 GHz.
Suicide is a major global health concern. Bhutanese refugees resettled in the USA are disproportionately affected by suicide, yet little research has been conducted to identify factors contributing to this vulnerability. This study aims to investigate the issue of suicide of Bhutanese refugee communities via an in-depth qualitative, social-ecological approach.
Focus groups were conducted with 83 Bhutanese refugees (adults and children), to explore the perceived causes, and risk and protective factors for suicide, at individual, family, community, and societal levels. Audio recordings were translated and transcribed, and inductive thematic analysis conducted.
Themes identified can be situated across all levels of the social-ecological model. Individual thoughts, feelings, and behaviors are only fully understood when considering past experiences, and stressors at other levels of an individual's social ecology. Shifting dynamics and conflict within the family are pervasive and challenging. Within the community, there is a high prevalence of suicide, yet major barriers to communicating with others about distress and suicidality. At the societal level, difficulties relating to acculturation, citizenship, employment and finances, language, and literacy are influential. Two themes cut across several levels of the ecosystem: loss; and isolation, exclusion, and loneliness.
This study extends on existing research and highlights the necessity for future intervention models of suicide to move beyond an individual focus, and consider factors at all levels of refugees’ social-ecology. Simply focusing treatment at the individual level is not sufficient. Researchers and practitioners should strive for community-driven, culturally relevant, socio-ecological approaches for prevention and treatment.
Epilepsy and mental illness have a bidirectional association. Psychiatrists are likely to encounter epilepsy as comorbidity. Seizures may present as mental illness. Equally, the management of psychiatric conditions has the potential to destabilise epilepsy. There is a need for structured epilepsy awareness and training amongst psychiatrists. This paper outlines key considerations around diagnosis, treatment and risk while suggesting practical recommendations.
OBJECTIVES/SPECIFIC AIMS: A course of oral broad-spectrum antibiotics frequently has a positive effect on morbidity and mortality in severe acute malnutrition (SAM), but the actual mechanism for this effect is unknown. This mechanism is especially important to find and quantify because of the possibility that using antibiotics prophylactically may accelerate the danger from antibiotic resistant infections. This study aims to answer (1) how antibiotic therapy improves the nutritional recovery and (2) how much it affects the prevalence of resistance genes in the microbiome. METHODS/STUDY POPULATION: Stool samples were collected from children with SAM between 6 and 60 weeks of age who received either one week of amoxicillin or placebo (n=164). The children were followed for 12 weeks with longitudinal sampling, and a subset were followed out to 2 years. All samples were frozen at −80°C and prepared for metagenome shotgun sequencing via the Illumina Nextera platform. RESULTS/ANTICIPATED RESULTS: Antibiotic treatment at the start of the nutritional program is associated with significant improvements in weight gain, mid-upper-arm circumference, and graduation from the treatment program. It is also associated with qualitative decreases in early-life fermenter Lactobacillus and known enteropathogen Campylobacter. Two years after the use of amoxicillin, the Shannon diversity index is significantly higher than that of malnourished children (effect size 0.507, 95% CI: 0.204–0.630, p=0.0007), while children who received placebo are not distinguishable from malnourished children by the same metric (effect size 0.147, 95% CI: −0.311, 0.630, p=0.5878). Sustained antibiotic resistance gene enrichment within the microbiota did not occur, as the enrichment effects disappears by week 4 of follow-up. DISCUSSION/SIGNIFICANCE OF IMPACT: The use of amoxicillin to treat uncomplicated SAM has therapeutic benefits visible by anthropometry and by content of the gut microbiota. The main concern with the use of prophylactic antibiotics for this purpose is the effect on antibiotic resistance gene enrichment in the children’s microbiota. This concern was not supported here. The benefit/cost ratio for the use of prophylactic antibiotics for individuals in this cohort is positive when weighing effects on anthropometry, microbiome, and antibiotic resistance. The results of this study impact the treatment of millions of children each year at nutritional therapy clinics around the world.
The basis of this paper is the elementary observation that the n-step descendant distribution of any Galton–Watson process satisfies a discrete Smoluchowski coagulation equation with multiple coalescence. Using this we obtain simple necessary and sufficient criteria for the convergence of scaling limits of critical Galton–Watson processes in terms of scaled family-size distributions and a natural notion of convergence of Lévy triples. Our results provide a clear and natural interpretation, and an alternate proof, of the fact that the Lévy jump measure of certain continuous-state branching processes (CSBPs) satisfies a generalized Smoluchowski equation. (This result was previously proved by Bertoin and Le Gall (2006).) Our analysis shows that the nonlinear scaling dynamics of CSBPs become linear and purely dilatational when expressed in terms of the Lévy triple associated with the branching mechanism. We prove a continuity theorem for CSBPs in terms of the associated Lévy triples, and use our scaling analysis to prove the existence of universal critical Galton–Watson processes and CSBPs analogous to Doeblin's `universal laws'. Namely, these universal processes generate all possible critical and subcritical CSBPs as subsequential scaling limits. Our convergence results rely on a natural topology for Lévy triples and a continuity theorem for Bernstein transforms (Laplace exponents) which we develop in a self-contained appendix.
In a period of anti-colonial political struggle and conservative reaction against liberal social reform in India, a band of Bengali men and women reached out to children through magazines with the intention of moulding them so that they would grow up to aid their nation's material progress and uphold a society bereft of colonial indignities and traditional injustices. Integral to this agenda was the attempt to explain the physical world scientifically to them, to make them knowledgeable, and to forge them into rational beings capable of looking at society critically. They wished the young to harbour a compassionate attitude towards nature, but they characterized the modern Western scientific way of knowing about the physical world as the only one worth imbibing, thereby infusing in children a bias against all who thought and lived otherwise. This science instruction was the endeavour of the avant-garde, an iconic hegemonic milieu that left its imprint in social reform and political struggle in colonial Bengali society for a long time.
The Bengali bhadralok have had an important impact on Indian nationalism in Bengal and in India more broadly. Their commitment to narratives of national progress has been noted. However, little attention has been given to how ‘earthly paradise’, ‘garden of delights’, and related ideas of refinement and nobility also informed their nationalism. This article excavates the idea of earthly paradise as it is portrayed in Satyajit Ray's 1958 Bengali film Jalsaghar, usually translated as The Music Room. Jalsaghar is typically taken to depict, broadly, the decadence and decline of aristocratic ‘feudal’ landowners (zamindars) who were granted their holdings and, often, noble rank, such as ‘Lord’ or ‘Raja’, during Mughal or British times, representing the languid past of the nobility, and the ascendance of a restless business-oriented class that represents an emerging present and possible future. The zamindars are shown as pursuing aesthetic and spiritual delight, ecstasy, and edification through soirées. These soirées are produced for those among the nobility who are sufficiently cultivated and cosmopolitan to appreciate the finer things in life, such as the classical music and dance showcased in this film. The businessmen, too, aspire to host such exceptional events, but are too crass to do so properly and, moreover, they are motivated by a desire to accrue prestige, thus using soirées as a means to an end, rather than to experience aesthetic and spiritual elevation as an end in itself. I argue that the film calls on the bhadralok to value aesthetic cultivation and to actively counter its evanescence. The film thus beckons and authorizes the bhadralok to sustain the value of the timeless past, including nobility and refinement. Yet the bhadralok are also expected to embody and expand a new, progressive, and utilitarian spirit that would modernize India. With the aristocrats gone, and the entrepreneurs eager to assume authority, the film charges the bhadralok to construct a nationalism in which the immortal, character-building values of classical art, for example, can yet be sutured to utilitarian progressivism. I argue that the film conveys this even though it does not explicitly portray or even mention the bhadralok, or feature uniquely Bengali music and art. Accordingly, this article does not focus on the actual aesthetic and political practices of bhadralok nationalism. The aim is to shed light on one genealogy through which the bhadralok sanctioned themselves as India's stewards along these lines.
In this paper, an experimental study is carried out while charging the sealed lead acid battery bank using a series-parallel (SP) compensated contactless power transfer (CPT) system. Constant current (CC) and constant voltage (CV) modes are used for charging the battery bank. An expression of optimum operating frequency is derived to maintain the maximum compensated coil efficiency throughout the load variation in charging process. An experimental setup of SP compensated CPT system is built for charging the battery bank. The variation of compensated coil efficiency and the load phase angle with respect to different operating frequencies in CC and CV modes is verified with the measurement. Based on the analysis, the control parameters are identified.