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Whether a mass casualty, earthquake or weather event at home, or a disaster abroad, proper preparation is essential for providing high-quality care. This concise guide brings together the views and knowledge of experienced responders to offer a much-needed review of the essential elements of anesthesia and intensive care for disasters and austere environments. Combining academic theory and practical advice, the book covers topics such as emergency and trauma surgery; airway management; chemical, biological and radiological exposure; personal protective equipment; and the psychological impact of working in the operating room in disaster situations. As successful care depends on the incident response team working collaboratively, the text also covers emergency communications, infrastructure preservation, and topics relevant to other medical specialists such as pain management and obstetrics. Featuring numerous high-quality illustrations, Essentials of Disaster Anesthesia is a vital, relevant resource for anesthetists, emergency physicians, nurses, and ancillary personnel.
The mechanism through which developmental programming of offspring overweight/obesity following in utero exposure to maternal overweight/obesity operates is unknown but may operate through biologic pathways involving offspring anthropometry at birth. Thus, we sought to examine to what extent the association between in utero exposure to maternal overweight/obesity and childhood overweight/obesity is mediated by birth anthropometry. Analyses were conducted on a retrospective cohort with data obtained from one hospital system. A natural effects model framework was used to estimate the natural direct effect and natural indirect effect of birth anthropometry (weight, length, head circumference, ponderal index, and small-for-gestational age [SGA] or large-for-gestational age [LGA]) for the association between pre-pregnancy maternal body mass index (BMI) category (overweight/obese vs normal weight) and offspring overweight/obesity in childhood. Models were adjusted for maternal and child socio-demographics. Three thousand nine hundred and fifty mother–child dyads were included in analyses (1467 [57.8%] of mothers and 913 [34.4%] of children were overweight/obese). Results suggest that a small percentage of the effect of maternal pre-pregnancy BMI overweight/obesity on offspring overweight/obesity operated through offspring anthropometry at birth (weight: 15.5%, length: 5.2%, head circumference: 8.5%, ponderal index: 2.2%, SGA: 2.9%, and LGA: 4.2%). There was a small increase in the percentage mediated when gestational diabetes or hypertensive disorders were added to the models. Our study suggests that some measures of birth anthropometry mediate the association between maternal pre-pregnancy overweight/obesity and offspring overweight/obesity in childhood and that the size of this mediated effect is small.
This is a cross-sectional study aiming to understand the early characteristics and background of bone health impairment in clinically well children with Fontan circulation.
We enrolled 10 clinically well children with Fontan palliation (operated >5 years before study entrance, Tanner stage ≤3, age 12.1 ± 1.77 years, 7 males) and 11 healthy controls (age 12.0 ± 1.45 years, 9 males) at two children’s hospitals. All patients underwent peripheral quantitative CT. For the Fontan group, we obtained clinical characteristics, NYHA class, cardiac index by MRI, dual x-ray absorptiometry, and biochemical studies. Linear regression was used to compare radius and tibia peripheral quantitative CT measures between Fontan patients and controls.
All Fontan patients were clinically well (NYHA class 1 or 2, cardiac index 4.85 ± 1.51 L/min/m2) and without significant comorbidities. Adjusted trabecular bone mineral density, cortical thickness, and bone strength index at the radius were significantly decreased in Fontan patients compared to controls with mean differences −30.13 mg/cm3 (p = 0.041), −0.31 mm (p = 0.043), and −6.65 mg2/mm4 (p = 0.036), respectively. No differences were found for tibial measures. In Fontan patients, the mean height-adjusted lumbar bone mineral density and total body less head z scores were −0.46 ± 1.1 and −0.63 ± 1.1, respectively, which are below the average, but within normal range for age and sex.
In a clinically well Fontan cohort, we found significant bone deficits by peripheral quantitative CT in the radius but not the tibia, suggesting non-weight-bearing bones may be more vulnerable to the unique haemodynamics of the Fontan circulation.
Following an outbreak of highly pathogenic avian influenza virus (HPAIV) in a poultry house, control measures are put in place to prevent further spread. An essential part of the control measures based on the European Commission Avian Influenza Directive 2005/94/EC is the cleansing and disinfection (C&D) of infected premises. Cleansing and disinfection includes both preliminary and secondary C&D, and the dismantling of complex equipment during secondary C&D is also required, which is costly to the owner and also delays the secondary cleansing process, hence increasing the risk for onward spread. In this study, a quantitative risk assessment is presented to assess the risk of re-infection (recrudescence) occurring in an enriched colony-caged layer poultry house on restocking with chickens after different C&D scenarios. The risk is expressed as the number of restocked poultry houses expected before recrudescence occurs. Three C&D scenarios were considered, namely (i) preliminary C&D alone, (ii) preliminary C&D plus secondary C&D without dismantling and (iii) preliminary C&D plus secondary C&D with dismantling. The source-pathway-receptor framework was used to construct the model, and parameterisation was based on the three C&D scenarios. Two key operational variables in the model are (i) the time between depopulation of infected birds and restocking with new birds (TbDR) and (ii) the proportion of infected material that bypasses C&D, enabling virus to survive the process. Probability distributions were used to describe these two parameters for which there was recognised variability between premises in TbDR or uncertainty due to lack of information in the fraction of bypass. The risk assessment estimates that the median (95% credible intervals) number of repopulated poultry houses before recrudescence are 1.2 × 104 (50 to 2.8 × 106), 1.9 × 105 (780 to 5.7 × 107) and 1.1 × 106 (4.2 × 103 to 2.9 × 108) under C&D scenarios (i), (ii) and (iii), respectively. Thus for HPAIV in caged layers, undertaking secondary C&D without dismantling reduces the risk by 16-fold compared to preliminary C&D alone. Dismantling has an additional, although smaller, impact, reducing the risk by a further 6-fold and thus around 90-fold compared to preliminary C&D alone. On the basis of the 95% credible intervals, the model demonstrates the importance of secondary C&D (with or without dismantling) over preliminary C&D alone. However, the extra protection afforded by dismantling may not be cost beneficial in the context of reduced risk of onward spread.
Historically, Parkinson's disease was viewed as a motor disorder and it is only in recent years that the spectrum of non-motor disorders associated with the condition has been fully recognised. There is a broad scope of neuropsychiatric manifestations, including depression, anxiety, apathy, psychosis and cognitive impairment. Patients are more predisposed to delirium, and Parkinson's disease treatments give rise to specific syndromes, including impulse control disorders, dopamine agonist withdrawal syndrome and dopamine dysregulation syndrome. This article gives a broad overview of the spectrum of these conditions, describes the association with severity of Parkinson's disease and the degree to which dopaminergic degeneration and/or treatment influence symptoms. We highlight useful assessment scales that inform diagnosis and current treatment strategies to ameliorate these troublesome symptoms, which frequently negatively affect quality of life.
Capitalist development has always, and everywhere, been characterized by the restless mobility of both capital and labour. While these two forms of mobility are fundamentally related, it is unusual to combine the study of both or seek connections between them. In an effort to make these connections more than three decades ago, Saskia Sassen commented that the two processes of capital and labour mobility ‘have been constructed into unrelated categories’ (1988: 12). This assessment still largely holds true. The objective of this book is to explore the links between these forms of mobility with a particular focus on Asia.
While the imperative to be mobile is well established as a systemic feature of capital, it is usually studied through frameworks that try to understand the behaviour of firms, conglomerates, production networks, or investors. An extensive body of literature addresses corporate structures and strategies of capital accumulation. For example, in the field of international business, attention has traditionally focused on the mobility of capital, primarily through foreign direct investment (FDI) (for example, Dunning, 1988). The underlying assumption is the immobility of labour. The multinational corporation, with its proprietary capital and know-how (ownership advantage) and governance within a hierarchical organization (internalization advantage), facilitates the mobility of capital in order to take advantage of location-bound factors of production (including labour). Other approaches have addressed the networks and supply chains in which firms are situated. There have been, for example, significant efforts at understanding the spatial structures of production through the lenses of global commodity chains and global production networks. These bodies of literature point out that significant levels of spatial flexibility and mobility in production capital have been created through non-ownership modes of control such as subcontracting (Gereffi and Korzeniewicz, 1994; Coe and Yeung, 2015). Complementing this work are studies that focus on corporate international expansion trajectories and governance structures to manage globally dispersed investments (for example, Cuervo-Cazurra and Ramamurti, 2014; Ramamurti and Singh, 2009). Labour seldom features centrally in such accounts, except as an in situ characteristic of a particular place, valued for its skills, affordability, or docility. At the human scale, it is usually the investor or manager who is assumed to be mobile, but mostly it is the spatial configuration of capital itself (through FDI, corporate structures, commodity trade, debt, and so on) that receives attention.
The phrase “anti-Jacobin novel,” like “Jacobin novel,” was created by and has circulated in academic discourse since the 1970s.1 The phrase barely appears in the print record of Wollstonecraft’s day, and other terms were used to locate such fiction within a larger terrain of novelistic practice. A rare instance of “anti-Jacobin novel” occurred in the April 1800 issue of a short-lived magazine edited by the anti-reform propagandist Robert Bisset, who published his own “anti-Jacobin” novel, Douglas, the same year. The magazine’s essay on “The History of Literature for the Year 1799” continued three recent related projects. It treated current literature largely as opposition between what it called “Jacobin” and “anti-Jacobin.” It summarized the principles of political-cultural-literary critique mounted by the Anti-Jacobin Magazine, to which Bisset was a contributor. And the essay corresponded to verse satires such as William Gifford’s Baviad (1791) and Maeviad (1795) and Thomas Mathias’ The Pursuits of Literature (1794, expanded). These aimed, with some justice, to associate political and other kinds of reformism with literary avant-gardism and political with artistic “innovation.” In Bisset’s Magazine, “anti-Jacobin novel” referred to George Walker’s The Vagabond in discussion of prose and verse “Works of fiction.” After treating Charlotte Smith’s and Mary Robinson’s novels as “Jacobin,” the essay turned to their “anti-Jacobin” opponents, including Henry James Pye’s The Democrat (1795), Charles Lloyd’s Edmund Oliver (1798), Isaac D’Israeli’s Vaurien (1797), The History of Sir George Warrington; or, The Political Quixote (1797), and Walker’s The Vagabond (1799), concluding, “As novels have, of late, been frequently employed to make men disloyal subjects and bad citizens, we rejoice to see that good talents are now employed in the same way, to make men loyal subjects and good citizens.”2
The DSM-5 introduced purging disorder (PD) as an other specified feeding or eating disorder characterized by recurrent purging in the absence of binge eating. The current study sought to describe the long-term outcome of PD and to examine predictors of outcome.
Women (N = 84) who met research criteria for PD completed a comprehensive battery of baseline interview and questionnaire assessments. At an average of 10.24 (3.81) years follow-up, available records indicated all women were living, and over 95% were successfully located (n = 80) while over two-thirds (n = 58) completed follow-up assessments. Eating disorder status, full recovery status, and level of eating pathology were examined as outcomes. Severity and comorbidity indicators were tested as predictors of outcome.
Although women experienced a clinically significant reduction in global eating pathology, 58% continued to meet criteria for a DSM-5 eating disorder at follow-up. Only 30% met established criteria for a full recovery. Women reported significant decreases in purging frequency, weight and shape concerns, and cognitive restraint, but did not report significant decreases in depressive and anxiety symptoms. Quality of life was impaired in the physical, psychological, and social domains. More severe weight and shape concerns at baseline predicted meeting criteria for an eating disorder at follow-up. Other baseline severity indicators and comorbidity did not predict the outcome.
Results highlight the severity and chronicity of PD as a clinically significant eating disorder. Future work should examine maintenance factors to better adapt treatments for PD.