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.
What do states gain by sending citizens into the streets? Ruling by Other Means investigates this question through the lens of State-Mobilized Movements (SMMs), an umbrella concept that includes a range of (often covertly organized) collective actions intended to advance state interests. The SMMs research agenda departs significantly from that of classic social movement and contentious politics theory, focused on threats to the state from seemingly autonomous societal actors. Existing theories assume that the goal of popular protest is to voice societal grievances, represent oppressed groups, and challenge state authorities and other powerholders. The chapters in this volume show, however, that states themselves organize citizens (sometimes surreptitiously and even transnationally) to act collectively to advance state goals. Drawn from different historical periods and diverse geographical regions, these case studies expand and improve our understanding of social movements, civil society and state-society relations under authoritarian regimes.
Palliative care plays an essential role in enhancing the quality of life and quality of death for residents in long-term care homes (LTCHs). Access to palliative care specialists is one barrier to providing palliative care to LTCHs. This project focused on palliative telemedicine, specifically evaluating whether integration of early palliative care specialist consultation into an LTCH would be feasible through the implementation of videoconferencing during routine interdisciplinary care conferences.
This was a mixed-methods evaluation of a pilot program implementation over 6 months, to integrate early palliative care into an LTCH. There were two pilot communities with a total of 61 residents. Resident demographics were collected by a chart review, and palliative telemedicine feasibility was evaluated using staff and family member surveys.
For the 61 residents, the average age of the residents was 87 years, with 61% being female and 69% having dementia as the primary diagnosis. The mean CHESS (Change in Health, End-Stage Disease, Signs, and Symptoms) and ADL (Activities of Daily Living) scores were 0.8 and 4.0, respectively, with 54% having a Palliative Performance Scale score of 40. Seventeen clinical staff surveys on palliative teleconferences were completed with the majority rating their experience as high. Ten out of the 20 family members completed the palliative teleconference surveys, and the majority were generally satisfied with the experience and were willing to use it again. Clinical staff confidence in delivering palliative care through telemedicine significantly increased (P = 0.0021).
Significance of results
The results support the feasibility of videoconferencing as a means of palliative care provision. Despite technical issues, most clinical staff and families were satisfied with the videoconference and were willing to use it again. Early integration of palliative care specialist services into an LTCH through videoconferencing also led to improved self-rated confidence in the palliative approach to care by clinical staff.
Cricothyrotomy is an intervention performed to salvage “can't intubate, can't ventilate” situations. Studies have shown poor accuracy with landmarking the cricothyroid membrane, particularly in female patients by surgeons and anesthesiologists. This study examines the perceived versus actual success rate of landmarking the cricothyroid membrane by resident and staff emergency physicians using obese and non-obese models.
Five male and female volunteers were models. Each model was placed supine, and a point-of-care ultrasound expert landmarked the borders of each cricothyroid membrane; 20 residents and 15 staff emergency physicians were given one attempt to landmark five models. Overall accuracy and accuracy stratified by sex and obesity status were calculated.
Overall landmarking accuracy amongst all participants was 58% (SD 18%). A difference in accuracy was found for obese males (88%) versus obese females (40%) (difference = 48%, 95% CI = 30–65%, p < 0.0001), and non-obese males (77%) versus non-obese females (46%) (difference = 31%, 95% CI = 12–51%, p = 0.004). There was no association between perceived difficulty and success (correlation = 0.07, 95% CI = −0.081–0.214, p = 0.37). Confidence levels overall were higher amongst staff physicians (3.0) than residents (2.7) (difference = 0.3, 95% CI = 0.1–0.6, p = 0.02), but there was no correlation between confidence in an attempt and its success (p = 0.33).
We found that physicians demonstrate significantly lower accuracy when landmarking cricothyroid membranes of females. Emergency physicians were unable to predict their own accuracy while landmarking, which can potentially lead to increased failed attempts and a longer time to secure the airway. Improved training techniques may reduce failed attempts and improve the time to secure the airway.
We consider evidence for the assertion that backbench members of parliament (MPs) in the UK have become less distinctive from one another in terms of their speech. Noting that this claim has considerable normative and substantive implications, we review theory and findings in the area, which are ultimately ambiguous on this question. We then provide a new statistical model of distinctiveness that extends traditional efforts to statistically characterize the “style” of authors and apply it to a corpus of Hansard speeches from 1935 to 2018. In the aggregate, we find no evidence for the claim of more homogeneity. But this hides intriguing covariate effects: at the MP-level, panel regression results demonstrate that on average, more senior backbenchers tend to be less “different” in speech terms. We also show, however, that this pattern is changing: in recent times, it is more experienced MPs who speak most distinctively.
Integrating geophysical survey with the study of community settlement patterns can be challenging because of cultural and environmental factors including (1) site formation and house preservation, (2) the coordination of domestic tasks at extra-household scales, and (3) the survey environment of the study area. In this article, we present the results of a program of geophysical survey comprising magnetic susceptibility and magnetometry at Weeden Island (8Pi1)—a shell-bearing, wooded site with nearly pure sand soils on the Gulf Coast of Florida. Combining remote sensing techniques mitigated some of the challenges of surveying forested terrain while providing insight into community organization at a site with minimal preserved structural remains. Compared with previous traditional surveys of the area, the geophysical survey extended the recognized boundaries of occupational activity, provided additional definition to the spatial structure of deposits, and allowed us to identify specific domestic features. Excavations at each area of intensive occupation provided evidence about the organization of the domestic economy at the site and showed the potential of this approach to reveal significant patterns of community settlement.
By examining Booker T. Washington's (little studied) relationship with Mormon elites, this article introduces the category of “usefulness” to scholars who investigate how racially and religiously marginalized Americans have sought acceptance in the “white American republic.” Washington's 1913 visit to Utah was the high point in a decade-long public campaign of mutual admiration. Washington and the Mormons’ high regard for each other—an aberration in much of black-Mormon relations—was based on similar histories of discrimination at the hands of white Protestant Americans. It was also based on similar beliefs that to overcome their status as “problem” people, Washington-led blacks and Mormons had to prove their “usefulness”—a form of respectability politics—to themselves and to the American republic. To do so, they pointed to the fruits of their own and each other's usefulness: economic productivity, educational advancement, and middle-class mores. While these fruits were similar, the roots were different, and racialized. For the Mormons, usefulness arose from a post-polygamy Mormon religion through which they asserted their whiteness. For Washington, usefulness arose not from the “Negro” church—the only independent black institution in American history—but from educational institutions like Tuskegee, which promoted black advancement under the control of white supremacy.
In wall-bounded turbulent flows, the wall-normal gradient in turbulence intensity causes inertial particles to move preferentially toward the wall, leading to elevated concentration levels in the viscous sublayer. At first glance, wall-modelled large-eddy simulations may seem ill suited for accurately simulating this behaviour, given that the sharp gradients and coherent structures in the viscous sublayer and buffer region are unresolved in this approach. In this paper, a detailed inspection of conservation equations describing the influence of turbophoresis and near-wall structures on particle concentration profiles reveals a more nuanced view depending on the friction Stokes number. The dynamics of low and moderate Stokes number particles indeed depends strongly on the complex spatio-temporal details of streaks, ejections, and sweeps in the near-wall region. This significantly impacts the near-wall particle concentration through a biased sampling effect which provides a net force away from the wall on the particle ensemble caused by the tendency of inertial particles to accumulate in low-speed ejection regions. At higher Stokes numbers, however, this biased sampling is of minimal importance, and the particle concentration becomes inversely proportional to the wall-normal particle velocity variance at a given distance from the wall. As a result, wall-modelled large-eddy simulations can predict concentration profiles with more accuracy in the high Stokes number regime than low Stokes numbers simply by modifying the interpolation scheme for particles between the first grid point and the boundary. However, accurate representation of low and moderate Stokes number particles depends critically on information not present in standard wall-modelled large-eddy simulations.
The Royal College of Psychiatrists’ Parliamentary Scholar Scheme gives higher trainees in psychiatry the opportunity to spend 1 day a week in the House of Lords working alongside a peer with an interest in health. This article describes the work of the House of Lords and Parliament using examples from the experiences of 2017–2018 scholars and outlines ways doctors can get more involved in policy and politics.
There is discontent and turnover among faculty at US academic health centers because of the challenges in balancing clinical, research, teaching, and work–life responsibilities in the current healthcare environment. One potential strategy to improve faculty satisfaction and limit turnover is through faculty mentoring programs.
A Mentor Leadership Council was formed to design and implement an institution-wide faculty mentoring program across all colleges at an academic health center. The authors conducted an experimental study of the impact of the mentoring program using pre-intervention (2011) and 6-year (2017) post-intervention faculty surveys that measured the long-term effectiveness of the program.
The percent of faculty who responded to the surveys was 45.9% (656/1428) in 2011 and 40.2% (706/1756) in 2017. For faculty below the rank of full professor, percent of faculty with a mentor (45.3% vs. 67.1%, P < 0.001), familiarity with promotion criteria (81.7% vs. 90.0%, P = 0.001), and satisfaction with department’s support of career (75.6% vs. 84.7%, P = 0.002) improved. The percent of full professors serving as mentors also increased from 50.3% in 2011 to 68.0% in 2017 (P = 0.002). However, the percent of non-retiring faculty considering leaving the institution over the next 2 years increased from 18.8% in 2011 to 24.3% in 2017 (P = 0.02).
Implementation of an institution-wide faculty mentoring program significantly improved metrics of career development and faculty satisfaction but was not associated with a reduction in the percent of faculty considering leaving the institution. This suggests the need for additional efforts to identify and limit factors driving faculty turnover.
The mission of the National Center for Advancing Translational Science (NCATS) is to catalyze the generation of innovative methods and technologies that will enhance the development, testing, and implementation of diagnostics and therapeutics across a wide range of human diseases and conditions.1 NCATS funded a predoctoral TL1 training grant at our institution. We developed a novel team-based Translational Journal Club utilizing three-member teams to find a basic science paper and two clinical study papers that covered a single therapeutic, either a pivotal study or a dissemination and implementation study; one member of the team presented a paper on the above topics in successive weeks. In addition, the trainees attended lectures on: how to design a pivotal clinical trial, dissemination and implementation, and drug development from a basic science discovery through its approval. From these presentations, the trainees appreciated the T0 to T3/4 continuum and its challenges. They also attended sessions on how to present scientific concepts, making them better communicators. The trainees found the Translational Journal club to be very rewarding, illuminating, and providing a much better understanding of the translational research processes required to develop new therapies.
Reading is a highly complex task that relies on the integration of visual, orthographic, phonological and semantic information. This complexity is clearly reflected in current computational models of reading (Coltheart et al., 2001; Harm & Seidenberg, 1999, 2004; Perry, Ziegler, & Zorzi, 2007, 2010; Plaut et al., 1996). These models specify the “ingredients” of the reading process in a precise and detailed fashion as they implement the units and computations that are necessary to go from the visual information to word recognition and word production. Such models make it possible to simulate real reading performance in terms of reading latencies (how long it takes to compute the pronunciation of a word or pseudoword) and reading accuracy (whether the output of the model is correct). Computational models are particularly well suited to helping us understand reading impairments, such as developmental or acquired dyslexia.
A new fossil site in a previously unexplored part of western Madagascar (the Beanka Protected Area) has yielded remains of many recently extinct vertebrates, including giant lemurs (Babakotia radofilai, Palaeopropithecus kelyus, Pachylemur sp., and Archaeolemur edwardsi), carnivores (Cryptoprocta spelea), the aardvark-like Plesiorycteropus sp., and giant ground cuckoos (Coua). Many of these represent considerable range extensions. Extant species that were extirpated from the region (e.g., Prolemur simus) are also present. Calibrated radiocarbon ages for 10 bones from extinct primates span the last three millennia. The largely undisturbed taphonomy of bone deposits supports the interpretation that many specimens fell in from a rock ledge above the entrance. Some primates and other mammals may have been prey items of avian predators, but human predation is also evident. Strontium isotope ratios (87Sr/86Sr) suggest that fossils were local to the area. Pottery sherds and bones of extinct and extant vertebrates with cut and chop marks indicate human activity in previous centuries. Scarcity of charcoal and human artifacts suggests only occasional visitation to the site by humans. The fossil assemblage from this site is unusual in that, while it contains many sloth lemurs, it lacks ratites, hippopotami, and crocodiles typical of nearly all other Holocene subfossil sites on Madagascar.
After reviewing the use of isolation in US prisons and public restrooms to confine transgender people in solitary cells and single‐occupancy bathrooms, I propose an explanatory theory of eliminative space. I argue that prisons and toilets are eliminative spaces: that is, spaces of waste management that use layers of isolation to sanctify social or individual waste, at the outer and inner limits of society. As such, they function according to an eliminative logic. Eliminative logic, as I develop it, involves three distinct but interrelated mechanisms: 1) purification of the social center, through 2) iterative segregation, presuming and enforcing 3) the reduced relationality of marginal persons. By evaluating the historical development and contemporary function of prisons and restrooms, I demonstrate that both seek to protect the gender binary through waves of segregation by sex, race, disability, and gender identity. I further argue that both assume the thin relationality of, in this case, transgender people, who are conceived of as impervious to the effects of isolation and thus always already isolable. I conclude that, if we are to counter the violence of these isolation practices, we not only need to think holistically about eliminative spaces and logic, but also to richly reconceptualize relationality.
Childhood abuse is a risk factor for poorer illness course in bipolar disorder, but the reasons why are unclear. Trait-like features such as affective instability and impulsivity could be part of the explanation. We aimed to examine whether childhood abuse was associated with clinical features of bipolar disorder, and whether associations were mediated by affective instability or impulsivity.
We analysed data from 923 people with bipolar I disorder recruited by the Bipolar Disorder Research Network. Adjusted associations between childhood abuse, affective instability and impulsivity and eight clinical variables were analysed. A path analysis examined the direct and indirect links between childhood abuse and clinical features with affective instability and impulsivity as mediators.
Affective instability significantly mediated the association between childhood abuse and earlier age of onset [effect estimate (θ)/standard error (SE): 2.49], number of depressive (θ/SE: 2.08) and manic episodes/illness year (θ/SE: 1.32), anxiety disorders (θ/SE: 1.98) and rapid cycling (θ/SE: 2.25). Impulsivity significantly mediated the association between childhood abuse and manic episodes/illness year (θ/SE: 1.79), anxiety disorders (θ/SE: 1.59), rapid cycling (θ/SE: 1.809), suicidal behaviour (θ/SE: 2.12) and substance misuse (θ/SE: 3.09). Measures of path analysis fit indicated an excellent fit to the data.
Affective instability and impulsivity are likely part of the mechanism of why childhood abuse increases risk of poorer clinical course in bipolar disorder, with each showing some selectivity in pathways. They are potential novel targets for intervention to improve outcome in bipolar disorder.
With the more and more growing demand for semantic Web services over large databases, an efficient evaluation of Datalog queries is arousing a renewed interest among researchers and industry experts. In this scenario, to reduce memory consumption and possibly optimize execution times, the paper proposes novel techniques to determine an optimal indexing schema for the underlying database together with suitable body-orderings for the Datalog rules. The new approach is compared with the standard execution plans implemented in DLV over widely used ontological benchmarks. The results confirm that the memory usage can be significantly reduced without paying any cost in efficiency.