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With up to 60 per cent of women experiencing both physical and emotional symptoms during the menopause, including hot flushes, mood swings and loss of libido, managing these symptoms can be a complex task. Managing the Menopause is a highly practical, evidence-based reference, covering all forms of management in detail. Providing guidance on prescribing, as well as the advantages and disadvantages of various products and therapies, particular emphasis is given to addressing concerns over the long-term complications of Menopausal Hormone Therapy (MHT) use. The book contains new chapters on nutrition, ovarian tissue cryopreservation and migraine in the menopause and previous chapters have been fully updated to inform readers of the latest research. Treatment plans are included in the text, helping clinicians to support their patients quickly and effectively. A comprehensive review of the menopause that is easily understood at all levels, this is an essential guide for clinicians.
Advance care planning and palliative care are gaining recognition as critical care components for adults with CHD, yet these often do not occur. Study objectives were to evaluate ACHD providers’ 1) comfort managing patients’ physical symptoms and psychosocial needs and 2) perspectives on the decision/timing of advance care planning initiation and palliative care referral.
Cross-sectional study of ACHD providers. Six hypothetical patients were described in case format, followed by questions regarding provider comfort managing symptoms, initiating advance care planning, and palliative care referral.
Fifty providers (72% physicians) completed surveys. Participants reported low levels of personal palliative care knowledge, without variation by gender, years in practice, or prior palliative care training. Providers appeared more comfortable managing physical symptoms and discussing prognosis than addressing psychosocial needs. Providers recognised advance directives as important, although the percentage who would initiate advance care planning ranged from 18 to 67% and referral to palliative care from 14 to 32%. Barriers and facilitators to discussing advance care planning with patients were identified. Over 20% indicated that advance care planning and end-of-life discussions are best initiated with the development of at least one life-threatening complication/hospitalisation.
Providers noted high value in advance directives yet were themselves less likely to initiate advance care planning or refer to palliative care. This raises the critical questions of when, how, and by whom discussion of these important matters should be initiated and how best to support ACHD providers in these endeavours.
Working memory is a system that allows for the maintenance of goal-relevant information in the face of concurrent processing and/or distraction. Working memory plays a role in many real-world cognitive tasks such as reading, reasoning, planning, and problem-solving. It consists of multiple components, including domain-general mechanisms associated with attention control and domain-specific processes associated with short-term storage. It is also a limited capacity system and working memory capacity is highly correlated with general fluid intelligence. This chapter provides a review of cognitive models of working memory, the measurement of working memory capacity, and evidence linking working memory capacity and intelligence. Several theoretical frameworks, such as executive attention theory and process overlap theory, are also discussed.
This study focuses on the mineralogical characterization of four raw clay samples from Dobrodo deposit, Serbia. Several analytical methods were applied to determine the chemical and mineralogical composition, morphology and physical properties (colour, plasticity, specific surface area, particle size and cation-exchange capacity) of the clay samples. Kaolinite, smectite and illite are the predominant phases in all of the samples studied that contain between 60.2 and 87.1 wt.% of clay. Quartz, feldspars, paragonite and Ti- and Fe-bearing phases were also identified. The relatively high SiO2/Al2O3 mass ratio indicates abundant quartz. The cation-exchange capacity of the samples varied between low and moderately charged clay minerals (12–52 mmol 100 g–1) with specific surface area values ranging from 94 to 410 m2 g–1. The plasticity index values (11–23%) suggest low to moderate plasticity. Preliminary results show that most of the raw clay from Dobrodo deposit might be suitable for use in ceramic applications.
The aim of the present study was to map the painting materials, degradation processes, and biological features present on the mural painting in the church of St. Mary in Beram (Croatia) to study their possible interaction and produce information helping the preservation of this valuable painting. The research was conducted on micro samples of painting materials taken from different sites along the painting and the characterization of the present fungal species was carried out. The painting samples, together with observable patinas and degradation products, were studied by optical microscopy (OM), scanning electron microscopy, energy-dispersive spectroscopy (SEM/EDS), Fourier-Transform Infrared spectroscopy, and powder X-ray diffraction. Fungal diversity was studied using cultivation methods followed by OM and SEM analyses in addition to molecular analysis. The results contribute to the characterization of the original painting materials, successively added materials and occurred interventions, to the understanding of degradation progressions and fungal biotransformation processes. A mineral, cumengite, a copper-based pigment extremely rarely used in art, was found. Its occurrence together with barium sulfate, gypsum, and calcium oxalate possibly produced by microbiological activity was studied and information was added regarding the composition of painting materials in St. Mary church mural cycle.
Subspecialisation is increasingly a fundamental part of the contemporary practice of medicine. However, little is known about how medical trainees learn in the modern era, and particularly in growing and relatively new subspecialties, such as adult CHD. The purpose of this study was to assess institutional-led and self-directed learning strategies of adult CHD fellows.
This international, cross-sectional online survey was conducted by the International Society for Adult Congenital Heart Disease and consisted primarily of categorical questions and Likert rating scales. All current or recent (i.e., those within 2 years of training) fellows who reported training in adult CHD (within adult/paediatric cardiology training or within subspecialty fellowships) were eligible.
A total of 75 fellows participated in the survey: mean age: 34 ± 5; 35 (47%) female. Most adult CHD subspecialty fellows considered case-based teaching (58%) as “very helpful”, while topic-based teaching was considered “helpful” (67%); p = 0.003 (favouring case-based). When facing a non-urgent clinical dilemma, fellows reported that they were more likely to search for information online (58%) than consult a faculty member (29%) or textbook (3%). Many (69%) fellows use their smartphones at least once daily to search for information during regular clinical work.
Fellows receiving adult CHD training reported a preference for case-based learning and frequent use of online material and smartphones. These findings may be incorporated into the design and enhancement of fellowships and development of online training resources.
The former rebel party Revolutionary United Front Party (RUFP) in Sierra Leone has struggled with a discredited wartime reputation and electoral defeats throughout the post-war period. In spite of this, the party has remained loyal to its wartime revolutionary ideas, symbols and political rhetoric. Why is this the case? In this article, I argue that the answer lies in the premises of party politics in war-torn states and new democracies on the African continent. In a political landscape where brokerage is power, retaining wartime identities can sometimes serve as a valuable source of (potential) patronage. With few other options for access to resources and opportunities, the core of the party membership has clung to its past as a means to both rally electoral support among the marginalized ex-combatant community and to get access to the long-awaited funds that were promised to them in the peace negotiations.
We propose a Boussinesq-type model to study the surface/interfacial wave manifestation of an underlying, slowly varying, long-wavelength baroclinic flow in a two-layer, density-stratified system. The results of our model show numerically that, under strong nonlinearity, surface waves, with their typical wavenumber being the resonant
, can be generated locally at the leading edge of the underlying, slowly varying, long-wavelength baroclinic flow. Here, the resonant
satisfies the class 3 triad resonance condition among two short-mode waves and one long-mode wave in which all waves propagate in the same direction. Moreover, when the slope of the baroclinic flow is sufficiently small, only one spatially localized large-amplitude surface wave packet can be generated at the leading edge. This localized surface wave packet becomes high in amplitude and large in group velocity after the interaction with its surrounding waves. These results are qualitatively consistent with various experimental observations including resonant surface waves at the leading edge of an internal wave. Subsequently, we propose a mechanism, referred to as the modulation-resonance mechanism, underlying these surface phenomena, based on our numerical simulations. The proposed modulation-resonance mechanism combines the linear modulation, ray-based, theory for the spatiotemporal asymmetric behaviour of surface waves and the nonlinear class 3 triad resonance theory for the energy focusing of surface waves around the resonant wavenumber
in Fourier space.
Letting ℳ denote the space of finite measures on ℕ, and μλ ∊ ℳ denote the Poisson distribution with parameter λ, the function W : [0, 1]2 → ℳ given by W(x, y) = μc log x log y is called the PAG graphon with density c. It is known that this is the limit, in the multigraph homomorphism sense, of the dense preferential attachment graph (PAG) model with edge density c. This graphon can then in turn be used to generate the so-called W-random graphs in a natural way, and similar constructions also work in the slightly more general context of the so-called PAGκ models. The aim of this paper is to compare these dense PAGκ models with the W-random graph models obtained from the corresponding graphons. Motivated by the multigraph limit theory, we investigate the expected jumble-norm distance of the two models in terms of the number of vertices n. We present a coupling for which the expectation can be bounded from above by O(log3/2n · n−1/2), and provide a universal lower bound that is coupling-independent, but without the logarithmic term.
How are we to understand what happens to Oedipus? What or who is the cause of the terrible deeds—predicted by oracles to both Laius and Oedipus—that he has already committed before the play begins and that are revealed in its course? The purpose of the present essay, whose title alludes to a well-known article by E.R. Dodds, is to draw attention to aspects of the play that have been ignored or explained away. To give them their due it will be necessary to take issue with two views of Dodds (one of which he owes to Wilamowitz) that I regard as mistaken. To argue against an article that is more than fifty years old might be thought a pointless exhumation, but Dodds's highly influential formulations, I will argue, have caused what Sophocles wrote to be either overlooked or misconstrued and are still causing misunderstanding in the second decade of the present century. It is time these views were examined critically.
Phosphate belongs to the major mineral nutrient category in plants and is a non-renewable resource. Many natural soils are phosphate deficient, and phosphate fixation into insoluble mineral complexes limits plant growth by decreasing root uptake. Different strategies have appeared during the evolution of land plants to cope with this situation, one of which is to interact with various microbes (bacteria and fungi) located in the plant rhizosphere. This chapter will focus on three major groups of fungi that colonise the roots of most land plants: arbuscular mycorrhizal fungi (Glomeromycotina), fungi from the order Sebacinales (Basidiomycota) and the diverse form-group of dark septate endophytes (Ascomycota). Three major mechanisms of fungal contribution to plant nutrition will be discussed. First, fungi are able to solubilise phosphate from inorganic sources that are not available to plants. Second, fungi can set free mineral nutrients from organic compounds/sources. Third, fungi are able to transport phosphate along their hyphae towards the plant, thereby bridging phosphate depletion zones around the roots. In this chapter, we summarise published knowledge on this topic and present some new non-published data to complete our current model.
Adults with congenital heart disease face psychological challenges although an understanding of depression vs. anxiety symptoms is unclear. We analyzed the prevalence of elevated symptoms of anxiety and depression and explored associations with demographic and medical factors as well as quality of life.
Adults with congenital heart disease enrolled from an outpatient clinic completed the Hospital Anxiety and Depression Scale and two measures of quality of life: the Linear Analogue Scale and the Satisfaction with Life Scale. Medical data were obtained by chart review.
Of 130 patients (median age = 32 years; 55% female), 55 (42%) had elevated anxiety symptoms and 16 (12%) had elevated depression symptoms on subscales of the Hospital Anxiety and Depression Scale. Most patients with elevated depression symptoms also had elevated anxiety symptoms (15/16; 94%). Of 56 patients with at least one elevated subscale, 37 (66%) were not receiving mental health treatment. Compared to patients with 0 or 1 elevated subscales, patients with elevations in both (n=15) were less likely to be studying or working (47% vs. 81%; p=0.016) and reported lower scores on the Linear Analogue Scale (60 vs. 81, p<0.001) and the Satisfaction with Life Scale (14 vs. 28, p<0.001).
Among adults with congenital heart disease, elevated anxiety symptoms are common and typically accompany elevated depressive symptoms. The combination is associated with unemployment and lower quality of life. Improved strategies to provide psychosocial care and support appropriate engagement in employment are required.