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 firstname.lastname@example.org
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.
WHILE Edward's place among the more successful of England's medieval monarchs has remained secure since the above lines were penned in the aftermath of his death in 1307, his reputation among scholars of medieval England has to some extent waxed and waned. Bishop Stubbs, the leading English medieval historian of the late nineteenth century, had no doubt of Edward's greatness; and for the ‘Whig’ school of history, his reign represented the pinnacle of English constitutional achievement in the Middle Ages (a characterisation accurately skewered by Sellar and Yeatman's chapter on Edward, headed ‘A Strong King’). Edward's work, Stubbs argued:
was crowned with the success that patience, wisdom, and faith amply deserve, and his share in the result is that of the direction of national growth and adaptation of the means and design of government to the consolidation and conscious exercise of national strength. He saw what was best for his age and his people; he led the way and kept the faith.
Edward's reputation remained high in the early twentieth century, though Frederick Tout was less forgiving of the king's autocratic tendencies than was Stubbs.5 His standing reached its zenith, however, under the admiring gaze of Maurice Powicke, who had been taught by Tout in Manchester before working alongside him there in the 1920s, though it was during his time in Oxford that he began to write extensively on the thirteenth century. Both Henry III and the Lord Edward (1947) and The Thirteenth Century (1953) saw Powicke describe Edward in glowing terms:
He lived intensely in conformity with the ideas and tendencies of his time, and found independence in applying them with vigour and precision. He was autocratic not in opposition to them but in full accordance with them … considering how busy he was, how incessant were the calls on his judgement, and how much self-seeking and conflicts of interest lay beneath the discipline of daily routine in every form of the life about him, he was a very great king.
The American Academy of Pediatrics (AAP) calls for the inclusion of office-based pediatricians in disaster preparedness and response efforts. However, there is little research about disaster preparedness and response on the part of pediatric practices. This study describes the readiness of pediatric practices to respond to disaster and delineates factors associated with increased preparedness.
An AAP survey was distributed to members to assess the state of pediatric offices in readiness for disaster. Potential predictor variables used in chi-square analysis included community setting, primary employment setting, area of practice, and previous disaster experience.
Three-quarters (74%) of respondents reported some degree of disaster preparedness (measured by 6 indicators including written plans and maintaining stocks of supplies), and approximately half (54%) reported response experience (measured by 3 indicators, including volunteering to serve in disaster areas). Respondents who reported disaster preparation efforts were more likely to have signed up for disaster response efforts, and vice versa.
These results contribute information about the state of pediatric physician offices and can aid in developing strategies for augmenting the inclusion of office-based pediatricians in community preparedness and response efforts.
People with severe mental illness (SMI) have numerous risk factors that may predispose them to food insecurity (FI), however the prevalence of FI and its effects on health are under-researched in this population. This study aimed to describe the prevalence of FI and its relationship to lifestyle factors in with SMI. This cross-sectional study recruited people with SMI receiving long-acting injectable (LAI) antipsychotic medication from community services at three sites in Sydney, Australia. Assessments were completed on physical health and lifestyle factors. Chi square tests, independent samples t-tests and binary logistic regression analyses were calculated to examine relationships between lifestyle factors and FI. 233 people completed the assessments: 154 were male (66%), mean age 44.8 ± 12.7 years, and the majority (70%) had a diagnosis of schizophrenia. FI was present in 104 (45%). People with FI were less likely to consume fruit (OR = 0.42, 95% CI 0.24 to 0.74, p = 0.003), vegetables (OR = 0.39, 95% CI 0.22 to 0.69, p = 0.001) and protein-based foods (OR = 0.45, 95% CI 0.25 to 0.83, p = 0.011) at least once daily, engaged in less moderate to vigorous physical activity (minutes) (OR = 0.997 (95% CI 0.993 to 1.000), p = 0.044), and were more likely to smoke (OR = 1.89, 95% CI 1.08 to 3.32, p = 0.026). FI is highly prevalent among people with SMI receiving LAI antipsychotic medications. Food-insecure people with SMI engage in less healthy lifestyle behaviours, increasing the risk of future non-communicable disease.
Understanding the effects of crop management practices on weed survival and seed production is imperative in improving long-term weed management strategies, especially for herbicide-resistant weed populations. Kochia [Bassia scoparia (L.) A.J. Scott] is an economically important weed in western North American cropping systems for many reasons, including prolific seed production and evolved resistance to numerous herbicide sites of action. Field studies were conducted in 2014 in a total of four field sites in Wyoming, Montana, and Nebraska to quantify the impact of different crop canopies and herbicide applications on B. scoparia density and seed production. Crops used in this study were spring wheat (Triticum aestivum L.), dry bean (Phaseolus vulgaris L.), sugar beet (Beta vulgaris L.), and corn (Zea mays L.). Herbicide treatments included either ALS-inhibitors effective on non-resistant B. scoparia or a non-ALS-inhibiting herbicide effective for both ALS-resistant and susceptible B. scoparia. Bassia scoparia density mid-season was affected more by herbicide choice than by crop canopy, whereas B. scoparia seed production per plant was affected more by crop canopy compared with herbicide treatment. Our results suggest that crop canopy and herbicide treatments were both influential on B. scoparia seed production per unit area, which is likely a key indicator of long-term management success for this annual weed species. The lowest germinable seed production per unit area was observed in spring wheat treated with non-ALS-inhibiting herbicides, and the greatest germinable seed production was observed in sugarbeet treated with ALS-inhibiting herbicides. The combined effects of crop canopy and herbicide treatment can minimize B. scoparia establishment and seed production.
Short-term peripheral venous catheter–related bloodstream infection (PVCR-BSI) rates have not been systematically studied in resource-limited countries, and data on their incidence by number of device days are not available.
Prospective, surveillance study on PVCR-BSI conducted from September 1, 2013, to May 31, 2019, in 727 intensive care units (ICUs), by members of the International Nosocomial Infection Control Consortium (INICC), from 268 hospitals in 141 cities of 42 countries of Africa, the Americas, Eastern Mediterranean, Europe, South East Asia, and Western Pacific regions. For this research, we applied definition and criteria of the CDC NHSN, methodology of the INICC, and software named INICC Surveillance Online System.
We followed 149,609 ICU patients for 731,135 bed days and 743,508 short-term peripheral venous catheter (PVC) days. We identified 1,789 PVCR-BSIs for an overall rate of 2.41 per 1,000 PVC days. Mortality in patients with PVC but without PVCR-BSI was 6.67%, and mortality was 18% in patients with PVC and PVCR-BSI. The length of stay of patients with PVC but without PVCR-BSI was 4.83 days, and the length of stay was 9.85 days in patients with PVC and PVCR-BSI. Among these infections, the microorganism profile showed 58% gram-negative bacteria: Escherichia coli (16%), Klebsiella spp (11%), Pseudomonas aeruginosa (6%), Enterobacter spp (4%), and others (20%) including Serratia marcescens. Staphylococcus aureus were the predominant gram-positive bacteria (12%).
PVCR-BSI rates in INICC ICUs were much higher than rates published from industrialized countries. Infection prevention programs must be implemented to reduce the incidence of PVCR-BSIs in resource-limited countries.
To synthesise evidence of urban dietary behaviours (macronutrients, types of foods, dietary diversity and dietary practices) in two African countries in relation to postulated changes in the context of nutrition transition.
Systematic review and meta-analyses, including six online databases and grey literature, 1971–2018 (Protocol CRD42017067718).
Urban Ghana and Kenya.
Population-based studies of healthy adolescents and adults.
The forty-seven included studies encompassed 20 726 individuals plus 6526 households. Macronutrients were within WHO-recommended ranges: mean energy intake was 1867 kcal/d (95 % CI 1764, 1969) and the proportions of macronutrients were carbohydrate 61·2 % (58·4, 64·0), fat 25·3 % (22·8, 28·0) and protein 13·7 % (12·3, 15·1). The proportion of population consuming fruit and vegetables was 51·6 %; unhealthy foods, 29·4 %; and sugar-sweetened beverages (SSBs), 39·9 %. Two-thirds (68·8 %) consumed animal-source proteins. Dietary diversity scores were within the mid-range. Meal patterns were structured (typically three meals per day), with evidence lacking on snacking or eating out.
Population-level diets fell within WHO macronutrient recommendations, were relatively diverse with structured meal patterns, but some indications of nutrition transition were apparent. The proportion of population consuming fruit and vegetables was low compared to healthy-eating recommendations, and consumption of SSBs was widespread. A paucity of evidence from 1971 to 2010 precluded a longitudinal analysis of nutrition transition. Evidence from these two countries indicates which aspects of dietary behaviours may be contributing to increasing overweight/obesity, namely a low proportion of population consuming fruit and vegetables and widespread consumption of SSBs. These are potential targets for promoting healthier diets.
We study decision procedures for two knowledge problems critical to the verification of security protocols, namely the intruder deduction and the static equivalence problems. These problems can be related to particular forms of context matching and context unification. Both problems are defined with respect to an equational theory and are known to be decidable when the equational theory is given by a subterm convergent term rewrite system (TRS). In this work, we extend this to consider a subterm convergent TRS defined modulo an equational theory, like Commutativity. We present two pairs of solutions for these important problems. The first solves the deduction and static equivalence problems in rewrite systems modulo shallow theories such as Commutativity. The second provides a general procedure that solves the deduction and static equivalence problems in subterm convergent systems modulo syntactic permutative theories, provided a finite measure is ensured. Several examples of such theories are also given.
The national implementation of competency-based medical education (CBME) has prompted an increased interest in identifying and tracking clinical and educational outcomes for emergency medicine training programs. For the 2019 Canadian Association of Emergency Physicians (CAEP) Academic Symposium, we developed recommendations for measuring outcomes in emergency medicine training in the context of CBME to assist educational leaders and systems designers in program evaluation.
We conducted a three-phase study to generate educational and clinical outcomes for emergency medicine (EM) education in Canada. First, we elicited expert and community perspectives on the best educational and clinical outcomes through a structured consultation process using a targeted online survey. We then qualitatively analyzed these responses to generate a list of suggested outcomes. Last, we presented these outcomes to a diverse assembly of educators, trainees, and clinicians at the CAEP Academic Symposium for feedback and endorsement through a voting process.
Academic Symposium attendees endorsed the measurement and linkage of CBME educational and clinical outcomes. Twenty-five outcomes (15 educational, 10 clinical) were derived from the qualitative analysis of the survey results and the most important short- and long-term outcomes (both educational and clinical) were identified. These outcomes can be used to help measure the impact of CBME on the practice of Emergency Medicine in Canada to ensure that it meets both trainee and patient needs.
Beginning with loose aggregations of dust particles coated with heterogeneous ices under vacuum at Kuiper Belt temperatures, moving to Jupiter/Saturn distances and eventually to low-perihelion orbit, we consider the likely development of the gaseous phase within a cometary nucleus over the course of its lifetime. From the perspective of physical chemistry, we consider limits on the spatial and temporal distribution and composition of this gaseous phase. The implications of the gaseous phase for heat transfer and for the possible spatial and temporal development of liquid phases are calculated. We conclude that the likely temperatures, pressures, and compositions beneath the outer crust of typical cometary nuclei are such that fluidised phases can exist at significant depths and that these reservoirs give a coherent explanation for the high-intensity outbursts observed from cometary nuclei at large distances from perihelion.
The goals of this study were to (1) specify the factor structure of the Uniform Dataset 3.0 neuropsychological battery (UDS3NB) in cognitively unimpaired older adults, (2) establish measurement invariance for this model, and (3) create a normative calculator for factor scores.
Data from 2520 cognitively intact older adults were submitted to confirmatory factor analyses and invariance testing across sex, age, and education. Additionally, a subsample of this dataset was used to examine invariance over time using 1-year follow-up data (n = 1061). With the establishment of metric invariance of the UDS3NB measures, factor scores could be extracted uniformly for the entire normative sample. Finally, a calculator was created for deriving demographically adjusted factor scores.
A higher order model of cognition yielded the best fit to the data χ2(47) = 385.18, p < .001, comparative fit index = .962, Tucker-Lewis Index = .947, root mean square error of approximation = .054, and standardized root mean residual = .036. This model included a higher order general cognitive abilities factor, as well as lower order processing speed/executive, visual, attention, language, and memory factors. Age, sex, and education were significantly associated with factor score performance, evidencing a need for demographic correction when interpreting factor scores. A user-friendly Excel calculator was created to accomplish this goal and is available in the online supplementary materials.
The UDS3NB is best characterized by a higher order factor structure. Factor scores demonstrate at least metric invariance across time and demographic groups. Methods for calculating these factors scores are provided.