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Many patients with advanced serious illness or at the end of life experience delirium, a potentially reversible form of acute brain dysfunction, which may impair ability to participate in medical decision-making and to engage with their loved ones. Screening for delirium provides an opportunity to address modifiable causes. Unfortunately, delirium remains underrecognized. The main objective of this pilot was to validate the brief Confusion Assessment Method (bCAM), a two-minute delirium-screening tool, in a veteran palliative care sample.
This was a pilot prospective, observational study that included hospitalized patients evaluated by the palliative care service at a single Veterans’ Administration Medical Center. The bCAM was compared against the reference standard, the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. Both assessments were blinded and conducted within 30 minutes of each other.
We enrolled 36 patients who were a median of 67 years (interquartile range 63–73). The primary reasons for admission to the hospital were sepsis or severe infection (33%), severe cardiac disease (including heart failure, cardiogenic shock, and myocardial infarction) (17%), or gastrointestinal/liver disease (17%). The bCAM performed well against the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, for detecting delirium, with a sensitivity (95% confidence interval) of 0.80 (0.4, 0.96) and specificity of 0.87 (0.67, 0.96).
Significance of Results
Delirium was present in 27% of patients enrolled and never recognized by the palliative care service in routine clinical care. The bCAM provided good sensitivity and specificity in a pilot of palliative care patients, providing a method for nonpsychiatrically trained personnel to detect delirium.
This study explores how learning English among one subset of English learners, Asian female international students at US colleges, contributes to the larger project of advancing gender equality. Using their narratives, we ask why Asian female international students invest so much of their identities and effort into learning English. We discuss the ways in which their endeavours may even silently promote the development of English as a gender-neutral language. The population of Asian students offers a compelling case of how the English language is potentially transformed via its spread to this English learner population and how it presents new avenues for identity formation for the growing number of female English users worldwide (cf. Brutt-Griffler, 2010: 232).
The purpose of this study was to clarify the association between hand, foot, and mouth disease (HFMD) epidemics and meteorological conditions. We used HFMD surveillance data of all 47 prefectures in Japan from January 2000 to December 2015. Spectral analysis was performed using the maximum entropy method (MEM) for temperature-, relative humidity-, and total rainfall-dependent incidence data. Using MEM-estimated periods, long-term oscillatory trends were calculated using the least squares fitting (LSF) method. The temperature and relative humidity thresholds of HFMD data were estimated from the LSF curves. The average temperature data indicated a lower threshold at 12 °C and a higher threshold at 30 °C for risk of HFMD infection. Maximum and minimum temperature data indicated a lower threshold at 6 °C and a higher threshold at 35 °C, suggesting a need for HFMD control measures at temperatures between 6 and 35 °C. Based on our findings, we recommend the use of maximum and minimum temperatures rather than the average temperature, to estimate the temperature threshold of HFMD infections. The results obtained might aid in the prediction of epidemics and preparation for the effect of climatic changes on HFMD epidemiology.
In this paper, we consider diffeomorphisms on a closed manifold
preserving a hyperbolic Sinaĭ–Ruelle–Bowen probability measure
having intersections for almost every pair of stable and unstable manifolds. In this context, we show the ergodicity of
when the dimension of
is at most three. If
is smooth, then it is ergodic when the dimension of
is at most four. As a byproduct of our arguments, we obtain sufficient (topological) conditions which guarantee that there exists at most one hyperbolic ergodic Sinaĭ–Ruelle–Bowen probability measure. Even in higher dimensional cases, we show that every transitive topological Anosov diffeomorphism admits at most one hyperbolic Sinaĭ–Ruelle–Bowen probability measure.
Dengue fever (DF) and leptospirosis are serious public problems in tropical regions, especially in Manila, the Philippines. In attempting to understand the causes of DF and leptospirosis seasonality, meteorological factors have been suspected, but quantitative correlation between seasonality and meteorological factors has not been fully investigated. In this study, we investigated correlation of temporal patterns of reported numbers of laboratory-confirmed cases of both DF and leptospirosis with meteorological conditions (temperature, relative humidity, rainfall) in Manila. We used time-series analysis combined with spectral analysis and the least squares method. A 1-year cycle explained underlying variations of DF, leptospirosis and meteorological data. There was a peak of the 1-year cycle in temperature during May, followed by maxima in rainfall, relative humidity and number of laboratory-confirmed DF and leptospirosis cases. This result suggests that DF and leptospirosis epidemics are correlated not only with rainfall but also relative humidity and temperature in the Philippines. Quantifying the correlation of DF and leptospirosis infections with meteorological conditions may prove useful in predicting DF and leptospirosis epidemics, and health services should plan accordingly.
The red variables whose amplitude is larger than 1.3 mag in the MOA database are studied for the LMC. Among 3 196 such stars, 532 stars are likely to be Miras or red semiregular variables. The period–colour relation of these stars is shown.
More than 4000 stars observed in both MOA and DENIS projects showing periodic or quasi-periodic light curves are studied. Almost all Mira stars are located on the classical period-luminosity relation, and the multiplicity of the period-luminosity relation is confirmed for small-amplitude stars. The colour-magnitude diagrams based on the MOA red band, Rm, and Ks constructed for the sequences, form a single strip with small successive shifts.
A large database of CCD photometry for 1.4 million stars towards both the LMC and the SMC, which has been established by the MOA project, is a useful resource to study variable stars. In our preliminary study, variables identified as β Lyrae type stars and Herbig Ae/Be stars have been found amongst blue stars.
A review of the MOA (Microlensing Observations in Astrophysics) project is presented. MOA is a collaboration of approximately 30 astronomers from New Zealand and Japan established with the aim of finding and detecting microlensing events towards the Magellanic Clouds and the Galactic bulge, which may be indicative of either dark matter or of planetary companions. The observing program commenced in 1995, using very wide band blue and red filters and a nine-chip mosaic CCD camera.
As a by-product of these observations a large database of CCD photometry for 1.4 million stars towards both LMC and SMC has been established. In one preliminary analysis 576 bright variable stars were confirmed, nearly half of them being Cepheids. Another analysis has identified large numbers of blue variables, and 205 eclipsing binaries are included in this sample. In addition 351 red variables (AGB stars) have been found. Light curves have been obtained for all these stars. The observations are carried out on a 61-cm f/6.25 telescope at Mt John University Observatory where a new larger CCD camera was installed in 1998 July. From this latitude (44° S) the Magellanic Clouds can be monitored throughout the year.
We investigated the seasonality of age-specific tuberculosis (TB) in Japan. To allow the development of TB control strategies for different age groups we used a time-series analysis, including a spectral analysis and least squares method, to analyse the monthly age-specific numbers of newly registered cases of all forms of active TB in Japan from January 1998 to December 2013. The time-series data are reported in 10-year age groups: 0–9, 10–19, …, 70–79, and ⩾80 years. We defined the contribution ratio of the 1-year cycle, Q1, as the contribution of the amplitude of a 1-year cycle to the whole amplitude of the time-series data. The Q1 values in the age groups corresponding to adolescence and middle life (10–39 years) and old age (⩾70 years) were high. The peaks in the active TB epidemics for the ⩾70 years age group occurred in August and September, 1–2 months behind the peaks for the 10–39 years age group (June and July). An active TB epidemic might be attributable to travel by public transport and irregular employment in the 10–39 years age group and immune system suppression by low winter temperatures in the ⩾70 years age group.
Shear bond strength (SBS) and the interfacial adaptation (IA) of self-adhesive resin (SAR) composites to dentin were evaluated. Two SARs [Vertise Flow (VTF) and Fusio Liquid Dentin (FLD)] were evaluated and compared with a conventional restorative system [adhesive: OptiBond FL and composite: Herculite Précis (OBF/HP)]. Human third molars were used for SBS testing and IA imaging (n=7) using optical coherence tomography (OCT). Flattened dentin disks were prepared and the composites were applied into molds (2.4 mm diameter) that were positioned on dentin. Samples were subjected to SBS testing and OCT analysis, which considered an increase in signal intensity at the bonded interface as evidence of internal gaps. SBS data were analyzed by one-way analysis of variance and Tukey’s test and IA data (% distribution of high brightness values) by Kruskal–Wallis and Dunn’s test (p≤0.05). No statistically significant difference in SBS was observed between VTF (13.9±3.6 MPa) and FLD (11.3±3.2 MPa), whereas OBF/HP showed higher average strength (27.3±6.1 MPa). However, there was a statistically significant difference in IA when VTF (33.3%) was compared with FLD (1.2%) and OBF/HP (1.5%). The conventional restorative system exhibited superior SBS performance compared with SARs. However, the IA of FLD to dentin had values that were not significantly different from OBF/HP.
In this paper we consider diffeomorphisms preserving hyperbolic Sinaĭ–Ruelle–Bowen (SRB) probability measures
having intersections for almost every pair of the stable and unstable manifolds. In this context, when the dimension of the unstable manifold is constant almost everywhere, we show the ergodicity of
. As an application we obtain another proof of the ergodicity of a hyperbolic SRB measure for transitive surface diffeomorphisms, which is shown by Rodriguez Hertz, Rodriguez Hertz, Tahzibi and Ures [Uniqueness of SRB measures for transitive diffeomorphisms on surfaces. Comm. Math. Phys.306(1) (2011), 35–49].
Annual periodicities of reported chickenpox cases have been observed in several countries. Of these, Japan has reported a two-peaked, bimodal annual cycle of reported chickenpox cases. This study investigated the possible underlying association of the bimodal cycle observed in the surveillance data of reported chickenpox cases with the meteorological factors of temperature, relative humidity and rainfall. A time-series analysis consisting of the maximum entropy method spectral analysis and the least squares method was applied to the chickenpox data and meteorological data of 47 prefectures in Japan. In all of the power spectral densities for the 47 prefectures, the spectral lines were observed at the frequency positions corresponding to the 1-year and 6-month cycles. The optimum least squares fitting (LSF) curves calculated with the 1-year and 6-month cycles explained the underlying variation of the chickenpox data. The LSF curves reproduced the bimodal and unimodal cycles that were clearly observed in northern and southern Japan, respectively. The data suggest that the second peaks in the bimodal cycles in the reported chickenpox cases in Japan occurred at a temperature of approximately 8·5 °C.
The catastrophic Great East Japan Earthquake in 2011 created a crisis in a university-affiliated hospital by disrupting the water supply for 10 days. In response, this study was conducted to analyze water use and prioritize water consumption in each department of the hospital by applying a business impact analysis (BIA). Identifying the minimum amount of water necessary for continuing operations during a disaster was an additional goal.
Water is essential for many hospital operations and disaster-ready policies must be in place for the safety and continued care of patients.
A team of doctors, nurses, and office workers in the hospital devised a BIA questionnaire to examine all operations using water. The questionnaire included department name, operation name, suggested substitutes for water, and the estimated daily amount of water consumption. Operations were placed in one of three ranks (S, A, or B) depending on the impact on patients and the need for operational continuity. Recovery time objective (RTO), which is equivalent to the maximum tolerable period of disruption, was determined. Furthermore, the actual use of water and the efficiency of substitute methods, practiced during the water-disrupted periods, were verified in each operation.
There were 24 activities using water in eight departments, and the estimated water consumption in the hospital was 326 (SD = 17) m3 per day: 64 (SD = 3) m3 for S (20%), 167 (SD = 8) m3 for A (51%), and 95 (SD = 5) m3 for B operations (29%). During the disruption, the hospital had about 520 m3 of available water. When the RTO was set to four days, the amount of water available would have been 130 m3 per day. During the crisis, 81% of the substitute methods were used for the S and A operations.
This is the first study to identify and prioritize hospital operations necessary for the efficient continuation of medical treatment during suspension of the water supply by applying a BIA. Understanding the priority of operations and the minimum daily water requirement for each operation is important for a hospital in the event of an unexpected adverse situation, such as a major disaster.
Electrochemical ceramic cells such as solid-oxide fuel cells (SOFCs) are typically operated at 700–800°C in order to realize practical performances that, in turn, result in higher efficiencies compared to that of other types of electrochemical cells. High-temperature operation, on the other hand, leads to increased system cost and limits application. Thus, lowering the operating temperature is expected to solve such problems. This article shows the effectiveness of redesigning the cell structure for reduction of the operating temperature to 650°C or lower using conventional SOFC materials. A microtubular cell design is found to be one means of lowering the operating temperature of SOFCs. Such developments in fabrication technology are key to realizing high-performance cells with a thin electrolyte and controlled electrode microstructures.
Although intersectionality analysis originates in a critique of legal doctrine and its confining approach to subject formation, intersectionality has been adopted widely outside of legal scholarship—nationally and internationally—to explain how fields of power operate and interact to produce hierarchy for any limitless combination of identities. Yet, within law, some scholars have raised questions precisely about the capacity of intersectionality to grapple with subjects who occupy multiple social positions and those with “partially privileged” identities in particular. Thus, over roughly a decade, a critique took shape about the theoretical capacity and normative commitment of intersectionality theory to address particular subgroups.
This essay tells part of the curious story about how a race-sexuality critique of intersectionality emerged, what may have motivated it, and how it has facilitated an emerging progressive masculinities literature that is “post-intersectional,” i.e., positioned over and against intersectionality. Like other post-intersectionality approaches, multidimensionality theorists decidedly seek to ‘get beyond’ something, and that ‘something’ that underwrites the turn away from intersectionality appears not as substantive theoretical or analytical content, or as political strategy, but rather, as identity-driven and engendered.