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Previous research has identified a lack of clarification regarding paramedic professional obligation to work. Understanding community expectations of paramedics will provide some clarity around this issue. The objective of this research was to explore the expectations of a sample of Australian community members regarding the professional obligation of paramedics to respond during pandemics.
The authors used qualitative methods to gather Australian community member perspectives immediately before the onset of the coronavirus disease 2019 (COVID-19) pandemic. Focus groups were used for data collection, and a thematic analysis was conducted.
The findings revealed 9 key themes: context of obligation (normal operations versus crisis situation), hierarchy of obligation (individual versus organizational obligation), risk acceptability, acceptable occupational risk (it’s part of the job), access to personal protective equipment, legal and ethical guidelines, education and training, safety, and acceptable limitations to obligation. The factors identified as being acceptable limitations to professional obligation are presented as further sub-themes: physical health, mental health, and competing personal obligations.
The issue of professional obligation must be addressed by ambulance services as a matter of urgency, especially in light of the COVID-19 coronavirus pandemic. Further research is recommended to understand how community member expectations evolve during and after the COVID-19 coronavirus pandemic.
Wind-driven snow redistribution can increase the spatial heterogeneity of snow accumulation on ice caps and ice sheets, and may prove crucial for the initiation and survival of glaciers in areas of marginal glaciation. We present a snowdrift model (Snow_Blow), which extends and improves the model of Purves, Mackaness and Sugden (1999, Journal of Quaternary Science 14, 313–321). The model calculates spatial variations in relative snow accumulation that result from variations in topography, using a digital elevation model (DEM) and wind direction as inputs. Improvements include snow redistribution using a flux routing algorithm, DEM resolution independence and the addition of a slope curvature component. This paper tests Snow_Blow in Antarctica (a modern environment) and reveals its potential for application in palaeoenvironmental settings, where input meteorological data are unavailable and difficult to estimate. Specifically, Snow_Blow is applied to the Ellsworth Mountains in West Antarctica where ablation is considered to be predominantly related to wind erosion processes. We find that Snow_Blow is able to replicate well the existing distribution of accumulating snow and snow erosion as recorded in and around Blue Ice Areas. Lastly, a variety of model parameters are tested, including depositional distance and erosion vs wind speed, to provide the most likely input parameters for palaeoenvironmental reconstructions.
Miner et al. (2018) do an excellent job of bringing the issue of gender disparity within STEM to the forefront of I-O psychology. However, we believe the focus on STEM is woefully inadequate and urge I-O psychologists to think bigger, better, and broader. There are clear problems with the way women are viewed and treated within the workforce, within the United States, and globally. In narrowing the discussion of the problem to target only STEM, we dramatically limit our understanding of and potential impact on the multifaceted and complex gender disparity problem in the world of work. Furthermore, we assert there are additional legitimizing myths that must be addressed in order to yield a more complete picture of the dilemma and allow us to move forward to make an impact.
The study objective was to determine the relative validity and reproducibility of a modified FFQ for ranking the nutrient intakes of New Zealand toddlers aged 12–24 months.
Dunedin, New Zealand.
One hundred and fifty-two participants completed a ninety-five-item FFQ twice, and five days of weighed diet recording (WDR), over one month. Validity and reproducibility were assessed for crude data and for data that were weighted for total fruit and vegetable intake (FV-adjusted).
De-attenuated correlations between FV-adjusted FFQ data and WDR data ranged from 0·45 (Zn) to 0·77 (Ca). The percentage classified to the correct WDR quartile by the FV-adjusted FFQ data ranged from 34·6 % (total fat, Zn) to 50·3 % (Fe). Average gross misclassification was 3 %. Bland–Altman statistics showed crude data had a range of 128–178 % agreement with the WDR and mean FV-adjusted intakes had 112–160 % agreement. FV-adjusted intra-class correlations, assessing reproducibility, ranged from 0·65 (vitamin C) to 0·75 (Ca).
The Eating Assessment in Toddlers (EAT) FFQ showed acceptable to good relative validity, and good reproducibility, for ranking participants’ nutrient intake and is able to identify toddlers at extremes of the nutrient intake distribution. It will be a useful tool for investigating toddlers’ nutrient intakes in studies that require a method of dietary assessment with low respondent burden.
The 2008 campaign marked the first time that a candidate's speech was set to music performed by popular musicians. Will.i.am, lead singer of the Black Eyed Peas, produced a YouTube music video of Barack Obama's “Yes We Can” speech. The “Yes We Can” video received more than 7 million views (January 2011), and Obama's words reached American youth in a way that had never been done. In short order, all of the candidates adopted the Internet as a platform for advertising, making 2008 the first YouTube presidential campaign. Candidates posted their television ads to YouTube as well as ads produced just for the new platform.
This is not the first time that candidates have adopted new technologies to reach voters. Historically, candidates have quickly embraced tools that expanded their access to voters – from Al Smith's first use of television to air an acceptance speech (1928), to Dwight Eisenhower's television ad campaign (1952), to Howard Dean's web-based credit card donation (2004). Now, YouTube, launched on February 14, 2005, has become one of the top three most-visited websites since at least 2008 (Alexa 2011). YouTube's popularity and its potential to reach voters were not lost on candidates.
Anne Mills, Professor of Health Economics and Policy London School of Hygiene & Tropical Medicine,
Sam Shillcutt, Research Fellow Health Economics and Financing Programme, London School of Hygiene and Tropical Medicine
The second half of the twentieth century saw enormous improvements in health across the whole world. Indeed, life expectancy in developing countries has increased faster than in the industrialized world, albeit from a lower baseline. People in many developing countries have life expectancies close to those in more advanced economies, but there is now a big gap between them and another group of countries, mainly in sub-Saharan Africa (SSA), where high mortality persists.
In 2002, there were 57 million deaths worldwide. Of these, 20% were children under five, and 98% of these childhood deaths occurred in developing countries. Communicable diseases represent seven out of the top 10 causes of child deaths in developing countries, and account for around 60% of all such deaths: more than 6 million deaths annually. A further problem in developing countries is premature mortality of adults (15–59), which represents 30% of all deaths, compared to only 20% in developed economies. As ever, it is the poorest in these countries who suffer disproportionately.
Non-smokers in the richest countries have a lower risk of dying throughout their life than other population categories. Deaths in excess of the rate in this category can be considered avoidable, and certain sectors of developing country societies, particularly infants and young women, are disproportionately affected. Around 90% of these avoidable deaths are caused by communicable diseases.
Objectives: The aim of this study was to assess the cost-effectiveness of a class-based exercise program supplementing a home-based program when compared with a home-based program alone. In addition, we estimated the probability that the supplementary class program is cost-effective over a range of values of a decision maker's willingness to pay for an additional quality-adjusted life-year (QALY).
Methods: The resource use and effectiveness data were collected as part of the clinical trial detailed elsewhere. Unit costs were estimated from published sources. The net benefit approach to cost-effectiveness analysis is used to estimate the probability of the intervention being cost-effective.
Results: The addition of a supplementary class-based group results in an increase in QALYs and lower costs. For all plausible values of a decision maker's willingness to pay for a QALY, the supplementary class group is likely to be cost-effective.
Conclusions: The addition of a class-based exercise program is likely to be cost-effective and, on current evidence, should be implemented.
Vesicomyid clam species are abundant in many deep-sea chemosynthetic communities, including cold seeps. They rely primarily on thiotrophic (sulphide-oxidizing) gill symbionts for nutrition and thus require sulphide-rich environments. Submersible surveys of megafaunal distributions at the Blake Ridge Diapir, a deep-sea methane-hydrate seep located ∼200 miles off the coast of Charleston, South Carolina, documented massive mortalities of vesicomyid clams. The cause of these mortalities is unknown, but sulphide deprivation, sulphide toxicity, and disease are possible agents of mortality in this system. Similar redox profiles in sediment cores from live and dead clam beds do not support the hypothesis that there has been a transient shift in the flux of sulphide. To address the potential for disease as a cause of mortality, we undertook a histological survey of microparasites and other indications of disease in clam tissues. Six morphological types of parasites were identified using light microscopy, including two viral-like inclusions, Rickettsia-like gill inclusions, possible bacterial gut inclusions, bacterial gill infections, and a protistan inclusion. Of these parasites, two were pathogenic: viral-like inclusions in mantle tissues caused tissue degradation; bacterial gill infections resulted in localized disruption and degradation of gill filaments. Infection prevalence and densities were low for all parasites observed. The majority of clams examined showed intense haemocytic responses in the absence of any obvious etiologic agent, suggesting the presence of parasites not detectable by our methods. Our findings indicate that the clam population at the Blake Ridge seep was in relatively good health at the time of sampling.
Despite the fact that ethics consultations are an accepted practice
in most healthcare organizations, many clinical ethicists continue to
feel marginalized by their institutions. They are often not paid for
their time, their programs often have no budget, and institutional
leaders are frequently unaware of their activities. One consequence has
been their search for concrete ways to evaluate their work in order to
prove the importance of their activities to their institutions through
demonstrating their efficiency and effectiveness.
Between the 1950s and the 1990s, the world saw enormous health improvements. However, developing countries have benefited unequally from health gains, with many, especially in sub-Saharan Africa (SSA), continuing to experience high mortality. Children bear a major burden of ill health, with infectious and parasitic diseases the main killers. Adults experience substantial premature mortality. Within countries, poorer groups have considerably worse health than the better off. Analysis of avoidable mortality highlights the importance of communicable disease, which represents around 90 percent of all avoidable mortality in almost all age—sex groups. The benefits of research mean that tools and approaches now exist to address the great majority of communicable disease, most notably malaria, TB and HIV/AIDS, as well as vaccine preventable diseases. However, large numbers of people do not have effective access to prevention and treatment, and die as a result.
The chapter focuses on three opportunities:
Strengthening basic health services.
This categorisation has been chosen largely because malaria and HIV/AIDS are major causes of disease burden and economic losses; cost-effective interventions are known to exist for their control; there is recent literature which can be drawn on to estimate costs and benefits; and these diseases are currently the focus of world attention.
Nb-silicide based in-situ composites consist of a ductile Nb-based solid solution with high-strength silicides, and they show excellent promise for aircraft engine applications. The Nb-silicide controls the high-temperature tensile behavior of the composite, and the Nb solid solution controls the low and intermediate temperature capability. The aim of the present study was to understand the effects of substitutional elements on the room temperature tensile behavior and identify the principal microstructural features contributing to strengthening mechanisms.
This essay examines the impact of the imposition of businesses techniques, in particular, those associated with Total Quality Management, on the relationships of important components of the health care delivery system, including payers, managed care organizations, institutional and individual providers, enrollees, and patients. It examines structural anomalies within the delivery system and concludes that the use of Total Quality Management techniques within the health care system cannot prevent the shift of attention of other components away from the enrollee and the patient, and may even contribute to it. It speculates that the organization ethics process may serve as a quality control mechanism to prevent this shift and so help eliminate some of the ethically problematic processes and outcomes within the health care delivery system.
The value of dendrochronology as a precise dating tool is well established (Ashmore, this volume) and this paper concentrates on other aspects of its value to Scottish archaeology and history. Timber in Scotland has been a resource under pressure for a long time, and consequently the history of timber trade and woodland exploitation is particularly interesting. Scotland now has very restricted semi-natural woodland, representing about 1% of land cover. While the extent of semi-natural woodland has undoubtedly shrunk in recent centuries, pollen evidence indicates that much of Scotland has been characterized by open landscapes since later prehistory (Tipping 1994).
Previously, the fabrication of air-gap structures for electrical interconnections was demonstrated using a sacrificial polymer encapsulated in conventional dielectric materials. The air-gaps were formed by thermally decomposing the sacrificial polymer and allowing the by-products to diffuse through the encapsulating dielectric. The diffusivity of the polymer decomposition products is adequate at elevated temperatures to allow the formation of air-gaps. This process was extended to form low dielectric constant, porous silica from commercially available methylsilsesquioxane (MSQ) by the addition of the sacrificial polymer to the MSQ. The porous MSQ film was thermally cured followed by decomposition of the NB at temperatures above 400°C. The dielectric constant of the MSQ was lowered from 2.7 to 2.3 by creating 70 nm pores in the MSQ. The voids created in the MSQ appeared to exhibit a closed-pore structure.
Sand quarrying in 1989 at Sand Fiold, Sandwick, in Orkney resulted in the accidental discovery of a rock-cut chamber containing a cist. Subsequent excavation revealed that this cist had a number of unusual features. The cist slabs had been fitted together exceptionally well and the completed cist was designed to be re-opened by the removal of a side slab. Within the chamber, access was provided to the opening side of the cist and a relieving structure was built over its capstone.
The cist contained cremation and inhumation burials that had been inserted on more than one occasion; as its builders intended. A collection of poorly preserved unburnt bone was found to comprise the remains of two individuals: a young adult and a foetus. Two collections of cremated bone, each derived from a single adult, were also present; one in a Food Vessel Urn, the second forming a pile on the floor and containing two burnt antler tines and two unburnt human teeth. The un-urned cremation deposit and the unburnt bones had been covered in mats of plant fibres derived from grass and sedge. The urn had been lined with basketry, also made from grass. Outside the cist, an exceptionally large collection of fuel ash slag (FAS), derived from a cremation pyre, had been deposited between the cist and the wall of the rock-cut chamber.
Radiocarbon dates indicate that the site and its contents had a long history. The FAS and the foetus skeleton date to 2900–2500 cal BC. Between 2200 and 1900 cal BC the urned cremation and young adult human bones were inserted and charcoal was deposited in the foundation slots for the back wall of the cist. The deposition of the un-urned cremation was dated to 1000–800 cal BC, some 900 years later, when the urn had already fallen over and broken. At this time, it is assumed that the urn was restored to an upright position and propped with stones, while the stone lid for the urn was reused in the foundation slot of the left-hand side of the cist. Reuse and refurbishment over two millennia seem evidenced in the results from this cist.