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One of the risks of electronic power morcellation, central to the morcellation debate, is the concern of spread of malignant uterine tissue. Uterine cancer is the most common gynaecologic cancer in the United States with an estimated 49,560 cases and 8,190 deaths in 2013. Uterine sarcomas arise from the mesodermal tissues of the uterine body and account for 3% of all uterine cancers, and represent 3.3 cases per 100,000 women . Leiomyosarcoma (LMS) represents 40% of all uterine sarcomas, and 2% of all uterine malignancies, and the annual incidence has been estimated to be 0.64 per 100,000 women . It can present at any age, but most commonly between 45 and 55 years old, and its prevalence increases by 10% in patients over 60 years old.
This article provides an overview of selected ongoing international efforts that have been inspired by Edward Zigler's vision to improve programs and policies for young children and families in the United States. The efforts presented are in close alignment with three strategies articulated by Edward Zigler: (a) conduct research that will inform policy advocacy; (b) design, implement, and revise quality early childhood development (ECD) programs; and (c) invest in building the next generation of scholars and advocates in child development. The intergenerational legacy left by Edward Zigler has had an impact on young children not only in the United States, but also across the globe. More needs to be done. We need to work together with a full commitment to ensure the optimal development of each child.
To determine risk factors for mortality among COVID-19 patients admitted to a system of community hospitals in the United States.
Retrospective analysis of patient data collected from the routine care of COVID-19 patients.
System of >180 acute-care facilities in the United States.
All admitted patients with positive identification of COVID-19 and a documented discharge as of May 12, 2020.
Determination of demographic characteristics, vital signs at admission, patient comorbidities and recorded discharge disposition in this population to construct a logistic regression estimating the odds of mortality, particular for those patients characterized as not being critically ill at admission.
In total, 6,180 COVID-19+ patients were identified as of May 12, 2020. Most COVID-19+ patients (4,808, 77.8%) were admitted directly to a medical-surgical unit with no documented critical care or mechanical ventilation within 8 hours of admission. After adjusting for demographic characteristics, comorbidities, and vital signs at admission in this subgroup, the largest driver of the odds of mortality was patient age (OR, 1.07; 95% CI, 1.06–1.08; P < .001). Decreased oxygen saturation at admission was associated with increased odds of mortality (OR, 1.09; 95% CI, 1.06–1.12; P < .001) as was diabetes (OR, 1.57; 95% CI, 1.21–2.03; P < .001).
The identification of factors observable at admission that are associated with mortality in COVID-19 patients who are initially admitted to non-critical care units may help care providers, hospital epidemiologists, and hospital safety experts better plan for the care of these patients.
The coronavirus disease 2019 (COVID-19) has greatly impacted health-care systems worldwide, leading to an unprecedented rise in demand for health-care resources. In anticipation of an acute strain on established medical facilities in Dallas, Texas, federal officials worked in conjunction with local medical personnel to convert a convention center into a Federal Medical Station capable of caring for patients affected by COVID-19. A 200,000 square foot event space was designated as a direct patient care area, with surrounding spaces repurposed to house ancillary services. Given the highly transmissible nature of the novel coronavirus, the donning and doffing of personal protective equipment (PPE) was of particular importance for personnel staffing the facility. Furthermore, nationwide shortages in the availability of PPE necessitated the reuse of certain protective materials. This article seeks to delineate the procedures implemented regarding PPE in the setting of a COVID-19 disaster response shelter, including workspace flow, donning and doffing procedures, PPE conservation, and exposure event protocols.
Existing research has suggested children of caregivers with histories of exposure to trauma are at heightened risk for victimization, but few studies have explored potential mechanisms that explain this intergenerational transmission of risk. With data from peri-urban households in Lima, Peru (N = 402), this study analyzes parenting behaviors in the relation between caregivers’ trauma history and child victimization for children aged 4–17. Results indicated caregivers’ trauma history and negative parenting behaviors related to child victimization, and negative parenting behaviors mediated this relation. Positive parenting behaviors did not have significant direct effects and were not mediators of risk transmission. Parenting behaviors did not moderate the relation between caregiver and child victimization, suggesting parenting behaviors may not buffer or exacerbate intergenerational transmission. Post-hoc analyses revealed family type (e.g., single, cohabitating/married) exerted significant direct and moderating effects on child risk, interacting with positive parenting. Families with married/cohabitating caregivers reported overall lower levels of child victimization; however, the relation between positive parenting and victimization was slightly stronger for children in single-parent families. Results highlight potential pathways of the intergenerational cycle of victimization and suggest high-risk families in Peru may benefit from parenting supports, especially pertaining to remediation of negative parenting behaviors.
Human-computer hybrid teams can meet challenges in designing complex engineered systems. However, the understanding of interaction in the hybrid teams is lacking. We review the literature and identify four key attributes to construct design research platforms that support multi-phase design, hybrid teams, multiple design scenarios, and data logging. Then, we introduce a platform for unmanned aerial vehicle (UAV) design embodying these attributes. With the platform, experiments can be conducted to study how designers and intelligent computational agents interact, support, and impact each other.
To examine the impact of Nutrition for Life (NFL), a goal-setting nutrition education program, on the knowledge, self-efficacy and behaviour of adults eligible for Supplemental Nutrition Assistance Program-Education.
NFL was developed using a 4-week goal-setting behavioural strategy focused on nutrition, physical activity and meal planning techniques. A quantitative repeated-measures design using self-reported data was collected at pre- and post-interventions and at 1-week and 1-month follow-ups.
Two Federally Qualified Health Centers in Philadelphia, PA, USA.
A total of ninety-eight participants enrolled in the intervention; the majority were women (80·2 %), Black/Non-Hispanic (75·0 %) and 45–54 year old (39·6 %).
Participants showed significant improvement in knowledge, self-efficacy and behaviour. Specifically, mean daily intake for vegetables increased by 0·31 cup (P < 0·05) and for fruits by 0·39 cup (P < 0·01) at 1-week follow-up. Participants also showed healthier behaviour at 1-month follow-up. Planning at least seven meals per week increased from 14·8 to 50 % (P < 0·01), completing at least 30 min of physical activity every day in the last week increased from 16·7 to 36 % (P < 0·01) and consuming water with all meals increased from 39 to 70·6 % (P < 0·01).
The implementation of a goal-oriented nutrition education program offers a promising approach at achieving positive behaviour change among SNAP-eligible adults.
Intracerebral calcifications are a facultative symptom of hypoparathyreoidism in 22q11.2 deletion syndrome (22qDS). We describe a patient with 22qDS, basal ganglia calcification (BGC) and psychotic symptoms and discuss the etiological connection of BGC with psychiatric symptoms. Future work needs to determine the prevalence of BGC in 22qDS and psychiatric disorders.
Schizophrenia is associated with impaired cognition, which persists despite current treatments, and is an important determinant of quality of life and overall function. Converging lines of evidence suggest that interleukin-6 (IL-6) may play a role in the pathophysiology of schizophrenia. We previously found that higher blood IL-6 levels were a significant predictor of greater cognitive impairment in schizophrenia after controlling for multiple potential confounding factors. We are conducting an 8-week open-label trial of adjunctive tocilizumab in schizophrenia. Tocilizumab is a humanized monoclonal antibody against the IL-6 receptor, approved by the US FDA for the treatment of adults with moderately to severely active rheumatoid arthritis. Tocilizumab is administered as an intravenous infusion every 4 weeks. Subjects in the trial are age 18–55, taking a nonclozapine antipsychotic, stable based on clinical judgment and no psychiatric hospitalizations in the past 3 months, and on the same psychotropic medications for at least 1 month. Following a screening visit, subjects receive a 4 mg/kg infusion of tocilizumab at baseline and again at 4 weeks. Cognition, as measured by the Brief Assessment of Cognition in Schizophrenia (BACS, using alternate forms) is assessed at baseline, and 2, 4, and 8 weeks. In the first 3 subjects, tocilizumab infusions were well tolerated without significant adverse effects. The mean improvement was 16% on the BACS composite score, including a significant mean 35% improvement (12 points) on digit symbol coding (p=0.03). These preliminary data suggest that anti-cytokine therapy may be a viable adjunctive treatment for cognitive impairment in schizophrenia.
Cytokines are regulators of inflammation that exert effects in the periphery and the brain. Interleukin-6 (IL-6) is a cytokine produced by leukocytes, and CNS microglia and astrocytes. Converging evidence suggests that IL-6 may play a role in the pathophysiology of schizophrenia. Previous studies have found that IL-6 levels have been associated with smaller left hippocampal volume and greater cognitive impairment in patients with schizophrenia. We will perform a case-control study of blood IL-6 levels, and longitudinal changes in cognition and hippocampal volume in subjects from the Northern Finland 1966 Birth Cohort. In n=33 patients with schizophrenia and =71 controls, blood IL-6 levels were measured at age 31, and MRI scans and cognitive assessments were completed at ages 34 and 43. We will test hypotheses that 1) at age 31, patients with schizophrenia have higher blood IL-6 levels than controls, controlling for multiple potential confounding factors, and 2) within schizophrenia, a) higher IL-6 levels at age 31 are associated with greater impairments in verbal learning and memory and smaller hippocampal gray matter volume at age 34, and b) higher IL-6 levels predict greater cognitive decline and reduction in hippocampal volumes over follow-up from age 34 to 43. Schizophrenia is also associated with impaired cognition, which persists despite current treatments, and is an important determinant of quality of life and overall function. This study will improve our understanding of the complex interactions between the immune system and the brain, including a core dimension of psychopathology for which available pharmacologic treatments are inadequate.
We begin with two bibliographical observations. First, scholarly interest in trust is no recent phenomenon, but lately there has been a flowering of academic literature studying numerous dimensions of trust from the standpoints of philosophy, economics, sociology and psychology. The depth and richness of this literature is impressive but hardly surprising, given that trust itself is a notoriously complex, elusive and fact-specific phenomenon. Secondly, scholarly interest in the fiduciary principle that plays such a central role in common law legal systems with a tradition of equity was scarce until the late twentieth century. However, that situation has most definitely changed (for the better), and we now enjoy an abundance of scholarship exploring the fiduciary principle in private law. Moreover, there is a growing body of work exploring ideas of fiduciary government and international law. Scholars are puzzling over fiduciaries and trust as never before.