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.
Electroconvulsive therapy (ECT) is recommended in treatment guidelines as an efficacious therapy for treatment-resistant depression. However, it has been associated with loss of autobiographical memory and short-term reduction in new learning.
To provide clinically useful guidelines to aid clinicians in informing patients regarding the cognitive side-effects of ECT and in monitoring these during a course of ECT, using complex data.
A Committee of clinical and academic experts from Australia and New Zealand met to the discuss the key issues pertaining to ECT and cognitive side-effects. Evidence regarding cognitive side-effects was reviewed, as was the limited evidence regarding how to monitor them. Both issues were supplemented by the clinical experience of the authors.
Meta-analyses suggest that new learning is impaired immediately following ECT but that group mean scores return at least to baseline by 14 days after ECT. Other cognitive functions are generally unaffected. However, the finding of a mean score that is not reduced from baseline cannot be taken to indicate that impairment, particularly of new learning, cannot occur in individuals, particularly those who are at greater risk. Therefore, monitoring is still important. Evidence suggests that ECT does cause deficits in autobiographical memory. The evidence for schedules of testing to monitor cognitive side-effects is currently limited. We therefore make practical recommendations based on clinical experience.
Despite modern ECT techniques, cognitive side-effects remain an important issue, although their nature and degree remains to be clarified fully. In these circumstances it is useful for clinicians to have guidance regarding what to tell patients and how to monitor these side-effects clinically.
Anaerobic digestion systems can reduce greenhouse gas emissions while turning waste products into energy. Past U.S. economic research on anaerobic digesters has studied dairy farms, but limited economic information is available on anaerobic digestion systems for swine. Net present values (NPVs) were calculated for biodigesters and covered lagoons under different coproduct and policy scenarios. With no government intervention, covered lagoons are more promising for swine operations than more capital-intensive biodigesters. As there is interest in subsidizing anaerobic digestion systems, subsidies equal to a $38/t social cost of carbon would provide positive NPVs.
To describe the pattern of blood culture utilization in an academic university hospital setting.
Retrospective cohort study.
A 789-bed tertiary-care university hospital that processes 40,000+blood cultures annually.
We analyzed blood cultures collected from adult inpatients at the Hospital of the University of Pennsylvania between July 1, 2014, and June 30, 2015. Descriptive statistics and regression models were used to analyze patterns of blood culture utilization: frequency of blood cultures, use of repeat cultures following a true-positive culture, and number of sets drawn per day.
In total, 38,939 blood culture sets were drawn during 126,537 patient days (incidence rate, 307.7 sets per 1,000 patient days). The median number of blood culture sets drawn per hospital encounter was 2 (range, 1–76 sets). The median interval between blood cultures was 2 days (range, 1–71 days). Oncology services and cultures with gram-positive cocci were significantly associated with greater odds of having repeat blood cultures drawn the following day. Emergency services had the highest rate of drawing single blood-culture sets (16.9%), while oncology services had the highest frequency of drawing ≥5 blood culture sets within 24 hours (0.91%). Approximately 10% of encounters had at least 1 true-positive culture, and 89.2% of those encounters had repeat blood cultures drawn. The relative risk of a patient having repeat blood cultures was lower for those in emergency, surgery, and oncology services than for those in general medicine.
Ordering practices differed by service and culture results. Analyzing blood culture utilization can contribute to the development of guidelines and benchmarks for appropriate usage.
The term ‘mood stabiliser’ is ill-defined and lacks clinical utility. We propose a framework to evaluate medications and effectively communicate their mood stabilising properties – their acute and prophylactic efficacy across the domains of mania and depression. The standardised framework provides a common definition to facilitate research and clinical practice.
Declaration of interest
The Treatment Algorithm Group (TAG) was supported logistically by Servier who provided financial assistance with travel and accommodation for those TAG members travelling interstate or overseas to attend the meeting in Sydney (held on 18 November 2017). None of the committee were paid to participate in this project and Servier have not had any input into the content, format or outputs from this project.
OBJECTIVES/SPECIFIC AIMS: The overall goal of this project is to enhance the use of GCRA in Latina breast cancer survivors at high risk of hereditary breast and ovarian cancer to reduce disparities in GCRA uptake. The aims of the study are to (1) develop a cultural adaptation of an evidence-based TGC intervention that consists of phone genetic counseling and a booklet, (2) evaluate the impact of TGC Versus Usual Care, and (3) explore the communication patterns in TGC and genetic counseling sessions with an interpreter. METHODS/STUDY POPULATION: We are conducting a 2-phase, mixed methods study. In Phase I we will develop a cultural adaption of an evidence-based intervention (TGC) for high-risk Latina breast cancer survivors using the Learner Verification and Revision Framework (n=15). In Phase II we will use a cluster randomized design with four community sites randomized to Spanish TGC (n=2 sites) or usual care (n=2 sites) (n=60; 15 per site). The primary outcome is genetic counseling uptake. Among women who receive genetic counseling either through TGC (n~30) or with an interpreter (n~15), we will assess counseling quality by reviewing 20 randomly selected audiotaped sessions (10 TGC; 10 interpreters). We will evaluate women’s HBOC knowledge and satisfaction with counseling. Communication processes and outcomes will be assessed using gold standard RIAS quantitative coding system and qualitative discourse analysis. RESULTS/ANTICIPATED RESULTS: We elicited input from transdisciplinary team members to develop an initial adaptation of a TGC print booklet and intervention protocol for use with high-risk Latina breast cancer survivors with limited English proficiency. The booklet contains low-literacy information about HBOC, risk factors, pros and cons of testing, and management strategies. Based on these materials and prior work, we anticipate TGC will consist of one 1 hour or less TGC session by phone. Participants interested in pursuing testing will receive a saliva kit and will participate in a second TGC session (30 min) to discuss test results and management options. DISCUSSION/SIGNIFICANCE OF IMPACT: Given access barriers and the shortage of Spanish-speaking genetic counselors, adapting and translating TGC intervention is a promising strategy that could reduce disparities by broadening the reach and accessibility to genetic counseling while enhancing the quality of the service for Latinas with limited English proficiency.
East german literary history is a case study of how political and cultural institutions interact. the state's cultural regime mo-nopolized the right to publish within its borders and demanded that the nation's new art describe contemporary life or its precedents. Even authors seen in the West as dissidents understood themselves, more often than not, as pursuing that goal and the broader aims of socialism with their work. During the lifespan of the German Democratic Republic, this political albatross weighed on all literary scholarship. Even now, whatever their feelings toward the socialist state, scholars, critics, and readers are bound to approach a text from East Germany as an artifact of its political culture—and rightly, because the political sphere encroached heavily on the artistic. But since German unification, the rise and fall in the stock of so many East German authors has directly resulted from political revelations, raising a number of troubling questions. Though historical distance seemed to have sprung up as abruptly as the Berlin Wall had come down, to what extent does scholarship from the German Democratic Republic represent only a heightened case of what is always true of literary history— namely, that political motivation colors critical evaluation? Is it possible to consider a work of literature with no recourse to the social and political circumstances under which it was written? And would it even be desirable to do so?
As part of a multifactorial approach to address weak incentives for innovative antimicrobial drug development, market entry rewards (MERs) are an emerging solution. Recently, the Duke-Margolis Center for Health Policy released the Priority Antimicrobial Value and Entry (PAVE) Award proposal, which combines a MER with payment reforms, transitioning from volume-based to “value-based” payments for antimicrobials. Here, the PAVE Award and similar MERs are reviewed, focusing on further refinement and avenues for implementation.
I. De Pater, University of California, Berkeley Berkeley, California, USA,
D. P. Hamilton, University of Maryland College Park, Maryland, USA,
M. R. Showalter, SETI Institute Mountain View, California, USA,
H. B. Throop, Planetary Science Institute Tucson, Arizona, USA,
J. A. Burns, Cornell University Ithaca, New York, USA
Among African Americans, spirituality is meaning or purpose in life and a faith in God who is in control of health and there to provide support and guidance in illness situations. Using qualitative methods, we explored the use of spirituality to make sense of the end-of-life and bereavement experiences among family members of a deceased cancer patient.
Data in this report come from 19 African Americans who experienced the loss of a family member to cancer. A qualitative descriptive design was used with criterion sampling, open-ended semistructured interviews, and qualitative content analysis.
Participants made sense of the death of their loved one using the following five themes: Ready for life after death; I was there; I live to honor their memory; God's wisdom is infinite; and God prepares you and brings you through. These five themes are grounded in conceptualizations of spirituality as connectedness to God, self, and others.
Significance of results
Our findings support the results that even during bereavement, spirituality is important in the lives of African Americans. African American family members might struggle with issues related to life after death, their ability to be physically present during end-of-life care, and disentangling beliefs around God's control over the beginning and ending of life. The findings in this report can be used to inform healthcare providers to better support and address the needs for support of African American family members during end-of-life and bereavement experiences.
We obtained radiocarbon (14C) dates with accelerator mass spectrometry (AMS) of vascular plant samples and a charcoal sample collected from peat deposits near the prehistoric village site informally designated CR-03 on Carlisle Island in the Islands of Four Mountains group, Alaska, to determine the eruption age of the CR-02 tephra. A fine vitric ash erupted from Okmok caldera, Umnak Island (ca. 2 ka BP) was also discovered in the bog. The ages of the CR-02 tephra and Okmok II ash are estimated to be 1050 and 2000 cal BP, respectively. Because both tephras are distinctive and widespread, these are important chronostratigraphic markers for archaeological sites in this island group. The 14C dates obtained from this bog are 800 years younger than the dates of the charcoal fragments from cultural layers in the Unit 3 of prehistoric village site CR-02 (AMK-0003).
Modern datasets provide the context necessary for accurate interpretations of isotopic data from archaeological faunal assemblages. In this study, we use the oxygen isotope ratios (δ18O) of modern small mammals from Chaco Canyon, New Mexico, to quantify expected isotopic variation in a local population. The δ18O values of local, modern small mammals encompass a broad range (−6.0‰ to 4.8‰ VPDB), which is expected given the extreme seasonal variation in the δ18O of precipitation on the Colorado Plateau (−11‰ to −3‰ VPDB). Isotopic ratios of small mammals obtained from excavated archaeological sites in Chaco Canyon (ca. AD 800 to 1200) show no significant differences with their modern counterparts, suggesting that there is no difference in the origins of the archaeological small-mammal collection and the modern, local Chaco Canyon small-mammal collection. In contrast, δ18O values of large mammals from Chaco archaeological sites are significantly different from those of modern specimens, reflecting a nonlocal, but also nonspecific, source in the past.
Bone is frequently dated in archaeological studies and, especially for very old bones (more than 40,000 years old), it is critical to have an accurate and precise measure of the material-specific background value and its associated uncertainty. The SUERC Radiocarbon Laboratory has obtained a mammoth bone as a background bone standard and an appropriate number are now routinely prepared and measured in each AMS batch, resulting in the accumulation of a large number of background bone results over a two-year period. Additionally, information on which of the two accelerator mass spectrometry (AMS) instruments was used to make the radiocarbon (14C) measurements, and which sample pretreatment method (modified Longin or modified ultrafiltration) was used to extract and purify the collagen, is recorded for each sample. These data have been used to estimate the laboratory bone background (to be subtracted from each unknown bone sample prepared in the laboratory) and its associated analytical uncertainty. The statistical analysis of the bone results has made use of a linear mixed effects model to examine the variation, and to apportion the overall variation between and within batches on both AMS instruments, and the different pretreatment methods used at SUERC.
A large eddy simulation framework is used to explore the structure of the turbulent flow in a thermally stratified wind turbine array boundary layer. The flow field is driven by a constant geostrophic wind with time-varying surface boundary conditions obtained from a selected period of the CASES-99 field experiment. Proper orthogonal decomposition is used to extract coherent structures of the turbulent flow under the considered thermal stratification regimes. The flow structure is discussed in the context of three-dimensional representations of key modes, which demonstrate features ranging in size from the wind turbine wakes to the atmospheric boundary layer. Results demonstrate that structures related to the atmospheric boundary layer flow dominate over those introduced by the wind farm for the unstable and neutrally stratified regimes; large structures in atmospheric turbulence are beneficial for the wake recovery, and consequently the presence of the turbulent wind turbine wakes is diminished. Contrarily, the flow in the stably stratified case is fully dominated by the presence of the turbines and highly influenced by the Coriolis force. A comparative analysis of the test cases indicates that during the stable regime, higher-order modes contribute less to the overall character of the flow. Under neutral and unstable stratification, important turbulence dynamics are distributed over a larger range of basis functions. The influence of the wind turbines on the structure of the atmospheric boundary layer is mainly quantified via the turbulence kinetic energy of the first ten modes. Linking the new insights into structure of the wind turbine/atmospheric boundary layer and their interaction addressed here will benefit the formulation of new simplified models for commercial application.
The SUERC Radiocarbon Laboratory employs a one-step “background subtraction” method when calculating 14C ages. An interglacial wood (VIRI Sample K) is employed as the non-bone organic background standard, while a mammoth bone (LQH12) from Latton Quarry is used as the bone background standard. Results over several years demonstrate that the bone background is consistently around a factor of two higher and more variable than the wood background. As a result, the uncertainty on routine bone measurements is higher than for other sample types. This study investigates the factors that may contribute to the difference in F14C values and the higher variability. Preparations of collagen using modified Longin or ultrafiltration methods show no significant difference, nor does eliminating the collagen dissolution step. Two bone samples of known infinite age with respect to radiocarbon are compared and again no significant difference is observed. Finally, the quantity and age of the organic matter in the water used during the pretreatment is investigated and it is shown that there is insufficient organic matter in the reverse osmosis water to influence background values significantly. The attention is now on determining if incomplete demineralization could lead to contaminants being retained by the phosphate in the hydroxyapatite.
Among other zooarchaeological remains, terrestrial snails’ shells from the Thaumastus and Megalobulimus genera are found in some Brazilian shellmounds, presenting a potential substitute for charcoal in radiocarbon dating analyses, as reliable representatives of the atmospheric carbon isotopic ratio. In this paper, we present statistically similar results of both charcoal and land snails samples from the same archaeological contexts in three settlements on the coast of Rio de Janeiro. The Manitiba I shellmound results range from 4.2 to 3.7 ka cal BP (95.4%), contemporary with the Saquarema shellmound, occupied during the period from 4.3 to 3.6 ka cal BP (95.4%). For the Usiminas shellmound, two groups of samples revealed different periods of time for two occupational layers from 2.3 to 2.1 ka cal BP (95.4%) and from 1.6 and 1.3 ka cal BP (95.4%). A model constraining each group of samples to within a single phase has a general agreement of 97% with only two outliers out of 22 dates, yielding minimum individual agreement of 74% and 7% posterior outlier probability for Saquarema shells. These are good examples of sites in which the occupation chronology can be successfully obtained by the radiocarbon dating of land snails.
Dense, controlled-impedance, superconducting cables with small cross-sections are desirable, especially for quantum computing applications. In this study, superconductivity properties, rf microwave response and mechanical reliability performance of embedded Nb dc cables and Nb microstrip transmission line resonators with different thicknesses of polyimide PI-2611 encapsulation layers (0, 4 and 8 μm) have been investigated. Critical temperature (Tc) and critical current (Ic) of embedded Nb dc cables are ∼ 8.2 K and ∼ 0.2 A, respectively. Embedded Nb resonators yield high loaded quality factor (QL), with values as high as 14481 at ∼ 1.2 K and at a fundamental resonance of ∼ 2 GHz. From mechanical fatigue testing, we have observed that a polyimide encapsulation layer can effectively enhance the mechanical reliability of superconducting Nb flexible cables.
There are growing calls to reduce, and where possible eliminate, the use of seclusion and restraint in mental health settings, but the attitudes and beliefs of consumers, carers and mental health professionals towards these practices are not well understood. The aim of this study was to compare the attitudes of mental health service consumers, carers and mental health professionals towards seclusion and restraint in mental health settings. In particular, it aimed to explore beliefs regarding whether elimination of seclusion and restraint was desirable and possible.
In 2014, an online survey was developed and widely advertised in Australia via the National Mental Health Commission and through mental health networks. The survey adopted a mixed-methods design, including both quantitative and qualitative questions concerning participants’ demographic details, the use of seclusion and restraint in practice and their views on strategies for reducing and eliminating these practices.
In total 1150 survey responses were analysed. A large majority of participants believed that seclusion and restraint practices were likely to cause harm, breach human rights, compromise trust and potentially cause or trigger past trauma. Consumers were more likely than professionals to view these practices as harmful. The vast majority of participants believed that it was both desirable and feasible to eliminate mechanical restraint. Many participants, particularly professionals, believed that seclusion and some forms of restraint were likely to produce some benefits, including increasing consumer safety, increasing the safety of staff and others and setting behavioural boundaries.
There was strong agreement across participant groups that the use of seclusion and restraint is harmful, breaches human rights and compromises the therapeutic relationship and trust between mental health service providers and those who experience these restrictive practices. However, some benefits were also identified, particularly by professionals. Participants had mixed views regarding the feasibility and desirability of eliminating these practices.
This article provides a new account of employers' advantages over employees in federal employment discrimination cases. We analyze the effects of judicial deference, in which judges use institutionalized employment structures to infer nondiscrimination without scrutinizing those structures in any meaningful way. Using logistic regression to analyze a representative sample of judicial opinions in federal EEO cases during the first thirty‐five years after the passage of the 1964 Civil Rights Act, we find that when judges uncritically use the presence of organizational structures to reason about whether discrimination occurred, employers are much more likely to prevail. This pattern is especially pronounced in opinions written by liberal judges. In light of these findings, we offer recommendations for judges, lawyers, and policy makers—including legal academics—who seek to improve the accuracy and efficacy of employment discrimination adjudications.
Relative sea-level change (RSL), from the Late Glacial through to the late Holocene, is reconstructed for the Assynt region, northwest Scotland, based on bio- and lithostratigraphical analysis. Four new radiocarbon-dated sea-level index points help constrain RSL change for the Late Glacial to the late Holocene. These new data, in addition to published material, capture the RSL fall during the Late Glacial and the rise and fall associated with the mid-Holocene highstand. Two of these index points constrain the Late Glacial RSL history in Assynt for the first time, reconstructing RSL falling from 2.47 ± 0.59 m OD to 0.15 ± 0.59 m OD at c. 14,000–15,000 cal yr BP. These new data test model predictions of glacial isostatic adjustment (GIA), particularly during the early deglacial period which is currently poorly constrained throughout the British Isles. Whilst the empirical data from the mid- to late-Holocene to present matches quite well with the recent GIA model output, there is a relatively poor fit between the timing of the Late Glacial RSL fall and early Holocene RSL rise. This mismatch, also evident elsewhere in northwest Scotland, may result from uncertainties associated with both the global and local ice components of GIA models.