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Collective bargaining in the public sector is under attack. Since 2011, numerous states have eliminated or severely curtailed public employee collective bargaining. For example, Oklahoma repealed its statute that provided collective bargaining rights for employees of mid-sized cities. Tennessee repealed a statute that for more than three decades had provided collective bargaining rights for teachers. The most visible development was Wisconsin’s enactment which, among other things, prohibited bargaining on all subjects except for increases in base wages which were capped at the increase in the Consumer Price Index, prohibited dues checkoff, and required that exclusive bargaining representatives undergo annual elections and receive the votes of at least 51 percent of all employees in the bargaining unit to remain certified. In 2017, Iowa followed Wisconsin’s model, prohibiting dues check-off, requiring annual recertification elections, and making base wages the only mandatory subject of bargaining, but not prohibiting bargaining on other subjects.
Introduction: 9-1-1 telecommunicators receive minimal education on agonal breathing, often resulting in unrecognized out-of-hospital cardiac arrest (OHCA). We successfully piloted an educational intervention that significantly improved telecommunicators’ OHCA recognition and bystander CPR rates in Ottawa. We sought to better understand the operations of Canadian 9-1-1 communications centers (CC) in preparation for a multi-centre study of this intervention. Methods: We conducted a National survey of all Canadian CCs. Survey domains included information on organizational structure, dispatch system used, education curriculum, and performance monitoring. It was peer-reviewed, translated in French, pilot-tested, and distributed electronically using a modified Dillman method. We designated respondents in each CC before distribution and used targeted follow-up and small incentives to increase response rate. Respondents also described functioning of neighboring CCs if known. Results: We received information from 51/51 provincial and 1/25 territorial CCs, representing 99.7% of the Canadian population. CCs largely utilize the Medical Dispatch Priority System (MPDS) platform (93%), many are Province/Ministry regulated (50%) and most require a High School diploma as minimum entry level education (78%). Telecommunicators receive initial in-class training (median 1.3 months, IQR 0.3-1.9; range 0.1-2.2), often followed by a preceptorship (84.4%) (median 1.0 months, IQR 0.7-1.7; range 0.4-6.0). Educational curriculum includes information on agonal breathing in 41% of CC, without audio examples in 34%. Among responding CCs, over 39,000 suspected OHCA 9-1-1 calls are received annually. Few CCs maintain local performance statistics on OHCA recognition (25%), bystander CPR rates (25%) or survival rates (50%). Most (97%) expressed interest in future research collaborations. Conclusion: Most Canadian telecommunicators receive no or minimal education in recognizing agonal breathing. Further training and improved OHCA monitoring may assist recognition and enhance outcomes.
The role of panendoscopy in the modern investigation of head and neck cancer is changing with the development of improved radiological techniques, in-office biopsy capabilities and the low rate of synchronous primary tumours. This study aimed to review the indications for panendoscopy in the investigation of newly diagnosed head and neck cancer.
A retrospective review was conducted of 186 patients with newly diagnosed head and neck cancer, between January 2014 and December 2015, at two tertiary centres.
Obtaining a tissue diagnosis was the most common indication for panendoscopy (65 per cent), followed by surgical planning including transoral robotic surgery suitability assessment (22.6 per cent), and the investigation of carcinoma of an unknown primary (11.3 per cent). Two synchronous primary tumours were identified, generating a yield of 1.1 per cent.
Panendoscopy remains integral in the assessment of transoral robotic surgery suitability. Refining indications for modern panendoscopy could reduce the need for this procedure in this cohort of patients.
A significant number of X-ray binaries are now known to exhibit long-term periodicities on timescales of ~10 - 100 days. Several physical mechanisms have been proposed that give rise to such periodicities, one of which is radiation-driven warping and precession of the accretion disk. Recent theoretical work predicts the stability to disk warping as a, function of the mass ratio, binary radius, viscosity and accretion efficiency. We investigate the stability of the superorbital periodicities in the neutron star X-ray binaries Cyg X-2, LMC X-4, SMC X-l and Her X-l, and thereby confront stability predictions with observation. We find that the period and nature of the superorbital variations in these sources is consistent with the predictions of warping theory.
The incidence of oropharyngeal squamous cell carcinoma in the Western world is increasing, with the human papillomavirus epidemic implicated in this observed trend. The optimal treatment modality is yet undetermined regarding oncological outcomes.
This study comprised 98 patients with oropharyngeal squamous cell carcinoma, treated with either primary transoral surgery with adjuvant therapy or primary chemoradiotherapy with curative intent, between 2008 and 2012. Clinicopathological characteristics including tumour–node–metastasis stage, human papillomavirus status, treatment modality, recurrence and overall survival were collated.
Five per cent of primary surgical patients had locoregional recurrences compared with 25 per cent of primary chemoradiotherapy patients. A lower rate of locoregional recurrence was observed in the human papillomavirus positive group.
This paper reports higher rates of overall survival and local control for oropharyngeal squamous cell carcinoma treated with primary surgery compared with primary chemoradiotherapy. This reflects overall lower tumour stage and higher human papillomavirus status in this group.
The objective of the present study was to investigate live weight (LW) gain, urinary nitrogen (UN) excretion and urination behaviour of dairy heifers grazing pasture, chicory and plantain in autumn and spring. The study comprised a 35-day autumn trial (with a 7-day acclimation period) and a 28-days spring trial (with a 7-day acclimation period). For each trial, 56 Friesian × Jersey heifers were blocked into five dietary treatments balanced for their LW and breeding worth (i.e. genetic merit of a cow for production and reproduction): 1·00 perennial ryegrass–white clover pasture (PA); 1·00 chicory (CH); 1·00 plantain (PL); 0·50 pasture + 0·50 chicory (PA + CH); and 0·50 pasture + 0·50 plantain (PA + PL). A fresh allocation of the herbage was offered every 3 days with allowance calculated according to feed requirement for maintenance plus gain of 1·0 kg LW/day. In both trials, LW gain was lower on CH than other treatments. In the spring trial, UN concentration and UN excretion were lower in CH and PL than other treatments. In autumn, a higher urination frequency was observed over the first 6 h after forage allocation in CH and PA + CH than other treatments. Data from the present study indicate that feeding CH alone limited heifer LW gain. However, heifers grazing swards containing chicory (CH and PA + CH) and plantain (PL and PA + PL) had the potential to lower nitrous oxide emissions and nitrate leaching from soil compared with heifers grazing PA, by reducing N loading in urine patches.
Uncoupling protein-1 (UCP1) plays a role in the regulation of body temperature, metabolic rate and energy expenditure in animals. While variation in UCP1 and its phenotypic effect has been investigated in humans and sheep, little is known about this gene in cattle. In this study, four regions of bovine UCP1 were investigated in 612 Holstein-Friesian × Jersey (HF × J) dairy cows using polymerase chain reaction-single stranded conformational polymorphism (PCR-SSCP) analyses. In the four regions of the gene analysed, a total of 13 SNPs were detected. Three sequences (a, b and c) were found in Region-2 and three sequences (A, B and C) were found in Region-4, and these were assembled into three (a-B, b-B and c-A) common and three (b-C, c-B and c-C) rare haplotypes. Of the three common haplotypes, b-B and c-A were associated (P < 0·007 and P < 0·043, respectively) with increased milk yield and tended to be associated (P < 0·085 and P < 0·070, respectively) with decreased fat percentage. Cows with genotype b-B/a-B produced more milk (P < 0·004), but with a lower percentage of fat (P < 0·035) and protein (P < 0·038) than cows with genotype a-B/a-B. Cows of genotype a-B/c-A had milk of low fat percentage (P < 0·017), but tended to produce more milk (P < 0·059) than cows of genotype a-B/a-B. This suggests that UCP1 affects milk yield, milk fat percentage and milk protein percentage.
To evaluate the prevalence of variations in the anatomical route of the spinal accessory nerve from the base of the skull to the point where it enters the trapezius muscle. A case report is used to demonstrate an example of a rare but clinically important anatomical variant of this nerve.
An independent review of the literature using Medline, PubMed and Q Read databases was performed using combinations of terms including ‘spinal accessory nerve’, ‘anatomy’, ‘surgical anatomy’, ‘anatomical variant’, ‘cranial nerve XI’ and ‘shoulder syndrome’.
Our report demonstrates marked variation in spinal accessory nerve anatomy. At the point of crossing over the internal jugular vein, the spinal accessory nerve passes most commonly laterally (anterior) to the internal jugular vein. The reported incidence of this lateral relationship varies from 67 to 96 per cent. The nerve can also pierce the internal jugular vein, as demonstrated in our case study, with incidence ranging from 0.48 to 3.3 per cent.
Anatomical variations of the spinal accessory nerve are not uncommon, and it is important for the surgeon to be aware of such variations when undertaking surgery in both the anterior and posterior triangles of the neck.
Employers in recent years have promulgated arbitration programs to resolve disputes with their present and former employees. Arbitration may in many cases provide a lower-cost forum than litigation for resolving such disputes. But the problem of representation of Americans of modest incomes still remains. Ann Hodges explores in this chapter whether labor unions can help address that representation gap.
In the 1980s, the Supreme Court began to enforce agreements to arbitrate statutory claims. The cases involved arbitration agreements between businesses of roughly equal bargaining power. Businesses, however, seized on the judicial approval of arbitration of statutory claims and began to include arbitration agreements in contracts of adhesion with employees and consumers. Arbitration agreements deprive the parties of jury trials. They may limit discovery and other procedures available in court. Perhaps most importantly, they may limit the ability to bring a class action suit, rendering many smaller claims uneconomical. With their long history of representing employees in arbitration, unions have an opportunity to provide representation for employees in these cases, enhancing their ability to enforce their legal rights. Private attorneys who represent employees are rarely attracted to individual arbitration cases because of the often limited potential for damages. In contrast, unions can offer representation as a benefit to recruit new employee members. Additionally, representation in arbitration can become part of a campaign against employer-imposed arbitration systems that limit the legal rights of employees. Accordingly, unions should explore cost-effective methods of providing such benefits to enhance workplace justice.
ARBITRATION OF EMPLOYMENT DISPUTES
For the employer, the arbitral forum offers certain advantages over litigation. It is not public, it is faster and often cheaper than litigation, and the case is not heard by a jury, which may be more sympathetic to an employee than a business. There is some evidence that employers who are sued in arbitration more than once benefit as repeat players in the system. Large employers have this advantage in both arbitration and litigation, although it is plausible that arbitrators may favor such employers if viewed as a source of repeat business. Over time, the employee bar has organized, which can balance the employer's repeat-player advantage for employees who use experienced employment lawyers. And, of course, the class action limitations are extremely valuable, particularly where the employees’ claims are of low value individually but large value collectively.
The present Report covers the period 1982-1984. As with previous Reports, it has not been possible to cover all publications or even every field of research. Some subsections of this Report, the Magellanic Clouds for example, report a body of work as extensive as that in some commissions.
To evaluate the reliability and validity of the FFQ administered to participants in the follow-up of the Melbourne Collaborative Cohort Study (MCCS), and to provide calibration coefficients.
A random sample stratified by country of birth, age, sex and BMI was selected from MCCS participants. Participants completed two FFQ and three 24 h recalls over 1 year. Reliability was evaluated by intraclass correlation coefficients (ICC). Validity coefficients (VC) were estimated from structural equation models and calibration coefficients obtained from regression calibration models.
Adults born in Australia, Greece or Italy.
Nine hundred and sixty-five participants consented to the study; of these, 459 participants were included in the reliability analyses and 615 in the validity and calibration analyses.
The FFQ showed good repeatability for twenty-three nutrients with ICC ranging from 0·66 to 0·80 for absolute nutrient intakes for Australian-born and from 0·51 to 0·74 for Greek/Italian-born. For Australian-born, VC ranged from 0·46 (monounsaturated fat) to 0·83 (Ca) for nutrient densities, comparing well with other studies. For Greek/Italian-born, VC were between 0·21 (Na) and 0·64 (riboflavin). Calibration coefficients for nutrient densities ranged from 0·39 (retinol) to 0·74 (Mg) for Australian-born and from 0·18 (Zn) to 0·54 (riboflavin) for Greek/Italian-born.
The FFQ used in the MCCS follow-up study is suitable for estimating energy-adjusted nutrients for Australian-born participants. However, its performance for estimating intakes is poorer for southern European migrants and alternative dietary assessment methods ought to be considered if dietary data are to be measured in similar demographic groups.
Ecuador harbours a diverse assemblage of tropical mammals, yet the natural history and local-scale distributions of many species remain poorly understood. We conducted the first systematic camera-trap survey of terrestrial mammalian carnivores at Wildsumaco Wildlife Sanctuary, a mid-elevation (1,250–1,450 m), montane rainforest site on the slopes of Sumaco Volcano, in the heart of the Tropical Andes biodiversity hotspot. We quantified trap success, latency to detection and temporal activity patterns for each species detected. We recorded nine carnivore species (four felids, two procyonids and three mustelids), including the first verified record of the jaguarundi Puma yagouaroundi in the region. These species comprise one-third of all terrestrial carnivore species known to occur in Ecuador and 82% of those thought to occur at mid-elevation. All except one of the carnivores we detected have reported elevational ranges ≤ 1,500 m; the one exception, the puma Puma concolor, occurs throughout mainland Ecuador at 0–4,500 m. No cloud forest or highland species (i.e. those with a reported lower elevational limit of ≥ 1,500 m) were detected. Trap success was highest, and latency to detection smallest, for the margay Leopardis wiedii, and temporal activity patterns for all species were consistent with those reported previously in the literature. Our results demonstrate that the mid-elevation montane rainforests of Sumaco Volcano support an exceptionally high diversity of co-existing mammalian carnivores, many of which appear to be near their upper elevational limits, and emphasize the conservation value of this area.
In 2011 we carried out the first systematic survey to determine the density and abundance of endemic forest primates in Siberut National Park, in the Mentawai Islands of West Sumatra, Indonesia. Distance sampling was employed to survey 18 transects located systematically throughout the Park, yielding a total survey effort of 192 km and 285 observations of primates for data analysis. From density estimates for the four resident primate species, the Siberut langur Presbytis siberu, the pig-tailed snub-nosed langur Simias concolor, Kloss's gibbon Hylobates klossii and the Siberut macaque Macaca siberu, we extrapolated a total population of c. 51,000 primates within the Park. We conclude that Siberut National Park is of major significance for the continued survival of Siberut's endemic primates, and provide recommendations to help ensure that it will continue to function as a refuge for primates.
The partial excavation under rescue conditions in 1961–63 of the ditches and
interior of an enclosure of the earlier neolithic period is described. The
enclosure, covering a total area of approximately 2.4 ha, was defined by
double concentric interrupted ditches, which were for the most part
naturally filled. There were many traces of activity within the interior,
presumed to be contemporary with the ditches, including pits, gullies, post-
and stake-holes, and varying concentrations of struck and burnt flint and
pottery. Human burials were found. There is a little Ebbsfleet pottery in
secondary contexts and there are later prehistoric, Roman and medieval
finds. It is probably not possible to ascribe a single or specific role to
the site, which may have been important as a place where several activities
were concentrated, including occupation, subsistence, exchange, enclosure or
defence, burial and ritual.
Approximately 25% of people with bulimia nervosa (BN) who undertake therapy are treated in groups. National guidelines do not discriminate between group and individual therapy, yet each has potential advantages and disadvantages and it is unclear how their effects compare. We therefore evaluated how group therapy for BN compares with individual therapy, no treatment, or other therapies, in terms of remission from binges and binge frequency.
We performed a systematic review and meta-analysis of randomized controlled trials of group therapies for BN, following standard guidelines.
A total of 10 studies were included. Studies were generally small with unclear risk of bias. There was low-quality evidence of a clinically relevant advantage for group cognitive behavioural therapy (CBT) over no treatment at therapy end. Remission was more likely with group CBT versus no treatment [relative risk (RR) 0.77, 95% confidence interval (CI) 0.62–0.96]. Mean weekly binges were lower with group CBT versus no treatment (2.9 v. 6.9, standardized mean difference = −0.56, 95% CI −0.96 to −0.15). One study provided low-quality evidence that group CBT was inferior compared with individual CBT to a clinically relevant degree for remission at therapy end (RR 1.24, 95% CI 1.03–1.50); there was insufficient evidence regarding frequency of binges.
Conclusions could only be reached for CBT. Low-quality evidence suggests that group CBT is effective compared with no treatment, but there was insufficient or very limited evidence about how group and individual CBT compared. The risk of bias and imprecise estimates of effect invite further research to refine and increase confidence in these findings.
Motivated by a wide range of applications, we consider a development of Whittle's restless bandit model in which project activation requires a state-dependent amount of a key resource, which is assumed to be available at a constant rate. As many projects may be activated at each decision epoch as resource availability allows. We seek a policy for project activation within resource constraints which minimises an aggregate cost rate for the system. Project indices derived from a Lagrangian relaxation of the original problem exist provided the structural requirement of indexability is met. Verification of this property and derivation of the related indices is greatly simplified when the solution of the Lagrangian relaxation has a state monotone structure for each constituent project. We demonstrate that this is indeed the case for a wide range of bidirectional projects in which the project state tends to move in a different direction when it is activated from that in which it moves when passive. This is natural in many application domains in which activation of a project ameliorates its condition, which otherwise tends to deteriorate or deplete. In some cases the state monotonicity required is related to the structure of state transitions, while in others it is also related to the nature of costs. Two numerical studies demonstrate the value of the ideas for the construction of policies for dynamic resource allocation, most especially in contexts which involve a large number of projects.
Cognitive remediation (CR) is an effective treatment for several psychiatric disorders. To date, there have been no published studies examining solely first-episode psychiatric cohorts, despite the merits demonstrated by early intervention CR studies. The current study aimed to assess the effectiveness of CR in patients with a first-episode of either major depression or psychosis.
Fifty-five patients (mean age = 22.8 years, s.d. = 4.3) were randomly assigned to either CR (n = 28) or treatment as usual (TAU; n = 27). CR involved once-weekly 2-h sessions for a total of 10 weeks. Patients were comprehensively assessed before and after treatment. Thirty-six patients completed the study, and analyses were conducted using an intent-to-treat (ITT) approach with all available data.
In comparison to TAU, CR was associated with improved immediate learning and memory controlling for diagnosis and baseline differences. Similarly, CR patients demonstrated greater improvements than TAU patients in psychosocial functioning irrespective of diagnosis. Delayed learning and memory improvements mediated the effect of treatment on psychosocial functioning at a marginal level.
CR improves memory and psychosocial outcome in first-episode psychiatric out-patients for both depression and psychosis. Memory potentially mediated the functional gains observed. Future studies need to build on the current findings in larger samples using blinded allocation and should incorporate longitudinal follow-up and assessment of potential moderators (e.g. social cognition, self-efficacy) to examine sustainability and the precise mechanisms of CR effects respectively.
Spectral reflectance and spectroscopic ellipsometry measurements have been made on SOS wafers with haze ratings 1-5. The wavelength dependence of reflectance is dominated by surface scattering, but degraded crystallinity effects are also observed, and are significant in some samples. Analysis of dielectric function spectra using an effective medium approximation has indicated the presence of α-Si and voids in surface layers up to 300Å thick in medium haze wafers, with concentrations decreasing away from the surface. The assessment parameter normally used for SOS, UVR No., has been shown to includeboth crystallinity and scattering effects, and their relative importance cannot be determined without more detailed measurements.
Monolithic Ni 3Al and composite Ni3Al/ceramic whisker bodies were fabricated by combined Self Propagating High Temperature Synthesis and in situ containerless Hot Isostatic Pressing (SHS/HIP), starting from cold pressed blends of nickel, aluminum, and boron powders, with and without additions of alumina whiskers. The resultant bodies were dense and had good ductility and mechanical strength at room temperature.