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.
Type 2 diabetes results mainly from weight gain in adult life and affects one in twelve people worldwide. In the Diabetes REmission Clinical Trial (DiRECT), the primary care-led Counterweight-Plus weight management program achieved remission of type 2 diabetes (for up to six years) for forty-six percent of patients after one year and thirty-six percent after two years. The objective of this study was to estimate the implementation costs of the program, as well as its two-year within-trial cost effectiveness and lifetime cost effectiveness.
Within-trial cost effectiveness included the Counterweight-Plus costs (including training, practitioner appointments, and low-energy diet), medications, and all routine healthcare contacts, combined with achieved remission rates. Lifetime cost per quality-adjusted life-year (QALY) was estimated according to projected durations of remissions, assuming continued relapse rates as seen in year two of DiRECT and the consequent life expectancy, quality of life and healthcare costs.
The two-year intervention cost was EUR 1,580 per participant, with over eighty percent of the costs incurred in year one. Compared with the control group, medication savings were EUR 259 (95% confidence interval [CI]: 166–352) for anti-diabetes drugs and EUR 29 (95% CI: 12–47) for anti-hypertensive medications. The intervention was modeled with a lifetime horizon to achieve a mean 0.06 (95% CI: 0.04–0.09) gain in QALYs for the DiRECT population and a mean total lifetime cost saving per participant of EUR 1,497 (95% CI: 755–2,331), with the intervention becoming cost-saving within six years.
The intensive weight loss and maintenance program reduced the cost of anti-diabetes drugs through improved metabolic control, achieved diabetes remission in over one-third of participants, and reduced total healthcare contacts and costs over two years. A substantial lifetime healthcare cost saving is anticipated from periods of diabetes remission and delaying complications. Healthcare resources could be shifted cost effectively to establish diabetes remission services, using the existing DiRECT intervention, even if remissions are only maintained for limited durations. However, more research investment is needed to further improve weight-loss maintenance and extend remissions.
Business closures and work-from-home orders have been a central part of Canada's plan to slow the spread of COVID-19. The success of these measures hinges on public support, which cannot be taken for granted as the orders induce considerable economic pain. As governments consider when to re-open the economy, one relevant variable is when the public expects the economy to re-open. At minimum, if public perceptions differ from government plans then additional government messaging is required to better align expectations.
Colonial institutions are thought to be highly persistent, but measuring that persistence is difficult. Using a text analysis method that allows us to measure similarity between bodies of text, we examine the extent to which one formal institution – the penal code – has retained colonial language in seven West African countries. We find that the contemporary penal codes of most countries retain little colonial language. Additionally, we find that it is not meaningful to speak of institutional divergence across the unit of French West Africa, as there is wide variation in the legislative post-coloniality of individual countries. We present preliminary analyses explaining this variation and show that the amount of time that a colony spent under colonisation correlates with more persistent colonial institutions.
Stone was a critical resource for prehistoric hunter-gatherers. Archaeologists, therefore, have long argued that these groups would actively have sought out stone of ‘high quality’. Although the defining of quality can be a complicated endeavour, researchers in recent years have suggested that stone with fewer impurities would be preferred for tool production, as it can be worked and used in a more controllable way. The present study shows that prehistoric hunter-gatherers at the Holocene site of Welling, in Ohio, USA, continuously selected the ‘purest’ stone for over 9000 years.
Antimicrobial stewardship (AS) involves the appropriate selection of antimicrobials. Antimicrobial stewardship programs are mandated in hospitals and are expanding to involve outpatient arenas. Multiple articles have been published describing the need for AS education for medical and pharmacy students, beginning early in the students’ career to develop into competent AS practitioners. Additionally, publications have described the role and impact of medical and pharmacy trainees on AS programs. Here, we review the published evidence describing medical and pharmacy trainees’ involvement in AS and call for future research in this area.
To identify the intracochlear electrode position in cochlear implant recipients and determine the correlation to speech perception for two peri-modiolar electrode arrays.
Post-operative cone-beam computed tomography images of 92 adult recipients of the ‘CI512’ electrode and 18 adult recipients of the ‘CI532’ electrode were analysed. Phonemes scores were recorded pre-implantation, and at 3 and 12 months post-implantation.
All CI532 electrodes were wholly within scala tympani. Of the 79 CI512 electrodes intended to be in scala tympani, 58 (73 per cent) were in scala tympani, 14 (17 per cent) were translocated and 7 (9 per cent) were wholly in scala vestibuli. Thirteen CI512 electrodes were deliberately inserted into scala vestibuli. Speech perception scores for post-lingual recipients were higher in the scala tympani group (69.1 per cent) compared with the scala vestibuli (54.2 per cent) and translocation (50 per cent) groups (p < 0.05). Electrode location outside of scala tympani independently resulted in a 10.5 per cent decrease in phoneme scores.
Cone-beam computed tomography was valuable for demonstrating electrode position. The rate of scala tympani insertion was higher in CI532 than in CI512 electrodes. Scala vestibuli insertion and translocation were associated with poorer speech perception outcomes.
Electricity demand exceeds supply in many parts of Africa, and this often results in rolling blackouts. This article argues that blackouts tend to concentrate on poorer places within countries, due to both economic and political factors. This argument is tested with an analysis of electricity availability across thirty-two neighborhoods in Accra and survey data from thirty-six African countries. Across these analyses, poorer people with a grid connection experience lower electricity supply than richer people. This article concludes by discussing implications for research on electricity availability, policymakers working on energy, and the distributive politics literature.
To investigate the effectiveness and usability of automated procedural guidance during virtual temporal bone surgery.
Two randomised controlled trials were performed to evaluate the effectiveness, for medical students, of two presentation modalities of automated real-time procedural guidance in virtual reality simulation: full and step-by-step visual presentation of drillable areas. Presentation modality effectiveness was determined through a comparison of participants’ dissection quality, evaluated by a blinded otologist, using a validated assessment scale.
While the provision of automated guidance on procedure improved performance (full presentation, p = 0.03; step-by-step presentation, p < 0.001), usage of the two different presentation modalities was vastly different (full presentation, 3.73 per cent; step-by-step presentation, 60.40 per cent).
Automated procedural guidance in virtual temporal bone surgery is effective in improving trainee performance. Step-by-step presentation of procedural guidance was engaging, and therefore more likely to be used by the participants.
As Paul Evans has shown in this volume, Thomas Pennant's initial scholarly successes lay in the fields of zoology and Asian geography. Later, however, he was to earn fame and fortune by developing his own literary genre to promote readable, well- illustrated books on exploratory cultural travel in late eighteenth- century Britain. An important legacy to researchers, Pennant's landscape, site and artefact descriptions are unique records of information now often lost. Alongside many other archaeological records, they are being slowly absorbed into searchable, publicly accessible Heritage Environment Records (HERs) throughout Britain; and most pertinently to this investigation, into Wales's ‘Coflein’, and Scotland's sister database ‘Canmore’. These resources not only gather up- to- date data to facilitate archaeological research; they are also tools vital to informing national planning policies, guiding implementation in matters of preserving and conserving sites and landscapes. Adding new data to them demands scholarly judgement to ensure accuracy and reliability. Pennant's archaeological contributions – including his commissioned graphic images – therefore need careful scrutiny to establish the degree to which they truly represented first- hand familiarity with their subject matter.
One of the main purposes of this essay is to consider some of Pennant's working practices as a step towards establishing how such scrutiny may be most usefully progressed. It begins with a brief review of Pennant's education and early mentoring meant to offer insights into his development as an antiquary It goes on to include some preliminary observations about his encounters with notable monuments and artefacts and their discoverers. Whereas the graphic records of historic architecture he commissioned and many other aspects of his scholarship merit extended discussion, the present essay is limited to archaeological topics mainly of interest to prehistory. Finally, Pennant's works are evaluated as legacies to scholarship and as documents recording features of a fugitive and continuously fragmenting historic environment before sug- gestions are offered for future research directions.
Like many of the squirearchy, in youth Pennant would have had access not only to the select library his family had built up at Downing (which he greatly expanded), but also to the collections at nearby Mostyn Hall. In later life he recalled how the Classics were shelved there with ‘numerous […] books related to the Greek and Roman antiquities’.
Evaluating the effectiveness of the Army Aboriginal Community Assistance Programs (AACAPs) from a military participant perspective provides the objective of this research. The study will identify areas of concern and provide guidance on current military policy, doctrine and protocol.
Army Aboriginal Community Assistance Programs (AACAPs) represent a co-operative initiative between the Australian Army and Australian Government, that delivers complex support for Disaster Relief and Humanitarian Assistance (HA/DR) to improve the health and well-being of indigenous communities. Since 1997, the Army has conducted a number of AACAPs in remote Indigenous communities within continental Australia. No previous evaluations of these programs exist.
A ‘Quality Improvement’ study underpins this evaluation. Shewhart’s “Plan, Do, Study, Act” Model provides the guiding framework for the study. Allen’s Logic Model exemplifies the most appropriate framework to articulate the program needs and objectives, and to delineate the processes inherent in the program for this evaluation. The Center for Disease Control (CDC) evaluation model for public health programs, provides the evaluation standards to examine the delivery of health care to the deployed force in an austere environment. Part 1 of the study will be a desktop examination of current military policy, doctrine and protocol relating to AACAP. Part 2 will overlay personal experience from military participants in the AACAPs through a semi-structured interview, to enable deployed health personnel the opportunity to comment on their experiences. Analysis will comprise quantitative and qualitative method, specifically descriptive statistics and thematic analysis respectively. Army has approved all required governance, and ethics approval will be sought from Monash University.
This is a proposed study, no results are available.
The benefit of this research will be gaining new knowledge with context of a humanitarian focused military task, through the lens of quality improvement to build capacity and enhance capability.
A number of laser facilities coming online all over the world promise the capability of high-power laser experiments with shot repetition rates between 1 and 10 Hz. Target availability and technical issues related to the interaction environment could become a bottleneck for the exploitation of such facilities. In this paper, we report on target needs for three different classes of experiments: dynamic compression physics, electron transport and isochoric heating, and laser-driven particle and radiation sources. We also review some of the most challenging issues in target fabrication and high repetition rate operation. Finally, we discuss current target supply strategies and future perspectives to establish a sustainable target provision infrastructure for advanced laser facilities.
To examine the extent to which foreign aid reaches people at different levels of wealth in Africa, I use household surveys to measure the subnational distribution of a country's population by wealth quintiles and match this information to data on the location of aid projects from two multilateral donors. Within countries, aid disproportionately flows to regions with more of the richest people. Aid does not favor regions with more of the poorest people. These findings violate the stated preferences of the multilateral donors under study, suggesting that the donors either cannot or are not willing to exercise control over the location of aid projects within countries. The results also suggest that aid is not being allocated effectively to alleviate extreme poverty.
A single specimen of a new species of the chasmataspidid Diploaspis Størmer, 1972 is described from the upper Silurian (Pridoli) Phelps Member of the Fiddlers Green Formation (Bertie Group) in Herkimer County, New York State, USA. Diploaspis praecursor sp. nov. is distinguished by the shape of the posterolateral margins of the buckler, which are drawn out into angular epimera, and by the lack of elongate tubercles on the postabdomen. This discovery increases the taxonomic diversity of the Bertie Group by extending the geographic extent of Diploaspididae into North America. D. praecursor pre-dates previously known species of Diploaspis by more than 10 million years.
We have compiled a catalogue of H ii regions detected with the Murchison Widefield Array between 72 and 231 MHz. The multiple frequency bands provided by the Murchison Widefield Array allow us identify the characteristic spectrum generated by the thermal Bremsstrahlung process in H ii regions. We detect 306 H ii regions between 260° < l < 340° and report on the positions, sizes, peak, integrated flux density, and spectral indices of these H ii regions. By identifying the point at which H ii regions transition from the optically thin to thick regime, we derive the physical properties including the electron density, ionised gas mass, and ionising photon flux, towards 61 H ii regions. This catalogue of H ii regions represents the most extensive and uniform low frequency survey of H ii regions in the Galaxy to date.
We compare first-order (refractive) ionospheric effects seen by the MWA with the ionosphere as inferred from GPS data. The first-order ionosphere manifests itself as a bulk position shift of the observed sources across an MWA field of view. These effects can be computed from global ionosphere maps provided by GPS analysis centres, namely the CODE. However, for precision radio astronomy applications, data from local GPS networks needs to be incorporated into ionospheric modelling. For GPS observations, the ionospheric parameters are biased by GPS receiver instrument delays, among other effects, also known as receiver DCBs. The receiver DCBs need to be estimated for any non-CODE GPS station used for ionosphere modelling. In this work, single GPS station-based ionospheric modelling is performed at a time resolution of 10 min. Also the receiver DCBs are estimated for selected Geoscience Australia GPS receivers, located at Murchison Radio Observatory, Yarragadee, Mount Magnet and Wiluna. The ionospheric gradients estimated from GPS are compared with that inferred from MWA. The ionospheric gradients at all the GPS stations show a correlation with the gradients observed with the MWA. The ionosphere estimates obtained using GPS measurements show promise in terms of providing calibration information for the MWA.
GLEAM, the GaLactic and Extragalactic All-sky MWA survey, is a survey of the entire radio sky south of declination + 25° at frequencies between 72 and 231 MHz, made with the MWA using a drift scan method that makes efficient use of the MWA’s very large field-of-view. We present the observation details, imaging strategies, and theoretical sensitivity for GLEAM. The survey ran for two years, the first year using 40-kHz frequency resolution and 0.5-s time resolution; the second year using 10-kHz frequency resolution and 2 s time resolution. The resulting image resolution and sensitivity depends on observing frequency, sky pointing, and image weighting scheme. At 154 MHz, the image resolution is approximately 2.5 × 2.2/cos (δ + 26.7°) arcmin with sensitivity to structures up to ~ 10° in angular size. We provide tables to calculate the expected thermal noise for GLEAM mosaics depending on pointing and frequency and discuss limitations to achieving theoretical noise in Stokes I images. We discuss challenges, and their solutions, that arise for GLEAM including ionospheric effects on source positions and linearly polarised emission, and the instrumental polarisation effects inherent to the MWA’s primary beam.
The first 100 years of research devoted to marine regions and provinces led to knowledge involving species distribution patterns, location of boundaries, and the extent of endemism. Within the past 40 years, it became apparent that regions and provinces were not static entities but had a dynamic relationship that reflected continuous changes in the distribution of species. It was recognized that vagile species could negotiate biogeographic barriers and were able to invade from places of high species diversity into less diverse areas. Within the past 5 years, it became apparent that invasive species were successful because they were accommodated by native species that occupied the appropriate habitats. Invasion success explained why certain dominant species were able to achieve broad geographic ranges. Finally, due to advances in phylogeography, we became aware that a few peripheral fish species had been able to invade toward instead of away from centers of higher diversity.
Our modern concept of marine biogeographical regions began with the work of James Dwight Dana, an American geologist, mineralogist, and naturalist. As a young man, Dana joined the United States Exploring Expedition to the South Seas. He served 4 years (1838–42) as a geologist but also undertook much of the zoological work. As the result of his discoveries on the corals and crustaceans, he was convinced that sea surface temperature was the important factor that determined distributional patterns. Dana used isocrymes (lines of mean minimum temperature for the coldest month) to explain the geographical separation of species groups, and published an Isocrymal Chart (map) that illustrated the worldwide distribution of marine animals . He was the first to observe that the latitudinal distribution of marine animals was restricted by the cold of winter, not the average temperature. Dana's chart laid the foundation for the biogeographic regions that are recognized today.
Edward Forbes, the English naturalist who first explored the depth distribution of marine organisms, also drew a map of marine life distribution that was published in Alexander K. Johnston's The Physical Atlas of Natural Phenomena .