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As the pathophysiology of Covid-19 emerges, this paper describes dysphagia as a sequela of the disease, including its diagnosis and management, hypothesised causes, symptomatology in relation to viral progression, and concurrent variables such as intubation, tracheostomy and delirium, at a tertiary UK hospital.
During the first wave of the Covid-19 pandemic, 208 out of 736 patients (28.9 per cent) admitted to our institution with SARS-CoV-2 were referred for swallow assessment. Of the 208 patients, 102 were admitted to the intensive treatment unit for mechanical ventilation support, of which 82 were tracheostomised. The majority of patients regained near normal swallow function prior to discharge, regardless of intubation duration or tracheostomy status.
Dysphagia is prevalent in patients admitted either to the intensive treatment unit or the ward with Covid-19 related respiratory issues. This paper describes the crucial role of intensive swallow rehabilitation to manage dysphagia associated with this disease, including therapeutic respiratory weaning for those with a tracheostomy.
OBJECTIVES/GOALS: 1. Understand the association between patient perceptions of care measured by the Interpersonal Processes of Care (IPC) Survey and glycemic control, appointment no-shows/cancellations and medication adherence in patients with type II diabetes. 2. Determine how these relationships differ by race for non-Hispanic White and Black patients. METHODS/STUDY POPULATION: This is a cross-sectional study of a random sample of 100 White and 100 Black Type II diabetic patients followed in Duke primary care clinics and prescribed antihyperglycemic medication. We will recruit through email and phone calls. Enrolled patients will complete the Interpersonal Processes of Care Short Form and Extent of Medication Adherence survey to measure patient perceptions of care (predictor) and medication adherence (secondary outcome). No show appointments and cancellations (secondary outcomes) and most recent hemoglobin A1c (primary outcome) will be collected from the Electronic Medical Record. We will also collect basic demographic information, insurance status, financial security, significant co-morbidities, and number and type (subcutaneous vs oral) of antihyperglycemic medications. RESULTS/ANTICIPATED RESULTS: -The study is powered to detect a 0.6% difference in HbA1c, our primary outcome, between high and low scorers on the Interpersonal Processes of Care subdomains. -We expect that higher patient scores in the positive domains of the IPC survey and lower DISCUSSION/SIGNIFICANCE OF IMPACT: This study will provide information to develop and implement targeted interventions to reduce racial and ethnic disparities in patients with Type II diabetes. We hope to gain information on potentially modifiable factors in patient-provider interactions that can be intervened upon to improve prevention and long-term outcomes in these populations.
In Canada, recreational use of cannabis was legalized in October 2018. This policy change along with recent publications evaluating the efficacy of cannabis for the medical treatment of epilepsy and media awareness about its use have increased the public interest about this agent. The Canadian League Against Epilepsy Medical Therapeutics Committee, along with a multidisciplinary group of experts and Canadian Epilepsy Alliance representatives, has developed a position statement about the use of medical cannabis for epilepsy. This article addresses the current Canadian legal framework, recent publications about its efficacy and safety profile, and our understanding of the clinical issues that should be considered when contemplating cannabis use for medical purposes.
Knowledge of the effects of burial depth and burial duration on seed viability and, consequently, seedbank persistence of Palmer amaranth (Amaranthus palmeri S. Watson) and waterhemp [Amaranthus tuberculatus (Moq.) J. D. Sauer] ecotypes can be used for the development of efficient weed management programs. This is of particular interest, given the great fecundity of both species and, consequently, their high seedbank replenishment potential. Seeds of both species collected from five different locations across the United States were investigated in seven states (sites) with different soil and climatic conditions. Seeds were placed at two depths (0 and 15 cm) for 3 yr. Each year, seeds were retrieved, and seed damage (shrunken, malformed, or broken) plus losses (deteriorated and futile germination) and viability were evaluated. Greater seed damage plus loss averaged across seed origin, burial depth, and year was recorded for lots tested at Illinois (51.3% and 51.8%) followed by Tennessee (40.5% and 45.1%) and Missouri (39.2% and 42%) for A. palmeri and A. tuberculatus, respectively. The site differences for seed persistence were probably due to higher volumetric water content at these sites. Rates of seed demise were directly proportional to burial depth (α=0.001), whereas the percentage of viable seeds recovered after 36 mo on the soil surface ranged from 4.1% to 4.3% compared with 5% to 5.3% at the 15-cm depth for A. palmeri and A. tuberculatus, respectively. Seed viability loss was greater in the seeds placed on the soil surface compared with the buried seeds. The greatest influences on seed viability were burial conditions and time and site-specific soil conditions, more so than geographical location. Thus, management of these weed species should focus on reducing seed shattering, enhancing seed removal from the soil surface, or adjusting tillage systems.
We present multi–epoch VLBI observations of the methanol and water masers in the high–mass star formation region G 339.884−1.259, made using the Australian Long Baseline Array (LBA). Our sub–milliarcsecond precision measurements trace the proper motions of individual maser features in the plane of the sky. When combined with the direct line–of–sight radial velocity (vlsr), these measure the 3 D gas kinematics of the associated high–mass star formation region, allowing us to probe the dynamical processes to within 1000 AU of the core.
Our 2015-2016 ALMA 1.3 to 0.87 mm observations (resolution ~200 au) of the massive protocluster NGC6334I revealed that an extraordinary outburst had occurred in the dominant millimeter dust core MM1 (luminosity increase of 70×) when compared with earlier SMA data. The outburst was accompanied by the flaring of ten maser transitions of three species. We present new results from our recent JVLA observations of Class II 6.7 GHz methanol masers and 6 GHz excited OH masers in this region. Class II masers had not previously been detected toward MM1 in any interferometric observations recorded over the past 30 years that targeted the bright masers toward other members of the protocluster (MM2 and MM3=NGC6334F). Methanol masers now appear both toward and adjacent to MM1 with the strongest spots located in a dust cavity ~1 arcsec (1300 au) north of the MM1B hypercompact HII region. In addition, new excited OH masers appear on the non-thermal source CM2. These data reveal the dramatic effects of episodic accretion onto a deeply-embedded high mass protostar and demonstrate its ongoing impact on the surrounding protocluster.
We report the discovery of widespread millimeter-wavelength Class I methanol maser emission associated with protostellar molecular outflows in the massive (proto)cluster G11.92−0.61. Our ~0.5″-resolution SMA and ALMA observations of the 229 GHz and 278 GHz Class I transitions reveal seven and twelve candidate masers, respectively: all 229 GHz masers have 278 GHz counterparts, and five are also coincident with 44 GHz Class I masers previously detected with the VLA. For paired masers, the peak intensities at 229 GHz and 278 GHz are correlated. We also find tentative evidence for a correlation between the strength of millimeter-wavelength Class I maser emission and the energy of the associated molecular outflow.
The final stages of low-mass stellar evolution are characterized by significant mass loss due to stellar pulsations during the AGB phase, which lead to the development of planetary nebulae. Molecular masers of H2O, SiO, and ground state OH transitions are commonly detected in oxygen-rich late-type stars (OH/IR objects). In contrast, excited OH maser transitions are rare. We discuss our study of the carbon-rich pre-planetary nebula CRL618 (a prototypical post-AGB star). Observations conducted in May 2008 with the 305m Arecibo Telescope resulted in the first detection of a 4765MHz OH maser line in a late-type stellar object; the detection was confirmed a few months later also with Arecibo. Subsequent observations in 2015 and 2017 resulted in non-detection of the 4765MHz OH line. Our observations indicate that the 4765MHz OH maser in CRL 618 is highly variable, possibly tracing a short-lived phenomenon during the development of a pre-planetary nebula.
Not only is depression associated with increased inflammation but inflammation is a risk factor for the genesis of depression. Many of the environmental risk factors for depression are transduced through inflammatory signaling. Anti-inflammatory agents show promise for the management of depression in preclinical, epidemiological, and early clinical studies. This opens the door to the potential for anti-inflammatory agents to treat and prevent depression. There are no evidence-based pharmacotherapies for depression prevention.
ASPREE-D, aspirin in the prevention of depression in the elderly, is a sub study of ASPREE, which explores the potential of aspirin to prevent a range of inflammation related disorders in the elderly. With a sample size of 19,114, and a duration of 5 years, this placebo controlled study will be one of the largest randomized controlled trials in psychiatry and will provide definitive evidence on the ability of aspirin to prevent depression.
This paper presents the rationale for the study and presents a summary of the study design.
ASPREE-D may not only define novel therapy but will provide mechanistic proof of concept of the role of inflammation in depression.
A number of sophisticated modelling approaches are available to investigate potential associations between antimicrobial use (AMU) and resistance (AMR) in animal health settings. All have their advantages and disadvantages, making it unclear as to which model is most appropriate. We used advanced regression modelling to investigate AMU-AMR associations in faecal non-type-specific Escherichia coli (NTSEC) isolates recovered from 275 pens of feedlot cattle. Ten modelling strategies were employed to investigate AMU associations with resistance to chloramphenicol, ampicillin, sulfisoxazole, tetracycline and streptomycin. Goodness-of-fit statistics did not show a consistent advantage for any one model type. Three AMU-AMR associations were significant in all models. Recent parenteral tetracycline use increased the odds of finding tetracycline-resistant NTSEC [odds ratios (OR) 1·1–3·2]; recent parenteral sulfonamide use increased the odds of finding sulfisoxazole-resistant NTSEC (OR 1·4–2·5); and recent parenteral macrolide use decreased the odds of recovering ampicillin-resistant NTSEC (OR 0·03–0·2). Other results varied markedly depending on the modelling approach, emphasizing the importance of exploring and reporting multiple modelling methods based on a balanced consideration of important factors such as study design, mathematical appropriateness, research question and target audience.
Influenza A (H1N1) pdm09 became the predominant circulating strain in the United States during the 2013–2014 influenza season. Little is known about the epidemiology of severe influenza during this season.
A retrospective cohort study of severely ill patients with influenza infection in intensive care units in 33 US hospitals from September 1, 2013, through April 1, 2014, was conducted to determine risk factors for mortality present on intensive care unit admission and to describe patient characteristics, spectrum of disease, management, and outcomes.
A total of 444 adults and 63 children were admitted to an intensive care unit in a study hospital; 93 adults (20.9%) and 4 children (6.3%) died. By logistic regression analysis, the following factors were significantly associated with mortality among adult patients: older age (>65 years, odds ratio, 3.1 [95% CI, 1.4–6.9], P=.006 and 50–64 years, 2.5 [1.3–4.9], P=.007; reference age 18–49 years), male sex (1.9 [1.1–3.3], P=.031), history of malignant tumor with chemotherapy administered within the prior 6 months (12.1 [3.9–37.0], P<.001), and a higher Sequential Organ Failure Assessment score (for each increase by 1 in score, 1.3 [1.2–1.4], P<.001).
Risk factors for death among US patients with severe influenza during the 2013–2014 season, when influenza A (H1N1) pdm09 was the predominant circulating strain type, shifted in the first postpandemic season in which it predominated toward those of a more typical epidemic influenza season.
Infect. Control Hosp. Epidemiol. 2015;36(11):1251–1260
With the recent shift in literary studies towards what is often described as a “global Renaissance,” it is hardly surprising that figures of merchants and travelers both in early modern travelogues and plays have come under greater scrutiny as sites for understanding the formation of a fluid English identity, transnational commerce, emergent colonialism, and nation building. What still remains largely unexplored, however, particularly in the context of the East Indies trade, is the impact of this emergent globalization on the bodies of the European women who were closely related to the merchants or factors. While scholarship on plays such as Fletcher's The Island Princess or Dryden's Amboyna emphasizes the roles of both European men and their beloved native women, the white woman still remains a shadowy presence at the fringes of our current academic interest in the early modern spice trade.
This essay seeks to address this gap by turning to the public stage, particularly to a play that explores how the emergent trade with the East Indies appeared to affect the physical and moral complexion of one such European woman. In the trial scene of John Webster's play The Devil's Law-Case (1623), Jolenta, the sister of Romelio, an East Indies merchant enters with “her face colour'd like that of a Moore,” accompanied by two Surgeons, “one of them like a Jew.” Although the assembled people quickly recognize her they still comment on her changed complexion. Ariosto the advocate exclaims, “Shee’s a blacke one indeed” (5.5.40) while Ercole, one of her suitors, wails “to what purpose / Are you thus ecclipst?” (5.5.57–58). Of course, Jolenta’s transformation is temporary and apparently superficial; yet her blackening appears to gesture towards deeper concerns regarding the impact of the East Indies trade, particularly on a woman who has never left her home or sailed the high seas to profit from pepper, cinnamon, cardamom and mace.
Gods apprentice is a jorneyman: he must allwayes learne the mystery of his profession, & walking forward aime hard to the marke for the price of his high calling. as the teacher in Gods schoole must give Line upon Line, precept upon precept: so to the scholler likewise nulla dies sine linea, no day must pass without a new lesson, as Cato said, so Gods child must grow old every day learning many things. And so in practise also. he must adde to his faith vertue, | & to plowing, sowing. Like Charles the fifth, plus ultra must be his motto: he must go from strength to strength untill he appeare be=fore the Lord in Sion. And that because, he is leaving his abode in this world but an im=perfect pilgrime. he is not what, he is not where he should be … [There are those who] ‘looke behind them, that turne their face in the day of battell, & quite give over Gods husbandry’, [those] ‘that forget their first love who though they forsake not the plough yet are they idle companions that do the worke of the Lord negligently … [For them] it had beene better never to have knowne the way of righ=teousness then that they should bee like a dog to his vomit & a sow to wallowing in the mire.
Analyses of Antony and Cleopatra have long noted the dialectical opposition between Rome and Egypt, an opposition that sets up a concomitant correspondence between geography and gender. Although recent scholarship has destabilized the categories, Rome has traditionally represented the masculine—solid, controlled, bounded—while Egypt is feminine—fluid, unchecked, limitless, and thus constantly generating. Egypt in the play evokes an elemental fecundity that is spontaneous and natural at the same time that it is corrupting and degenerate, “dungy,” in Antony's words. Further, the connection between Cleopatra and Egypt is inextricable in the play; she exists in metonymic relation to her country, the word “Egypt” used no less than seven times to refer to her directly. Picking up on Janet Adelman's argument that the play constructs Cleopatra as “one with her feminized kingdom as though it were her body,” this essay examines the complex idea of Egyptian earthiness in connection with Cleopatra and her fertile/infertile body by reading it in conjunction with various theories of reproduction—what the Renaissance called generation. Specifically, I seek to show how the trope of spontaneous generation allows Shakespeare to expand his interrogation of procreation in the play, blurring gender boundaries as he does so.