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Background: Cervical spondylotic myelopathy (CSM) is the leading cause of spinal cord impairment. In a public healthcare system, wait times to see spine specialists and eventually access surgical treatment for CSM can be substantial. The goals of this study were to determine consultation wait times (CWT) and surgical wait times (SWT), and identify predictors of wait time length. Methods: Consecutive patients enrolled in the Canadian Spine Outcomes and Research Network (CSORN) prospective and observational CSM study from March 2015 to July 2017 were included. A data-splitting technique was used to develop and internally validate multivariable models of potential predictors. Results: A CSORN query returned 264 CSM patients for CWT. The median was 46 days. There were 31% mild, 35% moderate, and 33% severe CSM. There was a statistically significant difference in median CWT between moderate and severe groups; 207 patients underwent surgical treatment. Median SWT was 42 days. There was a statistically significant difference in SWT between mild/moderate and severe groups. Short symptom duration, less pain, lower BMI, and lower physical component score of SF-12 were predictive of shorter CWT. Only baseline pain and medication duration were predictive of SWT. Both CWT and SWT were shorter compared to a concurrent cohort of lumbar stenosis patients (p <0.001). Conclusions: Patients with shorter duration (either symptoms or medication) and less neck pain waited less to see a spine specialist in Canada and to undergo surgical treatment. This study highlights some of the obstacles to overcome in expedited care for this patient population.
Distinguishing a disorder of persistent and impairing grief from normative grief allows clinicians to identify this often undetected and disabling condition. As four diagnostic criteria sets for a grief disorder have been proposed, their similarities and differences need to be elucidated.
Participants were family members bereaved by US military service death (N = 1732). We conducted analyses to assess the accuracy of each criteria set in identifying threshold cases (participants who endorsed baseline Inventory of Complicated Grief ⩾30 and Work and Social Adjustment Scale ⩾20) and excluding those below this threshold. We also calculated agreement among criteria sets by varying numbers of required associated symptoms.
All four criteria sets accurately excluded participants below our identified clinical threshold (i.e. correctly excluding 86–96% of those subthreshold), but they varied in identification of threshold cases (i.e. correctly identifying 47–82%). When the number of associated symptoms was held constant, criteria sets performed similarly. Accurate case identification was optimized when one or two associated symptoms were required. When employing optimized symptom numbers, pairwise agreements among criteria became correspondingly ‘very good’ (κ = 0.86–0.96).
The four proposed criteria sets describe a similar condition of persistent and impairing grief, but differ primarily in criteria restrictiveness. Diagnostic guidance for prolonged grief disorder in International Classification of Diseases, 11th Edition (ICD-11) functions well, whereas the criteria put forth in Section III of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) are unnecessarily restrictive.
Neurobehavioral disinhibition (ND) is a complex condition reflecting a wide range of problems involving difficulties with emotion regulation and behavior control. Respiratory sinus arrhythmia (RSA) is a physiological correlate of emotion regulation that has been studied in a variety of at-risk populations; however, there are no studies of RSA in children with ND. Data were drawn from a prospective longitudinal study of prenatal substance exposure that included 1,073 participants. Baseline RSA and RSA reactivity to an attention-demanding task were assessed at 3, 4, 5, and 6 years. ND was assessed at ages 8/9, 11, and 13/14 years via behavioral dysregulation and executive dysfunction composite measures. Greater exposure to early adversity was related to less RSA reactivity at 3 years, increases in RSA reactivity from ages 3 to 6 years, and increased behavioral dysregulation from ages 8/9 to 13/14. RSA reactivity was examined as a moderator of the association between early adversity and changes in ND. A significant Early Adversity × RSA Reactivity quadratic interaction revealed that children with decelerations in RSA reactivity exhibited increases in behavioral dysregulation, regardless of their exposure to early adversity. However, greater exposure to early adversity was related to greater increases in behavioral dysregulation, but only if children exhibited accelerations in RSA reactivity from ages 3 to 6 years. The results contribute to our understanding of how interactions across multiple levels of analysis contribute to the development of ND.
The growing number of nuclear power, research, and industrial facilities places increasing numbers of people and places at risk from an accident involving radioactive material. Fortunately, such accidents are infrequent. Unfortunately, this rarity often results in very limited hospital and physician interest and awareness. The incident at the nuclear facility at Three Mile Island (TMI) in Pennsylvania, USA, has demonstrated that despite its rarity, a radiation accident may not only occur, but occur on a scale large enough to require more than the radiation accident protocol which each hospital is required to have. There is a need, therefore, for the incorporation of radiation accidents into disaster planning and triage systems. We address the considerations to be made in planning an emergency medical system's response to a large radiation accident. We describe the application of a triage team in such a plan.
There is controversy concerning the best method for rapid fluid administration in shock secondary to severe or continuing blood loss. Some authors recommend immediate cutdown, while others support percutaneous central intravenous lines. In addition, the data available on maximum flow rates for various catheters is limited and does not compare different solutions. To gain more insight into these problems we have studied the flow rates for different lengths and gauges of catheters utilizing various physiologic solutions.
The negative effects of prenatal substance exposure on neurobiological and psychological development and of early adversity are clear, but little is known about their combined effects. In this study, multilevel analyses of the effects of prenatal substance exposure and early adversity on the emergence of neurobehavioral disinhibition in adolescence were conducted. Neurobehavioral disinhibition has previously been observed to occur frequently in multiproblem youth from high-risk backgrounds. In the present study, neurobehavioral disinhibition was assessed via behavioral dysregulation and poor executive function composite measures. Data were drawn from a prospective longitudinal investigation of prenatal substance exposure that included 1,073 participants followed from birth through adolescence. The results from latent growth modeling analyses showed mean stability but significant individual differences in behavioral dysregulation and mean decline with individual differences in executive function difficulties. Prior behavioral dysregulation predicted increased executive function difficulties. Prenatal drug use predicted the emergence and growth in neurobehavioral disinhibition across adolescence (directly for behavioral dysregulation and indirectly for executive function difficulties via early adversity and behavioral dysregulation). Prenatal drug use and early adversity exhibited unique effects on growth in behavioral dysregulation; early adversity uniquely predicted executive function difficulties. These results are discussed in terms of implications for theory development, social policy, and prevention science.
The wide bandgap semiconductor ZnSe has been nucleated on epitaxial (In,Ga)P buffer layers (on GaAs substrates) having various In compositions, and hence various lattice constants. The III-V ternary alloy offers a wide range of lattice constants for the heteroepitaxy of a multitude of potential II-VI light emitting devices, such as blue pn injection lasers composed of the (Zn,Mg)(S,Se) material system. Since the II-VI and III-V layers are grown using gas source molecular beam epitaxy in separate dedicated reactors, the technique of amorphous As deposition is employed to passivate the (In,Ga)P surface prior to the ex situ transfer. High resolution double crystal x-ray diffraction measurements on the ZnSe/(In,Ga)P/GaAs heterostructures indicate that for In compositions of 50-52%, the buffer layers with a thickness of 4 μm were only partially relaxed on the GaAs substrates, with the residual mismatch remaining at the ZnSe/III-V heterointerface. The critical thickness of (In,Ga)P, with In concentrations near 52-56%, on GaAs greatly exceeds the predicted critical thickness from either the energy balancing or force balancing model. For an In composition of 56% (and a film thickness of 4 μm), the buffer layers contain an in-plane lattice constant equal to that of ZnSe, and therefore represent the lattice-matched condition, even though the film is not fully relaxed. For (In,Ga)P buffer layers lattice-matched to ZnSe, but mismatched to GaAs, the surface exhibits the expected cross-hatched surface morphology. The occurrence of the cross-hatched surface is significantly alleviated by the addition of a pseudomorphic layer of GaAs positioned between the ZnSe and (In,Ga)P layer.
High quality ZnSe:Cl has been grown on GaAs by gas source molecular beam epitaxy (GSMBE); elemental Zn and H2Se are used as source materials, with ZnCl2 as a dopant source for donors. Atomic Cl concentrations ([Cl]) approaching 1020 cm−3 have been incorporated into the lattice as indicated by secondary ion mass spectrometry (SIMS). At incorporation levels greater than 1020 cm−3, an appreciable decrease in the growth rate has been observed. The sharp transition to a negligible growth rate is attributed to the occurrence of a surface chemical reaction originating from Cl and H which are present in the GSMBE environment. For [Cl] as high as 4 x 1018 cm−3, the films exhibited high crystalline quality, as indicated by photoluminescence originating from a single intense donor-bound excitonic transition. Hydrogenation of semiconductors can potentially result in the electrical passivation of incorporated acceptor and donor species. In the case of ZnSe:Cl, H was present in the ZnSe layers, but did not appear to adversely affect the electrical properties of the n-type films. In contrast, for the growth of ZnSe:N, where a nitrogen plasma cell was employed as a source of nitrogen, the H concentration (as determined by SIMS) was observed to track the N concentration. The ZnSe:N films were highly resistive for various amounts of N incorporation, which suggests that H incorporation is an issue of primary importance in the p-type doping of ZnSe grown by GSMBE.
While there is growing evidence of the increasing use of medicines by the elderly, research undertaken to critically examine differences among types of medicine users in this population is limited. Using population data, we examine the influence of social, demographic, and health-related factors on likelihood of being a non-user, a user of non-prescribed medicines only, or a user of prescription medicines only. We find some evidence of the rational use of drugs (i.e., those who are in better health are more likely to be non-users or to use non-prescribed medicines than those who are in poor health) and of rational explanations for reported use (i.e., being female is associated with less likelihood of non-use or exclusive use of non-prescription medicines than being male). Further analysis of the medicine-use patterns and decisions of elderly men and of those of elderly persons who are widowed or separated/divorced is warranted.
Two new X-autosome Robertsonian (Rb) translocations, Rb(X.9)6H and Rb(X.12)7H, were found during the course of breeding the Rb(X.2)2Ad rearrangement at Harwell. The influence of these new Rbs on meiotic chromosome segregation was investigated in hemizygous males and heterozygous females and compared to that of Rb(X. 2)2Ad. Screening of metaphase II spermatocytes gave incidences of sex chromosome aneuploidy of 9·2% in Rb(X. 2)6H/Y and 9·6% in Rb(X.9)2Ad/Y males; no metaphase II cells were present in the testes of the Rb(X. 12)7H/Y males examined and no males with this karyotype have so far proved fertile. In breeding tests, 5% of the progeny of Rb(X.2)2Ad/Y males were sex chromosome aneuploids compared to 10% of the Rb(X. 9)6H/Y offspring. The difference was not significant, however. Cytogenetic analyses of metaphase II stage oocytes showed elevated rates of hyperhaploidy (n + l) in Rb heterozygous females over chromosomally normal mice: 4·2% for Rb(X.2)2Ad/+; 2·1% for Rb(X.9)6H/+; 2·2% for Rb(X.12)7H/+ and 1·1% for normal females. There was, however, no statistically significant difference in the rates of hyperhaploidy between the three different Rb types, nor overall between Rb/ + and normal females. Karyotypic analyses of liveborn offspring of Rb heterozygous females revealed low incidences of X0 animals but no other type of sex chromosome aneuploidy. Intercrosses of heterozygous females and hemizygous males yielded 5·5% aneuploidy for Rb(X.2)2Ad and 5·4% for Rb(X.9)6H. In heterozygous females, there was evidence from the metaphase II and breeding test data for all three rearrangements, of preferential segregation of the Rb metacentric to the polar body resulting in a deficiency of cells and progeny carrying a translocation chromosome.
Intensive agriculture played a pivotal role in the development of archaic states, but there is considerable debate concerning its relationship to population growth, climatic variability, and centralization.
The template-synthetic method is a general approach for preparing tubular micro-and nanostructures. This method has been used to prepare micro- and nanostructures composed of metals, carbons, semiconductors, polymers, and Li+-intercalation materials. This paper describes the use of the template method to prepare composite tubular micro- and nanostructures. These composite structures consist of an outer tubule of one material surrounding inner tubules of different materials. Chemical strategies used to prepare these composite tubular structures include electroless deposition of Au, electropolymerization of conductive and insulating polymers, electrodeposition of metals and semiconductors, carbonization of polymer precursors, chemical vapor deposition synthesis, and sol-gel synthesis.