Book chapters will be unavailable on Saturday 24th August between 8am-12pm BST. This is for essential maintenance which will provide improved performance going forwards. Please accept our apologies for any inconvenience caused.
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.
Make recommendations on approaches to building and strengthening relationships between academic departments or divisions of Emergency Medicine and rural and regional emergency departments.
A panel of leaders from both rural and urban/academic practice environments met over 8 months. Draft recommendations were developed from panel expertise as well as survey data and presented at the 2018 Canadian Association of Emergency Physicians (CAEP) Academic Symposium. Symposium feedback was incorporated into final recommendations.
Seven recommendations emerged and are summarized below:
1)CAEP should ensure engagement with other rural stakeholder organizations such as the College of Family Physicians of Canada and the Society of Rural Physicians of Canada.
2)Engagement efforts require adequate financial and manpower resources.
3)Training opportunities should be promoted.
4)The current operational interface between the academic department of Emergency Medicine and the emergency departments in the catchment area must be examined and gaps addressed as part of building and strengthening relationships.
5)Initial engagement efforts should be around projects with common value.
6)Academic Departments should partner with and support rural scholars.
7)Academic departments seeking to build or strengthen relationships should consider successful examples from elsewhere in the country as well as considering local culture and challenges.
These recommendations serve as guidance for building and strengthening mutually beneficial relationships between academic departments or divisions of Emergency Medicine and rural and regional emergency departments.
Suboptimality of decision making needs no explanation. High-level accounts of suboptimality in diverse tasks cannot add up to a mechanistic theory of perceptual decision making. Mental processes operate on the contents of information brought by the experimenter and the participant to the task, not on the amount of information in the stimuli without regard to physical and social context.
Decision-makers are increasingly recognizing the usefulness of qualitative research to inform patient-centered policy decisions, and are accordingly increasingly demanding qualitative evidence as part of health technology assessment (HTA). In the context of tight HTA timelines, a new form of evidence synthesis has emerged—rapid qualitative reviews. The need for rapidity requires either an increase in resources or, more commonly, a compromise in rigor, yet guidance on appropriate compromises for qualitative reviews is lacking.
In order to inform de novo guidance, we conducted a systematic scoping review to identify existing guidance and published examples of rapid qualitative reviews. We searched Medline and CINAHL using medical subject headings and keywords related to “rapid reviews” and “qualitative” research, and screened the 1,771 resultant citations independently in duplicate. Additionally, we searched the grey literature and solicited examples from our contacts and other evidence-synthesis organizations. We summarized included guidance and reviews using the Search, AppraisaL, Synthesis, Analysis (SALSA) framework to identify abbreviations in the review process.
We found no guidance documents specific to rapid qualitative reviews. We found one published peer-reviewed rapid qualitative review, and several more (>10; grey literature search in process) through our organizational contacts. While methods to abbreviate the process are poorly reported, an abbreviated literature search (years and databases searched) and the use of a single reviewer appear common.
A number of agencies are producing rapid qualitative reviews, however our review identifies the urgent need to develop and explore methods for the synthesis of qualitative research that balance rapidity and rigor.
For many decades thinness has been a desirable attribute for women in prosperous northern European and American cultures. Over the last 20 years or so the acceptable female shape has become even slimmer (Garner & Garfinkel, 1980). The increased emphasis on thinness among women is also apparent from the rising number of articles on slimming in women's magazines in recent years.
The role that vitamin D plays in pulmonary function remains uncertain. Epidemiological studies reported mixed findings for serum 25-hydroxyvitamin D (25(OH)D)–pulmonary function association. We conducted the largest cross-sectional meta-analysis of the 25(OH)D–pulmonary function association to date, based on nine European ancestry (EA) cohorts (n 22 838) and five African ancestry (AA) cohorts (n 4290) in the Cohorts for Heart and Aging Research in Genomic Epidemiology Consortium. Data were analysed using linear models by cohort and ancestry. Effect modification by smoking status (current/former/never) was tested. Results were combined using fixed-effects meta-analysis. Mean serum 25(OH)D was 68 (sd 29) nmol/l for EA and 49 (sd 21) nmol/l for AA. For each 1 nmol/l higher 25(OH)D, forced expiratory volume in the 1st second (FEV1) was higher by 1·1 ml in EA (95 % CI 0·9, 1·3; P<0·0001) and 1·8 ml (95 % CI 1·1, 2·5; P<0·0001) in AA (Prace difference=0·06), and forced vital capacity (FVC) was higher by 1·3 ml in EA (95 % CI 1·0, 1·6; P<0·0001) and 1·5 ml (95 % CI 0·8, 2·3; P=0·0001) in AA (Prace difference=0·56). Among EA, the 25(OH)D–FVC association was stronger in smokers: per 1 nmol/l higher 25(OH)D, FVC was higher by 1·7 ml (95 % CI 1·1, 2·3) for current smokers and 1·7 ml (95 % CI 1·2, 2·1) for former smokers, compared with 0·8 ml (95 % CI 0·4, 1·2) for never smokers. In summary, the 25(OH)D associations with FEV1 and FVC were positive in both ancestries. In EA, a stronger association was observed for smokers compared with never smokers, which supports the importance of vitamin D in vulnerable populations.
Some individuals have a neurogenetic vulnerability to developing strong facilitation of ingestive movements by learned configurations of biosocial stimuli. Condemning food as addictive is mere polemic, ignoring the contextualised sensory control of the mastication of each mouthful. To beat obesity, the least fattening of widely recognised eating patterns needs to be measured and supported.
The collective response of electrons in an ultrathin foil target irradiated by an ultraintense (
) laser pulse is investigated experimentally and via 3D particle-in-cell simulations. It is shown that if the target is sufficiently thin that the laser induces significant radiation pressure, but not thin enough to become relativistically transparent to the laser light, the resulting relativistic electron beam is elliptical, with the major axis of the ellipse directed along the laser polarization axis. When the target thickness is decreased such that it becomes relativistically transparent early in the interaction with the laser pulse, diffraction of the transmitted laser light occurs through a so called ‘relativistic plasma aperture’, inducing structure in the spatial-intensity profile of the beam of energetic electrons. It is shown that the electron beam profile can be modified by variation of the target thickness and degree of ellipticity in the laser polarization.
Among dialysis facilities participating in a bloodstream infection (BSI) prevention collaborative, access-related BSI incidence rate improvements observed immediately following implementation of a bundle of BSI prevention interventions were sustained for up to 4 years. Overall, BSI incidence remained unchanged from baseline in the current analysis.
The measured spatial-intensity distribution of the beam of protons accelerated from the rear side of a solid target irradiated by an intense (>1019 Wcm−2) laser pulse provides a diagnostic of the two-dimensional fast electron density profile at the target rear surface and thus the fast electron beam transport pattern within the target. An analytical model is developed, accounting for rear-surface fast electron sheath dynamics, ionization and projection of the resulting beam of protons. The sensitivity of the spatial-intensity distribution of the proton beam to the fast electron density distribution is investigated. An annular fast electron beam transport pattern with filamentary structure is inferred for the case of a thick diamond target irradiated at a peak laser intensity of 6 × 1019 Wcm−2.
Using photometry at just two wavelengths it is possible to fit a blackbody to the spectrum of infrared excess that is the signature of a debris disc. From this the location of the dust can be inferred. However, it is well known that dust in debris discs is not a perfect blackbody. By resolving debris discs we can find the actual location of the dust and compare this to that inferred from the blackbody fit. Using the Herschel Space Observatory we resolved many systems as part of the DEBRIS survey. Here we discuss a sample of 9 discs surrounding A stars and find that the discs are actually located between 1 and 2.5 times further from their star than predicted by blackbody fits to the spectral energy distribution (SED). The variation in this ratio is due to differences in stellar luminosities, location of the dust, size distribution and composition of the dust.
Future success in microelectronics will demand rapid innovation, rapid product introduction and ability to react to a change in technological and business climate quickly. These technological advances in integrated electronics will require development of flexible manufacturing technology for VLSI systems. However, the current approach of establishing factories for mass manufacturing of chips at a cost of more than 200 million dollars is detrimental to flexible manufacturing. We propose concepts of a micro factory which may be characterized by more economical small scale production, higher flexibility to accommodate many products on several processes, and faster turnaround and learning. In-situ multiprocessing equipment where several process steps can be done in sequence may be a key ingredient in this approach. For this environment to be flexible, the equipment must have ability to change processing environment, requiring extensive in-situ measurements and real time control. In this paper we describe the development of a novel single wafer Rapid Thermal Multiprocessing (RTM) reactor for next generation flexible VLSI manufacturing. This reactor will combine lamp heating, remote microwave plasma and photo processing in a single cold-wall chamber, with applications for multilayer in-situ growth and deposition of dielectrics, semiconductors and metals.
It is now widely recognized that a decentralized approach to the control of parasitic infections in rural sub-Saharan populations allows for the design of more effective control programmes and encourages high compliance. Compliance is usually an indicator of treatment success, but cannot be used as a measure of long-term benefit since re-infection will be strongly influenced by a number of factors including the social ecology of a community. In this paper qualitative and quantitative methods are used to identify and understand the structural and behavioural constraints that may influence water contact behaviour and create inequalities with respect to Schistosoma re-infection following anti-helminth drug treatment. The research is set in a community where participant engagement has remained uniformly high throughout the course of a 10-year multidisciplinary study on treatment and re-infection, but where levels of re-infection have not been uniform and, because of variations in water contact behaviour, have varied by age, sex and ethnic background. Variations in the biomedical knowledge of schistosomiasis, socioeconomic constraints and ethnic differences in general attitudes towards life and health are identified that may account for some of these behavioural differences. The observations highlight the benefits of understanding the socio-ecology of control and research settings at several levels (both between and within ethnic groups); this will help to design more effective and universally beneficial interventions for control and help to interpret research findings.
A discrete subaortic membrane cannot only cause left ventricular outflow tract obstruction, but can grow onto the aortic valve leaflets. The late finding of this encroachment is aortic valve insufficiency or stenosis. Echocardiography is used to follow the progression of outflow tract obstruction, but its ability to show subaortic membrane encroachment onto the aortic valve is unclear. The purpose of this study is to determine the sensitivity and specificity of echocardiography for diagnosing whether a discrete subaortic membrane involves the aortic valve.
A pre-operative determination of aortic valve involvement by a discrete subaortic membrane was obtained by review of the official pre-operative echocardiogram reading and a retrospective blinded review of the pre-operative echocardiogram by an independent echocardiographer. These findings were compared to the intra-operative findings.
A total of 48 consecutive patients underwent primary resection for isolated discrete subaortic membrane between October, 1995 and May, 2006. The pre-operative and blinded readings both predicted a statistically lower rate of aortic valve involvement – 35% in 11 of 31 patients and 31% in 10 of 31 patients, respectively – than found at surgery – 65% in 31 of 48 patients. The sensitivity and specificity of pre-operative echocardiography to diagnose aortic valve involvement is 35% and 76%. Overall survival was 100%. There were no strokes, re-operations for bleeding or wound infections, or need for a pacemaker.
Echocardiography is not sensitive in assessing whether a discrete subaortic membrane involves the aortic valve. Since the morbidity and mortality for discrete subaortic membrane resection is negligible, resection may be indicated at the time of diagnosis to minimise aortic valve impairment.
In this paper we report on the diversity and distribution of a set of non-LTR retrotransposon (RTP) reverse transcriptase (RT) sequences isolated from phlebotomine sandflies, and their potential for investigating the evolutionary histories of members of this subfamily of flies (Diptera: Psychodidae, Phlebotominae). The phlebotomine RT sequence families derived from one species were as different from each other as they were from RT sequences derived from other species. When each was used to probe Southern blots of sandfly genomic DNA they hybridized only to the species of source and, usually, to others of the same subgenus, but not to DNA from other subgenera — a hybridization pattern consistent with vertical evolution. There was considerable intraspecific variation in hybridization pattern, suggesting the RTs were part of non-LTR RTPs that are (or were recently) subject to flux in genomic position and copy number. Most of the RT families detected in phlebotomines are monophyletic with respect to previously described RTs, and all are monophyletic with RTs of the F/Jockey (Drosophila melanogaster) type of RTP. Orthologous sequences were isolated from the closely related species Phlebotomus perniciosus and P. tobbi (subgenus Larroussius), and different populations of P. perniciosus. The level of sequence divergence among these orthologous RTs, the subgeneric distribution of each RT family, and the intraspecific variation in hybridization pattern of many of them, indicate this class of sequence will provide genetic markers at the sub-generic level.
The effects of varying the pulse energy of a picosecond laser used in the pulsed-laser atom-probe (PLAP) tomography of an as-quenched Ni-6.5 Al-9.5 Cr at.% alloy are assessed based on the quality of the mass spectra and the compositional accuracy of the technique. Compared to pulsed-voltage atom-probe tomography, PLAP tomography improves mass resolving power, decreases noise levels, and improves compositional accuracy. Experimental evidence suggests that Ni2+, Al2+, and Cr2+ ions are formed primarily by a thermally activated evaporation process, and not by post-ionization of the ions in the 1+ charge state. An analysis of the detected noise levels reveals that for properly chosen instrument parameters, there is no significant steady-state heating of the Ni-6.5 Al-9.5 Cr at.% tips during PLAP tomography.
This study investigated factors that influence occurrence and persistence of plant DNA in the soil environment in three crop rotations. In each rotation, soil was sampled in May before planting, in July and August while crops were growing, and in October after harvest. Total DNA was recovered from soil samples taken at two different depths in the soil profile and quantified. Three target plant genes (corn CP4 epsps, corn 10-kD Zein, and soybean CP4 epsps) also were quantified in these DNA extracts using species-specific quantitative real-time PCR assays. In general, total plant DNA content in the soil environment was greatest when the crop was growing in the field and decreased rapidly after harvest. Nevertheless, low levels of target plant DNA were often still detectable the following spring. Age of rotation did not influence target DNA quantities found in the soil environment. Data were collected for a combination of 10 location-years, which allowed for estimation of the variance components for six factors including time of sampling, year, location, crop, sampling depth, and herbicide to total and target DNA content in the soil samples. Mean target recombinant DNA content in soil was influenced most strongly by time of sampling and year (85 and 6%, respectively), whereas total soil DNA content was less dynamic and was most strongly influenced by location and year (49 and 25%, respectively). Over the duration of this study, no accumulation of transgenic plant DNA in the soil environment was observed.
Types of sensory receptor can only be identified by multidimensional discrimination of a familiar version of a sensed object from variants that disconfound putative types. By that criterion, there is as yet no evidence against just the four classic types of gustatory receptor, for sodium salts, alkaloids, sugars, and proton donors.
Money does not stimulate receptors in mimicry of natural agonists; so, by definition, money is not a drug. Attractions of money other than to purchase goods and services could arise from instincts similar to hoarding in other species. Instinctual activities without evolutionary function include earning a billion and writing for BBS.