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A space X is said to be Lipschitz 1-connected if every Lipschitz loop 𝛾 : S1 → X bounds a O (Lip(𝛾))-Lipschitz disk f : D2 → X. A Lipschitz 1-connected space admits a quadratic isoperimetric inequality, but it is unknown whether the converse is true. Cornulier and Tessera showed that certain solvable Lie groups have quadratic isoperimetric inequalities, and we extend their result to show that these groups are Lipschitz 1-connected.
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.
Objectives: Rates of cognitive, academic and behavioral comorbidities are elevated in children with epilepsy. The contribution of environmental and genetic influences to comorbidity risk is not fully understood. This study investigated children with epilepsy, their unaffected siblings, and controls to determine the presence and extent of risk associated with family relatedness across a range of epilepsy comorbidities. Methods: Participants were 346 children (8–18 years), n=180 with recent-onset epilepsy, their unaffected siblings (n=67), and healthy first-degree cousin controls (n=99). Assessments included: (1) Child Behavior Checklist/6-18 (CBCL), (2) Behavior Rating Inventory of Executive Function (BRIEF), (3) history of education and academic services, and (4) lifetime attention deficit hyperactivity disorder (ADHD) diagnosis. Analyses consisted of linear mixed effect models for continuous variables, and logistic mixed models for binary variables. Results: Differences were detected between the three groups of children across all measures (p<.001). For ADHD, academic problems, and executive dysfunction, children with epilepsy exhibited significantly more problems than unaffected siblings and controls; siblings and controls did not differ statistically significantly from each other. For social competence, children with epilepsy and their unaffected siblings displayed more abnormality compared with controls, with no statistically significant difference between children with epilepsy and unaffected siblings. For behavioral problems, children with epilepsy had more abnormality than siblings and controls, but unaffected siblings also exhibited more abnormalities than controls. Conclusions: The contribution of epilepsy and family relatedness varies across specific neurobehavioral comorbidities. Family relatedness was not significantly associated with rates of ADHD, academic problems and executive dysfunction, but was associated with competence and behavioral problems. (JINS, 2018, 24, 1–9)
The suboptimal provision of analgesia to children in the emergency department (ED) is well-described. A yet unexplored barrier is caregiver or child refusal of analgesia. We sought to evaluate the frequency of caregiver/child acceptance of analgesia offered in the ED.
We conducted a two-centre cross-sectional study of 743 caregivers of children 4–17 years presenting to the pediatric ED with an acutely painful condition using a survey and medical record review. The primary outcome was the proportion of children/caregiver pairs who accepted analgesia in the ED.
The median (IQR) age of children was 11 (7) years, and 339/743 (45.6%) were female. The overall survey response rate was 73% (743/1018). In the 24 hours preceding ED arrival, the median (IQR) maximal pain score rated by children and caregivers was 8/10 (4) and 5/10 (2), respectively, and 30.4% (226/743) of caregivers offered analgesia. In the ED, children reported a median (IQR) pain score of 8/10 (2) and 54.9% (408/743) were offered analgesia. When offered in the ED, analgesia was accepted by 91% (373/408). Overall, 55.7% (414/743) of children received some form of analgesia.
Most caregivers/children accept analgesia when offered by ED personnel, suggesting refusal is not a major barrier to optimal management of children’s pain and highlighting the importance of ED personnel in encouraging adequate analgesia. A large proportion of children in pain are not offered analgesia by caregivers or ED personnel. Educational strategies for recognizing and treating pain should be directed at children, caregivers, and ED personnel.
The Flow of drugs from Mexico to the United States has been a source of trouble in US-Mexican relations for at least two decades. The dominant view in Mexico is that the problem arises from the inability of the United States to control its domestic demand for heroin, cocaine, and marijuana. The dominant US view has been that the Mexican government has failed to make effective efforts to control the supply of drugs. At times — in particular after the killing of Enrique Camarena, an agent of the Drug Enforcement Administration (DEA), in 1985 — US government anger at Mexico's alleged failure to maintain the integrity of its anti-drug efforts has been the dominant source of friction between the two nations.
In Just 20 Years Peru has shifted from beacon of hope to basket case. As late as the mid-1970s, Peru's reformist military government (1968-1980) appeared to offer significant possibilities for economic and political development (defined as improved distribution of income and greater participation by the citizenry). From 1940 to 1975, economic growth and low inflation had been the norm. A major agrarian reform during the military docenio (12-year rule) created production cooperatives nation wide; the industrial community gave workers a meaningful management role in the operation of their firms. Both stirred the imagination of many Peruvians and the academic community alike.
Burn patients are particularly vulnerable to infection, and an estimated half of all burn deaths are due to infections. This study explored risk factors for healthcare-associated infections (HAIs) in adult burn patients.
Retrospective cohort study.
Tertiary-care burn center.
Adults (≥18 years old) admitted with burn injury for at least 2 days between 2004 and 2013.
HAIs were determined in real-time by infection preventionists using Centers for Disease Control and Prevention criteria. Multivariable Cox proportional hazards regression was used to estimate the direct effect of each risk factor on time to HAI, with inverse probability of censor weights to address potentially informative censoring. Effect measure modification by burn size was also assessed.
Overall, 4,426 patients met inclusion criteria, and 349 (7.9%) patients had at least 1 HAI within 60 days of admission. Compared to <5% total body surface area (TBSA), patients with 5%–10% TBSA were almost 3 times as likely to acquire an HAI (hazard ratio [HR], 2.92; 95% CI, 1.63–5.23); patients with 10%–20% TBSA were >6 times as likely to acquire an HAI (HR, 6.38; 95% CI, 3.64–11.17); and patients with >20% TBSA were >10 times as likely to acquire an HAI (HR, 10.33; 95% CI, 5.74–18.60). Patients with inhalational injury were 1.5 times as likely to acquire an HAI (HR, 1.61; 95% CI, 1.17–2.22). The effect of inhalational injury (P=.09) appeared to be larger among patients with ≤20% TBSA.
Larger burns and inhalational injury were associated with increased incidence of HAIs. Future research should use these risk factors to identify potential interventions.
This article reviews the major paradigm shifts that have occurred in the area of the application of clinical and experimental neuropsychology to epilepsy and epilepsy surgery since the founding of the International Neuropsychological Society. The five paradigm shifts discussed include: 1) The neurobiology of cognitive disorders in epilepsy – expanding the landscape of syndrome-specific neuropsychological impairment; 2) pathways to comorbidities: bidirectional relationships and their clinical implications; 3) discovering quality of life: The concept, its quantification and applicability; 4) outcomes of epilepsy surgery: challenging conventional wisdom; and 5) Iatrogenic effects of treatment: cognitive and behavioral effects of antiepilepsy drugs. For each area we characterize the status of knowledge, the key developments that have occurred, and how they have altered our understanding of the epilepsies and their management. We conclude with a brief overview of where we believe the field will be headed in the next decade which includes changes in assessment paradigms, moving from characterization of comorbidities to interventions; increasing development of new measures, terminology and classification; increasing interest in neurodegenerative proteins; transitioning from clinical seizure features to modifiable risk factors; and neurobehavioral phenotypes. Overall, enormous progress has been made over the lifespan of the INS with promise of ongoing improvements in understanding of the cognitive and behavioral complications of the epilepsies and their treatment. (JINS, 2017, 23, 791–805)
Two medium-depth ice cores were retrieved from Berkner Island by a joint project between the Alfred-Wegener-Institut and the British Antarctic Survey in the 1994/95 field season. A 151m deep core from the northern dome (Reinwarthhöhe) of Berkner Island spans 700 years, while a 181 m deep core from the southern dome (Thyssenhöhe) spans approximately 1200 years. Both cores display clear seasonal cycles in electrical conductivity measurements, allowing dating by annual-layer counting and the calculation of accumulation profiles. Stable-isotope measurements (both δ18O and δD), together with the accumulation data, allow us to estimate changes in climate for most of the past millennium: the data show multi-decadal variability around a generally stable long-termmean. In addition, a full suite of major chemistry measurements is available to define the history of aerosol deposition at these sites: again, there is little evidence that the chemistry of the sites has changed over the past six centuries. Finally, we suggest that the southern dome, with an ice thickness of 950 m, is an ideal site from which to gain a climate history of the late stages of the last glacial and the deglaciation for comparison with the records from the deep Antarctic ice cores, and with other intermediate-depth cores such as Taylor Dome and Siple Dome.
A large number of multispectral and stereo-image data are expected to become available as part of the Global Land Ice Measurements from Space project. We investigate digital elevation model extraction, anisotropic reflectance correction and selected glacier analysis tasks that must be developed to achieve full utility of these new data. Results indicate that glaciers in the Karakoram and Nanga Parbat Himalaya, northern Pakistan, exhibit unique spectral, spatial and geomorphometric patterns that can be exploited by various models and algorithms to produce accurate information regarding glacier extent, supraglacial features and glacier geomorphology The integration of spectral, spatial and geomorphometric features, coupled with approaches for advanced pattern recognition, can help geoscientists study glacier mass balance, glacier erosion, sediment-transfer efficiency and landscape evolution.
For a sample of halo binaries, we find that the transition between circular and eccentric orbits occurs at a period of at least 18.7 days. This is consistent with the Goldman & Mazeh theory of tidal circularization on the main sequence.
From a new photometric and spectroscopic survey of high proper motion stars, combined with previously published work, we find that the local value of the escape velocity from the Galaxy exceeds 500 km s−1. This gives direct dynamical evidence that the total Galactic mass exceeds the mass inside the solar orbit by a factor of at least five.
We are investigating a complete sample of flat-spectrum extragalactic radio quasars drawn from the Parkes 2.7 GHz survey. The sample is being used to map the space distribution of radio quasars and to determine their luminosity function. Accurate positions are being measured for a selection of the brighter quasars in order to establish an extragalactic position reference frame in the Southern Hemisphere.