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Conventional approaches to evidence that prioritise randomised controlled trials appear increasingly inadequate for the evaluation of complex mental health interventions. By focusing on causal mechanisms and understanding the complex interactions between interventions, patients and contexts, realist approaches offer a productive alternative. Although the approaches might be combined, substantial barriers remain.
Declaration of interest
All authors had financial support from the National Institute for Health Research Health Services and Delivery Research Programme while completing this work. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the National Health Service, the National Institute for Health Research, the Medical Research Council, Central Commissioning Facility, National Institute for Health Research Evaluation, Trials and Studies Coordinating Centre, the Health Services and Delivery Research Programme or the Department of Health. S.P.S. is part funded by Collaboration for Leadership in Applied Health Research and Care West Midlands. K.B. is editor of the British Journal of Psychiatry.
Children with CHD and acquired heart disease have unique, high-risk physiology. They may have a higher risk of adverse tracheal-intubation-associated events, as compared with children with non-cardiac disease.
Materials and methods
We sought to evaluate the occurrence of adverse tracheal-intubation-associated events in children with cardiac disease compared to children with non-cardiac disease. A retrospective analysis of tracheal intubations from 38 international paediatric ICUs was performed using the National Emergency Airway Registry for Children (NEAR4KIDS) quality improvement registry. The primary outcome was the occurrence of any tracheal-intubation-associated event. Secondary outcomes included the occurrence of severe tracheal-intubation-associated events, multiple intubation attempts, and oxygen desaturation.
A total of 8851 intubations were reported between July, 2012 and March, 2016. Cardiac patients were younger, more likely to have haemodynamic instability, and less likely to have respiratory failure as an indication. The overall frequency of tracheal-intubation-associated events was not different (cardiac: 17% versus non-cardiac: 16%, p=0.13), nor was the rate of severe tracheal-intubation-associated events (cardiac: 7% versus non-cardiac: 6%, p=0.11). Tracheal-intubation-associated cardiac arrest occurred more often in cardiac patients (2.80 versus 1.28%; p<0.001), even after adjusting for patient and provider differences (adjusted odds ratio 1.79; p=0.03). Multiple intubation attempts occurred less often in cardiac patients (p=0.04), and oxygen desaturations occurred more often, even after excluding patients with cyanotic heart disease.
The overall incidence of adverse tracheal-intubation-associated events in cardiac patients was not different from that in non-cardiac patients. However, the presence of a cardiac diagnosis was associated with a higher occurrence of both tracheal-intubation-associated cardiac arrest and oxygen desaturation.
Cattle manure value chains play important biological and economic roles in smallholder crop–livestock systems in developing countries, but relative to other livestock products our understanding of the nature and impact of manure sales is limited. In regions with an active manure trade, farmers face a choice between manure use on-farm and sales, which affects nutrient flows and participant incomes. We analyzed the manure value chain operating in south-central Vietnam as an example of the function and role of manure trade in crop–livestock systems. Lowland cattle farmers sell manure through a network of chain participants, including small-scale collectors, lowland and highland traders, to pepper, coffee, dragon fruit and rubber farms in the central highlands and southeast coast. We collected and summarized quantitative data (e.g., manure-related labor, manure transactions, and fertilizer and manure use) gathered in semi-structured interviews with value-chain participants [lowland cattle owners (n = 101), traders (n = 27) and end users (n = 72)]. Lowland cattle owners were selected by stratified random sampling, and subsequent participants were identified in preceding interviews. One key finding concerns the seasonality of the manure value chain: most manure flowed between February and August (lowland dry season and period of peak highland demand) from lowland communes to highland coffee and pepper farms for use as organic soil amendments. Fewer sales occurred, at a lower price, to southeast coastal dragon fruit farms and rubber companies. Value addition to manure occurred via drying, bagging, collection, transport and composting. The presence of local traders facilitated market sales for smallholder cattle owners, and prices through the value chain generally reflected costs for value addition. The geographic distribution of cattle relative to agricultural land influenced the flow of manure, with net outflows from regions with higher animal density to regions with lower density and higher value crop production. Manure trade was an important source of supplementary income for farmers and a primary livelihood activity for traders. Value chain participant net incomes ranged from near US$100 yr−1 for lowland farmers to over US$13,000 yr−1 for traders, and returns to labor were just over US$0.50 h−1 for lowland farmers and US$2 h−1 for traders. The quantitative information generated during our descriptive assessment provides an important first step toward manure value chain improvement, indicates survey methods that can be applied in other areas, and identifies next steps necessary to evaluate chain evolution and resilience.
Individual variables and area-level variables have been identified as explaining much of the variance in rates of compulsory in-patient treatment.
To describe rates of voluntary and compulsory psychiatric in-patient treatment in rural and urban settings in England, and to explore the associations with age, ethnicity and deprivation.
Secondary analysis of 2010/11 data from the Mental Health Minimum Dataset.
Areas with higher levels of deprivation had increased rates of in-patient treatment. Areas with high proportions of adults aged 20–39 years had the highest rates of compulsory in-patient treatment as well as the lowest rates of voluntary in-patient treatment. Urban settings had higher rates of compulsory in-patient treatment and ethnic density was associated with compulsory treatment in these areas. After adjusting for age, deprivation and urban/rural setting, the association between ethnicity and compulsory treatment was not statistically significant.
Age structure of the adult population and ethnic density along with higher levels of deprivation can account for the markedly higher rates of compulsory in-patient treatment in urban areas.
We demonstrate that the second-Stokes output from a diamond Raman laser, pumped by a femtosecond Ti:Sapphire laser, can be used to efficiently excite red-emitting dyes by two-photon excitation at 1,080 nm and beyond. We image HeLa cells expressing red fluorescent protein, as well as dyes such as Texas Red and Mitotracker Red. We demonstrate the potential for simultaneous two-color, two-photon imaging with this laser by using the residual pump beam for excitation of a green-emitting dye. We demonstrate this for the combination of Alexa Fluor 488 and Alexa Fluor 568. Because the Raman laser extends the wavelength range of the Ti:Sapphire laser, resulting in a laser system tunable to 680–1,200 nm, it can be used for two-photon excitation of a large variety and combination of dyes.
The glass substrate plays a crucial role in the successful performance of advanced flat panel displays (FPDs). These FPD technologies include active-matrix liquid crystal displays (AMLCD) and Plasma Displays (PDP). Although these displays are different in the way in which they operate, there are several common substrate requirements, all of which are determined by the process for making the entire display. These include issues relating to substrate size, thermal shrinkage, high temperature stability, and substrate surface quality.
While AMLCD technology is moving toward larger sizes, PDPs are currently large size displays, requiring large glass substrates. The primary issue in using larger substrates is minimizing distortion of the glass during high temperature processes, both viscous sag and shrinkage. These are related to the high temperature thermal stability which, in turn, is largely determined by the strain point and thermal history of the substrate. Finally, thickness uniformity and surface flaws are critical to the performance of the final display.
Coming's Code 1737 glass substrate meets the requirements for AMLCDs and has become the industry standard. Corning/Saint-Gobain Code CS25 glass is a new glass that has significant benefits over soda-lime glass for PDP applications. This paper will discuss these two glasses in terms of the above-mentioned issues.
In this study, we use novel thermal deposition techniques to synthesize films of poly(vinlyidene fluoride), or PVDF, containing nanoparticles of the ceramic titanium dioxide (TiO2). This ferroelectric polymer has shown promise as a capacitor dielectric material, and possible enhanced electrical properties when combined with ceramic nanoparticles. Characterization of these composite films has been performed including chemical structure and microstructure using SFM, XPS, and EDS techniques. Measurements of film parameters such as dielectric constant and breakdown voltage have also been performed, and the dispersion of the ceramic particles within the films has been characterized
ATIGA AND ACIA — IMPORTANT DEVELOPMENTS FOR BUSINESS
The ATIGA and ACIA are important developments in ASEAN for the business community:
• They consolidate many existing agreements thereby providing more coherence and transparency for business;
• They have been improved and modernized to address the complex linkages needed for doing business in an integrated market; and
• They provide more policy certainty for business by fleshing out how ASEAN intends to build its single market.
THE INFORMATION CHALLENGE
Even though they are not entirely new, the agreements contain a huge amount of information of policy significance to business and it will not be easy for business to absorb this information and assess the new opportunities that can emerge.
It is vital that ASEAN governments, the ASEAN Secretariat and the business community address the information gap very quickly. The gap needs to be filled through better access to information, information that can be understood by business, and socialization of that information.
Some ASEAN countries have built websites specifically for business and they are very helpful. However, not all developing countries in ASEAN have the capacity to duplicate these types of websites and that may not be an effective use of resources for much of the information about ASEAN. Rather, the ASEAN Secretariat should be the information hub of the emerging economic community. It should be provided with sufficient funds and resources to build a single business Web portal that can be supplemented by government and business in individual countries.
ASEAN documents must be translated into a language and format that is useful and practical for business, especially for smaller and medium sized firms who may not be as familiar with analysing formal international agreements.
At present, it is difficult to design socialization programmes for business with information in the current format. And with only six years to go before the AEC is to go into full effect, there is an urgent need for more socialization for business in ASEAN on a significant scale.
Marine and terrestial animals have been shown to be particularly abundant in a wildlife community associated with a marine sewer outfall from the City of Vancouver. These same animals are contaminated with high levels of heavy-metals but are apparently protected from their poisonous effects by the production of a protein known as metallothionein. The amount of metallothionein and heavy-metal loading appears to depend primarily on the degree of pollution and secondly on the species of animal and its position in the food-web.
The increasing popularity of national parks and other wilderness areas has focused attention on the need for effective wilderness management policies. In many cases active management programmes are required to assure that naturally functioning ecosystems are preserved. External influences such as air pollution, exotic species, and impacts from visitor-use, must be understood and controlled. This paper reviews a case-example of management strategies that were utilized to minimize visitor use-impacts in the backcountry wilderness of Kings Canyon National Park in the southern Sierra Nevada of California.
The exclusion of fire from the low-elevation foothills of the southern Sierra Nevada of California over the past century has resulted in large expanses of over-mature, senescent chaparral. The fuel buildup associated with this situation poses a threat, in that any fire which gets started has the potential of becoming a major holocaust.
A detailed analysis is made of the vegetational succession following fire in four different-aged stands of Chamise chaparral in the southern Sierra Nevada. Progression from a diverse multi-species herb and shrub community towards a dense, structurally uniform, low-diversity stand dominated by a single woody species, Adenostoma fasciculatum (Chamise), is demonstrated. An increase in shrub cover and height along with the amount of dead material found laddered through the canopy, create optimal conditions for combustion within some 35 years following the last fire. The herbaceous vegetation shows a high diversity and cover in the first few years after burning, but rapidly decreases thereafter. Evidence is presented that frequent fires are required to maintain the chaparral community in a vigorous and healthy state. The need to institute progressive fuel-management programmes which recognize the natural role of fire in the evolution of the chaparral type wherever it is found, is discussed and advocated. Attempts are also made to relate these findings to the preservation of other fire-adapted vegetation types of the world.
After Selective Availability (SA) was turned off, the rate of change with time of the DGPS common errors (atmospheric delay, satellite orbit and clock error) became quite slow. This inevitably leads to a requirement to modify various configurations of DGPS correction message broadcasting, and reference station (RS) managers need to examine the characteristics of GPS measurement errors with SA-off. GPS error sources are temporally and spatially decorrelated, so the DGPS user position accuracy is varied by the baud-rate of the RS, the distance between the user and the station, and the noise statistics of the receiver. We identify the minimum and maximum size of correction data, interval time, the coverage range and the baud-rate that are required to maintain the existing DGPS service. Moreover, the compatibility and accuracy can be assessed to meet the users' requirements without measurements being needed. The results in this paper are used in the study and testing for the redesign of United States Coast Guard (USCG) RS. We hope that our study will be a great help in determining the flexible factors of both the RS and the user.
ASEAN integration offers significant gains to all members. It allows them to capture the gains from interactions with other countries both within ASEAN and with the rest of the world so as to facilitate faster economic growth and improve living standards. The gains include those from freer trade in goods and services, from more open capital flows and from transfers in technology.
Increasing economic integration with other ASEAN countries and with the world brings these benefits, but it also involves more competition and change. For example:
• Market shares are continually evolving, and new suppliers continue to emerge in the home market and in third-country markets. China and its impact on world markets is the most recent startling example, but the same processes are at work within ASEAN as well.
• Not only does competitiveness in traditional products change, but also new products emerge. The finer division of production processes, the greater complexity in global supply chains and the growth of trade in components in the region are examples.
• There are new ways of organizing business and new forms of international business. The rise in significance of trade in services in its own right and as a complement to other forms of international business is an example.
• Foreign direct investment (FDI) has always been a critical part of the business-led integration of economies in East Asia. Businesses losing competitiveness in higher income countries have relocated offshore. Now new investors are emerging, and new partnership possibilities are developing. Examples are related to the growing flows of FDI from India and from China.
These changes are all sources of benefit, but the willingness of a community to open their economy demands a level of confidence about the ability to adjust to them. The importance of this confidence and its impact on the process of integration are key issues in capturing the gains from integration. We comment on the connections between community confidence, policy reform and economic integration below.
The purpose of the study was to develop a questionnaire measuring health-related R1 quality of life for children and adolescents with congenital heart disease, the ConQol, that would have both clinical and research applications. We describe here the process of construction of a questionnaire, the piloting and the development of a weighted scoring system, and data on the psychometric performance of the measure in a sample of 640 children and young people recruited via 6 regional centres for paediatric cardiology from across the United Kingdom. The ConQol has two versions, one designed for children aged from 8 to 11 years, and the other for young people aged from 12 to 16 years. Initial findings suggest that it is a valid and reliable instrument, is acceptable to respondents, and is simple to administer in both a research and clinical context.