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Develop an aptitude for defining key topics, features and processes, vital for your FRCS (Tr&Orth) Viva exam success, with this newly updated and detailed guide. This new edition expertly delivers invaluable insights into tactics and planning, for candidates to sharpen exam skills, and gain confidence. Thoroughly updated to include an expanded basic science section, to answer all of your viva questions, this guide also supplies candidates with new illustrations and exam-specific diagrams; adapting to meet the expectations of a constantly changing syllabus. Vital for orthopaedic surgeons in training, this forward-looking text includes a drawing chapter, for candidates to practise creating succinct, exam-style illustrations, before the exam itself. Proactive in its approach, this book addresses the balance between trauma,general orthopaedics and basic science; by editors with extensive national and international experience of preparing candidates for the FRCS(Tr & Orth).
To increase the proportion of patients with no psychotropic drug discrepancies at the community mental health team (CMHT)–general practice interface. Three CMHTs participated. Over a 14 month period, quality improvement methodologies were used: individual patient-level feedback to patient's prescribers, run charts and meetings with CMHTs.
One CMHT improved medicines reconciliation accuracy and demonstrated significant reductions in prescribing discrepancies. One in three (119/356) patients had ≥1 discrepancy involving 20% (166/847) of all prescribed psychotropics. Discrepancies were graded as: ‘fatal’ (0%), ‘serious’ (17%) and ‘negligible/minor harm’ (83%) but were associated with extra avoidable prescribing costs. For medicines routinely supplied by secondary care, 68% were not recorded in general practice electronic prescribing systems.
Improvements in medicines reconciliation accuracy were achieved for one CMHT. This may have been partly owing to a multidisciplinary team approach to sharing and addressing prescribing discrepancies. Improving prescribing accuracy may help to reduce avoidable drug-related harms to patients.
Psychosocial acceleration theory suggests that pubertal maturation is accelerated in response to adversity. In addition, suboptimal caregiving accelerates development of the amygdala–medial prefrontal cortex circuit. These findings may be related. Here, we assess whether associations between family environment and measures of the amygdala–medial prefrontal cortex circuit are mediated by pubertal development in more than 2000 9- and 10-year-old children from the Adolescent Brain Cognitive Development Study (http://dx.doi.org/10.15154/1412097). Using structural equation modeling, demographic, child-reported, and parent-reported data on family dynamics were compiled into a higher level family environment latent variable. Magnetic resonance imaging preprocessing and compilations were performed by the Adolescent Brain Cognitive Development Study's data analysis core. Anterior cingulate cortex (ACC) thickness, area, white matter fractional anisotropy, amygdala volume, and cingulo-opercular network–amygdala resting-state functional connectivity were assessed. For ACC cortical thickness and ACC fractional anisotropy, significant indirect effects indicated that a stressful family environment relates to more advanced pubertal stage and more mature brain structure. For cingulo-opercular network–amygdala functional connectivity, results indicated a trend in the expected direction. For ACC area, evidence for quadratic mediation by pubertal stage was found. Sex-stratified analyses suggest stronger results for girls. Despite small effect sizes, structural measures of circuits important for emotional behavior are associated with family environment and show initial evidence of accelerated pubertal development.
One generation's experience of childhood maltreatment is associated with that of the next. However, whether this intergenerational transmission is specific to distinct forms of maltreatment and what factors may contribute to its continuity remains unclear. Borderline personality pathology is predicted by childhood maltreatment and characterized by features (e.g., dysregulated emotion, relationship instability, impulsivity, and inconsistent appraisals of others) that may contribute to its propagation. Among 364 older adults and 573 of their adult children (total n = 937), self-reported exposure to distinct forms of childhood maltreatment (i.e., emotional, physical, and sexual abuse, and emotional and physical neglect as assessed by the Childhood Trauma Questionnaire) showed homotypic and heterotypic associations across generations with little evidence that latent factors unique to specific forms of maltreatment show generational continuity. General nonspecific indices of childhood maltreatment showed evidence of intergenerational transmission after accounting for demographic factors and parent socioeconomic status (b = 0.126, p = 9.21 × 10−4). This continuity was partially mediated by parental borderline personality pathology (assessed longitudinally through a variety of measures and sources, indirect effect: b = 0.031, 95% confidence interval [0.003, 0.060]). The intergenerational continuity of childhood maltreatment may largely represent general risk for nonspecific maltreatment that may, in part, be propagated by borderline personality pathology and/or shared risk factors.
Rudd’s Lark Heteromirafra ruddi is a globally threatened species endemic to eastern South Africa’s highland grasslands, where climate envelope modelling has predicted a dramatic reduction in its already small and fragmented distribution. Here we assess recent changes in one of its last strongholds, the Wakkerstroom grasslands. We assessed changes in Rudd’s Lark population and habitat condition over 12 years, within a core section of an area intensively surveyed in 2002–2004. Our 2016 survey found lower absolute numbers of Rudd’s Larks (five transects with Rudd’s Lark present compared to nine in 2002; nine individuals compared to 32), as well as a lower probability of encounter. Transects with shorter grass and higher altitude had a higher probability of Rudd’s Larks occurrence, consistent with findings in 2002. Point locations where Rudd’s Larks were recorded had shorter grass, higher forb cover and more bare ground cover, and tended to be at higher altitudes than random locations in the surrounding grassland. Remotely-sensed fire data showed that late-season fires, which pose a threat to Rudd’s Lark nestling survival, are generally uncommon. Field observations indicated that seven transects (of which two previously contained Rudd’s Lark) that had previously been grassland had been converted to intensive crop production. While Rudd’s Lark may be affected by direct loss of grassland habitat through conversion to crops, the species has also declined within remaining grassland habitat. The drivers of decline remain unclear but this recent observed local decline of Rudd’s Lark in the immediate Wakkerstroom area supports the species’ recent IUCN uplisting to globally ‘Endangered’, given that its previous downlisting was based on habitat requirements and breeding success from this area.
This paper proposes the concept of a ‘hybrid institution’, defined with reference to certain institutions within the UK's constitutional order which provide oversight of national security processes. It focuses in particular on the Commissioners who have overseen and oversee the use of investigatory powers and the work of the intelligence services. These institutions, as was once said of another hybrid institution – the Independent Reviewer of Terrorism Legislation – are designed in order to operate within situations in which ‘potential conflicts between state power and civil liberties are acute, but information is tightly rationed’. They are ‘hybrid’ institutions in that they marry certain of the features characteristic of political institutions with others characteristic of legal institutions. The paper considers the relevant institutions and the role they play within the national security constitution, showing how their hybrid status facilitates the performance of a function which neither fully legal nor fully political institutions could fulfil.
Three new tephras have been identified in Southeast Alaska. An 8-cm-thick black basaltic tephra with nine discrete normally graded beds is present in cores from a lake on Baker Island. The estimated age of the tephra is 13,492 ± 237 cal yr BP. Although similar in age to the MEd tephra from the adjacent Mt. Edgecumbe volcanic field, this tephra is geochemically distinct. Black basaltic tephras recovered from two additional sites in Southeast Alaska, Heceta Island and the Gulf of Esquibel, are also geochemically distinct from the MEd tephra. The age of the tephra from Heceta Island is 14,609 ± 343 cal yr BP. Whereas the tephras recovered from Baker Island/Heceta Island/Gulf of Esquibel are geochemically distinct from each other, similarities in the ages of these tephras and the MEd tephra suggest a shared eruptive trigger, possibly crustal unloading caused by retreat of the Cordilleran Ice Sheet. The submerged Addington volcanic field on the continental shelf, which may have been subaerially exposed during the late Pleistocene, is a possible source for the Southeast Alaska tephras.
The presence of metal oxide films from wave solder baths on timed module pins are partly responsible for non-wet problems in subsequent soldering steps. The cylindrical geometry of the pins lends itself to the characterization of thin oxide films by using the highly sensitive Debye-Scherrer camera method. As confirmed by Electron Hicroprobe Analysis (EMA), pins containing thin oxide films were used to obtain the diffraction patterns. A software program was developed that subtracts the diffraction angles of an oxids-free control pin from the pattern of the contaminated pin, and tabulates the residual d-spacing (interplanar distance) of the contaminant film.
Recently there has been a considerable rise in the frequency of metabolic diseases, such as obesity, due to changes in lifestyle and resultant imbalances between energy intake and expenditure. Whey proteins are considered as potentially important components of a dietary solution to the obesity problem. However, the roles of individual whey proteins in energy balance remain poorly understood. This study investigated the effects of a high-fat diet (HFD) containing α-lactalbumin (LAB), a specific whey protein, or the non-whey protein casein (CAS), on energy balance, nutrient transporters expression and enteric microbial populations. C57BL/6J mice (n 8) were given an HFD containing either 20 % CAS or LAB as protein sources or a low-fat diet containing CAS for 10 weeks. HFD-LAB-fed mice showed a significant increase in cumulative energy intake (P=0·043), without differences in body weight, energy expenditure, locomotor activity, RER or subcutaneous and epididymal white adipose tissue weight. HFD-LAB intake led to a decrease in the expression of glut2 in the ileum (P=0·05) and in the fatty acid transporter cd36 (P<0·001) in both ileum and jejunum. This suggests a reduction in absorption efficiency within the small intestine in the HFD-LAB group. DNA from faecal samples was used for 16S rRNA-based assessment of intestinal microbiota populations; the genera Lactobacillus, Parabacteroides and Bifidobacterium were present in significantly higher proportions in the HFD-LAB group. These data indicate a possible functional relationship between gut microbiota, intestinal nutrient transporters and energy balance, with no impact on weight gain.
Viscoelastic flow past a cylinder is a classic benchmark problem that is not completely understood. Using novel three-dimensional (3D) holographic particle velocimetry, we report three main discoveries of the elastic instability upstream of a single cylinder in viscoelastic channel flow. First, we observe that upstream vortices initiate at the corner between the cylinder and the wall, and grow with increasing flow rate. Second, beyond a critical Weissenberg number, the flow upstream becomes unsteady and switches between two bistable configurations, leading to symmetry breaking in the cylinder axis direction that is highly 3D in nature. Lastly, we find that the disturbance of the elastic instability propagates relatively far upstream via an elastic wave, and is weakly correlated with that in the cylinder wake. The wave speed and the extent of the instability increase with Weissenberg number, indicating an absolute instability in viscoelastic fluids.
Although polyphenols inhibit glucose absorption and transport in vitro, it is uncertain whether this activity is sufficient to attenuate glycaemic response in vivo. We examined this using orange juice, which contains high levels of hesperidin. We first used a combination of in vitro assays to evaluate the potential effect of hesperidin and other orange juice components on intestinal sugar absorption and then tested whether this translated to an effect in healthy volunteers. Hesperidin attenuated transfer of 14C-labelled glucose across differentiated Caco-2/TC7 cell monolayers. The involvement of the sugar transporter GLUT2 was demonstrated by experiments carried out in the absence of Na to exclude the contribution of sodium-glucose linked transporter 1 and further explored by the use of Xenopus laevis oocytes expressing human GLUT2 or GLUT5. Fructose transport was also affected by hesperidin partly by inhibition of GLUT5, while hesperidin, even at high concentration, did not inhibit rat intestinal sucrase activity. We conducted three separate crossover interventions, each on ten healthy volunteers using orange juice with different amounts of added hesperidin and water. The biggest difference in postprandial blood glucose between orange juice and control, containing equivalent amounts of glucose, fructose, sucrose, citric acid and ascorbate, was when the juice was diluted (ΔCmax=–0·5 mm, P=0·0146). The effect was less pronounced when the juice was given at regular strength. Our data indicate that hesperidin can modulate postprandial glycaemic response of orange juice by partial inhibition of intestinal GLUT, but this depends on sugar and hesperidin concentrations.
Carrion in the form of dead seal pups and algal mats placed on soft bottom habitats at Explorers Cove and Salmon Bay, McMurdo Sound, attract scavenging invertebrates that are driven away by hydrogen sulphide produced by sulphate-reducing bacteria sequestered below a layer of Beggiatoa/Thioploca-like filamentous bacteria. This system is usually found for lipid-rich marine mammal carrion, but also occurred with natural algal mats.
Popularizations attempt to present a body of information in an intelligible form to the non-specialist. Sometimes their goal is simply to enable the reader to pass the time in an interesting way. In this case, the popularizer has no other goal than entertainment. Other popularizations have the serious purpose of being of some utility to their audience. Today in North America, serious popularizations attempt to bring the work of experts to the attention of the general public. At times the author's purpose is not only to disseminate information but to stimulate public policy along certain lines. When such books are well-written and convey the enthusiasm or outrage of the author, they can have great influence.