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There are numerous historical reconstructions of the lead-up to the Battle of Gaugamela, albeit often as a short prelude to the battle itself. The focus tends to be historical reality, with the extant sources blended to produce a probable sequence of events. Such narratives have their place, but the process masks the details provided by specific sources. This article analyses Arrian's representation of events to understand his narrative better. Particular attention is paid to his chronological ‘mistake’, specifically the loss of a day which is usually just corrected by commentators. I suggest that this was not an error at all, but a deliberate construct. I show that Arrian manipulates ‘narrative time’ by using the night in order to blur historical time, and how this creates a framework within which Arrian carefully constructs his Alexander–Parmenio exchanges. The construct of the adviser, the use of night imagery, and the select use of terminology (kleptein) are utilized by Arrian in order to maintain his heroic image of Alexander and to conceal any strategies of deception.
The first demonstration of laser action in ruby was made in 1960 by T. H. Maiman of Hughes Research Laboratories, USA. Many laboratories worldwide began the search for lasers using different materials, operating at different wavelengths. In the UK, academia, industry and the central laboratories took up the challenge from the earliest days to develop these systems for a broad range of applications. This historical review looks at the contribution the UK has made to the advancement of the technology, the development of systems and components and their exploitation over the last 60 years.
We conducted a program of research to derive and test the reliability of a clinical prediction rule to identify high-risk older adults using paramedics’ observations.
We developed the Paramedics assessing Elders at Risk of Independence Loss (PERIL) checklist of 43 yes or no questions, including the Identifying Seniors at Risk (ISAR) tool items. We trained 1,185 paramedics from three Ontario services to use this checklist, and assessed inter-observer reliability in a convenience sample. The primary outcome, return to the ED, hospitalization, or death within one month was assessed using provincial databases. We derived a prediction rule using multivariable logistic regression.
We enrolled 1,065 subjects, of which 764 (71.7%) had complete data. Inter-observer reliability was good or excellent for 40/43 questions. We derived a four-item rule: 1) “Problems in the home contributing to adverse outcomes?” (OR 1.43); 2) “Called 911 in the last 30 days?” (OR 1.72); 3) male (OR 1.38) and 4) lacks social support (OR 1.4). The PERIL rule performed better than a proxy measure of clinical judgment (AUC 0.62 vs. 0.56, p=0.02) and adherence was better for PERIL than for ISAR.
The four-item PERIL rule has good inter-observer reliability and adherence, and had advantages compared to a proxy measure of clinical judgment. The ISAR is an acceptable alternative, but adherence may be lower. If future research validates the PERIL rule, it could be used by emergency physicians and paramedic services to target preventative interventions for seniors identified as high-risk.
In recent years, there has been a renewed interest in the role of dietary fibre in obesity management. Much of this interest stems from animal and human studies which suggest that an increased intake of fermentable fibre can suppress appetite and improve weight management. A growing number of reports have demonstrated that the principal products of colonic fermentation of dietary fibre, SCFA, contribute to energy homeostasis via effects on multiple cellular metabolic pathways and receptor-mediated mechanisms. In particular, over the past decade it has been identified that a widespread receptor system exists for SCFA. These G-protein-coupled receptors, free fatty acid receptor (FFAR) 2 and FFAR3 are expressed in numerous tissue sites, including the gut epithelium and adipose tissue. Investigations using FFAR2- or FFAR3-deficient animal models suggest that SCFA-mediated stimulation of these receptors enhances the release of the anorectic hormones peptide tyrosine tyrosine and glucagon-like peptide-1 from colonic L cells and leptin from adipocytes. In addition, the SCFA acetate has recently been shown to have a direct role in central appetite regulation. Furthermore, the SCFA propionate is a known precursor for hepatic glucose production, which has been reported to suppress feeding behaviour in ruminant studies through the stimulation of hepatic vagal afferents. The present review therefore proposes that an elevated colonic production of SCFA could stimulate numerous hormonal and neural signals at different organ and tissue sites that would cumulatively suppress short-term appetite and energy intake.
The aim of this study was to examine the long-term course of cognitive
impairment in people with schizophrenia. Forty-three people with
schizophrenia were followed up over an average of 33 years along with a
control group of 12 matched individuals free from psychosis. Cognitive
function was assessed at baseline and follow-up. The participants with
schizophrenia were found to show impairment in verbal and non-verbal
intelligence at baseline compared with estimated premorbid scores, this was
not found in the control group. At follow-up there was a significant decline
in non-verbal intelligence over time in participants with schizophrenia
compared with controls (P=0.007). This differential change
over time was not seen in verbal intelligence (P=
Clinical prediction rules are decision-making tools that incorporate three or more variables from the history, physical examination or simple tests. They help clinicians make diagnostic or therapeutic decisions by standardizing the collection and interpretation of clinical data. There is growing interest in the methodological standards for their development and validation. This article describes the methods used to derive the Canadian C-Spine Rule and provides a valuable reference for investigators planning to develop future clinical prediction rules.
This paper is Part I of a 2-part series to describe the background and methodology for the Canadian C-Spine Rule study to develop a clinical decision rule for rational imaging in alert and stable trauma patients. Current use of radiography is inefficient and variable, in part because there has been a lack of evidence-based guidelines to assist emergency physicians. Clinical decision rules are research-based decision-making tools that incorporate 3 or more variables from the history, physical examination or simple tests. The Canadian CT Head and C-Spine (CCC) Study is a large collaborative effort to develop clinical decision rules for the use of CT head in minor head injury and for the use of cervical spine radiography in alert and stable trauma victims. Part I details the background and rationale for the development of the Canadian C-Spine Rule. Part II will describe in detail the objectives and methods of the Canadian C-Spine Rule study.
‘What men will fight for seems to be worth looking into’
Historians have long studied warfare, albeit within a selective framework that includes dates, places, and the description of tactics. Moreover, explanations of ‘why’ and ‘how’ conflicts occur seldom deviate from the political or the long term strategic outlook. It is only recently that we have come to qualify the effect war has on combatants and civilians alike, and how actions and choices in war can also be explained by the stresses to which participants are exposed. Studies such as Jonathon Shay's Achilles in Vietnam and Lawrence Tritle's From Melos to My Lai in part demonstrably link such psychological trauma with the destructive and savage actions undertaken by soldiers in the conflicts of every epoch. It seems reasonable, therefore, that our growing understanding of combat psychology in the twentieth century A.D. may help us unravel problematic events in history, or at least provide a new way to approach old questions.
Silicon-incorporated amorphous hydrocarbon (Si-aC:H) films with varying Si contents were deposited onto a Ti interlayer on Si and steel substrates by reactive sputtering in an unbalanced magnetron sputtering system. The objective of this study was to measure and relate the structural, chemical, and mechanical properties of these Si-aC:H films. Transmission electron microscopy revealed that the Si-aC:H phase is amorphous and TiC exists at the Si-aC:H/Ti phase boundary for all compositions. Mechanical properties such as hardness, indentation modulus, and intrinsic stress decreased with increasing Si and H content in the films, for Si/C ≥ 0.04. XPS measurements suggested that this is most likely due to the decreasing presence of a C-C sp3 interlinked network, accompanied by an increase in C-H and Si-H bonds. This conclusion was supported by radial distribution functions obtained using extended electron energy-loss fine structure analysis (EXELFS).
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