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Ventilator bundles encompass practices that reduce the risk of ventilator complications, including ventilator-associated pneumonia. The impact of ventilator bundles on the risk of developing ventilator-associated events (VAEs) is unknown. We sought to determine whether decreased compliance to the ventilator bundle increases the risk for VAE development.
Nested case-control study.
This study was conducted at 6 adult intensive care units at an academic tertiary-care center in Tennessee.
In total, 273 patients with VAEs were randomly matched in a 1:4 ratio to controls by mechanical ventilation duration and ICU type.
Controls were selected from the primary study population at risk for a VAE after being mechanically ventilated for the same number of days as a specified case. Using conditional logistic regression analysis, overall cumulative compliance, and compliance with individual components of the bundle in the 3 and 7 days prior to VAE development (or the control match day) were examined.
Overall bundle compliance at 3 days (odds ratio [OR], 1.15; P=.34) and 7 days prior to VAE diagnosis (OR, 0.96; P=.83) were not associated with VAE development. This finding did not change when limiting the outcome to infection-related ventilator-associated complications (IVACs) and after adjusting for age and gender. In the examination of compliance with specific bundle components increased compliance with chlorhexidine oral care was associated with increased risk of VAE development in all analyses.
Ventilator bundle compliance was not associated with a reduced risk for VAEs. Higher compliance with chlorhexidine oral care was associated with a greater risk for VAE development.
From the bites and scratches of lovers and the threat of flogging that hangs over the comic slave, to murder, rape, dismemberment, and crucifixion, violence is everywhere in Latin literature. The contributors to this volume explore the manifold ways in which violence is constructed and represented in Latin poetry and prose from Plautus to Prudentius, examining the interrelations between violence, language, power, and gender, and the narrative, rhetorical, and ideological functions of such depictions across the generic spectrum. How does violence contribute to the pleasure of the text? Do depictions of violence always reinforce status-hierarchies, or can they provoke a reassessment of normative value-systems? Is the reader necessarily complicit with authorial constructions of violence? These are pressing questions both for ancient literature and for film and other modern media, and this volume will be of interest to scholars and students of cultural studies as well as of the ancient world.
Integrated weed management (IWM) became an accepted, and frequently used, term by weed scientists in the early 1970's. It has been argued by some that IWM is simply new terminology for a system that was previously called “weed control”. In any event, the acceptance of the “management concept” has assured the grower that chemicals for weed control are merely a component part of a total system for managing weeds in crops (9, 65).
A field experiment was conducted to quantify changes in soil aggregation and aggregate-associated soil organic carbon (SOC) concentration 1, 3, 5 and 10 years after abandoned, salinized land in the Manasi River Basin was reclaimed for cotton (Gossypium hirsutum L.). Results showed that reclamation significantly increased SOC concentrations and SOC stocks. Specifically, 10 years of cotton production increased SOC concentrations by 45% in the 0–60 cm depth and SOC stocks by 35%. The SOC concentrations and stocks decreased as soil depth increased. Reclamation time, season and soil depth had significant interaction effects on SOC. The SOC concentrations were significantly and positively correlated with available soil nitrogen and available soil phosphorus. Compared with abandoned farmland, macro-aggregate-associated (>250 µm) SOC concentrations in the 0–60 cm depth increased by 47% after 5 years of cotton production and by 53% after 10 years of cotton production. The contribution of macro-aggregate-associated SOC to total SOC in the 0–60 cm depth increased by 87% after 5 years of cotton production and by 69% after 10 years of cotton production. The findings indicate that soil aggregates were more stable after abandoned, salinized farmland was reclaimed for cotton production. Furthermore, cotton production can increase SOC concentrations and sequester C in this arid area.
This study evaluated whether exposure to maternal pre- or postnatal depression or anxiety symptoms predicted psychopathology in adolescent offspring. Growth mixture modeling was used to identify trajectories of pre- and postnatal depression and anxiety symptoms in 577 women of low socioeconomic status selected from a prenatal clinic. Logistic regression models indicated that maternal pre- and postnatal depression trajectory exposure was not associated with offspring major depression, anxiety, or conduct disorder, but exposure to the high depression trajectory was associated with lower anxiety symptoms in males. Exposure to medium and high pre- and postnatal anxiety was associated with the risk of conduct disorder among offspring. Male offspring exposed to medium and high pre- and postnatal anxiety had higher odds of conduct disorder than did males with low exposure levels. Females exposed to medium or high pre- and postnatal anxiety were less likely to meet conduct disorder criteria than were females with lower exposure. To the best of our knowledge, this is the first study to examine the effect of pre- and postnatal anxiety trajectories on the risk of conduct disorder in offspring. These results suggest new directions for investigating the etiology of conduct disorder with a novel target for intervention.
We report on 475 measurements of depth to ice-cemented ground in four high-elevation valleys of the Quartermain Mountains, McMurdo Dry Valleys, Antarctica. These valleys have pervasive ice-cemented ground, and the depth to ice-cemented ground and the ice composition may be indicators of climate change. In University Valley, the measured depth to ice-cemented ground ranges from 0–98 cm. There is an overall trend of increasing depth to ice-cemented ground with distance from a small glacier at the head of the valley, with a slope of 32 cm depth per kilometre along the valley floor. For Farnell Valley, the depth to ice-cemented ground is roughly constant (c. 30 cm) in the upper and central parts of the valley, but increases sharply as the valley descends into Beacon Valley. The two valleys north of University Valley also have extensive ice-cemented ground, with depths of 20–40 cm, but exhibit no clear patterns of ice depth with location. For all valleys there is a tendency for the variability in depth to ice-cemented ground at a site to increase with increasing depth to ice. Snow recurrence, solar insolation, and surface albedo may all be factors that cause site to site variations in these valleys.
Tissue transplantation is an important adjunct to modern medical care and is used daily to save or improve patient lives. Tissue allografts include bone, tendon, corneas, heart valves and others. Increasing utilization may lead to tissue shortages, and tissue procurement organizations continue to explore ways to expand the cadaveric donor pool. Currently more than half of all deaths occur outside the acute care setting.
Many who suffer prehospital deaths might be eligible for non-organ tissue donation.
A retrospective review of electronic prehospital medical records was conducted from May 1, 2008 through December 31, 2009. All prehospital deaths were included irrespective of cause. Once identified, additional medical history was obtained from prehospital, inpatient, and emergency department records. Age, medical history, and time of death were compared to exclusion criteria for four tissue procurement organizations (MTF, LifeNet, LifeCell, EyeBank). After analysis, percentages of eligible donors were calculated.
Over 50,000 prehospital records were reviewed; 432 subjects died in the field and were eligible for analysis. Ages ranged from four to 103 years of age; the average was 68.3 (SD = 20.1) years. After exclusion for age, medical conditions, and time of death, 185 unique patients (42.8%) were eligible for donation to at least one of the four tissue procurement organizations (range 11.6%-34.3%).
After prehospital death, many individuals may be eligible for tissue donation. These findings suggest that future prospective studies exploring tissue donation after prehospital death are indicated. These studies should aim to clarify eligibility criteria, create protocols and infrastructure, and explore the ethical implications of expanding tissue donation to include this population.
ShiroffAM, GaleSC, MerlinMA, CrystalJS, LingerM, ShahAD, BeaumontE, LustigerE, TabakinE, GraciasVH. Enhancing the Tissue Donor Pool through Donation after Death in the Field. Prehosp Disaster Med. 2013;28(2):1-4.
We report the dry etch of GaSb(001) by inductively coupled plasma reactive ion etcher. Silicon Oxide, deposited by PECVD, was used as a mask. The oxide layer proved to be almost unaffected compared to the GaSb, when using chlorine compound gases as etchants (Cl2, BCl3, and SiCl4) as well as argon. This provides high selectivity for GaSb to the mask layer. The sample holder has no silicon that may contribute to the etching process. Etching using Cl2 + Ar showed increase in the etching rate as the chlorine ratio increases; however, the process led to grassy surface and chemical like reaction. The use of SiCl4+Cl2+Ar mixture with low chlorine ratio resulted in anisotropic etch with smooth sides. It has been found for this case that the increase of the chlorine ratio led to an increased etching rate as well. The repeat of previously reported result by Swaminathan et al. [Thin Solid Films 516 (2008) 8712.] yet with a sample holder not having silicon, proved the effect of Si-contribution in producing vertical profile etch with smooth surfaces.
The compatibility of both bulk and porous silicon at the subcutaneous site has been assessed for the first time, following ISO standard procedures. The in-vivo responses to implantation were monitored in the guinea pig and histopathological reactions evaluated at 1, 4, 12 and 26 weeks. Attention is focused here on the histological assessment protocols used, and the results demonstrating in-vivo evidence for good tissue compatibility, and porous Si bioactivity with regards calcification.
Two techniques have been used to measure the velocity of the amorphous-crystalline boundary during scanned laser crystallization of amorphous Ge films on fused-silica substrates. Values in the vicinity of 200 cm sec-1 have been measured by both methods. The results obtained by the first technique, an optical transmission method, confirm our theoretical model for the periodic motion of the boundary. The measurements made by the second technique, which is based on an examination of the structural features obtained at laser scanning rates up to about 600 cm sec-1 , show the boundary velocity to be rather insensitive to film thickness and background temperature. Controlled crystallization is expected to require stability of the laser beam power.