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Background: Over 35,000 Canadians lose their lives to cardiac arrest each year. CPR and automated external defibrillator (AED) use are modifiable factors. Survival rates drop by 7-10% each minute that defibrillation is delayed, and survival rates are less than 5% after 12 minutes of ventricular fibrillation which stresses the need for bystander AED use in out-of-hospital arrests. Niagara Region lacks a publicly accessible registry of AEDs. AED access is a major focus in King County, Washington which has higher survival rates and has all AEDs registered with Emergency Medical Services. Aim Statement: This project aims to log 100 or more AEDs within a year into a publicly accessible registry and to connect the registry information to medical trainees in the Niagara region and all employees of the Niagara Health System involved in patient care. Measures & Design: PulsePoint is an application used to register AEDs within the Niagara region. PulsePoint allows users to geotag AEDs while tracking data entries. Over 16 weeks, 4 PDSA cycles tested the effectiveness of logging methods for AEDs including opportunistic logging, daily emailed reminders, and contacting organizations with high likelihood of having an AED. Information about the project and registry was shared with residents and medical students in Niagara. A second phase of cycles involves relaying information to Niagara Health system employees and the medical community. A final cycle will target a broader group of local organizations with intermediate probability of having AEDs. Primary outcome measures include the numbers of regional AEDs logged and members reached by knowledge sharing cycles. Evaluation/Results: PulsePoint was found to be an effective, free, publicly accessible resource to log AEDs within the Niagara region. The initial round of 4 PDSA cycles added a total of 56 new AEDs within the region, which were logged into PulsePoint app and the Excel spreadsheet. Through the fourth PDSA cycle, 136 businesses were contacted and made aware of the project and the AED application. In addition,138 health-related colleagues and medical students were contacted to raise awareness. PDSA cycles five through eight are currently ongoing or in the planning stages. Discussion/Impact: Raising awareness among emergency services and sharing information about the registry to local CPR training providers will be paramount. Creating awareness of PulsePoint and installing AEDs in locations that currently lack such devices could ultimately improve cardiac arrest survival rates within Niagara Region.
Heart rate variability (HRV) is known to be reduced in depression; however, is unclear whether this is a consequence of the disorder or due to antidepressant medication.
We analysed data on 4750 participants from the first wave of The Irish Longitudinal Study on Ageing (TILDA). Time [standard deviation of normal to normal intervals (SDNN ms2)] and frequency domain [low frequency (LF) and high frequency (HF)] measures of HRV were derived from 3-lead surface electrocardiogram records obtained during 10 min of supine rest. Depression was assessed using the Center for Epidemiologic Studies – Depression scale.
Participants on antidepressants [with (n = 80) or without depression (n = 185)] differed significantly from controls (not depressed and not taking antidepressants n = 4107) on all measures of HRV. Depressed participants not taking antidepressants (n = 317) did not differ from controls on any measures of HRV. In linear regression analysis adjusted for relevant factors all antidepressants were associated with lower measures HRV. Participants on selective serotonin reuptake inhibitors (SSRIs) had higher measures of HRV relative to participants on tricyclic antidepressants or serotonin–norepinephrine reuptake inhibitors respectively.
Our results suggest that reductions in HRV observed among depressed older adults are driven by the effects of antidepressant medications. SSRIs have less impact on HRV than other antidepressants but they are still associated with lower measures of HRV. Study limitations include the use of a self-report measure of depression and floor effects of age on HRV could have limited our ability to detect an association between HRV and depression.
The objective of this research was to assess current patterns of hospital antibiotic prescribing in Northern Ireland and to determine targets for improving the quality of antibiotic prescribing. A point prevalence survey was conducted in four acute teaching hospitals. The most commonly used antibiotics were combinations of penicillins including β-lactamase inhibitors (33·6%), metronidazole (9·1%), and macrolides (8·1%). The indication for treatment was recorded in 84·3% of the prescribing episodes. A small fraction (3·9%) of the surgical prophylactic antibiotic prescriptions was for >24 h. The results showed that overall 52·4% of the prescribed antibiotics were in compliance with the hospital antibiotic guidelines. The findings identified the following indicators as targets for quality improvement: indication recorded in patient notes, the duration of surgical prophylaxis and compliance with hospital antibiotic guidelines. The results strongly suggest that antibiotic use could be improved by taking steps to address the identified targets for quality improvement.
Mach wave radiation is one of the better understood sources of jet noise. However, the exact conditions of its onset are difficult to determine and the literature to date typically explores Mach wave radiation well above its onset conditions. In order to determine the conditions for the onset of Mach wave radiation and to explore its behaviour during onset and beyond, three ideally expanded jets with Mach numbers Mj = 0.9, 1.3 and 1.65 and stagnation temperature ratios ranging over To/T∞ = 1.0–2.5 (acoustic Mach number 0.83–2.10) were used. Data are collected using a far-field microphone array, schlieren imaging and streamwise two-component particle image velocimetry. Using arc filament plasma actuators to force the jet provides an unprecedented tool for detailed examination of Mach wave radiation. The response of the jet to various forcing parameters (combinations of one azimuthal mode m = 0, 1 and 3 and one Strouhal number StDF = 0.09–3.0) is explored. Phase-averaged schlieren images clearly show the onset and evolution of Mach wave radiation in response to both changes in the jet operating conditions and forcing parameters. It is observed that Mach wave radiation is initiated as a coalescing of the near-field hydrodynamic pressure fluctuations in the immediate vicinity of the large-scale structures. As the jet exit velocity increases, the hydrodynamic pressure fluctuations coalesce, first into a curved wavefront, then flatten into the conical wavefronts commonly associated with Mach wave radiation. The results show that the largest and most coherent structures (e.g. forcing with m = 0 and StDF ~ 0.3) produce the strongest Mach wave radiation. Conversely, Mach wave radiation is weakest when the structures are the least coherent (e.g. forcing with m = 3 and StDF > 1.5).
Within the EURECA project (Towards self-sustainable EUropean REgional CAttle breeds), we interviewed a total of 371 farmers of 15 local cattle breeds in eight European countries. Besides collecting data on farmers, land use, herd composition and economic role of cattle, we aimed at understanding farmers' motives and values in keeping local cattle. The most frequent first reason to keep the local breed was productivity, followed by tradition. When comparing the local breed with a mainstream breed, only in four breeds was productivity considered the same, while in three breeds more than 50 percent of farmers valued the local breed as more profitable. The local breed was valued as always superior or the same on functional traits. Farmers were asked which type of appreciation they thought representatives of various stakeholders had on their local breed: a positive appreciation was observed in 33 percent of farmers. On average across breeds, 39 percent of farmers expect to increase the size of their herd in the next few years and 5 percent plan to give up farming. The degree of dependence of farmers on economic incentives was estimated by asking farmers their expected behaviour under three scenarios of change of subsidies. Most farmers demanded activities for promoting local breed farming. The results are discussed in terms of breed sustainability and conservation.
An axisymmetric perfectly expanded Mach 1.3 jet, with a Reynolds number based on the nozzle exit diameter (ReD) of 1.1 × 106 and turbulent boundary layer at the nozzle exit, was excited using localized arc filament plasma actuators over a wide range of forcing Strouhal numbers (StDF). Eight actuators distributed azimuthally were used to excite azimuthal modes m = 0–3. Far-field acoustic, flow velocity and irrotational near-field pressure were probed with a three-fold objective: (i) to investigate the broadband far-field noise amplification reported in the literature at lower speeds and ReD using excitation of m = 0 at low StDF; (ii) to explore broadband far-field noise suppression using excitation of m = 3 at higher StDF; and (iii) to shed some light on the connection between the flow field and the far-field noise. The broadband far-field noise amplification observed is not as extensive in amplitude or frequency range, but still sufficiently large to be of concern in practical applications. Broadband far-field noise suppression of 4–5 dB at 30° polar angle peak frequency, resulting in approximately 2 dB attenuation in the overall sound pressure level, is achieved with excitation of m = 3 at StDF ~ 0.9. Some of the noteworthy observations and inferences are (a) there is a strong correlation between the far-field broadband noise amplification and the turbulence amplification; (b) far-field noise suppression is achieved when the jet is forced with the maximum jet initial growth rate frequency thus limiting significant dynamics of structures to a shorter region close to the nozzle exit; (c) structure breakdown and dynamic interaction seem to be the dominant source of noise; and (d) coherent structures dominate the forced jet over a wide range of StDF (up to ~ 1.31) with the largest and most organized structures observed around the jet preferred mode StDF.
We present surprising evidence that the fracture resistance of porous forms of poly(arylene) ether (PAE) films exhibit increasing fracture resistance with increasing porosity. Such behavior is in stark contrast to the fracture toughness of porous solids, which typically decrease markedly with increasing porosity. A fracture mechanics based model is presented to rationalize the increase in fracture toughness of the voided polymer film and explain the behavior in terms of the pore size and volume fraction. It is shown that a certain dependence of pore size and volume fraction is required to increase rather than decrease the fracture resistance. The research has implications for the optimum void size and volume fraction needed to enhance the fracture resistance of porous ductile polymer films.
Laser-produced plasmas have many properties similar to, or which can be scaled to, those encountered in space, magnetospheric, ionospheric, and astrophysical situations. We describe several such experiments performed with the PHAROS III Nd-laser facility at NRL.
This study is concerned with the coping strategies and personality characteristics of headache sufferers. Comparisons were made between headache patients, tinnitus patients and normal controls (N = 105) on the Neuroticism subscale of the Eysenck Personality Questionnaire (EPQ), Taylor Manifest Anxiety Scale (MAS), Beck Depression Inventory (BDI), Unpleasant Events Schedule (UES), a measure of emotional control and a measure of cognitive appraisal of stressors. Statistical analyses revealed that headache sufferers scored in the more pathological direction than the controls on the EPQ, MAS and the measure of cognitive appraisal of stressors. Tinnitus patients did not differ from normal controls on these measures. These results are compared with those of other studies of the personality characteristics and psychological features of headache sufferers. Implications for further research in this area, and for the treatment of headaches, are discussed.
Pollen, macrofossil (logs and needles), and oxygen-isotope data from tree rings are presented for three alpine bog sites in the Maligne Range of the Canadian Rockies. Organic sedimentation at the Watchtower site began prior to ca. 9500 14C yr B.P. and by 8770 yr B.P. timberlines were at least 100 m above present levels. The two pollen records are dominated by Pinus and subsequent changes in timberlines are inferred from pollen-ratio data (Abies/Pinus) and from macrofossils. The recovered records indicate two periods of high Hypsithermal timberlines ca. 8800-7500 and 7200-5200 yr B.P. separated by a short interval ca. 7300–7400 yr B.P. when timberline approached modern levels. After ca. 4500 yr B.P. timberlines have been similar to or lower than present, reaching minimum values in the last 500 yr. δ18O determinations from the α-cellulose of samples of 5 or 10 annual rings cut from contemporary Picea englemannii at timberline show strong correlations with mean annual temperatures at Jasper. Isotopic determinations from Hypsithermal-age logs recovered from sites above present timberline indicate mean annual temperatures were at least 0.5°C warmer ca. 8060 and 8770 yr B.P. than at present at the Watchtower site. Data from logs at the Maligne Pass site suggest that temperatures were about 1.2° and 1.6°C warmer ca. 6000 and 5300 yr B.P. Estimates of temperature from the pollen-ratio data are more conservative and suggest maximum differences of ca. 1.0°C in July temperatures over the last 8000 yr.
Naloxone hydrochloride eyedrops 1 mg/ml dilated the pupils of 36 out of 47 opiate addicts on methadone maintenance treatment, without precipitation of acute withdrawal effects, but not those of healthy unmedicated subjects. The response in addicts was attenuated by certain ancillary treatments and by withdrawal of methadone treatment. The size of the response suggests some potential clinical use for topical naloxone as a diagnostic test of current opioid influence and possibility of physical dependence. The local mydriatic response, which was restricted to the treated eye, indicates that the effect of opiates on the pupil in man is determined, at least in part, by a peripheral action.
The internal politics of the Counter-Reformation varied in accordance with the individual circumstances of each European country. Nevertheless, many of the problems raised were common to all. The reception of the Tridentine decrees, the clash of regular and secular clergy, the pressure of local, ecclesiastical, and secular interests, the influence of the Spanish monarchy, and the part played by changing conditions in the structure of the Curia itself, especially the foundation of the Congregation of Propaganda in 1622—these affected societies as disparate as the Holy Roman Empire and Ireland. Against this background, Irish ecclesiastical history is of more than parochial or diocesan interest, and its disputes during the early seventeenth century throw light, by analogy, upon wider European developments. Indeed, so far as the British Isles are concerned, the Counter-Reformation was mainly an ‘Irish question’, much as Catholic Emancipation was to be later, although it was to throw up no figures of the same calibre as Campion or Parsons.
Almost nothing is known of trade between Ireland and the continent during the first half of the seventeenth century. It is true that the existence of direct commercial links can be deduced from isolated references in the state papers and elsewhere, but these give little or no material for constructing a detailed picture. The importance of the wine trade may be inferred from the fact that when customs duties were increased in 1632, wine, along with salt, was the only imported commodity to be affected; from this one may conclude that the administration considered that the quantity of wine imported was sufficiently great for an increased duty to be worthwhile. This is indirect evidence, however. The value of the present document is that it throws some direct light upon the state of an important branch of Irish overseas trade in a particular year. The destruction of all but a few of the Irish port books makes such direct evidence all the more valuable. Mention may here be made of copies of some of the earliest Irish port books which are to be found in the papers of Sir Arthur Ingram who was one of the original farmers for Ireland in 1613. The examination of continental economic arcives may in due course help to fill the gap still futher.