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Silver nitrate cautery and bipolar electrocautery are commonly used in the treatment of epistaxis. Currently, there are no recommendations on optimum contact times or power for nasal cautery. ENT consultant practice in the UK has not previously been evaluated.
This study examined the burn depth associated with silver nitrate (75 per cent concentration) cautery and bipolar electrocautery on porcine septum samples, using varying contact times and power. ENT consultants completed a survey evaluating their practice.
Results and conclusion
ENT consultant practice of nasal cautery was shown to vary widely. Silver nitrate cautery with a contact time of less than 30 seconds does not cause a full thickness burn. The findings lend some support to bilateral cauterisation with silver nitrate. Bipolar electrocautery should be set at lower than 10 W and with a contact time of less than 4 seconds to reduce the risk of complications associated with a full thickness burn.
The micro-organisms which inhabit the human gut (i.e. the intestinal microbiota) influence numerous human biochemical pathways and physiological functions. The present review focuses on two questions, ‘Are intestinal microbiota effects measurable and meaningful?’ and ‘What research methods and variables are influenced by intestinal microbiota effects?’. These questions are considered with respect to doubly labelled water measurements of energy expenditure, heat balance calculations and models, measurements of RMR via indirect calorimetry, and diet-induced energy expenditure. Several lines of evidence suggest that the intestinal microbiota introduces measurement variability and measurement errors which have been overlooked in research studies involving nutrition, bioenergetics, physiology and temperature regulation. Therefore, we recommend that present conceptual models and research techniques be updated via future experiments, to account for the metabolic processes and regulatory influences of the intestinal microbiota.
The aim of this study was to explore the experiences of radiotherapy students on clinical placement, specifically focussing on the provision of well-being support from clinical supervisors.
Materials and methods:
Twenty-five students from the University of the West of England and City University of London completed an online evaluation survey relating to their experiences of placement, involving Likert scales and open-ended questions.
The quantitative results were generally positive; however, the qualitative findings were mixed. Three themes emerged: (1) provision of information and advice; (2) an open, inclusive and supportive working environment; and (3) a lack of communication, understanding, and consistency.
Students’ experiences on placement differed greatly and appeared to relate to their specific interactions with different members of staff. It is suggested that additional training around providing well-being support to students may be of benefit to clinical supervisors.
Laser–solid interactions are highly suited as a potential source of high energy X-rays for nondestructive imaging. A bright, energetic X-ray pulse can be driven from a small source, making it ideal for high resolution X-ray radiography. By limiting the lateral dimensions of the target we are able to confine the region over which X-rays are produced, enabling imaging with enhanced resolution and contrast. Using constrained targets we demonstrate experimentally a
X-ray source, improving the image quality compared to unconstrained foil targets. Modelling demonstrates that a larger sheath field envelope around the perimeter of the constrained targets increases the proportion of electron current that recirculates through the target, driving a brighter source of X-rays.
A multichannel calorimeter system is designed and constructed which is capable of delivering single-shot and broad-band spectral measurement of terahertz (THz) radiation generated in intense laser–plasma interactions. The generation mechanism of backward THz radiation (BTR) is studied by using the multichannel calorimeter system in an intense picosecond laser–solid interaction experiment. The dependence of the BTR energy and spectrum on laser energy, target thickness and pre-plasma scale length is obtained. These results indicate that coherent transition radiation is responsible for the low-frequency component (
1 THz) of BTR. It is also observed that a large-scale pre-plasma primarily enhances the high-frequency component (
3 THz) of BTR.
How cognitive impairment and frailty combine to impact on older adults’ Quality of Life (QoL) is little studied, but their inter-relationships are important given how often they co-occur. We sought to examine how frailty and cognitive impairment, as well as changes in frailty and cognition, are associated with QoL and how these relationships differ based on employment status and social circumstances.
Using the Survey of Health, Ageing, and Retirement in Europe data, we employed moderated regression, followed by simple slopes analysis, to examine how the relationships between levels of health (i.e., of frailty and cognition) and QoL varied as a function of sex, age, education, social vulnerability, and employment status. We used the same analysis to test whether the relationships between changes in health (over two years) and QoL varied based on these same moderators.
Worse frailty (b = −1.61, p < .001) and cognitive impairment (b = −0.08, p < .05) were each associated with lower QoL. Increase in frailty (b = −2.17, p < .001) and cognitive impairment (b = −0.25, p < .001) were associated with lower QoL. The strength of these relationships varied depending on interactions with age, sex, education, social vulnerability, and employment status. Higher social vulnerability was consistently associated with lower QoL in analyses examining both static health (b = −3.16, p < .001) and change in health (b = −0.66, p < .001).
Many predictors of QoL are modifiable, providing potential targets to improve older adults’ QoL. Even so, the relationships between health, cognition, and social circumstances that shape QoL in older adults are complex, highlighting the importance for individualized interventions.
Despite aspirations to be a world-class national curriculum, the Australian Curriculum (AC) has been criticised as ‘manifestly deficient’ (Australian Government Department of Education and Training, 2014 p. 5) as an inclusive curriculum, failing to meet the needs of all students with disabilities (SWD) and their teachers. There is a need for research into the daily attempts of educators to navigate the tension between a ‘top-down’ system-wide curriculum and a ‘bottom-up’ regard for individual student needs, with a view to informing both policy and practice. This article is the first of two research papers in which we report the findings from a national online Research in Special Education (RISE) Australian Curriculum Survey of special educators in special schools, classes, and units regarding their experience using the AC to plan for and teach SWD. Survey results indicated (a) inconsistent use of the AC as the primary basis for developing learning objectives and designing learning experiences, (b) infrequent use of the achievement standards to support assessment and reporting, and (c) considerable supplementation of the AC from other resources when educating SWD. Overall, participants expressed a lack of confidence in translating the AC framework into a meaningful curriculum for SWD. Implications for policy, practice, and future research are discussed.
Introduction: Prehospital blood transfusion has been adopted by many civilian helicopter emergency medical service (HEMS) agencies and early outcomes are positive. Shock Trauma Air Rescue Service (STARS) operates six bases in Western Canada and in 2013 implemented a prehospital transfusion program. We describe the processes and standard work ensuring safe storage, administration, and stewardship of this precious resource. Our aim was to produce a sustainable and safe blood storage system that could be carried on each mission flown. Methods: Close collaboration with transfusion services and adherence to Canadian Transfusion Standards was key at each step of development. An inexpensive, reusable, temperature controlled thermal packaging device was obtained along with an electronic temperature logger. Conditioning of the device and temperature maintenance (1 6C) was tested to ensure safe storage conditions. Online training programs were developed for air medical crew (AMC) as well as transport physicians (TPs) regarding administration indications, safety, and stewardship processes. Blood traceability and usage was monitored on an ongoing basis for quality assurance. Results: Two units of O negative packed red blood cells (pRBCs) are now carried on each flight. The blood box is conditioned and prepared by transfusion services for routine exchange every 72 hours. If pRBCs are administered the blood bank is immediately notified for preparation of another cooler. Unused blood is returned to blood bank circulation. Conclusion: The introduction of the STARS blood on board program supports the provision of emergent transfusion to selected patients in the pre-hospital environment. Our standard work and stewardship processes minimize wastage of blood products while keeping it readily available for critically ill and injured patients. Subsequent work will aim to describe characteristics and patient centred outcomes.
Ceramic fiber–matrix composites (CFMCs) are exciting materials for engineering applications in extreme environments. By integrating ceramic fibers within a ceramic matrix, CFMCs allow an intrinsically brittle material to exhibit sufficient structural toughness for use in gas turbines and nuclear reactors. Chemical stability under high temperature and irradiation coupled with high specific strength make these materials unique and increasingly popular in extreme settings. This paper first offers a review of the importance and growing body of research on fiber–matrix interfaces as they relate to composite toughening mechanisms. Second, micropillar compression is explored experimentally as a high-fidelity method for extracting interface properties compared with traditional fiber push-out testing. Three significant interface properties that govern composite toughening were extracted. For a 50-nm-pyrolytic carbon interface, the following were observed: a fracture energy release rate of ∼2.5 J/m2, an internal friction coefficient of 0.25 ± 0.04, and a debond shear strength of 266 ± 24 MPa. This research supports micromechanical evaluations as a unique bridge between theoretical physics models for microcrack propagation and empirically driven finite element models for bulk CFMCs.
Giant electromagnetic pulses (EMP) generated during the interaction of high-power lasers with solid targets can seriously degrade electrical measurements and equipment. EMP emission is caused by the acceleration of hot electrons inside the target, which produce radiation across a wide band from DC to terahertz frequencies. Improved understanding and control of EMP is vital as we enter a new era of high repetition rate, high intensity lasers (e.g. the Extreme Light Infrastructure). We present recent data from the VULCAN laser facility that demonstrates how EMP can be readily and effectively reduced. Characterization of the EMP was achieved using B-dot and D-dot probes that took measurements for a range of different target and laser parameters. We demonstrate that target stalk geometry, material composition, geodesic path length and foil surface area can all play a significant role in the reduction of EMP. A combination of electromagnetic wave and 3D particle-in-cell simulations is used to inform our conclusions about the effects of stalk geometry on EMP, providing an opportunity for comparison with existing charge separation models.
To determine the patterns and predictors of treatment response trajectories for veterans with post-traumatic stress disorder (PTSD).
Conditional latent growth mixture modelling was used to identify classes and predictors of class membership. In total, 2686 veterans treated for PTSD between 2002 and 2015 across 14 hospitals in Australia completed the PTSD Checklist at intake, discharge, and 3 and 9 months follow-up. Predictor variables included co-morbid mental health problems, relationship functioning, employment and compensation status.
Five distinct classes were found: those with the most severe PTSD at intake separated into a relatively large class (32.5%) with small change, and a small class (3%) with a large change. Those with slightly less severe PTSD separated into one class comprising 49.9% of the total sample with large change effects, and a second class comprising 7.9% with extremely large treatment effects. The final class (6.7%) with least severe PTSD at intake also showed a large treatment effect. Of the multiple predictor variables, depression and guilt were the only two found to predict differences in response trajectories.
These findings highlight the importance of assessing guilt and depression prior to treatment for PTSD, and for severe cases with co-morbid guilt and depression, considering an approach to trauma-focused therapy that specifically targets guilt and depression-related cognitions.
The SkyMapper Transient survey (SMT) is exploring variability in the southern sky by performing (a) a rolling search to discover and study supernovæ, and (b) a Target of Opportunity programme that uses the robotic SkyMapper Telescope at Siding Spring Observatory. The supernova survey is obtaining a non-targeted sample of Type Ia supernovæ (SNe Ia) at low redshifts, z < 0.1, and studying other interesting transients found with the search strategy. We have a Target of Opportunity programme with an automatic response mechanism to search for optical counterparts to gravitational-wave and fast radio-burst events; it benefits from SkyMapper’s large field of view of 5.7 sq. deg. and a rapid data reduction pipeline.
We present first results of the SMT survey. The SMT pipeline can process and obtain potential candidates within 12 hours of observation. It disentangles real transients from processing artefacts using a machine-learning algorithm. To date, SMT has discovered over 60 spectroscopically confirmed supernovæ, several peculiar objects, and over 40 SNe Ia including one (SNIa 2016hhd) which was found within the first few days of explosion. We have also participated in searches for optical counterparts of gravitational waves, fast radio bursts and other transients, and have published observations of the optical counterpart of the gravitational-wave event GW170817. We also participate in coordinated observations with the Deeper Wider Faster programme, and the Kepler K2 cosmology project.
The study explored posttraumatic growth (PTG) and its relationship with the quality of life (QOL), posttraumatic stress, and resilience among survivors of terror attacks over 10 years post-injury. Participants were patients of Hadassah Medical Center, Israel, who were injured in terror attacks between 2000 and 2004 during the second Intifada. Variables of interest were obtained from a survey and patients' medical files. In total, 42 patients participated, 66% were men, and the average age was 41.4 years. Multivariate analysis was utilized to predict PTG from a variety of demographic variables including gender, ethnicity, relationship status, age, education, income, religiosity, and injury/disability type. Additional primary variables of study included current levels of QOL, posttraumatic stress, and resilience. Results revealed that married/partnered individuals had higher levels of PTG than divorced or single individuals. Findings suggest that social support following trauma is important for PTG and should be prioritized in recovery interventions with trauma survivors.
Ancient history begins and ends with the ancient evidence. The evidence represents not only the foundation of the discipline, but the material out of which any argument must be built, and it is not possible to go further than it allows. This is part of the reason why the nature and value of the evidence for early Rome have long been, and remain, matters of considerable and sometimes contentious debate. The best evidence, simply because it is contemporary, is arguably the archaeological, but the sorts of questions that archaeological evidence can answer are often of little help when it comes to matters such as the politics and political structures of early Rome, which are the focus of this collection. For such matters, it is still necessary to work with the literary evidence. However, since the historical value of the literary evidence is so hotly contested, the uses to which that evidence is put and the conclusions that are drawn from it inevitably vary considerably. Despite more than a century of research, there is still nothing even remotely resembling a consensus on how the literary sources should best be handled. This paper explores some of the problems with the evidence for early Rome, considers something of the limits and uses of that evidence, as well as introduces the contributions that make up this collection of studies on power and politics in early Rome.
While the general absence of Rome’s nobility from the traditions of the regal period has often been noted, the nobility’s prompt appearance at the beginning of the republican period has elicited little comment. This paper argues that the nobility’s appearance is more significant than its earlier absence, precisely on account of its very promptness and also because the nobility appears primarily with the consulship. Given the special importance that the consulship later came to have, following the emergence of Rome’s office-holding nobility, these circumstances inevitably raise questions about the value of the early consular fasti, and indeed even about the whole premise on which the early fasti are based, namely that the consulship was established immediately after the expulsion of the kings. It is argued here that this premise is anachronistic, and that the early consular fasti are unreliable and often tendentious; it is further argued that this premise is also responsible for some of the confusion surrounding the mysterious consular tribunate. The consular tribunate was a magistracy about which ancient writers quite clearly knew very little, and their ignorance and the inconsistencies in what they had to say about the tribunate inevitably undermine their claim to possess better and more detailed information about earlier times.