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Starting in 2016, we initiated a pilot tele-antibiotic stewardship program at 2 rural Veterans Affairs medical centers (VAMCs). Antibiotic days of therapy decreased significantly (P < .05) in the acute and long-term care units at both intervention sites, suggesting that tele-stewardship can effectively support antibiotic stewardship practices in rural VAMCs.
Introduction: Adolescents who present to emergency departments (ED) following intentional injuries present a challenge in terms of ascertaining their intent and risk for future self-injurious or suicidal behaviour. Our ED has seen an 80% increase in visits for mental health issues over the past ten years. As usage of our Emergency Mental Health and Addictions Services (EMHAS) team continues to rise, it is increasingly important to understand the incidence of NSSI among our youth, explore if NSSI is reported at triage and identify characteristics that may distinguish these adolescents from others presenting for mental health assessment. Methods: This is an exploratory research study using retrospective data. Patients who had an Emergency Mental Health Triage (EMHT) form on their health record from an ED visit between June 1, 2017 and May 31, 2018 were eligible. Trained research assistants, using a structured data collection form in REDCap. abstracted data from the EMHT form, the EMHAS Assessment form, the Assessment of Suicide Risk Inventory and our CHIRPP (Canadian Hospitals Injury Reporting and Prevention Program) database. We calculated kappa values and 95% confidence intervals to describe the extent to which the forms agree with respect to identifying NSSI. We will compare the cohort who reports NSSI with the cohort who does not report NSSI using chi-square statistics depending. We will use descriptive statistics to characterize the NSSI patients. Results: During the one-year study period 955 patients had an EMHT form completed. In preliminary analysis 558 (58.4%) reported a history of NSSI. Patients reported NSSI on both the EMHT form and the EMHAS assessment form 64.7% of the time (kappa 0.56) indicating moderate agreement. In patients with NSSI, 9.5% of patients reported it only at triage and 25.8% of patients reported it only during their EMHAS assessment. Between group comparisons and descriptive analysis is underway. Conclusion: More than half of youth triaged with an emergency mental health complaint in our ED reported a history of NSSI. Screening at triage was moderately effective in identifying adolescents with NSSI compared to an in-depth assessment by the mental health team. Further research is needed to clarify how NSSI relates to risk for suicide.
Introduction: Croup is a common viral upper airway infection in children aged 6 months to 6 years. Although a single dose of dexamethasone decreases return visits, the prescribed dose varies from 0.15mg/kg to 0.6mg/kg. Our objective was to examine the effect of varied dexamethasone dosing on unplanned return ED visits for croup. Methods: This was a retrospective chart review of IWK ED patient treatment records from September 1, 2014 – August 31, 2016 of children aged 6 months to 6 years with an ICD-10 discharge diagnosis code of croup. Data were abstracted by trained research assistants using a structured data collection form in REDCap. A sample of 5% of charts had double data abstraction to test for agreement. Our primary outcome was return visits to the ED within 7 days. Secondary outcomes were ED length of stay (LOS), admission to hospital and admission to the pediatric intensive care unit (PICU). Data were analyzed using descriptive statistics and chi-square for between group comparisons. Results: The dataset included 1595 patient visits for croup. Data analysis is in progress. Triage acuity as per CTAS included: resuscitation n = 5; emergent n = 351; urgent n = 558; less urgent n = 605; and, non-urgent n = 2. Most patients had no co-morbid conditions (n = 1548). Dexamethasone dosing varied: 0.15 mg/kg n = 64; 0.3 mg/kg n = 838; and, 0.6 mg/kg n = 493. ED LOS was under 1 hour in 483 patients, 1-3 hours in 805, 3-6 hours in 225 and 6-12 hours in 9 patients. Few patients were admitted to hospital (n = 22) and no patients were admitted to PICU. Within 7 days of the index visit, 78 patients had an unplanned return visit to the ED for croup. Conclusion: The data analysis is in progress. This study will inform our future research on a practice change in our ED to comply with the dose of dexamethasone recommended by the Canadian Pediatric Society for the treatment of croup in 2017.
Zn plays an important role in maintaining the anti-oxidant status within the heart and helps to counter the acute redox stress that occurs during myocardial ischaemia and reperfusion. Individuals with low Zn levels are at greater risk of developing an acute myocardial infarction; however, the impact of this on the extent of myocardial injury is unknown. The present study aimed to compare the effects of dietary Zn depletion with in vitro removal of Zn (N,N,N′,N′-tetrakis(2-pyridinylmethyl)-1,2-ethanediamine (TPEN)) on the outcome of acute myocardial infarction and vascular function. Male Sprague–Dawley rats were fed either a Zn-adequate (35 mg Zn/kg diet) or Zn-deficient (<1 mg Zn/kg diet) diet for 2 weeks before heart isolation. Perfused hearts were subjected to a 30 min ischaemia/2 h reperfusion (I/R) protocol, during which time ventricular arrhythmias were recorded and after which infarct size was measured, along with markers of anti-oxidant status. In separate experiments, hearts were challenged with the Zn chelator TPEN (10 µm) before ischaemia onset. Both dietary and TPEN-induced Zn depletion significantly extended infarct size; dietary Zn depletion was associated with reduced total cardiac glutathione (GSH) levels, while TPEN decreased cardiac superoxide dismutase 1 levels. TPEN, but not dietary Zn depletion, also suppressed ventricular arrhythmias and depressed vascular responses to nitric oxide. These findings demonstrate that both modes of Zn depletion worsen the outcome from I/R but through different mechanisms. Dietary Zn deficiency, resulting in reduced cardiac GSH, is the most appropriate model for determining the role of endogenous Zn in I/R injury.
Forest ecosystems in South Africa are at risk from a variety of anthropogenic threats impacting the faunal species dependent on them. These impacts often differ depending on species-specific characteristics. Range data on forest dependent bird species from the South African Bird Atlas Project (SABAP1 and SABAP2) were analysed to determine links between deforestation, species characteristics and range declines. Half of the species studied were found to have declining ranges. Range change data for these species were correlated with data on changes in land cover from 1990 to 2014. To determine which land cover changes affect extinction, occupancy was modelled for 30 sites across South Africa which experienced a loss of more than 10 species. Most species lost were birds of prey or insectivores. Indigenous forest decreased in 17% (n = 5) sites, while plantations/woodlots decreased in 60% (n = 18) sites. Occupancy modelling showed extinction to be mitigated by plantations in 6/28 species, and forest expansion mitigated extinction in 7/28 species. Responses to deforestation did not appear to be related to particular species characteristics. Half of South Africa’s forest-dependent bird species have declining ranges, with the loss of these species most prominent in the Eastern Cape province. Four responses to changes in forest and plantation cover are discussed: direct effects, with forest loss causing species loss; matrix effects, where plantation loss resulted in species loss; degradation of indigenous forest; and the advent of new forest arising from woody thickening caused by carbon fertilisation, which may not result in optimal habitat for forest-dependent birds.
A radiochemical 71Ga−71 Ge experiment to determine the integral flux of neutrinos from the sun has been constructed at the Baksan Neutrino Observatory in the USSR. Measurements have begun with 30 tonnes of gallium. The experiment is being expanded with the addition of another 30 tonnes. The motivation, experimental procedures, and present status of this experiment are presented.
Most individuals with dementia live in the community, receiving care from family or lay carers. Carers’ wellbeing, and the quality of the care they provide, depends on their resilience in the face of the challenges associated with caring for someone with dementia. However, factors associated with carers’ resilience are not yet fully understood. The aim of this review is to present a narrative synthesis of factors, materials and resources associated with carers’ resilience. Electronic and hand searches identified relevant published literature, which was narratively synthesized. A framework consisting of three inter-related domains of factors influencing carers’ resilience emerged, encompassing: social and cultural factors; properties of the care relationship; and carers’ psychological factors. Holistic assessment based on this framework can help practitioners to identify vulnerable carers and to target help on factors that help to make them vulnerable but that are amenable to change.
Late medieval wooden caskets decorated with leather have attracted much greater attention in Germany and Belgium than in England. The Spitzer collection is one of the first that included examples of them, and the first major survey that mentioned them was that of Dr. H. Kohlhausen in 1926. His discussion of Minnekästchen, the romantic name given in the nineteenth century to caskets with secular subjects, included both caskets of wood alone and wood covered with leather. He discussed leather caskets now in the Deutsches Ledermuseum at Offenbach and in the Cluny Museum, Paris but, since he was solely concerned with secular iconography, he did not discuss other leather caskets whose style and technique indicated that they had a related origin. The whole group of leather caskets, including the two already mentioned and also caskets at Lucca and in the collection of Mr. Robert Martin on loan to the Cloisters, New York, was first discussed as a whole by Dr. G. Gall in his magisterial survey of European leatherwork. He assigned the Offenbach and Cloisters caskets to northern France or Flanders in the second half of the fourteenth century and the Lucca casket to Northern France or Flanders around 1400. Earlier in 1952 Mme A. M. Marien Dugardin reviewed the evidence for a number of leather caskets mainly in Belgium museums but including the example in the Cluny Museum and concluded from their use of Flemish for the inscriptions around their lids that they were Flemish in origin. In 1975 Mr. H. Bober discussed the Martin casket on loan to the Cloisters and concluded that it was of Flemish origin and dated to about 1400 or slightly earlier. In contradiction to the previously expressed views R. Didier in 1978, in the catalogue of the exhibition Die Parler und der Schöne Stil, discussing the lid of a casket preserved at Nivelles rejected a Flemish origin for the group and suggested that the caskets found an origin in the French sphere of influence, probably in Paris. This article will see how far the casket recently acquired by the British Museum (pis. xxviii-xxxin a) relates to these caskets and will review the evidence for its place of production.
Hoards of coins that include jewellery are uncommon in the middle ages. In England up to 1966 there were only three such hoards known. These are the twelfth-century hoard from Lark Hill, Worcester, which contained six rings; the hoard from Coventry of c. 1290–8 containing two silver ring brooches; and the Thame hoard deposited after 1457 and containing five rings. In 1966 the discovery of a hoard of gold coins and jewellery at Fishpool, Nottinghamshire, added a fourth hoard to this sequence.
The effect of a concrete-based repository on local geological conditions and properties has been explored. As part of a complete description of repository behaviour, a static model of clay-alkali interactions has been set up. Parallel experiments have demonstrated the buffering capacity of clays, and are indicating the chemical and physical changes that may occur when an alkali plume interacts with a clay host rock.
When a rigid two-dimensional triangular crystalline layer of colloidal spheres confined between two smooth repulsive walls is gradually given freedom to move out of plane, it buckles dynamically undergoing several Peierls transitions involving different soft phonon modes before forming a two layer crystal with square in-plane symmetry. We have mapped out the complex phase diagram of the buckling transitions as a function of sphere density and wall separation. Digital imaging is used to study the instantaneous particle positions and trajectories of the uniform, highly charged 0.3 μm diameter polystyrene spheres that comprise the crystalline layer in water suspension. Brownian motion of the spheres creates a true thermodynamic system with a real temperature, which is studied using video microscopy. We follow the collective dynamics of the system as well as individual particle motions and the motions and rearrangements of topological defects and domains. At sufficiently low sphere densities the system melts into a fluid. As the wall separation increases to the point of two layer formation we observe square symmetry in the fluid correlation volumes.
Highly conductive epiraxial silicon thin films, with conductivities more than 680 ¥Ø-1cm-1, were obtained using plasma enhanced chemical vapor deposition (PECVD) technique at 300¢ªC. The effect of hydrogen in growth of low temperature extrinsic Si thin films was studied using conductivity, Hall, and Raman measurements, and it was shown that epitaxial growth was possible at hydrogen dilution (HD) ratios more than 85%. The epitaxial growth of the extrinsic Si thin films at high hydrogen dilution regime was confirmed by high resolution transmission electron microscopy (HRTEM).
Metarhizium anisopliae exhibits two different developmental patterns under nutrient-deprived conditions: appressorium formation in early stages and conidiation in late stages of pathogenesis in its insect hosts. In this study we isolated genes enriched during mature conidial production under nutrient-deprived conditions in M. anisopliae by using the method of suppression subtractive hybridization. We sequence-identified seven conidiation-associated genes (cag) in M. anisopliae. One of the genes, cag7, encoded an extracellular subtilisin-like protease, Pr1, that plays a fundamental role in cuticular protein degradation. Reverse-transcription polymerase chain reaction (RT-PCR) analysis confirmed that cag cDNAs are expressed during the development of mature conidia under nutrient-deprived conditions. RT-PCR analysis was also performed for Pr1 during infection of greater wax moth larvae (Galleria mellonella). Results showed up-regulation of Pr1 in the infected insect as the mycelia emerge and produce conidia on the surface of the cadaver. It is well documented that Pr1 is produced during the initial stages of transcuticular penetration by M. anisopliae. Here we show that Pr1 is also up-regulated during the final stages of pathogenesis as the fungus emerges from the dead host and subsequently conidiates on the cadaver.
Patients undergoing cancer treatments, including radiotherapy, frequently report fatigue during their treatment. Recent research indicates that structured exercise programmes can alleviate fatigue and, in light of this research, many centres are now advocating activity as part of the strategy with which to combat fatigue. The aim of this investigation was to see how well this strategy would be received by patients and what effect it would have on fatigue levels. Of the 147 patients who agreed to take part in the study 123 completed all the questionnaires. Fiftyfour of the patients received the standard advice whilst 69 received the modified advice. Fatigue was measured at four time points using the MFI scale. Fatigue scores at the end of treatment were significantly higher than at the start of treatment but there was no difference in fatigue scores between the two groups of patients receiving the different advice. Activity levels between the two groups were comparable, as was their change in activity level compared to normal, indicating a reluctance to use this strategy.
The Archaeological Site Index to Radiocarbon Dates for Great Britain and Ireland, pioneered by the Council for British Archaeology in 1971, is now being prepared as a fully computerized database. This note describes the genesis and format of this invaluable new tool.