To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
The development of large-scale shale gas production has been described as a game-changer for the US energy market and has generated interest in expanding the use of natural gas in sectors such as electricity generation and transportation. This development has been made possible by improvements in drilling technologies—specifically utilizing hydraulic fracturing in conjunction with horizontal drilling—that have enabled the production of natural gas from unconventional formations. However, the environmental implications of natural gas production and its use have been called into question. Environmental impacts associated with shale gas development can occur at the global and local levels and include impacts to climate, local air quality, water availability, water quality, seismic events, and the local community. A variety of technologies and practices are available to operators to reduce these impacts. Policies are currently under development at the federal, state, and local level to mitigate environmental impacts. In this document, we discuss the technologies involved in shale gas production, the potential abiotic impacts of shale gas production with an emphasis on air and water issues, and the practices and policies currently being developed and implemented to mitigate these impacts.
Event planning for mass gatherings involves the utilization of methods that prospectively can predict medical resource use. However, there is growing recognition that historical data for a specific event can help to accurately forecast medical requirements. This study was designed to investigate the differences in medical usage rates between two popular mass-gathering sports events in the UK: rugby matches and horse races.
A retrospective study of all attendee consultations with the on-site medical teams at the Leicester Tigers Rugby Football Club and the Leicester Racecourse from September 2008 through August 2009 was undertaken. Patient demographics, medical usage rates, level of care, as well as professional input and the effects of alcohol use were recorded.
Medical usage rates were higher at the Leicester Racecourse (P < .01), although the demographics of the patients were similar and included 24% children and 16% staff. There was no difference in level of care required between the two venues with the majority of cases being minor, although a higher proportion of casualties at the Leicester Tigers event were seen by a health care professional compared with the Leicester Racecourse (P < .001). Alcohol was a contributing factor in only 5% of consultations.
These two major sporting venues had similar attendance requirements for medical treatment that are comparable to other mass-gathering sports events. High levels of staff and pediatric presentations may have an impact on human resource planning for events on a larger scale, and the separation of treatment areas may help to minimize the number of unnecessary or opportunistic reviews by the on-site health care professionals.
BurtonJO, CorrySJ, LewisG, PriestmanWS. Differences in Medical Care Usage between Two Mass-Gathering Sporting Events. Prehosp Disaster Med.2012;27(4):1-5.
Evidence suggests that adipose tissue-derived adipokines induce mild inflammation and may play a role in insulin resistance associated with diabetes. The present study was designed to examine a series of adipokines and markers of inflammation in dogs before and after a successful weight loss. The study included fasting serum samples from twenty-five dogs before and after a weight-loss programme. Serum C-reactive protein (CRP) and monocyte chemoattractant protein-1 (MCP-1) were measured as indicators of chronic inflammation, while serum adipokines including total adiponectin, high-molecular-weight (HMW) adiponectin, resistin and leptin were also examined. Medians for CRP (before, 10·0 (interquartile range 5·4–15·0) μg/ml; after, 5·6 (interquartile range 3·8–7·0) μg/ml) and MCP-1 (before, 212 (interquartile range 157–288) ng/ml; after, 185 (interquartile range 143–215) ng/ml) decreased significantly after weight loss. Medians for resistin showed a mild, yet significant reduction (before, 67·1 (interquartile range 44·4–88·5) pg/ml; after, 60·5 (interquartile range 32·3–67·1) pg/ml), while leptin showed a dramatic decrease after weight loss (before, 18·9 (interquartile range 10·8–35·4) ng/ml; after, 6·6 (interquartile range 3·9–10·2) ng/ml). Serum total adiponectin and HMW adiponectin were unchanged on all analyses performed. These data suggest that weight loss can decrease chronic inflammation; however, the clinical implications of this decrease are not well elucidated in dogs. Surprisingly, there was no increase in total or HMW serum adiponectin after weight loss, as observed previously in human subjects. The lack of change in total and HMW adiponectin might explain why insulin resistance and type 2 diabetes are less prevalent in obese dogs when compared with humans and cats.
An interdisciplinary study of a small sedimentary basin at Neumark Nord 2 (NN2), Germany, has yielded a high-resolution record of the palaeomagnetic Blake Event, which we are able to place at the early part of the last interglacial pollen sequence documented from the same section. We use this data to calculate the duration of this stratigraphically important event at 3400 ± 350 yr. More importantly, the Neumark Nord 2 data enables precise terrestrial–marine correlation for the Eemian stage in central Europe. This shows a remarkably large time lag of ca. 5000 yr between the MIS 5e ‘peak’ in the marine record and the start of the last interglacial in this region.
This paper provides a detailed overview of variable annuities. Consideration is given first to the definition of the term variable annuity. Common terminology used in the variable annuity market is introduced. The current state of the United Kingdom and other international markets is described. Then, by reference to a simplified product, an analysis of customer outcomes, pricing, reserving, risk management and hedging is carried out. The paper ends with a description of current U.K. pensions legislation and how it potentially constrains product development.
Background. The present paper describes a component of a large population cost-effectiveness study that aimed to identify the averted burden and economic efficiency of current and optimal treatment for the major mental disorders. This paper reports on the findings for the anxiety disorders (panic disorder/agoraphobia, social phobia, generalized anxiety disorder, post-traumatic stress disorder and obsessive–compulsive disorder).
Method. Outcome was calculated as averted ‘years lived with disability’ (YLD), a population summary measure of disability burden. Costs were the direct health care costs in 1997–8 Australian dollars. The cost per YLD averted (efficiency) was calculated for those already in contact with the health system for a mental health problem (current care) and for a hypothetical optimal care package of evidence-based treatment for this same group. Data sources included the Australian National Survey of Mental Health and Well-being and published treatment effects and unit costs.
Results. Current coverage was around 40% for most disorders with the exception of social phobia at 21%. Receipt of interventions consistent with evidence-based care ranged from 32% of those in contact with services for social phobia to 64% for post-traumatic stress disorder. The cost of this care was estimated at $400 million, resulting in a cost per YLD averted ranging from $7761 for generalized anxiety disorder to $34 389 for panic/agoraphobia. Under optimal care, costs remained similar but health gains were increased substantially, reducing the cost per YLD to <$20 000 for all disorders.
Conclusions. Evidence-based care for anxiety disorders would produce greater population health gain at a similar cost to that of current care, resulting in a substantial increase in the cost-effectiveness of treatment.
Symptomatic brain metastases from prostatic carcinoma are rare (0.05% to 0.5%).
A 70-year-old man presented with a homonymous hemianopsia due to brain metastatic prostatic carcinoma shortly before becoming symptomatic of prostatic disease. CT and MRI of the brain showed a tumour deep in the right hemisphere near the thalamus and involving the optic radiation.
Routine haematological and biochemical tests were normal. The prostate specific antigen level was low on two separate occasions. The prostatic and brain tumours showed identical appearances, namely of a poorly differentiated adenocarcinoma with neuroendocrine differentiation (small cell carcinoma).
A literature review suggests that small cell carcinoma of the prostate is more likely to spread to the brain compared to adenocarcinoma and that brain metastases indicate a poor prognosis. The prostate gland should be remembered as a possible cause of brain metastases and that a normal serum prostate specific antigen does not exclude this diagnosis.
The experiences of 51 elderly depressed female patients with a standardized course “Coping with Depression and Anxiety” were investigated. Preliminary findings concerning the effectiveness of this course in 34 patients who completed the course will also be presented. This course consisted of psychoeducation and skills training. Depressive symptoms were scored by using the SCL-90 depression scale and the Geriatric Depression Scale. Results indicate that patients were very enthusiastic about the course and that there was no need to make major changes in its structure and content. Also, depressive symptoms were significantly reduced after completion of the course, which emphasizes the importance of this psychoeducational program in the treatment of depression in elderly female patients.
Eighteen strains of Campylobacter sputorum bv. paraureolyticus
(isolated over a 12-month
period from seven dairy cows contained in a single herd) were examined
by resistotyping, and
macrorestriction profiling using pulsed field gel electrophoresis (PFGE).
The resistotypes of
these strains were identical, although repeat testing indicated resistance
to metronidazole was
not a reliable trait for typing purposes. Five SmaI-derived genotypes
were identified among the
18 strains. In 5 of 7 cows, isolates obtained from the same animal, but
from different time
periods, were genotypically indistinguishable, indicating persistence of
Macrorestriction profiles of 5 strains representing the 5 SmaI
genotypes and 8 other strains of
C. sputorum from various sources, were prepared using 4 endonucleases
(SmaI, SalI, BamHI
and KpnI). The only other strain of C. sputorum bv. paraureolyticus
examined (a Canadian
isolate from human faeces), was found to have a SmaI macrorestriction
profile identical with
one of the five clones isolated from the cattle. Moreover, SalI
and BamHI profiles of all bv.
paraureolyticus strains were similar, while digestion with KpnI
was not observed. By contrast,
the seven strains of C. sputorum bv. sputorum yielded various
macrorestriction profiles with all
the enzymes used, and features distinguishing the two biovars studied could
be identified. This
study indicates that C. sputorum can persist in cattle for at
least 12 months and exhibits a
clonal population genetic structure.
A case is presented of a laterally occurring thyroglossal cyst. In conventional teaching, thyroglossal duct remnants occupy the midline, or a position adjacent to the midline, and are found in a line marking the descent of the thyroid anlage and move upwards on protruding the tongue. Laterally presenting thyroglossal duct remnants are unusual.
A fluorescent-dye technique has been developed to measure root length of field crops. Roots are washed from soil samples, stained for about 30 min in a solution of fluorescein diacetate in acetone, washed, spread out on a tension table and photographed under UV light. Lengths of fluorescent roots recorded on the photograph are estimated by line intersection. The method is quick, simple, inexpensive and largely eliminates the usual time-consuming, tedious process of hand-sorting live roots from organic debris. Whereas all the roots of young laboratory-grown plants take up the dye, some older roots of field-grown crops do not fluoresce. Data indicate that the method may also give information on root diameter.
The major results from a comprehensive study of the Amery Ice Shelf are presented, following the work of a wintering expedition in 1968 and supplemented by further measurements during the summer seasons of 1969 to 1971. The Programme included ice-core drilling, oversnow surveys for ice movement and optical levelling, ice-thickness sounding, and measurements of snow accumulation. The new data obtained provide the basis for a more accurate assessment of the mass balance and dynamics of the ice shelf than was possible from the earlier surveys.
The results indicate a substantial growth of basal ice under the ice shelf inland where the ice thickness is greater than 450 m. Further towards the ice front the high strain thinning is approximately balanced by the horizontal ice advection.
The velocity distribution over the ice shelf is primarily governed by a substantial surface slope towards the ice front and high restraining shear stress along the sides.
The events of the last thirty years have reinforced the attachment of the thoughtful to the Rule of Law. After watching the shocking excesses of rulers who had escaped from the restraints of law, we can think of dozens of reasons for maintaining the authority of law, which we could not have articulated thirty years ago. But agreement on the end has not enabled us to agree on the means. What kind of institutional arrangements are needed to meet the requirements of the Rule of Law? Since there are infinite possible gradations between the untrammelled licence of rulers and the Rechtstaat of eighteenth-century England, what minimum framework of restraints on rulers is needed? Supposing we could determine the formal requirements of the minimum, in what kind of a society can they be maintained and guaranteed? To be specific, will the inner nature and the inexorable requirements of the collectivist societies in which we live erode and submerge them?
What is required for the Rule of Law to be effective? On the one hand, some have contended that the phrase is essentially meaningless because it means only that the exercisers of power must show that it was conferred on them by law. Hitler showed a scrupulous regard for legal and constitutional forms as he persuaded the German Reichstag to confer on him practically boundless discretion. He could always point to legal warrant for the substance of his actions. In this sense, we might become subject to the most capricious tyranny without ever abandoning the Rule of Law.