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The common femoral artery is a continuation of the external iliac artery and is approximately 4 cm long. It begins directly behind the inguinal ligament, midway between the anterior superior iliac spine and the symphysis pubis.
The profunda femoris artery arises from the lateral aspect of the common femoral artery, towards the femur, approximately 3–4 cm below the inguinal ligament. The common femoral artery continues obliquely down the anteromedial aspect of the thigh as the superficial femoral artery.
The superficial femoral artery exits the femoral triangle to enter the subsartorial canal and ends by passing through an opening in the adductor magnus to become the popliteal artery.
In the upper third of the thigh, the femoral vessels are contained within the femoral triangle (Scarpa’s triangle).
The femoral triangle is formed laterally by the medial border of the sartorius muscle, medially by the adductor longus, and superiorly by the inguinal ligament.
In the femoral triangle, the femoral vein lies medial to the femoral artery. The greater saphenous vein drains into the femoral vein about 3–4 cm below the inguinal ligament; further distally, the femoral vein lies posterior to the artery and maintains this relationship in the popliteal fossa. The femoral nerve and its branches are found lateral to the common femoral artery.
In the middle third of the thigh, the femoral artery lies within the adductor canal (Hunter’s canal), an aponeurotic tunnel in the middle third of the thigh that extends from the apex of the femoral triangle to the opening in the adductor magnus.
The adductor canal is bounded by the sartorius muscle anteriorly, the vastus medialis laterally, and the adductor longus and magnus posteromedially. A fascial plane between the vastus medialis and adductor longus and magnus covers the canal.
The canal contains the femoral artery and vein, the saphenous nerve which crosses from lateral to medial, and branches of the femoral nerve.
The femoral vein courses from a medial position in the groin to a posterior and then lateral position with respect to the artery as it moves distally towards the knee.
The greater saphenous vein courses medially to lie on the anterior surface of the thigh, before entering the fascia lata and joining the common femoral vein at the sapheno-femoral junction near the femoral triangle.
The chapter summarises the main findings from the SDG chapters (1–17) combined with the results from a workshop in 2018 to answer the following questions: How is Agenda 2030 likely to interact with forests and people? What are the possible synergies, trade-offs between goals and targets? What are the contextual conditions that shape the interactions between SDGs and targets and subsequent impacts on forests and people? Two broad groups of SDGs emerge. One includes SDGs that primarily focus on institutional, governance and social conditions. Those contribute to an enabling environment for inclusive forest management and conservation with associated livelihood benefits. A second group of SDGs affect land use directly and thus are expected to impact forests. Progress in the first group of SDGs results in synergistic interactions and positive outcomes for forests and peoples. Among the second group of SDGs, the potential for trade-offs is high, with important repercussions for forest and people. Understanding the potential for these trade-offs is essential in order to avoid implementation pathways that favour a small subset of these SDGs at the expense of the others.
The introductory chapter introduces the Agenda 2030 and its 17 SDGs and briefly presents the process that led to its adoption. It discusses the nature of the SDGs, recognising the great variation in the nature, scope and function of the SDGs and related targets, and drawing attention to the interlinkages among the goals and targets. Forests provide ecosystem services that are crucial for human welfare and for reaching the SDGs. The chapter gives a brief overview of the world’s forests and forests’ contributions to the SDGs. Forests are only mentioned in two SDGs (SDG 6 and SDG 15). However, due to the interrelated nature of the SDGs and targets, the implementation of the SDG agenda will inevitably influence forests and forest-related livelihoods and the possibilities to achieve the forest specific targets. Understanding the potential impacts of SDGs on forests, forest-related livelihoods and forest-based options to generate progress towards achieving the SDGs, as well as the related tradeoffs and synergies, is crucial for efforts undertaken to reach these goals. It is especially important for reducing potential negative impacts and to leverage opportunities to create synergies that will ultimately determine whether comprehensive progress towards the SDGs will be accomplished.
This chapter summarises the lessons learnt in the book, based on a reflection process amongst the editors and a joint workshop with the lead authors. The key messages are that 1) forests are a crucial base for sustainable development, and need to be fully considered in all related decision making, 2) the SDGs will impact forests and the people dependent on them in many ways, with the exact impact being highly dependant on the respective ecological and socio-economic context, 3) the SDGs include partially conflicting visions for forests and people, corresponding to distinct values and interests, involving the necessity to consider trade-offs and set priorities when implementing them, 4) there are fundamental values and principles that may guide sustainable development related to forests and people regardless of the context, including basic human rights but also forest-specific aspects and principles for how existing trade-offs can be managed, 5) that there is the necessity to continuously learn from, and adapt, the process of implementing the SDGs. The chapter concludes by addressing the urgency of creative and forward-looking human engagement at the forest–people interface, to make sure that sustainable development can benefit both forests and people.
Throughout his brief life Lord Byron attracted the gazes of others – because he was disabled, because he was a lord, because he was a literary idol, because “at least a third part of the day, [he] was a dandy” (Stendhal quoted in HVSV 201), because he was fat, because he was thin, because of his beauty or because his appearance disappointed. Byron was surveyed, prepared himself to be surveyed and surveyed himself internally. His own self-fashioning, as author, as part-time dandy and as athlete (pugilist and swimmer especially), took place in the context of his experiences in his own body, but his self-fashioning takes place for us, above all, in his words.
Forests provide vital ecosystem services crucial to human well-being and sustainable development, and have an important role to play in achieving the seventeen Sustainable Development Goals (SDGs) of the United Nations 2030 Agenda. Little attention, however, has yet focused on how efforts to achieve the SDGs will impact forests and forest-related livelihoods, and how these impacts may, in turn, enhance or undermine the contributions of forests to climate and development. This book discusses the conditions that influence how SDGs are implemented and prioritised, and provides a systematic, multidisciplinary global assessment of interlinkages among the SDGs and their targets, increasing understanding of potential synergies and unavoidable trade-offs between goals. Ideal for academic researchers, students and decision-makers interested in sustainable development in the context of forests, this book will provide invaluable knowledge for efforts undertaken to reach the SDGs. This title is available as Open Access via Cambridge Core.
Distinguishing between hypertrophic cardiomyopathy and other causes ofleft ventricular hypertrophy can be difficult in children. We hypothesised that cardiac MRI T1 mapping could improve diagnosis of paediatric hypertrophic cardiomyopathy and that measures of myocardial function would correlate with T1 times and extracellular volume fraction.
Thirty patients with hypertrophic cardiomyopathy completed MRI with tissue tagging, T1-mapping, and late gadolinium enhancement. Left ventricular circumferential strain was calculated from tagged images. T1, partition coefficient, and synthetic extracellular volume were measured at base, mid, apex, and thickest area of myocardial hypertrophy. MRI measures compared to cohort of 19 healthy children and young adults. Mann–Whitney U, Spearman’s rho, and multivariable logistic regression were used for statistical analysis.
Hypertrophic cardiomyopathy patients had increased left ventricular ejection fraction and indexed mass. Hypertrophic cardiomyopathy patients had decreased global strain and increased native T1 (−14.3% interquartile range [−16.0, −12.1] versus −17.3% [−19.0, −15.7], p < 0.001 and 1015 ms [991, 1026] versus 990 ms [972, 1001], p = 0.019). Partition coefficient and synthetic extracellular volume were not increased in hypertrophic cardiomyopathy. Global native T1 correlated inversely with ejection fraction (ρ = −0.63, p = 0.002) and directly with global strain (ρ = 0.51, p = 0.019). A logistic regression model using ejection fraction and native T1 distinguished between hypertrophic cardiomyopathy and control with an area under the receiver operating characteristic curve of 0.91.
In this cohort of paediatric hypertrophic cardiomyopathy, strain was decreased and native T1 was increased compared with controls. Native T1 correlated with both ejection fraction and strain, and a model using native T1 and ejection fraction differentiated patients with and without hypertrophic cardiomyopathy.
Antimicrobial stewardship improves patient care and reduces antimicrobial resistance, inappropriate use, and adverse outcomes. Despite high-profile mandates for antimicrobial stewardship programs across the healthcare continuum, descriptive data, and recommendations for dedicated resources, including appropriate physician, pharmacist, data analytics, and administrative staffing support, are not robust. This review summarizes the current literature on antimicrobial stewardship staffing and calls for the development of minimum staffing recommendations.
Smoking prevalence is higher amongst individuals with schizophrenia and depression compared with the general population. Mendelian randomisation (MR) can examine whether this association is causal using genetic variants identified in genome-wide association studies (GWAS).
We conducted two-sample MR to explore the bi-directional effects of smoking on schizophrenia and depression. For smoking behaviour, we used (1) smoking initiation GWAS from the GSCAN consortium and (2) we conducted our own GWAS of lifetime smoking behaviour (which captures smoking duration, heaviness and cessation) in a sample of 462690 individuals from the UK Biobank. We validated this instrument using positive control outcomes (e.g. lung cancer). For schizophrenia and depression we used GWAS from the PGC consortium.
There was strong evidence to suggest smoking is a risk factor for both schizophrenia (odds ratio (OR) 2.27, 95% confidence interval (CI) 1.67–3.08, p < 0.001) and depression (OR 1.99, 95% CI 1.71–2.32, p < 0.001). Results were consistent across both lifetime smoking and smoking initiation. We found some evidence that genetic liability to depression increases smoking (β = 0.091, 95% CI 0.027–0.155, p = 0.005) but evidence was mixed for schizophrenia (β = 0.022, 95% CI 0.005–0.038, p = 0.009) with very weak evidence for an effect on smoking initiation.
These findings suggest that the association between smoking, schizophrenia and depression is due, at least in part, to a causal effect of smoking, providing further evidence for the detrimental consequences of smoking on mental health.
The development of Middle Preclassic (900–300 BC) ceremonial architecture is receiving more attention by archaeologists conducting research in the Maya Lowlands. Although a few examples have been partially excavated, there is still a dearth of information on how and why monumental constructions were originally built. This is largely because early structures often lie below several layers of sequential architecture, making them difficult to locate. Even when Middle Preclassic architecture is identified, exposure is often too limited to fully investigate its form and function. A well-preserved and accessible Middle Preclassic platform would be a rare find and could greatly enhance our knowledge and understanding of the subject. At Pacbitun, Cayo District, Belize, such a discovery has been made beneath the artificially raised surface of the main plaza. To make the most of this opportunity, five seasons of excavation worked to expose this massive building in its entirety. In this article, we provide details concerning the structural design of the platform and its abandonment, as well as present potential architectural comparisons. We conclude by reevaluating complexity at Pacbitun.
A new fossil site in a previously unexplored part of western Madagascar (the Beanka Protected Area) has yielded remains of many recently extinct vertebrates, including giant lemurs (Babakotia radofilai, Palaeopropithecus kelyus, Pachylemur sp., and Archaeolemur edwardsi), carnivores (Cryptoprocta spelea), the aardvark-like Plesiorycteropus sp., and giant ground cuckoos (Coua). Many of these represent considerable range extensions. Extant species that were extirpated from the region (e.g., Prolemur simus) are also present. Calibrated radiocarbon ages for 10 bones from extinct primates span the last three millennia. The largely undisturbed taphonomy of bone deposits supports the interpretation that many specimens fell in from a rock ledge above the entrance. Some primates and other mammals may have been prey items of avian predators, but human predation is also evident. Strontium isotope ratios (87Sr/86Sr) suggest that fossils were local to the area. Pottery sherds and bones of extinct and extant vertebrates with cut and chop marks indicate human activity in previous centuries. Scarcity of charcoal and human artifacts suggests only occasional visitation to the site by humans. The fossil assemblage from this site is unusual in that, while it contains many sloth lemurs, it lacks ratites, hippopotami, and crocodiles typical of nearly all other Holocene subfossil sites on Madagascar.
Photonic crystal surfaces represent a class of resonant optical structures that are capable of supporting high intensity electromagnetic standing waves with near-field and far-field properties that can be exploited for high sensitivity detection of biomolecules and cells. While modulation of the resonant wavelength of a photonic crystal by the dielectric permittivity of adsorbed biomaterials enables label-free detection, the resonance can also be tuned to coincide with the excitation wavelength of common fluorescent tags - including organic molecules and semiconductor quantum dots. Photonic crystals are also capable of efficiently channeling fluorescent emission into a preferred direction for enhanced extraction efficiency. Photonic crystals can be designed to support multiple resonant modes that can perform label free detection, enhanced fluorescence excitation, and enhanced fluorescence extraction simultaneously on the same device. Because photonic crystal surfaces may be inexpensively produced over large surface areas by nanoreplica molding processes, they can be incorporated into disposable labware for applications such as pharmaceutical high throughput screening. In this talk, the optical properties of surface photonic crystals will be reviewed and several applications will be described, including results from screening a 200,000-member chemical compound library for inhibitors of protein-DNA interactions, gene expression microarrays, and high sensitivity of protein biomarkers.
Infective endocarditis is a microbial infection of the endothelial surface of the heart, predominantly the heart valves, that is associated with high mortality and morbidity. Few contemporary data exist regarding affected children in our context.
Aims and Objectives:
We aimed to describe the profile and treatment outcomes of infant and childhood endocarditis at our facilities.
This is a retrospective analysis of infants and children with endocarditis at two public sector hospitals in the Western Cape Province of South Africa over a 5-year period. Patients with “definite” and “possible” endocarditis according to Modified Duke Criteria were included in the review.
Forty-nine patients were identified for inclusion; 29 had congenital heart disease as a predisposing condition; 64% of patients met “definite” and 36% “possible” criteria. The in-hospital mortality rate was 20%; 53% of patients underwent surgery with a post-operative mortality rate of 7.7%. The median interval from diagnosis to surgery was 20 days (interquartile range, 9–47 days). Valve replacement occurred in 28% and valve repair in 58%. There was a significant reduction in valvular dysfunction in patients undergoing surgery and only a marginal improvement in patients treated medically. Overall, 43% of patients had some degree of residual valvular dysfunction.
Endocarditis is a serious disease with a high in-hospital mortality and presents challenges in making an accurate diagnosis. Despite a significant reduction in valvular dysfunction, a portion of patients had residual valvular dysfunction. Early surgery is associated with a lower mortality rate, but a higher rate of valve replacement compared with delayed surgery.
In the 2015 review paper ‘Petawatt Class Lasers Worldwide’ a comprehensive overview of the current status of high-power facilities of
was presented. This was largely based on facility specifications, with some description of their uses, for instance in fundamental ultra-high-intensity interactions, secondary source generation, and inertial confinement fusion (ICF). With the 2018 Nobel Prize in Physics being awarded to Professors Donna Strickland and Gerard Mourou for the development of the technique of chirped pulse amplification (CPA), which made these lasers possible, we celebrate by providing a comprehensive update of the current status of ultra-high-power lasers and demonstrate how the technology has developed. We are now in the era of multi-petawatt facilities coming online, with 100 PW lasers being proposed and even under construction. In addition to this there is a pull towards development of industrial and multi-disciplinary applications, which demands much higher repetition rates, delivering high-average powers with higher efficiencies and the use of alternative wavelengths: mid-IR facilities. So apart from a comprehensive update of the current global status, we want to look at what technologies are to be deployed to get to these new regimes, and some of the critical issues facing their development.