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The role of vegetable and fruit intake in reducing falls risk in elderly populations is uncertain. This study examined the associations of vegetable and fruit intake with falls-related hospitalisations in a prospective cohort study of elderly women (n 1429, ≥70 years), including effects on muscular function, which represented a potential causal pathway. Muscular function, measured using grip strength and timed-up-and-go (TUG), and vegetable and fruit intake, quantified using a validated FFQ, were assessed at baseline (1998). Incident falls-related hospitalisation over 14·5-year follow-up was captured by the Hospital Morbidity Data Collection, linked via the Western Australian Data Linkage System. Falls-related hospitalisation occurred in 568 (39·7 %) of women. In multivariable-adjusted models, falls-related hospitalisations were lower in participants consuming more vegetables (hazard ratio (HR) per 75 g serve: 0·90 (95 % CI 0·82, 0·99)), but not fruit intake (per 150 g serve: 1·03 (95 % CI 0·93, 1·14)). Only total cruciferous vegetable intake was inversely associated with falls-related hospitalisation (HR: per 20 g serve: 0·90 (95 % CI 0·83, 0·97)). Higher total vegetable intake was associated with lower odds for poor grip strength (OR: 0·87 (95 % CI 0·77, 0·97)) and slow TUG (OR: 0·88 (95 % CI 0·78, 0·99)). Including grip strength and TUG in the multivariable-adjusted model attenuated the association between total vegetable intake and falls-related hospitalisations. In conclusion, elderly women with higher total and cruciferous vegetable intake had lower injurious falls risk, which may be explained in a large part by better physical function. Falls reduction may be considered an additional benefit of higher vegetable intake in older women.
BACKGROUND: Meningiomas are the most common primary benign brain tumors in adults. Given the extended life expectancy of most meningiomas, consideration of quality of life (QOL) is important when selecting the optimal management strategy. There is currently a dearth of meningioma-specific QOL tools in the literature. OBJECTIVE: In this systematic review, we analyze the prevailing themes and propose toward building a meningioma-specific QOL assessment tool. METHODS: A systematic search was conducted, and only original studies based on adult patients were considered. QOL tools used in the various studies were analyzed for identification of prevailing themes in the qualitative analysis. The quality of the studies was also assessed. RESULTS: Sixteen articles met all inclusion criteria. Fifteen different QOL assessment tools assessed social and physical functioning, psychological, and emotional well-being. Patient perceptions and support networks had a major impact on QOL scores. Surgery negatively affected social functioning in younger patients, while radiation therapy had a variable impact. Any intervention appeared to have a greater negative impact on physical functioning compared to observation. CONCLUSION: Younger patients with meningiomas appear to be more vulnerable within social and physical functioning domains. All of these findings must be interpreted with great caution due to great clinical heterogeneity, limited generalizability, and risk of bias. For meningioma patients, the ideal QOL questionnaire would present outcomes that can be easily measured, presented, and compared across studies. Existing scales can be the foundation upon which a comprehensive, standard, and simple meningioma-specific survey can be prospectively developed and validated.
We report on direct numerical simulations to examine the spectral behaviour of turbulence close to and at a flat, stress-free surface. We find, consistent with field measurements near such a free surface, that an inertial-range type of behaviour is obtained for the horizontal components of the velocity at and near the stress-free surface, at horizontal wavelengths for which the vertical velocity is much smaller than the horizontal components. At approximately an integral length scale from the stress-free surface, the flow has adjusted back to more classical isotropic turbulence. The behaviour of the turbulence near the stress-free surface is similar to that observed recently for strongly stratified flows, and we argue that the causes of that behaviour are the same in both flows: the suppression of the large-scale vertical velocity and the allowance of strong vertical shearing of the horizontal velocity leading to a downscale transfer of energy and to the development of the
spectra for the horizontal velocities.
The effectiveness of practice bundles on reducing ventilator-associated pneumonia (VAP) has been questioned.
To implement a comprehensive program that included a real-time bundle compliance dashboard to improve compliance and reduce ventilator-associated complications.
Before-and-after quasi-experimental study with interrupted time-series analysis.
Academic medical center.
In 2007 a comprehensive institutional ventilator bundle program was developed. To assess bundle compliance and stimulate instant course correction of noncompliant parameters, a real-time computerized dashboard was developed. Program impact in 6 adult intensive care units (ICUs) was assessed. Bundle compliance was noted as an overall cumulative bundle adherence assessment, reflecting the percentage of time all elements were concurrently in compliance for all patients.
The VAP rate in all ICUs combined decreased from 19.5 to 9.2 VAPs per 1,000 ventilator-days following program implementation (P<.001). Bundle compliance significantly increased (Z100 score of 23% in August 2007 to 83% in June 2011 [P<.001]). The implementation resulted in a significant monthly decrease in the overall ICU VAP rate of 3.28/1,000 ventilator-days (95% CI, 2.64–3.92/1,000 ventilator-days). Following the intervention, the VAP rate decreased significantly at a rate of 0.20/1,000 ventilator-days per month (95% CI, 0.14–0.30/1,000 ventilator-days per month). Among all adult ICUs combined, improved bundle compliance was moderately correlated with monthly VAP rate reductions (Pearson correlation coefficient, −0.32).
A prevention program using a real-time bundle adherence dashboard was associated with significant sustained decreases in VAP rates and an increase in bundle compliance among adult ICU patients.
Infect. Control Hosp. Epidemiol. 2015;36(11):1261–1267
Influenza A (H1N1) pdm09 became the predominant circulating strain in the United States during the 2013–2014 influenza season. Little is known about the epidemiology of severe influenza during this season.
A retrospective cohort study of severely ill patients with influenza infection in intensive care units in 33 US hospitals from September 1, 2013, through April 1, 2014, was conducted to determine risk factors for mortality present on intensive care unit admission and to describe patient characteristics, spectrum of disease, management, and outcomes.
A total of 444 adults and 63 children were admitted to an intensive care unit in a study hospital; 93 adults (20.9%) and 4 children (6.3%) died. By logistic regression analysis, the following factors were significantly associated with mortality among adult patients: older age (>65 years, odds ratio, 3.1 [95% CI, 1.4–6.9], P=.006 and 50–64 years, 2.5 [1.3–4.9], P=.007; reference age 18–49 years), male sex (1.9 [1.1–3.3], P=.031), history of malignant tumor with chemotherapy administered within the prior 6 months (12.1 [3.9–37.0], P<.001), and a higher Sequential Organ Failure Assessment score (for each increase by 1 in score, 1.3 [1.2–1.4], P<.001).
Risk factors for death among US patients with severe influenza during the 2013–2014 season, when influenza A (H1N1) pdm09 was the predominant circulating strain type, shifted in the first postpandemic season in which it predominated toward those of a more typical epidemic influenza season.
Infect. Control Hosp. Epidemiol. 2015;36(11):1251–1260
Smooth, anisotropic etching of InN and GaN is obtained in BI3- or BBr3-based Inductively Coupled Plasmas. Etch selectivities of 100:1 were achieved for InN over both GaN and AlN in the BI3 mixtures, while for BBr3 discharges values of 100:1 for InN over AlN and 25:1 for InN over GaN were measured. The etched surface morphologies of InN and GaN with both mixtures are similar or better than those of control samples.
Many visitors (and would-be visitors) to the Antonine Wall World Heritage Site find the task of interpreting and understanding the visible archaeological remains somewhat challenging. Over a number of years in the role of Head of Multimedia in the Hunterian Museum, and as an Associate Lecturer with the School of Computing Science at the University of Glasgow, the author has been exploring ways of addressing this issue. Multimedia technologies have the potential to aid in the presentation and interpretation of archaeological sites, and their associated artefacts held in local museums collections, for a wide range of public audiences.
The coming of age of interactive digital information and communication technologies has provided cultural heritage organisations with a range of opportunities to utilise these ever more flexible digital technologies to provide access to their cultural resources in increasingly innovative ways. The advent of the World Wide Web, over 20 years ago now, presented heritage organisations with a unique opportunity to provide access to their resources to a truly global audience. Resources which hitherto were only available to those fortunate enough to live within travelling distance of archaeological sites or museum collections were suddenly accessible via the then new medium of web technology. Moreover, many museums around the world saw the potential to turn this new medium into additional virtual display space in which to reveal many artefacts that had been languishing in storage or in reserve collections.
It is not difficult to find images of the Romans and information about Ancient Rome in contemporary sources. There are cartoons, picture books for young children, Hollywood films, television comedies, websites, school textbooks and popular histories for the general public, children's toys and violent computer games. This chapter discusses why the Romans and their barbarian enemies have been badly or incorrectly portrayed so often and for so long. In the UK, school textbooks from the 19th century and throughout most of the 20th century have often failed to present what classical texts, archaeologists and historians have revealed. More than that, these early school resources hardly ever presented any evidence for the authors' bold statements of presumed fact. This chapter also discusses the role of information books for children and the use of cartoons in storybooks about the Romans.
Although schools had existed since the early medieval period in Britain there was little opportunity for most children, and especially for girls, to be educated until parish schools became more common in the 17th century. The Education Act of 1870 created the opportunity to build secular day schools all over the country. School Boards were established in most districts and built public elementary schools, many of which still survive today as primary schools. Many children were educated at home in the 19th century and this promoted the growth of suitable textbooks for mothers or governesses to use in the home. Several history textbooks were written by women, sometimes using pen names, which demonstrated publishers' understanding of the market available to them.
Issues in the public presentation and interpretation of the archaeology of Hadrian's Wall and other frontiers of the Roman Empire are explored and addressed here. A central theme is the need for interpretation to be people-focussed, and for visitors to be engaged through narratives and approaches which help them connect with figures in the past: daily life, relationships, craft skills, communications, resonances with modern frontiers and modern issues all provide means of helping an audience to connect, delivering a greater understanding, better visitor experiences, increased visiting and spend, and an enhanced awareness of the need to protect and conserve our heritage. Topics covered include re-enactment, virtual and physical reconstruction, multi-media, smartphones, interpretation planning and design; while new evidence from audience research is also presented to show how visitors respond to different strategies of engagement. Nigel Mills is Director, World Heritage and Access, The Hadrian's Wall Trust. Contributors: Genevieve Adkins, M.C. Bishop, Lucie Branczik, David J. Breeze, Mike Corbishley, Jim Devine, Erik Dobat, Matthias Flück, Christof Flügel, Snezana Golubovic, Susan Greaney, Tom Hazenberg, Don Henson, Richard Hingley, Nicky Holmes, Martin Kemkes, Miomir Korac, Michaela Kronberger, Nigel Mills, Jürgen Obmann, Tim Padley, John Scott, R. Michael Spearman, Jürgen Trumm, Sandra Walkshofer, Christopher Young.
‘But Dad, history is boring and the Romans are the most boring bit of it all.’ I may have paraphrased my son's attempted justification for not doing homework but the essence of his argument is, and was, very plain. A similar argument was deployed always when discussing going to visit one of the site museums on Hadrian's Wall; and yet a walk along the Wall where ‘British war parties’ (children), waiting in ambush for Roman supply columns (parents), were routinely ‘flushed-out’ by Roman scouts (the dog) but rallied to win the ensuing battle, were, for a time, one of the most attractive of weekend activities.
Where have we, as teachers, academics and interpreters gone so badly wrong? How have we managed to make the Romans such a hated topic? Readers may think I overreact but on a very brief and totally unsystematic survey (conducted in the last few minutes with two of my children and eight of their friends, home for lunch from school), the result was almost unanimous: the Romans are the most boring part of history — with one dissenter identifying ‘Medicine Through Time’ (although, when pressed by his peers, he acknowledged that the worst bit of this was ‘The Romans and the beginning of public health’ as there was no gruesome dissection or surgery to talk of …).