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Many studies document cognitive decline following specific types of acute illness hospitalizations (AIH) such as surgery, critical care, or those complicated by delirium. However, cognitive decline may be a complication following all types of AIH. This systematic review will summarize longitudinal observational studies documenting cognitive changes following AIH in the majority admitted population and conduct meta-analysis (MA) to assess the quantitative effect of AIH on post-hospitalization cognitive decline (PHCD).
We followed Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Selection criteria were defined to identify studies of older age adults exposed to AIH with cognitive measures. 6566 titles were screened. 46 reports were reviewed qualitatively, of which seven contributed data to the MA. Risk of bias was assessed using the Newcastle–Ottawa Scale.
The qualitative review suggested increased cognitive decline following AIH, but several reports were particularly vulnerable to bias. Domain-specific outcomes following AIH included declines in memory and processing speed. Increasing age and the severity of illness were the most consistent risk factors for PHCD. PHCD was supported by MA of seven eligible studies with 41,453 participants (Cohen’s d = −0.25, 95% CI [−0.02, −0.49] I2 35%).
There is preliminary evidence that AIH exposure accelerates or triggers cognitive decline in the elderly patient. PHCD reported in specific contexts could be subsets of a larger phenomenon and caused by overlapping mechanisms. Future research must clarify the trajectory, clinical significance, and etiology of PHCD: a priority in the face of an aging population with increasing rates of both cognitive impairment and hospitalization.
This article presents the results of multi-scalar investigations into the Later Bronze Age (LBA; 1500–600 bc) landscape of Inishark in County Galway, Ireland. The European LBA along the Atlantic coast was characterized by the development of long-distance maritime exchange systems that transformed environmentally marginal seascapes into a corridor of human interaction and movement of goods and people. Archaeological survey, test excavation, and radiocarbon analysis documented the LBA occupation on Inishark. The communities living on Inishark and other small islands on the western Irish coast were on the periphery of both the European continent and of the elite spheres of influence at hillforts in Ireland; yet they were connected to the Atlantic maritime exchange routes. A focus on small coastal islands contributes to a better understanding of LBA socioeconomic systems and the development of social complexity in Bronze Age societies.
n-3 Fatty acids, flavonoids and resveratrol are well publicised for their beneficial effects on human health and wellbeing. Identifying common, underlying biological mechanisms targeted by these functional foods would therefore be informative for the public health sector for advising on nutritional health and disease, food and drug product development and consumer interest. The aim of this study was to explore the potential effects of gene expression changes associated with n-3 fatty acids EPA and DHA, flavonoids and resveratrol on modifying biological systems and disease pathways. To test this, publicly available human microarray data for significant gene expression changes associated with dietary intervention with EPA/DHA, flavonoids and resveratrol was subjected to pathway analysis and significance testing for overlap with signals from genome-wide association studies (GWAS) for common non-communicable diseases and biological functions. There was an enrichment of genes implicated in immune responses and disease pathways which was common to all of the treatment conditions tested. Analysis of biological functions and disease pathways indicated anti-tumorigenic properties for EPA/DHA. In line with this, significance testing of the intersection of genes associated with these functional foods and GWAS hits for common biological functions (ageing and cognition) and non-communicable diseases (breast cancer, CVD, diabesity, neurodegeneration and psychiatric disorders) identified significant overlap between the EPA/DHA and breast cancer gene sets. Dietary intervention with EPA/DHA, flavonoids and resveratrol can target important biological and disease pathways suggesting a potentially important role for these bioactive compounds in the prevention and treatment of dietary-related diseases.
In this study, nanoindentation was utilized to measure the local, three-dimensional properties of Kevlar 49 and Kevlar KM2 on the length scales of the fiber microstructure. First, atomic force microscopy-based methods were used to explore the extent of property changes with respect to radial position in the fibers’ axial and hoop planes. From these measurements, no significant change in response was found for Kevlar 49 fibers, consistent with transverse isotropy. However, a reduced stiffness “shell” region (up to ∼300–350 nm thick) was observed for KM2 fibers. Instrumented indentation was then used to evaluate fiber response with respect to orientation and contact size and establish a critical contact size above which the response is independent of indenter size (i.e., “homogeneous” behavior). A previously proposed analytical method for indentation of a transversely isotropic material was used to estimate the local material properties of the Kevlar fibers from the measured homogeneous response.
The effects of inequality and financial globalization on democratization are central issues in political science. The relationships among economic inequality, capital mobility, and democracy differ in the late twentieth century for financially integrated autocracies vs. closed autocracies. Financial integration enables native elites to create diversified international asset portfolios. Asset diversification decreases both elite stakes in and collective action capacity for opposing democracy. Financial integration also changes the character of capital assets—including land—by altering the uses of capital assets and the nationality of owners. It follows that financially integrated autocracies, especially those with high levels of inequality, are more likely to democratize than unequal financially closed autocracies. We test our argument for a panel of countries in the post–World War II period. We find a quadratic hump relationship between inequality and democracy for financially closed autocracies, but an upward sloping relationship between inequality and democratization for financially integrated autocracies.
An instrumented indentation method is established to accurately measure the local elastic-plastic material properties of a single fiber by accounting for the additional sources of compliance associated with fiber indentation. The Oliver-Pharr instrumented indentation data analysis method is compared for indentation of a standard, planar fused silica sample and in the radial direction of homogeneous, isotropic E-glass fibers of two different diameters. Compliance contributions from substrate deflection and other nonindentation-related fiber deflections are quantified and shown to be negligible. The added compliance observed is attributed to the lack of constraint due to the finite geometry of a curved fiber surface. This compliance contribution is accounted for by using a proposed area correction to capture the geometry of the curved fiber-probe contact combined with a structural compliance correction. Implementation of these corrections to experimental indentation curves results in accurate measurements of the fiber elastic modulus and hardness.
To characterize the clinical outcomes of patients with bloodstream infection caused by carbapenem-resistant Acinetobacter baumannii during a 2-state monoclonal outbreak.
Multicenter observational study.
Four tertiary care hospitals and 1 long-term acute care hospital.
A retrospective medical chart review was conducted for all consecutive patients during the period January 1, 2005, through April 30, 2006, for whom 1 or more blood cultures yielded carbapenem-resistant A. baumannii.
We identified 86 patients from the 16-month study period. Their mortality rate was 41%; of the 35 patients who died, one-third (13) had positive blood culture results for carbapenem-resistant A. baumannii at the time of death. Risk factors associated with mortality were intensive care unit stay, malignancy, and presence of fever and/or hypotension at the time blood sample for culture was obtained. Only 5 patients received adequate empirical antibiotic treatment, but the choice of treatment did not affect mortality.
Fifty-seven patients (66.2%) had a single positive blood culture result for carbapenem-resistant A. baumannii; the only factor associated with a single positive blood culture result was the presence of decubitus ulcers. Interestingly, during the study period, a transition from single to multiple positive blood culture results was observed. Four patients, 3 of whom were in a burn intensive care unit, were bacteremic for more than 30 days (range, 36–86 days).
To our knowledge, this is the first time a study has described 2 patterns of bloodstream infection with A. baumannii: single versus multiple positive blood culture results, as well as a subset of patients with prolonged bacteremia.
We describe the investigation and control of a Klebsiella pneumoniae carbapenemase-producing K. pneumoniae outbreak in a 20-bed surgical intensive care unit during the period from January 1, 2009 through January 1, 2010. Nine patients were either colonized or infected with a monoclonal strain of K. pneumoniae. The implementation of a bundle of interventions on July 2009 successfully controlled the further horizontal spread of this organism.
Protection of the environment during training and operations is an important priority of the United States Navy. Maintaining the appropriate balance between environmental protection and mission achievement is a complex proposition, as the focus of operations shifts along the continuum from peacetime training, to military operations other than war, to warfare itself. This chapter describes the United States Navy's efforts – in concert with other military services, the Joint Staff, and international military organizations – to develop environmental protection doctrine and policy that provides appropriate guidance for operational staff and leaders in this critically important area. This chapter gives substantial treatment to military operations other than war (MOOTW).
First, this chapter helps to identify the essential linkages through which legal principles pertaining to the protection of environment in military operations are given real-world effect. Clear international consensus on appropriate norms for environmental protection during war, even if achievable, would be considerably less effective without meaningful translation of those norms into military doctrine and policy governing battlespace practice. Environmental protection can be much more efficiently achieved through prevention of environmental injury in the first place (a result of enlightened operational decisionmaking) than through post-conflict damage assessment, recovery from and/or prosecution of responsible parties, and efforts to remedy the damage.
Second, for the foreseeable future the prospect of all-out world war – full-scale multinational conflict on several continents – is thankfully minimal. By contrast, it is virtually certain that most nations will continue to conduct military training and exercises, and that many states will periodically engage in large-scale military operations other than war.
The growth hormone (GH) response to apomorphine, thought to reflect central dopaminergic receptor sensitivity, has been reported as enhanced in acute schizophrenia. We investigated this response in relation to the psychotic episodes associated with Parkinson's disease (PD).
The GH response to apomorphine was measured in three groups of patients with Parkinson's disease: those currently psychotic (n = 9), those with a past history of psychosis (n = 7) and those who had never been psychotic (n = 8).
Apomorphine-induced GH response was not related to psychosis but was unexpectedly associated with measures of depression.
Visual hallucinations were a prominent feature in the psychotic patients and the atypical nature of these psychoses might explain why we found no evidence of dopaminergic sensitivity. Serotonergic dysfunction would be in keeping with this. Dopaminergic mechanisms may contribute to the minor depressive symptomatology seen in PD.
This report deals with the asymptotic behaviour of solutions of the wave equation in a domain Ω ⊆Rn. The boundary, Γof Ωft consists of two parts. One part reflects all energy while the other part absorbs energy to a degree. If the energy-absorbing part is non-empty we show that the energy tends to zero as t→∞. With stronger assumptions we are able to obtain decay rates for the energy. Certain relationships with controlability are discussed and used to advantage.
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