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.
Advances in biomedical engineering have led to three-dimensional (3D)-printed models being used for a broad range of different applications. Teaching medical personnel, communicating with patients and relatives, planning complex heart surgery, or designing new techniques for repair of CHD via cardiac catheterisation are now options available using patient-specific 3D-printed models. The management of CHD can be challenging owing to the wide spectrum of morphological conditions and the differences between patients. Direct visualisation and manipulation of the patients’ individual anatomy has opened new horizons in personalised treatment, providing the possibility of performing the whole procedure in vitro beforehand, thus anticipating complications and possible outcomes. In this review, we discuss the workflow to implement 3D printing in clinical practice, the imaging modalities used for anatomical segmentation, the applications of this emerging technique in patients with structural heart disease, and its limitations and future directions.
New Zealand's ageing population and health inequities for Māori (Indigenous peoples) have prompted calls for innovative, culturally based approaches to improving health and wellbeing, and managing transitions in later life. This is particularly important for kaumātua (Māori elders) who, despite cultural strength and resilience, carry a significant burden in health, economic and social inequities. This paper describes the culture-centred development of a ‘tuakana‒teina’ (elder sibling‒younger sibling) peer support education programme designed to help kaumātua support other kaumātua experiencing transitions in later life. Taking a strengths-based approach that highlights ‘kaumātua mana motuhake’ (elder independence and autonomy), the study used kaupapa Māori (Māori approach, knowledge, skills, attitudes and values) and community-based participatory research methodology, to develop and pilot a culture-centred tuakana‒teina/peer education programme. Methods included establishing two advisory groups (one of kaumātua and one of sector experts); holding five focus groups with kaumātua; and running a pilot programme with 21 kaumātua. The findings demonstrate the value in a strengths-based approach that centralises Māori culture and kaumātua potential, capacity and ability, and recognises the continuing value and contribution of kaumātua to society. The study helps shift the focus from dominant stereotypes of ageing populations as a burden on society and shows the value of kaumātua supporting others during transitions in later life.
We read with interest the recent editorial, “The Hennepin Ketamine Study,” by Dr. Samuel Stratton commenting on the research ethics, methodology, and the current public controversy surrounding this study.1 As researchers and investigators of this study, we strongly agree that prospective clinical research in the prehospital environment is necessary to advance the science of Emergency Medical Services (EMS) and emergency medicine. We also agree that accomplishing this is challenging as the prehospital environment often encounters patient populations who cannot provide meaningful informed consent due to their emergent conditions. To ensure that fellow emergency medicine researchers understand the facts of our work so they may plan future studies, and to address some of the questions and concerns in Dr. Stratton’s editorial, the lay press, and in social media,2 we would like to call attention to some inaccuracies in Dr. Stratton’s editorial, and to the lay media stories on which it appears to be based.
Ho JD, Cole JB, Klein LR, Olives TD, Driver BE, Moore JC, Nystrom PC, Arens AM, Simpson NS, Hick JL, Chavez RA, Lynch WL, Miner JR. The Hennepin Ketamine Study investigators’ reply. Prehosp Disaster Med. 2019;34(2):111–113
The aim of this study was to estimate the effectiveness of first-line biologic disease modifying drugs(boDMARDs), and their approved biosimilars (bsDMARDs), compared with conventional (csDMARD) treatment, in terms of ACR (American College of Rheumatology) and EULAR (European League against Rheumatism) responses.
Systematic literature search, on eight databases to January 2017, sought ACR and EULAR data from randomized controlled trials (RCTs) of boDMARDs / bsDMARDs (in combination with csDMARDs, or monotherapy). Two adult populations: methotrexate (MTX)-naïve patients with severe active RA; and csDMARD-experienced patients with moderate-to-severe active RA. Network meta-analyses (NMA) were conducted using a Bayesian Markov chain Monte Carlo simulation using a random effects model with a probit link function for ordered categorical.
Forty-six RCTs met the eligibility criteria. In the MTX-naïve severe active RA population, no biosimilar trials meeting the inclusion criteria were identified. MTX plus methylprednisolone (MP) was most likely to achieve the best ACR response. There was insufficient evidence that combination boDMARDs was superior to intensive (two or more) csDMARDs. In the csDMARD-experienced, moderate-to-severe RA population, the greatest effects for ACR responses were associated with tocilizumab (TCZ) monotherapy, and combination therapy (plus MTX) with bsDMARD etanercept (ETN) SB4, boDMARD ETN and TCZ. These treatments also had the greatest effects on EULAR responses. No clear differences were found between the boDMARDs and their bsDMARDs.
In MTX-naïve patients, there was insufficient evidence that combination boDMARDs was superior to two or more csDMARDs. In csDMARD-experienced patients, boDMARDs and bsDMARDs were comparable and all combination boDMARDs / bsDMARDs were superior to single csDMARD.
SNP in the vitamin D receptor (VDR) gene is associated with risk of lower respiratory infections. The influence of genetic variation in the vitamin D pathway resulting in susceptibility to upper respiratory infections (URI) has not been investigated. We evaluated the influence of thirty-three SNP in eleven vitamin D pathway genes (DBP, DHCR7, RXRA, CYP2R1, CYP27B1, CYP24A1, CYP3A4, CYP27A1, LRP2, CUBN and VDR) resulting in URI risk in 725 adults in London, UK, using an additive model with adjustment for potential confounders and correction for multiple comparisons. Significant associations in this cohort were investigated in a validation cohort of 737 children in Manchester, UK. In all, three SNP in VDR (rs4334089, rs11568820 and rs7970314) and one SNP in CYP3A4 (rs2740574) were associated with risk of URI in the discovery cohort after adjusting for potential confounders and correcting for multiple comparisons (adjusted incidence rate ratio per additional minor allele ≥1·15, Pfor trend ≤0·030). This association was replicated for rs4334089 in the validation cohort (Pfor trend=0·048) but not for rs11568820, rs7970314 or rs2740574. Carriage of the minor allele of the rs4334089 SNP in VDR was associated with increased susceptibility to URI in children and adult cohorts in the United Kingdom.
Access to transition-related medical interventions (TRMIs) for transgender veterans has been the subject of substantial public interest and debate. To better inform these important conversations, the current study investigated whether undergoing hormone or surgical transition intervention(s) relates to the frequency of recent suicidal ideation (SI) and symptoms of depression in transgender veterans.
This study included a cross-sectional, national sample of 206 self-identified transgender veterans. They self-reported basic demographics, TRMI history, recent SI, and symptoms of depression through an online survey.
Significantly lower levels of SI experienced in the past year and 2-weeks were seen in veterans with a history of both hormone intervention and surgery on both the chest and genitals in comparison with those who endorsed a history of no medical intervention, history of hormone therapy but no surgical intervention, and those with a history of hormone therapy and surgery on either (but not both) the chest or genitals when controlling for sample demographics (e.g., gender identity and annual income). Indirect effect analyses indicated that lower depressive symptoms experienced in the last 2-weeks mediated the relationship between the history of surgery on both chest and genitals and SI in the last 2-weeks.
Results indicate the potential protective effect that TRMI may have on symptoms of depression and SI in transgender veterans, particularly when both genitals and chest are affirmed with one's gender identity. Implications for policymakers, providers, and researchers are discussed.
The Sasanian Empire had many large, multicultural and typically heavily defended cities. Literary sources are filled with direct or indirect references to the deportation or internal transfer of populations from one region to another, and boosting the urban population was clearly an important part of imperial economic planning, but there has been relatively little study of Sasanian urbanism. This chapter provides a timely overview by re-examining the archaeological evidence for the physical appearance and distribution of some of these urban centres, discusses their forms, and uses Google imagery to locate two previously archaeologically unrecorded cities which feature in the Arab conquest and Heraclius’ campaign shortly before. It goes on to use the excavated evidence from three city sites in Iraq, Iran and Turkmenistan to illustrate the physical appearance of residential and/or commercial quarters, and concludes with some observations on the importance of the Sasanian urban economy.
The term ‘Sasanian’ conjures a popular image of armoured knights, fire worshippers, courtly arts and conspicuous consumption, but a 400-year empire which stretched from Syria to Pakistan, recovered from the capture and death of one emperor on an eastern battlefield, and was one of Rome's biggest rivals and threats was not just built on exceptional kingship, feudalism and faith. Its success lay instead in effective bureaucracy and good management. Integrated planning for economic, military and civilian needs was fundamental, and without it the massive capital projects and military capabilities of the Sasanian state could not have been sustained. The huge number of mints known from marks on silver drachms implies a monetarised economy despite the fact that many of the mints are still physically unlocated. Moreover, many seals give the names of cities with which their owners were associated. The rapid movement of the Arab-led armies during the Islamic conquest was regularly punctuated by lengthy sieges and protracted negotiations with local commanders, which can be explained by the sheer number of cities and the scale of their defences.
Mitral valve anatomy has a significant impact on potential surgical options for patients with hypoplastic or borderline left ventricle. Papillary muscle morphology is a major component regarding this aspect. The purpose of this study was to use cardiac magnetic resonance to describe the differences in papillary muscle anatomy between normal, borderline, and hypoplastic left ventricles.
We carried out a retrospective, observational cardiac magnetic resonance study of children (median age 5.36 years) with normal (n=30), borderline (n=22), or hypoplastic (n=13) left ventricles. Borderline and hypoplastic cases had undergone an initial hybrid procedure. Morphological features of the papillary muscles, location, and arrangement were analysed and compared across groups.
All normal ventricles had two papillary muscles with narrow pedicles; however, 18% of borderline and 46% of hypoplastic cases had a single papillary muscle, usually the inferomedial type. In addition, in borderline or hypoplastic ventricles, the supporting pedicle occasionally displayed a wide insertion along the ventricular wall. The length ratio of the superolateral support was significantly different between groups (normal: 0.46±0.08; borderline: 0.39±0.07; hypoplastic: 0.36±0.1; p=0.009). No significant difference, however, was found when analysing the inferomedial type (0.42±0.09; 0.38±0.07; 0.39±0.22, p=0.39). The angle subtended between supports was also similar among groups (113°±17°; 111°±51° and 114°±57°; p=0.99). A total of eight children with borderline left ventricle underwent biventricular repair. There were no significant differentiating features for papillary muscle morphology in this subgroup.
The superolateral support can be shorter or absent in borderline or hypoplastic left ventricle cases. The papillary muscle pedicles in these patients often show a broad insertion. These changes have important implications on surgical options and should be described routinely.
As survival after cardiac surgery continues to improve, an increasing number of patients with hypoplastic left heart syndrome are reaching school age and beyond, with growing recognition of the wide range of neurodevelopmental challenges many survivors face. Improvements in fetal detection rates, coupled with advances in fetal ultrasound and MRI imaging, are contributing to a growing body of evidence that abnormal brain architecture is in fact present before birth in hypoplastic left heart syndrome patients, rather than being solely attributable to postnatal factors. We present an overview of the contemporary data on neurodevelopmental outcomes in hypoplastic left heart syndrome, focussing on imaging techniques that are providing greater insight into the nature of disruptions to the fetal circulation, alterations in cerebral blood flow and substrate delivery, disordered brain development, and an increased potential for neurological injury. These susceptibilities are present before any intervention, and are almost certainly substantial contributors to adverse neurodevelopmental outcomes in later childhood. The task now is to determine which subgroups of patients with hypoplastic left heart syndrome are at particular risk of poor neurodevelopmental outcomes and how that risk might be modified. This will allow for more comprehensive counselling for carers, better-informed decision making before birth, and earlier, more tailored provision of neuroprotective strategies and developmental support in the postnatal period.
This article details a successful case of restitution of important antiquities stolen from the National Museum of Afghanistan in Kabul during the Afghan Civil War (1992–94). These items had been excavated by the Délégation Archéologique Française en Afghanistan at the site of Begram during 1937 and 1939 and were allocated to the museum in Kabul when the excavated finds were divided between the National Museum of Afghanistan and the Musée Guimet (Paris). In Kabul, the most important objects were put on permanent display, but they were placed in storage in 1989 when the museum was officially closed and the capital threatened by war after the withdrawal of Soviet forces. Many objects were hidden, and some are now touring in an international exhibition hosted by the British Museum in 2011.1 However, most of the Begram ivories were stolen and entered different collections. The following article discusses how a group of 20 of these exquisite carvings were acquired, conserved, exhibited, and returned to Kabul as a direct result of the negotiations for the British Museum exhibition.2 This allowed the first scientific analyses of Indian ivories of this period, and the results provided important new evidence for the extent of polychromy as well as the scale of the different unrecorded conservation treatments previously applied to these highly fragile objects.3 The objects were returned safely to Kabul in 2012. This article also sets out some of the lessons learned from this chain of events and how it can provide an example for future restitutions.
The book consists of a volume of essays in honor of the outstanding sociologist, Edward A. Tiryakian; whose work has spanned a considerable number of countries, regions and topics. He has been highly influential, particularly in American and French sociology.
The contributors include such luminaries as Alan Sica, Bryan Turner, George Ritzer, John Simpson, Piotr Sztompka, Hans Joas, Roland Robertson and John Torpey.
Robert Bellah's Religion in Human Evolution: From the Paleolithic to the Axial Age was published by Harvard University Press in September 2011 (Bellah 2011). Bellah's death in July 2013 made it the last book he wrote and published during his lifetime. Based on more than two decades of reading and research plus discussions with his Habits of the Heart coauthors (Bellah et al. 1985) and others (Bellah 2011: xxv–xxvii). Religion in Human Evolution marks the final flourish of Bellah's notable scholarly career.
To him we owe such things as his analysis of religion and the turn to modernity in nineteenth-century Japan (Bellah 1957); a twentieth-century version of the idea of civil religion and its use in understanding American society (Bellah 1967: 1–21); an elaboration of the idea of symbolic realism (Bellah 1970); and his widely cited article, “Religious Evolution” (Bellah 1964: 358–75). These and many other items constitute a major oeuvre among scholars and researchers in the sociology of religion coming of age professionally in the mid-twentieth century.
Religion in Human Evolution has been described as Bellah's magnum opus (Wolfe 2011: 1). There is no doubt that it is a book that displays a sweep of learning and an effort to organize literatures ranging over the social sciences, the humanities and the physical and life sciences. In the first part the reader is asked to consider cosmology and evolution according to Bellah. In the second part he lays out tribal and archaic religion as precursor types and then moves on to the civilizations of the Axial Age: Ancient Israel, Ancient Greece, China in the Late First Millennium BCE and Ancient India.
While not described as such, a Guttman-like progression characterizes Bellah's description of religions, from tribal to those of the Axial Age. New things appear, but nothing is lost. Tribal religion—the earliest type—is undifferentiated from the society in which it is expressed. Archaic religion entails the appearance of differentiated religious symbol systems and cultic practices, and the entwinement of meaning (god) and power (king) in stratified societies (rulers and ruled). In the Axial Age, the idea of transcendence and immanence occurs along with the force of critique that, via observation from a standpoint (usually preserved in writing), can support the persistence of imminent good or the need for change.