We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save 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 saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
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 saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved 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.
A hydrodynamic theory of premixed flame propagation within closed vessels is developed assuming the flame is much thinner than all other fluid dynamic lengths. In this limit, the flame is confined to a surface separating the unburned mixture from burned combustion products, and propagates at a speed determined from the analysis of its internal structure. Unlike freely propagating flames that propagate under nearly isobaric conditions, combustion in a closed vessel results in continuous increases in pressure, burning rate and flame temperature, and a progressive decrease in flame thickness. The flame speed is shown to depend on the voluminal stretch rate, which measures the deformation of a volume element of the flame zone, and on the rate of pressure rise. Both effects are modulated by pressure-dependent Markstein numbers that depend on heat release and mixture properties while capturing the effects of temperature-dependent transport and stoichiometry. The model applies to flames of arbitrary shape propagating in general flows, laminar or turbulent, within vessels of general configurations. The main limitation of hydrodynamic flame theories is the assumption that variations inside the flame zone due to chemistry or turbulence, which could potentially alter its internal structure, are physically unresolved. Nonetheless, the theory, deduced from physical first principles, identifies the various mechanisms involved in the combustion process as demonstrated in detailed discussions of planar flames propagating in rectangular channels and spherically expanding flames in spherical vessels. It also enables the construction of instructive models to numerically simulate the evolution of multi-dimensional and corrugated flames under confinement.
Medical students have been under immense pressure throughout their studies, impacting their mental health and academic performance. Stress reduction is a fundamental skill that all students require to manage their studies and lives efficiently. Biofeedback devices providing information about physiological states have been shown to aid stress reduction. Methods to reduce stress should be taught to medical students to help them tackle the challenges of medical school.
Objectives
Our goal was to teach stress reduction methods such as extracurricular activities and paced breathing aided by biofeedback training and its application in simulated healthcare situations to medical students.
Methods
15 medical students who completed medical physiology were recruited for an elective course of 7 sessions on practical techniques in stress management. One credit was offered to those who completed the course requirements consisting of participation in sessions and individual biofeedback training.
Sessions (classes) consisted of presentations on good sleeping and eating patterns, group simulations of stressful hospital environments, visiting a science centre with interactive displays, an orchestra performance, and nature walks. Before biofeedback training, heart and respiration rates were taken individually by a biofeedback device during the first week of the course. Data was processed using a code created in statistical software. Heartbeats per minute and heart rate variability (HRV) for every 10 seconds were calculated and plotted on a graph. Two measurements were taken with each student: a baseline measurement for 10 minutes and another measurement during controlled breathing paced at 6 breaths per minute for 15 minutes, of which the first 10 minutes were used for calculation and plotting. Students provided narrative feedback in an essay submitted after the course was completed.
Results
5 males and 10 females from years 2-5 registered for the elective, and 12 participated in individually scheduled sessions. Heart beats per minute decreased, whereas HRV increased during paced breathing sessions in 83% of them. Most students reported feeling calm and drowsy during the sessions, and 2 students fell asleep by the end.
Feedback from 11 students showed that the music session and the science centre visit were the highlights throughout the elective. Improvements recommended were to have a consistent time slot for all sessions and fewer simulations.
Conclusions
In concert with the literature, biofeedback training seems to be a feasible and effective method for relaxation in medical students. This method could be offered as part of mental health services for students. Data could be used to follow students’ progress and identify those requiring extra support. Providing them with avenues to de-stress while emphasizing activities outside medicine could boost their confidence and improve their coping skills.
Carrot is an important vegetable crop worldwide valued for its fleshy edible roots of varied colours. Owing to its highly cross-pollinated nature and small flower size, cytoplasmic male sterility (CMS) is being utilized for hybrid development. Among different types of male sterility, petaloid CMS is widely used for hybrid carrot breeding globally. This study aimed to develop selection criteria for parents in developing heterotic F1 hybrids using CMS lines. A large number of agro-morphological traits and Simple Sequence Repeats (genomic-SSRs) were used to assess the diversity among parental lines. We developed 60 F1 hybrids by crossing four petaloid CMS lines and 15 testers in line × tester mating design and evaluated them in replicated randomized block design trial for four vegetative and 11 economic traits. The mean squares of all the traits in line × tester interactions were significant. The estimates of genetic components of variance indicated predominance of non-additive gene action except for root maturity, root length and core diameter. The hybrids with highest per se performance also had significant positive specific combining ability effects. The root yield and root weight showed highest heterosis percentage (33%). The best performing heterotic hybrids were DCatH-5392, DCatH-700 and DCatH-9892. Correlation between genetic distance and relative heterosis of economic traits indicated no significant association and thus genetic distance could not be used to predict heterosis. As most of the yield-related traits were controlled by non-additive gene action, heterosis breeding could be potentially used along with combining ability analysis to reduce time in selection of best parents and crosses in tropical carrot.
Since becoming free from British colonialism in 1960, Nigeria has experienced, in total, nearly thirty years of military rule: 1966–79 and then again from 1983–99. While the years from 1960–66 and 1979–83 might be seen as periods of Nigerian democracy, they were nonetheless fractured times. Only since 1999 has democracy in Nigeria sustainably taken hold, and even then, the last eighteen years have not been easy. There is an insurgency ongoing in the northeast against the Boko Haram network, and the Delta region of the country also continues to witness instability.
Recurrent acute otitis media is common in children. The preferred treatment measures for recurrent acute otitis media have a mixed evidence base. This study sought to assess baseline practice across ENT departments in England.
Methods
A national telephone survey of healthcare staff was conducted. Every ENT centre in England was contacted. A telephone script was used to ask about antibiotic and grommet use and duration in recurrent acute otitis media cases.
Results
Ninety-six centres (74 per cent) provided complete information. Recurrent acute otitis media treatment across England by ENT departments varied. The antibiotic first- and second-line prophylaxis offered varies, with trimethoprim used in 33 centres and 29 centres not offering any antibiotics. The timing or choice about when to use grommets also varies, but 87 centres (91 per cent) offer grommet surgery at one stage.
Conclusion
The treatments received by children in England for recurrent acute otitis media vary by centre; collaborative research in this area is advised.
We describe system verification tests and early science results from the pulsar processor (PTUSE) developed for the newly commissioned 64-dish SARAO MeerKAT radio telescope in South Africa. MeerKAT is a high-gain (
${\sim}2.8\,\mbox{K Jy}^{-1}$
) low-system temperature (
${\sim}18\,\mbox{K at }20\,\mbox{cm}$
) radio array that currently operates at 580–1 670 MHz and can produce tied-array beams suitable for pulsar observations. This paper presents results from the MeerTime Large Survey Project and commissioning tests with PTUSE. Highlights include observations of the double pulsar
$\mbox{J}0737{-}3039\mbox{A}$
, pulse profiles from 34 millisecond pulsars (MSPs) from a single 2.5-h observation of the Globular cluster Terzan 5, the rotation measure of Ter5O, a 420-sigma giant pulse from the Large Magellanic Cloud pulsar PSR
$\mbox{J}0540{-}6919$
, and nulling identified in the slow pulsar PSR J0633–2015. One of the key design specifications for MeerKAT was absolute timing errors of less than 5 ns using their novel precise time system. Our timing of two bright MSPs confirm that MeerKAT delivers exceptional timing. PSR
$\mbox{J}2241{-}5236$
exhibits a jitter limit of
$<4\,\mbox{ns h}^{-1}$
whilst timing of PSR
$\mbox{J}1909{-}3744$
over almost 11 months yields an rms residual of 66 ns with only 4 min integrations. Our results confirm that the MeerKAT is an exceptional pulsar telescope. The array can be split into four separate sub-arrays to time over 1 000 pulsars per day and the future deployment of S-band (1 750–3 500 MHz) receivers will further enhance its capabilities.
There has been considerable interest internationally in the assessment and treatment of individuals who have a severe personality disorder and who might pose a high-risk of future recidivism. In the United Kingdom, the ‘Dangerous and Severe Personality Disorder’ (DSPD) programme was initiated to deal with just this group. It is important, however, that the DSPD service is filling a treatment void and not competing with already well-established and effective services for (non-DPSD) personality disordered patients. Objective: To establish whether those admitted to innovative DSPD services are different from those admitted to conventional personality disorder (PD) services.
Aim
To compare patients admitted to DSPD services with those admitted to personality disordered (non-DPSD) services.
Method
Sixty patients admitted to DSPD services, under DSPD criteria, were compared with 44 patients admitted to personality disordered (non-DSPD) services within the same high secure psychiatric hospital, on risk measures, including
(1) an index of predicted future violence
(2) previous offending behaviour and
(3) pre-treatment levels of institutional risk-related behaviour.
Results
DSPD patients do pose a greater clinical and management risk, have a higher number of pre-treatment risk-related behaviour, and have a greater number of convictions and imprisonments after age 18, relative to PD patients.
Conclusion
The findings broadly confirm the hypotheses as to the higher risk in DSPD patients and thus offer support for the main purpose of DSPD services: to provide treatment for those who represent the highest priority in terms of treatment need and risk to public protection. Implications are discussed.
We evaluated the efficacy of eszopiclone (ESZ) and concurrent escitalopram oxalate (EO) in patients with insomnia and co-morbid GAD.
Methods:
Patients meeting DSM-IV-TR criteria for GAD and insomnia received 10 weeks of EO 10mg and co-therapy with ESZ 3mg or placebo (PBO) for 8 weeks. For the last 2 weeks, ESZ was replaced with single-blind PBO to evaluate discontinuation effects. Sleep, daytime functioning and anxiety measures were captured during the study.
Results:
ESZ+EO improved sleep and daytime functioning at each week and the double-blind period average (p<0.05). At Week 8, significantly more ESZ+EO patients had no clinically meaningful insomnia based on ISI</=7. Significant improvements with ESZ+EO (relative to PBO+EO) were observed in HAM-A total scores each week, and Weeks 4-10 excluding the insomnia item. ESZ+EO was significantly better at every timepoint on CGI-I (p<0.02); CGI-S was not different between treatments after Week 1. Median time to anxiolytic response was reduced with ESZ+EO based on HAM-A and CGI-I. HAM-A response and remission rates at Week 8 were higher with ESZ+EO, and HAM-D17 scores were improved at all timepoints (p<0.004). After eszopiclone discontinuation, there was no evidence of rebound insomnia, and no treatment differences in sleep or daytime function. Significant treatment differences in anxiety and mood were maintained after discontinuation.
Conclusion:
In this study, ESZ+EO was well tolerated and associated with improved sleep and daytime function without evidence of tolerance. Improvements in anxiety and mood were observed with ESZ+EO.
Support for this study provided by Sepracor Inc., Marlborough, MA.
We describe a simple method to objectively identify the threshold for edge detection in morphometric measurement of brain structures. This method correlates highly with the subjective operator-driven approach to edge detection. While the objective approach, using a histogram of pixel intensities, reduces rater bias and may reliably identify brain-CSF boundaries, its value in morphometric measurements of smaller cerebral structures may be somewhat limited.
Introduction: Online medical education resources are widely used in emergency medicine (EM), but strategies to assess quality remain elusive. We previously derived the Medical Education Translational Resources: Impact and Quality (METRIQ) 8 instrument to evaluate quality in medical education blog posts. Methods: As part of a subsequent validation study (The METRIQ Blog Study), a mixed-methods usability analysis was performed to obtain user feedback on the quality assessment instrument in order to improve its clarity and reliability. Participants in the METRIQ Study were first asked to rate five blog posts using the METRIQ-8 Score. They then evaluated the METRIQ-8 instruments ease of use and likelihood of being recommended to others using a 7-point Likert scale and free text comments. Participants were also asked to flag and comment on items within the score that they felt were unclear. Global usability ratings were summarized using median scores or percent rated unclear. We used ANOVA to test associations between ease of use and demographic factors. A thematic analysis was performed on the comments. Results: 309 EM medical students, residents, and attendings completed the survey. Global ratings were generally very favorable (median 2 [IQR 2-3], with 7 being the lowest score) for ease of use and likelihood of recommendation, and did not vary by participants country of origin, frequency of blog use, or learner level. Participants stated that the score was structured, systematic, and straightforward. They found it useful for junior learners and for guiding blog creation. Four questions in the score (questions 2, 4, 5, and 7) were identified by 10% of subjects to be unclear. Thematic analysis of comments identified suggested four main themes for improving the score: adding clearer definitions with marking rubrics; shortening the 7-point scale; adding items evaluating blog post presentation and utility; and, rephrasing the wording of certain questions for clarity. Conclusion: A mixed methods usability analysis of the METRIQ-8 instrument for assessing blog quality was globally well received by EM medical students, residents, and attendings. Qualitative analyses revealed multiple areas to improve the instruments clarity and usability. The METRIQ score is a promising instrument for evaluating the quality of blogs; further development and testing is needed to improve its utility.
The discovery of the first electromagnetic counterpart to a gravitational wave signal has generated follow-up observations by over 50 facilities world-wide, ushering in the new era of multi-messenger astronomy. In this paper, we present follow-up observations of the gravitational wave event GW170817 and its electromagnetic counterpart SSS17a/DLT17ck (IAU label AT2017gfo) by 14 Australian telescopes and partner observatories as part of Australian-based and Australian-led research programs. We report early- to late-time multi-wavelength observations, including optical imaging and spectroscopy, mid-infrared imaging, radio imaging, and searches for fast radio bursts. Our optical spectra reveal that the transient source emission cooled from approximately 6 400 K to 2 100 K over a 7-d period and produced no significant optical emission lines. The spectral profiles, cooling rate, and photometric light curves are consistent with the expected outburst and subsequent processes of a binary neutron star merger. Star formation in the host galaxy probably ceased at least a Gyr ago, although there is evidence for a galaxy merger. Binary pulsars with short (100 Myr) decay times are therefore unlikely progenitors, but pulsars like PSR B1534+12 with its 2.7 Gyr coalescence time could produce such a merger. The displacement (~2.2 kpc) of the binary star system from the centre of the main galaxy is not unusual for stars in the host galaxy or stars originating in the merging galaxy, and therefore any constraints on the kick velocity imparted to the progenitor are poor.
To estimate the proportion of products meeting Indian government labelling regulations and to examine the Na levels in packaged foods sold in India.
Design
Nutritional composition data were collected from the labels of all packaged food products sold at Indian supermarkets in between 2012 and 2014. Proportions of products compliant with the Food Safety Standards Authority of India (FSSAI) regulations and labelled with Na content, and mean Na levels were calculated. Comparisons were made against 2010 data from Hyderabad and against the UK Department of Health (DoH) 2017 Na targets.
Setting
Eleven large chain retail stores in Delhi and Hyderabad, India.
Subjects
Packaged food products (n 5686) categorised into fourteen food groups, thirty-three food categories and ninety sub-categories.
Results
More packaged food products (43 v. 34 %; P<0·001) were compliant with FSSAI regulations but less (32 v. 38 %; P<0·001) reported Na values compared with 2010. Food groups with the highest Na content were sauces and spreads (2217 mg/100 g) and convenience foods (1344 mg/100 g). Mean Na content in 2014 was higher in four food groups compared with 2010 and lower in none (P<0·05). Only 27 % of foods in sub-categories for which there are UK DoH benchmarks had Na levels below the targets.
Conclusions
Compliance with nutrient labelling in India is improving but remains low. Many packaged food products have high levels of Na and there is no evidence that Indian packaged foods are becoming less salty.
Tuberculosis is a global health problem that is especially prevalent in developing countries such as India. Recently, atypical presentation has become more common and a high index of suspicion is essential. This study analysed the various presenting symptoms and signs of tuberculous otitis media and the role of diagnostic tests, with the aim of formulating criteria for the diagnosis.
Methods:
A total of 502 patients underwent tympanomastoidectomy over a two-year period. Microbiological and histopathological examinations and polymerase chain reaction analysis of tissue taken during tympanomastoidectomy were performed.
Results:
A total of 25 patients (5 per cent) were diagnosed with tuberculous otitis media. Severe mixed hearing loss, facial palsy, labyrinthine fistula, post-aural fistula, perichondritis and extradural abscess were noted.
Conclusion:
There seems to be a resurgence in tuberculous otitis media in India. Microbiological, histopathological and polymerase chain reaction tests for tuberculosis are helpful for its diagnosis.
Acromelic dysplasias are a group of skeletal dysplasias characterised by short-limbed short stature with other distinctive phenotypic features including small hands and feet and stiff joints. Geleophysic dysplasia is an acromelic dysplasia that is associated with characteristic facial features, progressive cardiac valvular thickening, and tracheal stenosis. Owing to overlapping clinical features with other types of short-limbed skeletal dysplasias, it is important to make a precise diagnosis as they have different cardiac morbidity and mortality. We present the cases of three patients with geleophysic dysplasia and progressive mitral valve disease to emphasise the natural history of this disorder and provide guidance regarding cardiac health supervision in these individuals.
Introduction: The use of free open access medicine, particularly open educational resources (OERs), by medical educators and learners continues to increase. As OERs, especially blogs and podcasts, rise in popularity, their ease of dissemination raises concerns about their quality. While critical appraisal of primary research and journal articles is formally taught, no training exists for the assessment of OERs. Thus, the ability of educators and learners to effectively assess the quality of OERs using gestalt alone has been questioned. Our goal is to determine whether gestalt is sufficient for emergency medicine learners (EM) and physicians to consistently rate and reliably recommend OERs to their colleagues. We hypothesized that EM physicians and learners would differ substantively in their assessment of the same resources. Methods: Participants included 31 EM learners and 23 EM attending physicians from Canada and the U.S. A modified Dillman technique was used to administer 4 survey blocks of 10 blog posts per subject between April and August, 2015. Participants were asked whether they would recommend each OER to 1) a learner or 2) an attending physician. The ratings reliability was assessed using single measures intraclass correlations and their correlations amongst the groups were assessed using Spearman’s rho. Family-wise adjustments were made for multiple comparisons using the Bonferroni technique. Results: Learners demonstrated poor reliability when recommending resources for other learners (ICC= 0.21, 95% CI 0.13-0.39) and attending physicians (ICC = 0.16, 95% CI=0.09-0.30). Similarly, attendings had poor reliability when recommending resources for learners (ICC= 0.27, 95% CI 0.18-0.41) and other attendings (ICC=0.22, 95% CI 0.14-0.35). Learners and attendings demonstrated moderate consistency between them when recommending resources for learners (rs=0.494, p<.01) and attendings (rs=0.491, p<.01). Conclusion: Using a gestalt-based rating system is neither reliable nor consistent when recommending OERs to learners and attending physicians. Learners’ gestalt ratings for recommending resources for other learners and attendings were especially unreliable. Our findings suggests the need for structured rating systems to rate OERs.
Brazil today has a legal market that allows for foreign lawyers and foreign firms, but existing regulations are restrictive. Foreign lawyers cannot practice domestic law or litigation, nor can Brazilian‐licensed lawyers working for foreign firms or partnering with foreign lawyers. This was not always the case, however. Until 1963, there was little regulation of the legal profession. Beginning in 1913, elite US lawyers traveled to Brazil, with some even becoming prominent domestic practitioners. They partnered with local elite lawyers (who maintained their domestic privileges) and served as key brokers for US businesses seeking market entry. Drawing on the elite theory literature, and on ethnographies, interview data, and over 1,000 pages of rare Portuguese and English archival sources, this study's thesis is that sophisticated US and Brazilian legal elites capitalized on the lack of regulation to advance their financial interests, and in the process transformed Brazil's corporate legal sector.