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 firstname.lastname@example.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 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.
Children with CHD and acquired heart disease have unique, high-risk physiology. They may have a higher risk of adverse tracheal-intubation-associated events, as compared with children with non-cardiac disease.
Materials and methods
We sought to evaluate the occurrence of adverse tracheal-intubation-associated events in children with cardiac disease compared to children with non-cardiac disease. A retrospective analysis of tracheal intubations from 38 international paediatric ICUs was performed using the National Emergency Airway Registry for Children (NEAR4KIDS) quality improvement registry. The primary outcome was the occurrence of any tracheal-intubation-associated event. Secondary outcomes included the occurrence of severe tracheal-intubation-associated events, multiple intubation attempts, and oxygen desaturation.
A total of 8851 intubations were reported between July, 2012 and March, 2016. Cardiac patients were younger, more likely to have haemodynamic instability, and less likely to have respiratory failure as an indication. The overall frequency of tracheal-intubation-associated events was not different (cardiac: 17% versus non-cardiac: 16%, p=0.13), nor was the rate of severe tracheal-intubation-associated events (cardiac: 7% versus non-cardiac: 6%, p=0.11). Tracheal-intubation-associated cardiac arrest occurred more often in cardiac patients (2.80 versus 1.28%; p<0.001), even after adjusting for patient and provider differences (adjusted odds ratio 1.79; p=0.03). Multiple intubation attempts occurred less often in cardiac patients (p=0.04), and oxygen desaturations occurred more often, even after excluding patients with cyanotic heart disease.
The overall incidence of adverse tracheal-intubation-associated events in cardiac patients was not different from that in non-cardiac patients. However, the presence of a cardiac diagnosis was associated with a higher occurrence of both tracheal-intubation-associated cardiac arrest and oxygen desaturation.
Assessing the significance of current glacier loss on Kilimanjaro, Tanzania, demands a well-constrained temporal perspective. That context is provided by direct measurements, ancillary observations of the ice fields and the analyses of the ice cores collected from them. Ice retreat mechanisms observed there today are consistent with the preservation of the oldest ice, ~11.7 ka, in the central deepest part of the Northern Ice Field (NIF). This ice-core derived paleoclimate history published by Thompson and others (2002) is further confirmed by more recent paleoclimate records from tropical East Africa. Mounting evidence suggests that the (anticipated) loss of the entire NIF will be unprecedented within the past 10 000 years. New evidence bears directly on the mechanisms driving the current ice loss. Measurements made in 2000 on the NIF document that air temperature at 0.5 and 1.5 m above the surface remained below 5°C, while a surface temperature of 0.0°C was sustained for up to 8 hours d-1 under clear conditions, consistent with observations of melting on all Kilimanjaro summit ice fields. The linear relationship between oxygen and hydrogen isotopic ratios for all six ice cores drilled in 2000 lies very close to the global meteoric waterline and does not support sublimation (evaporation) as a major driver of ice loss today or in the past on Kilimanjaro.
Seven low redshift QSOs have been observed spectroscopically at infrared and optical wavelengths at McDonald Observatory. The two instruments used were the infrared grating spectrometer (IRGS; see Lester, Harvey, and Carr 1988 for a description) on the 2.7m reflector, and the es-2 cassegrain spectrometer on the 2.1m. Table 1 shows the objects and spectra taken.
This article identifies the liberties of the Church and the City of London which were intended to be protected by Magna Carta from 1215. The liberties intended were a recognition of a form of autonomy for the Church and the City and have no connection with the individual freedoms that are identified for protection by modern human rights instruments. The clauses in Magna Carta conferring that autonomy are among the very few that have not been repealed, but they have not been asserted for hundreds of years. While the idea of church autonomy has resonance with the ideas of subsidiarity and sphere-sovereignty developed in Catholic and Calvinist social teaching from the late nineteenth century, recent American jurisprudence suggests that religious autonomy may be the best way to defend religious liberty in the future. This article suggests that, just as English kings were persuaded to provide towns, colonial endeavours and eventually corporate free enterprise with limited autonomy for a fee, so charters conferring limited autonomy on religious communities may provide a philosophical and practical basis from which to defend religious liberty in the future, even if the assertion of individual religious liberty becomes politically incorrect.
Lidar has shown considerable utility for answering specific questions regarding anthropogenic landscape alteration in archaeological contexts. We document the extent and timing of these alterations in the construction of the public and political core architectural groups at Uxbenká, Belize, using combined data from Lidar and archaeological excavations. We detail how Lidar methods combined with archaeological excavations enhance the precision of our measurements of the broad range of impacts on the landscape from investment in the built environment. We conclude that the large social investment in landscape alteration to accommodate public architecture occurred early in the polity's history (prior to A.D. 400) and that later developments, including architectural reconfigurations, did not expand greatly on these initial investments.
Illegal killing/taking of birds is a growing concern across the Mediterranean. However, there are few quantitative data on the species and countries involved. We assessed numbers of individual birds of each species killed/taken illegally in each Mediterranean country per year, using a diverse range of data sources and incorporating expert knowledge. We estimated that 11–36 million individuals per year may be killed/taken illegally in the region, many of them on migration. In each of Cyprus, Egypt, Italy, Lebanon and Syria, more than two million birds may be killed/taken on average each year. For species such as Blackcap Sylvia atricapilla, Common Quail Coturnix coturnix, Eurasian Chaffinch Fringilla coelebs, House Sparrow Passer domesticus and Song Thrush Turdus philomelos, more than one million individuals of each species are estimated to be killed/taken illegally on average every year. Several species of global conservation concern are also reported to be killed/taken illegally in substantial numbers: Eurasian Curlew Numenius arquata, Ferruginous Duck Aythya nyroca and Rock Partridge Alectoris graeca. Birds in the Mediterranean are illegally killed/taken primarily for food, sport and for use as cage-birds or decoys. At the 20 worst locations with the highest reported numbers, 7.9 million individuals may be illegally killed/taken per year, representing 34% of the mean estimated annual regional total number of birds illegally killed/taken for all species combined. Our study highlighted the paucity of data on illegal killing/taking of birds. Monitoring schemes which use systematic sampling protocols are needed to generate increasingly robust data on trends in illegal killing/taking over time and help stakeholders prioritise conservation actions to address this international conservation problem. Large numbers of birds are also hunted legally in the region, but specific totals are generally unavailable. Such data, in combination with improved estimates for illegal killing/taking, are needed for robustly assessing the sustainability of exploitation of birds.
Previous studies have identified a number of psychosocial risk factors of dysregulated cortisol (frequently referred to as the “stress hormone”) among older adults with depression. However, these studies have typically only examined a handful of risk factors at a time and have sometimes yielded inconsistent results.
This study aims to address this gap in the literature by simultaneously examining a range of relevant psychosocial predictors of diurnal cortisol among 54 older adults with a depressive disorder. Salivary cortisol was assessed upon awakening, at 5 PM, and at 9 PM across two consecutive days. Participants also completed measures of global psychosocial stress, current psychiatric symptomatology, pervasive distress (e.g. history of past depression), and protective factors (e.g. social support, resiliency, extent to which one has “made sense” of a significant stressor).
High levels of current depressive symptoms, psychiatric comorbidities, past depressive episodes, trait anxiety, and poorer ability to make sense of one's stress were found to be associated with flatter (more abnormal) cortisol slopes. However, when all of these variables were entered simultaneously in a multiple regression analysis, only history of past depression and the degree of sense made of stress emerged as unique predictors of cortisol in the model.
These findings have important implications for identifying depressed elderly individuals with dysregulated cortisol patterns who may be most at risk for health complications. Treatments that aim to limit the chronicity of depression and help to increase the sense made of stress could potentially have a positive impact on health.
Energy Dispersive Spectroscopy (EDS) X-ray detectors have undergone a wave of technology enhancements since the first silicon drift-based EDS detector (SDD) was commercially introduced roughly 15 years ago. The first such EDS systems featured an active area of 5 mm2, an energy resolution between 160 eV–200 eV, and a maximum collection rate approaching only 100,000 input counts/second.