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Unlike other fetal therapies, cardiac interventions have not been tested by randomized controlled trials (RCT), such as the one to determine the optimal management of twin-to-twin transfusion syndrome (TTTS) . Most reports of fetal cardiac interventions have no appropriate control subjects and have resulted in level three evidence at best, so their clinical value and generalizability to the fetal population with obstructive cardiac lesions remain uncertain.
Detecting gastrointestinal (GI) infection transmission among men who have sex with men (MSM) in England is complicated by a lack of routine sexual behavioural data. We investigated whether gender distributions might generate signals for increased transmission of GI pathogens among MSM. We examined the percentage male of laboratory-confirmed patient-episodes for patients with no known travel history for 10 GI infections of public health interest in England between 2003 and 2013, stratified by age and region. An adult male excess was observed for Shigella spp. (annual maximum 71% male); most pronounced for those aged 25–49 years and living in London, Brighton and Manchester. An adult male excess was observed every year for Entamoeba histolytica (range 59.8–76.1% male), Giardia (53.1–57.6%) and Campylobacter (52.1–53.5%) and for a minority of years for hepatitis A (max. 69.8%) and typhoidal salmonella (max. 65.7%). This approach generated a signal for excess male episodes for six GI pathogens, including a characterised outbreak of Shigella among MSM. Stratified analyses by geography and age group were consistent with MSM transmission for Shigella. Optimisation and routine application of this technique by public health authorities elsewhere might help identify potential GI infection outbreaks due to sexual transmission among MSM, for further investigation.
Introduction: Cognitive processing theories postulate that decision making depends on both fast and slow thinking. Experienced physicians (EPs) make diagnoses quickly and with less effort by using fast, intuitive thinking, whereas inexperienced medical students rely on slow, analytical thinking. This study used a cognitive task analysis to examine EPs cognitive processes and ability to provide knowledge translation to learners. Methods: A novel mind mapping approach was used to examine how EPs translate their clinical reasoning to learners, when evaluating a patient for a possible venous thromboembolism (VTE). Nine EPs were interviewed and shown two different videos of a medical student patient interview (randomized from six possible videos). Results: EPs were asked to demonstrate their clinical approach to the scenario using a mind map, assuming they were teaching a learner in the Emergency Department. EPs were later re-interviewed to examine response stability, and given the opportunity to make clarifying or substantive mind map modifications. Maps were broken into component pieces and analyzed using mixed-methods techniques. A mean of 15.7 component pieces were identified within each mind map (standard deviation (SD) 7.8). Maps were qualitatively coded, with a mean of 2.8 clarifying amendments (e.g. adding a time course caveat) (SD 1.5-5.75) and 4.4 substantive modifications (e.g. changing the flow of the map) (SD 2-5). Conclusion: Resulting mind maps displayed significant heterogeneity in teaching points and the degree to which EPs used slow thinking. EPs frequently made fast thinking jumps, although learners could prompt slow thinking by questioning unclear points. This is particularly important as learners engage in cognitive apprenticeship throughout their training. An improved understanding of EPs cognitive processes through mind mapping will allow learners to improve their own clinical reasoning (Merrit et al., 2017). Educating EPs on these processes will allow modification of their teaching styles to better suit learners.
The myocardium first starts to contract about 26 days after conception as a consequence of the rhythmical electrical depolarization of pacemaker-precursor cells. Cardiac arrhythmias are commonly encountered later in development and have been reported in about 2% of all pregnancies. With increasing use of antenatal screening, arrhythmias are more likely to be encountered, usually as a random pick-up. While the majority of them are benign (mostly atrial ectopic beats), some are associated with significant morbidity and mortality. For the latter group appropriate antenatal diagnosis may improve outcome by proper pre- and postnatal therapy.
M. J. Davis, School of Mathematics and Physics, University of Queensland,
T. M. Wright, School of Mathematics and Physics, University of Queensland, St. Lucia QLD 4072, Australia,
T. Gasenzer, Universität Heidelberg,
S. A. Gardiner, Department of Physics, Durham University,
N. P. Proukakis, School of Mathematics and Statistics, Newcastle University
The problem of understanding how a coherent, macroscopic Bose- Einstein condensate (BEC) emerges from the cooling of a thermal Bose gas has attracted significant theoretical and experimental interest over several decades. The pioneering achievement of BEC in weakly interacting dilute atomic gases in 1995 was followed by a number of experimental studies examining the growth of the BEC number, as well as the development of its coherence. More recently, there has been interest in connecting such experiments to universal aspects of nonequilibrium phase transitions, in terms of both static and dynamical critical exponents. Here, the spontaneous formation of topological structures such as vortices and solitons in quenched cold-atom experiments has enabled the verification of the Kibble-Zurek mechanism predicting the density of topological defects in continuous phase transitions, first proposed in the context of the evolution of the early universe. This chapter reviews progress in the understanding of BEC formation and discusses open questions and future research directions in the dynamics of phase transitions in quantum gases.
The equilibrium phase diagram of the dilute Bose gas exhibits a continuous phase transition between condensed and noncondensed phases. The order parameter characteristic of the condensed phase vanishes above some critical temperature Tc and grows continuously with decreasing temperature below this critical point. However, the dynamical process of condensate formation has proved to be a challenging phenomenon to address both theoretically and experimentally. This formation process is a crucial aspect of Bose systems and of direct relevance to all condensates discussed in this book, despite their evident system-specific properties. Important questions leading to intense discussions in the early literature include the time scale for condensate formation and the role of inhomogeneities and finite-size effects in “closed” systems. These issues are related to the concept of spontaneous symmetry breaking, its causes, and implications for physical systems (see, for example, Chapter 5 by Snoke and Daley).
In this chapter, we give an overview of the dynamics of condensate formation and describe the present understanding provided by increasingly well-controlled cold-atom experiments and corresponding theoretical advances over the past twenty years. We focus on the growth of BECs in cooled Bose gases, which, from a theoretical standpoint, requires a suitable nonequilibrium formalism.
We observed the Planetary Nebula NGC 6720 with the Gemini Telescope and the Gemini Multi-Object Spectrographs. We obtained spatial maps of 36 emission-lines in the wavelength range between 3600 Å and 9400 Å. We derived maps of c(Hβ), electronic densities, electronic temperatures, ionic and elemental abundances, and Ionization Correction Factors (ICFs) in the source and investigated the mass-loss history of the progenitor. The elemental abundance results indicate the need for ICFs based on three-dimensional photoionization models.
The evidence underpinning the developmental origins of health and disease (DOHaD) is overwhelming. As the emphasis shifts more towards interventions and the translational strategies for disease prevention, it is important to capitalize on collaboration and knowledge sharing to maximize opportunities for discovery and replication. DOHaD meetings are facilitating this interaction. However, strategies to perpetuate focussed discussions and collaborations around and between conferences are more likely to facilitate the development of DOHaD research. For this reason, the DOHaD Society of Australia and New Zealand (DOHaD ANZ) has initiated themed Working Groups, which convened at the 2014–2015 conferences. This report introduces the DOHaD ANZ Working Groups and summarizes their plans and activities. One of the first Working Groups to form was the ActEarly birth cohort group, which is moving towards more translational goals. Reflecting growing emphasis on the impact of early life biodiversity – even before birth – we also have a Working Group titled Infection, inflammation and the microbiome. We have several Working Groups exploring other major non-cancerous disease outcomes over the lifespan, including Brain, behaviour and development and Obesity, cardiovascular and metabolic health. The Epigenetics and Animal Models Working Groups cut across all these areas and seeks to ensure interaction between researchers. Finally, we have a group focussed on ‘Translation, policy and communication’ which focusses on how we can best take the evidence we produce into the community to effect change. By coordinating and perpetuating DOHaD discussions in this way we aim to enhance DOHaD research in our region.
We have undertaken a study of the 3-D spatial distribution of the older (τ ≥ 1–2 Gyr) stellar population lying beyond ~ 2 kpc in projected radial distance from the centre of the SMC. The study will eventually cover 120 square degrees including six overlapping Schmidt fields. Here we present the results from an area of 80 square degrees including the western, northern and north-eastern outer parts of the SMC.
We examined the use of functional analysis methodologies to identify the environmental determinants of challenging behaviour for two students with severe disabilities. With one student the functional analysis was conducted in an outpatient clinic which was removed from the school setting. The functional analysis was conducted in the classroom setting with the other student. These assessments produced clear hypotheses regarding the controlling contingencies for challenging behaviour with both students. Individualised support plans were then developed and were successfully implemented by classroom personnel. The results of this study are discussed in terms of using a flexible approach to functional assessment in schools based on the individual characteristics of the student and the classroom context.
The Western diet is typically high in salt and fructose, which have pressor activity. Maternal diet can affect offspring blood pressure, but the extent to which maternal intake of excess salt and fructose may influence cardiovascular function of the offspring is unknown. We sought to determine the effect of moderate maternal dietary intake of salt and/or fructose on resting and stimulated cardiovascular function of the adult male and female offspring. Pregnant rats were fed purified diets (±4 % salt) and water (±10 % fructose) before and during gestation and through lactation. Male and female offspring were weaned onto standard laboratory chow. From 9 to 14 weeks of age, cardiovascular parameters (basal, circadian and stimulated) were assessed continuously by radiotelemetry. Maternal salt intake rendered opposite-sex siblings with a 25-mmHg difference in blood pressure as adults; male offspring were hypertensive (15 mmHg mean arterial pressure (MAP)) and female offspring were hypotensive (10 mmHg MAP) above and below controls, respectively. Sex differences were unrelated to endothelial nitric oxide activity in vivo, but isolation-induced anxiety revealed a significantly steeper coupling between blood pressure and heart rate in salt-exposed male offspring but not in female offspring. MAP of all offspring was refractory to salt loading but sensitive to subsequent dietary fructose, an effect exacerbated in female offspring from fructose-fed dams. Circadian analyses of pressure in all offspring revealed higher mean set-point for heart rate and relative non-dipping of nocturnal pressure. In conclusion, increased salt and fructose in the maternal diet has lasting effects on offspring cardiovascular function that is sex-dependent and related to the offspring’s stress–response axis.
We present a systematic review providing estimates of the overall and regional burden of infectious complications following prostate biopsy. A directly standardized prevalence estimate was used because it reflects the burden of disease more explicitly. Complications included sepsis, hospitalization, bacteraemia, bacteriuria, and acute urinary retention after biopsy. There were 165 articles, comprising 162 577 patients, included in the final analysis. Our findings demonstrate that transrectal biopsy was associated with a higher burden of hospitalization (1·1% vs. 0·9%) and sepsis (0·8% vs. 0·1%) compared to transperineal biopsy, while acute urinary retention was more prevalent after transperineal than transrectal biopsy (4·2% vs. 0·9%). The differences were statistically non-significant because of large heterogeneity across countries. We also demonstrate and discuss regional variations in complication rates, with Asian studies reporting higher rates of sepsis and hospitalization.
The centrality of knowledge sharing to organizations’ sustainability has been established. This research explores and illustrates the influences for individual professionals and paraprofessionals – specifically civil engineers and design drafters – to share their deep, personally constructed knowledge, in a public sector provider of railways infrastructure. It investigates the extent to which: (i) knowledge sharing will be positively influenced by the professional identity, values and knowledge culture to achieve organizational and project goals; and (ii) sharing of deep personal expertise will be influenced by the quality of relational capital among individuals and individual perspectives. It finds that knowledge sharing develops within frameworks established through the alignment among sector, profession and organization values. However, individual behavior is found to be most strongly influenced by the presence and quality of relational capital and individuals’ personal perspectives.
This case report describes a patient who suffered an acute, severe complication of unilateral submandibular sialolithiasis, the disease process and management of these patients.
A 70-year-old woman was under investigation for a recurrent, painful right submandibular swelling and subsequently presented with an acute exacerbation. She exhibited symptoms of acute submandibular sialadenitis, and also reported breathing difficulty and a change in voice quality. Computed tomography imaging showed that this was caused by a submandibular gland duct sialolith, with inflammation extending to the ipsilateral supraglottis. She was treated medically and the stone was removed when the inflammation had stabilised.
This case highlights the need to thoroughly assess patients with neck swellings, especially when symptoms are atypical, to avoid life-threatening complications.
Choosing the best word or phrase for a given context from among the candidate near-synonyms, such as slim and skinny, is a difficult language generation problem. In this paper, we describe approaches to solving an instance of this problem, the lexical gap problem, with a particular focus on affect and subjectivity; to do this we draw upon techniques from the sentiment and subjectivity analysis fields. We present a supervised approach to this problem, initially with a unigram model that solidly outperforms the baseline, with a 6.8% increase in accuracy. The results to some extent confirm those from related problems, where feature presence outperforms feature frequency, and immediate context features generally outperform wider context features. However, this latter is somewhat surprisingly not always the case, and not necessarily where intuition might first suggest; and an analysis of where document-level models are in some cases better suggested that, in our corpus, broader features related to the ‘tone’ of the document could be useful, including document sentiment, document author, and a distance metric for weighting the wider lexical context of the gap itself. From these, our best model has a 10.1% increase in accuracy, corresponding to a 38% reduction in errors. Moreover, our models do not just improve accuracy on affective word choice, but on non-affective word choice also.
Assessment of foetal cardiac function is more challenging than in the adult, in whom emerging technologies are tested. The postnatal cardio-respiratory interaction is replaced by the cardio-placental circulation and impedance of the brain, and distal vascular beds play an important role in modulating flow to enable its redistribution in the foetal body. Prenatal specialists, comprising obstetricians and cardiologists, have tested a variety of traditional methodologies, as well as non-Doppler offline ultrasound methods in the foetus. This article reviews the development of techniques, outlines their use, and draws attention to pitfalls in adapting technologies validated in the adult heart to the small, fast beating, remote, and largely ungated foetal heart.
The Carnegie Council's work “is rooted in the premise that the incorporation of ethical concerns into discussions of international affairs will yield more effective policies both in the United States and abroad.” In honor of the Council's centenary, we have been asked to (briefly) present our views on the ethical and policy issues posed by climate change, focusing on what people need to know that they probably do not already know, and what should be done. In that spirit, this essay argues that climate change poses a profound ethical challenge, that the ongoing evasion of this challenge produces ineffective policy, and, therefore, that a fundamental paradigm shift is needed. More specifically, I maintain that the climate problem is usually misdiagnosed as a traditional tragedy of the commons, that this obscures two deeper and distinctively ethical challenges (what I call the tyranny of the contemporary and the perfect moral storm), and that we should address these challenges head on, by calling for a global constitutional convention focused on future generations.