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.
Perioperative medicine describes the practice of patient-centred, multidisciplinary, and integrated medical care of patients from the moment of contemplation of surgery until full recovery (Grocott & Mythen, 2015). This encompasses the three stages of surgical care: preoperative, intraoperative, and postoperative.
This definition covers a wide range of patients with many different conditions, ranging from a low-risk, young, healthy person undergoing minor surgery in an ambulatory care setting to a high-risk older person with multiple co-morbidities undergoing major and complex surgery.
A classic example of microbiome function is its role in nutrient assimilation in both plants and animals, but other less obvious roles are becoming more apparent, particularly in terms of driving infectious and non-infectious disease outcomes and influencing host behaviour. However, numerous biotic and abiotic factors influence the composition of these communities, and host microbiomes can be susceptible to environmental change. How microbial communities will be altered by, and mitigate, the rapid environmental change we can expect in the next few decades remain to be seen. That said, given the enormous range of functional diversity conferred by microbes, there is currently something of a revolution in microbial bioengineering and biotechnology in order to address real-world problems including human and wildlife disease and crop and biofuel production. All of these concepts are explored in further detail throughout the book.
This is the second volume of a series of mainly expository articles on the arithmetic theory of automorphic forms. It forms a sequel to On the Stabilization of the Trace Formula published in 2011. The books are intended primarily for two groups of readers: those interested in the structure of automorphic forms on reductive groups over number fields, and specifically in qualitative information on multiplicities of automorphic representations; and those interested in the classification of I-adic representations of Galois groups of number fields. Langlands' conjectures elaborate on the notion that these two problems overlap considerably. These volumes present convincing evidence supporting this, clearly and succinctly enough that readers can pass with minimal effort between the two points of view. Over a decade's worth of progress toward the stabilization of the Arthur-Selberg trace formula, culminating in Ngo Bau Chau's proof of the Fundamental Lemma, makes this series timely.
Stunting increases a child's susceptibility to diseases, increases mortality, and is associated over long term with reduced cognitive abilities, educational achievement, and productivity. We aimed to assess the most effective public health nutritional intervention to reduce stunting in Myanmar.
We searched the literature and developed a conceptual framework for interventions known to reduce stunting. We focused on the highest impact and most feasible interventions to reduce stunting in Myanmar, described policies to implement them, and compared their costs and projected effect on stunting using data-based decision trees. We estimated costs from the government perspective and calculated total projected cases of stunting prevented and cost per case prevented (cost-effectiveness). All interventions were compared to projected cases of stunting resulting from the current situation (e.g., no additional interventions).
Three new policy options were identified. Operational feasibility for all three options ranged from medium to high. Compared to the current situation, two were similarly cost-effective, at an additional USD 598 and USD 667 per case of stunting averted. The third option was much less cost-effective, at an additional USD 27,741 per case averted. However, if donor agencies were to expand their support in option three to the entire country, the prevalence of 22.5 percent would be reached by 2025 at an additional USD 667 per case averted.
A policy option involving immediate expansion of the current implementation of proven nutrition-specific interventions is feasible. It would have the highest impact on stunting and would approach the WHO 2025 target.
This paper completes the construction of
-functions for unitary groups. More precisely, in Harris, Li and Skinner [‘
-functions for unitary Shimura varieties. I. Construction of the Eisenstein measure’, Doc. Math.Extra Vol. (2006), 393–464 (electronic)], three of the authors proposed an approach to constructing such
-functions (Part I). Building on more recent results, including the first named author’s construction of Eisenstein measures and
-adic differential operators [Eischen, ‘A
-adic Eisenstein measure for unitary groups’, J. Reine Angew. Math.699 (2015), 111–142; ‘
-adic differential operators on automorphic forms on unitary groups’, Ann. Inst. Fourier (Grenoble)62(1) (2012), 177–243], Part II of the present paper provides the calculations of local
-integrals occurring in the Euler product (including at
). Part III of the present paper develops the formalism needed to pair Eisenstein measures with Hida families in the setting of the doubling method.
The adventures of Sherlock Holmes and John Watson begin at the end of Watson's personal mobility. He has ‘gravitated to London, that great cesspool into which all the loungers and idlers of the Empire are irresistibly drained’, with his health, and his career as a colonial medic, ‘irretrievably ruined’ (Doyle 2006: 14). Watson, curious about his new flatmate's profession, makes a list of his new friend's unique specializations and areas of ignorance – Holmes possesses a precise knowledge of London and the surrounding suburbs and an encyclopaedic catalogue of crime and chemistry, but knows little else (34). Holmes's unconventional occupation is revealed not in some dramatic conversation about a crime, but through his particular beliefs about the brain's ability to store a finite amount of information, like an ‘attic’ belonging to a ‘workman’ (32). Sherlock Holmes, with his carefully stocked ‘brain attic’, is a domestic detective and so his skills are described in domestic terms. The ‘attic’ is immobile; his skills are limited and specialized; and his knowledge of London's geography is not transferrable to another locale. He is so narrowly specialized that we (and even Watson) might say he is provincial.
The irony in calling Sherlock Holmes provincial is that his province, his region or specialty, is London as the Victorian imperial centre. Holmes is an ideal late-Victorian scientist taken to a distinctly un-Victorian extreme of specificity. And yet, this strange, provincial character is central both in imperial space, as London's superdetective, and in the international genre of detective fiction writ large, as a prototype of ‘the great consulting detective’. Holmes's empire over the genre is wide but the character’s abilities as a detective are decidedly narrow.
There is a parallel relationship between how a great detective's skills are described and how the space they inhabit relates to imperial-cultural centres. A Holmes-like detective whose investigative space includes a different type of space or place might choose a different metaphor than ‘brain attic’ to describe their investigative toolkit, as their relationship to their space is different. Adapting a genre's conventions or tropes to local conditions and conventions is a well-studied phenomenon. What is not often discussed, and what is revealed by these subtle changes to Holmes-like detectives, is the politics inherent in this practice.
The value of decolonization as a strategy for preventing methicillin-resistantStaphylococcus aureus (MRSA) in the neonatal intensive care unit (NICU) remains to be determined.
After adding decolonization to further reduce MRSA transmission in our NICU, we conducted this retrospective review to evaluate its effectiveness.
The review included patients who were admitted to our NICU between April 2015 and June 2018 and were eligible for decolonization including twice daily intranasal mupirocin and daily chlorhexidine gluconate bathing over 5 consecutive days. Patients were considered successfully decolonized if 3 subsequent MRSA screenings conducted at 1-week intervals were negative. The MRSA acquisition rate (AR) was calculated as hospital-acquired (HA) MRSA per 1,000 patient days (PD) and was used to measure the effectiveness of the decolonization.
Of the 151 MRSA patients being reviewed, 78 (51.6%) were HA-MRSA, resulting in an overall AR of 1.27 per 1,000 PD. Between April 2015 and February 2016, when only the decolonization was added, the AR was 2.38 per 1,000 PD. Between March 2016 and June 2018 after unit added a technician dedicated to the cleaning of reusable equipment, the AR decreased significantly to 0.92 per 1,000 PD (P < .05). Of the 78 patients who were started on the decolonization, 49 (62.8%) completed the protocol, 11 (14.1%) remained colonized, and 13 (16.7%) were recolonized prior to NICU discharge.
In a NICU with comprehensive MRSA prevention measures in place, enhancing the cleaning of reusable equipment, not decolonization, led to significant reduction of MRSA transmission.
It is sometimes said that American writers are insular, and write only, or at least primarily, about America. While this may be true in some cases, it is hardly true of Thomas Pynchon. George Saunders has said that Pynchon tries to cram the whole world into his fiction, and Saunders finds a hint of Buddhism in Pynchon’s impulse to absorb the world, especially evident in his longer novels. Of the many international locales Pynchon takes his readers to, Africa and Latin America occupy a prominent place. Rather than show how small our world is becoming, Pynchon seems intent on preserving the largeness of the world – in terms of its cultural diversity – in the face of the reductionist onslaughts of colonialism, Western cultural domination, and technological advances that overshadow traditional ways of knowing and seeing. Much of Pynchon’s fiction represents his charting through several centuries of history the precarious survival of cultures, such as those in Africa and Latin America, which represent alternative ways of life, full of vitality that Europe and North America lack. Thus, if Saunders is accurate about Pynchon’s desire to include the whole world in his work, then Africa and Latin America represent vital parts of that world.
Rare copy number variants (CNVs) are associated with risk of neurodevelopmental disorders characterised by varying degrees of cognitive impairment, including schizophrenia, autism spectrum disorder and intellectual disability. However, the effects of many individual CNVs in carriers without neurodevelopmental disorders are not yet fully understood, and little is known about the effects of reciprocal copy number changes of known pathogenic loci.
We aimed to analyse the effect of CNV carrier status on cognitive performance and measures of occupational and social outcomes in unaffected individuals from the UK Biobank.
We called CNVs in the full UK Biobank sample and analysed data from 420 247 individuals who passed CNV quality control, reported White British or Irish ancestry and were not diagnosed with neurodevelopmental disorders. We analysed 33 pathogenic CNVs, including their reciprocal deletions/duplications, for association with seven cognitive tests and four general measures of functioning: academic qualifications, occupation, household income and Townsend Deprivation Index.
Most CNVs (24 out of 33) were associated with reduced performance on at least one cognitive test or measure of functioning. The changes on the cognitive tests were modest (average reduction of 0.13 s.d.) but varied markedly between CNVs. All 12 schizophrenia-associated CNVs were associated with significant impairments on measures of functioning.
CNVs implicated in neurodevelopmental disorders, including schizophrenia, are associated with cognitive deficits, even among unaffected individuals. These deficits may be subtle but CNV carriers have significant disadvantages in educational attainment and ability to earn income in adult life.
To identify potential participants for clinical trials, electronic health records (EHRs) are searched at potential sites. As an alternative, we investigated using medical devices used for real-time diagnostic decisions for trial enrollment.
To project cohorts for a trial in acute coronary syndromes (ACS), we used electrocardiograph-based algorithms that identify ACS or ST elevation myocardial infarction (STEMI) that prompt clinicians to offer patients trial enrollment. We searched six hospitals’ electrocardiograph systems for electrocardiograms (ECGs) meeting the planned trial’s enrollment criterion: ECGs with STEMI or > 75% probability of ACS by the acute cardiac ischemia time-insensitive predictive instrument (ACI-TIPI). We revised the ACI-TIPI regression to require only data directly from the electrocardiograph, the e-ACI-TIPI using the same data used for the original ACI-TIPI (development set n = 3,453; test set n = 2,315). We also tested both on data from emergency department electrocardiographs from across the US (n = 8,556). We then used ACI-TIPI and e-ACI-TIPI to identify potential cohorts for the ACS trial and compared performance to cohorts from EHR data at the hospitals.
Receiver-operating characteristic (ROC) curve areas on the test set were excellent, 0.89 for ACI-TIPI and 0.84 for the e-ACI-TIPI, as was calibration. On the national electrocardiographic database, ROC areas were 0.78 and 0.69, respectively, and with very good calibration. When tested for detection of patients with > 75% ACS probability, both electrocardiograph-based methods identified eligible patients well, and better than did EHRs.
Using data from medical devices such as electrocardiographs may provide accurate projections of available cohorts for clinical trials.
Internal gravity wave energy contributes significantly to the energy budget of the oceans, affecting mixing and the thermohaline circulation. Hence it is important to determine the internal wave energy flux
is the pressure perturbation field and
is the velocity perturbation field. However, the pressure perturbation field is not directly accessible in laboratory or field observations. Previously, a Green’s function based method was developed to calculate the instantaneous energy flux field from a measured density perturbation field
, given a constant buoyancy frequency
. Here we present methods for computing the instantaneous energy flux
for an internal wave field with vertically varying background
, as in the oceans where
typically decreases by two orders of magnitude from the pycnocline to the deep ocean. Analytic methods are presented for computing
from a density perturbation field for
varying linearly with
. To generalize this approach to arbitrary
, we present a computational method for obtaining
. The results for
for the different cases agree well with results from direct numerical simulations of the Navier–Stokes equations. Our computational method can be applied to any density perturbation data using the MATLAB graphical user interface ‘EnergyFlux’.
Inefficiencies in the national clinical research infrastructure have been apparent for decades. The National Center for Advancing Translational Science—sponsored Clinical and Translational Science Award (CTSA) program is able to address such inefficiencies. The Trial Innovation Network (TIN) is a collaborative initiative with the CTSA program and other National Institutes of Health (NIH) Institutes and Centers that addresses critical roadblocks to accelerate the translation of novel interventions to clinical practice. The TIN’s mission is to execute high-quality trials in a quick, cost-efficient manner. The TIN awardees are composed of 3 Trial Innovation Centers, the Recruitment Innovation Center, and the individual CTSA institutions that have identified TIN Liaison units. The TIN has launched a national scale single (central) Institutional Review Board system, master contracting agreements, quality-by-design approaches, novel recruitment support methods, and applies evidence-based strategies to recruitment and patient engagement. The TIN has received 113 submissions from 39 different CTSA institutions and 8 non-CTSA Institutions, with projects associated with 12 different NIH Institutes and Centers across a wide range of clinical/disease areas. Already more than 150 unique health systems/organizations are involved as sites in TIN-related multisite studies. The TIN will begin to capture data and metrics that quantify increased efficiency and quality improvement during operations.
This paper reports on undergraduate health care students’ perception of societal vulnerability to disasters in the context of population aging. Forecast increases in extreme weather events are likely to have a particularly devastating effect on older members of the community.
Undergraduate paramedicine and nursing students were surveyed using the Perceptions of Ageing and Disaster Vulnerability Scale (PADVS) to determine their views on the risks posed to older members of the community by disasters. Data analysis included a comparison of subscales relating to isolation, health system readiness, declining function, and community inclusiveness.
Students reported a moderate level of concern about disaster vulnerability. Students who had previously completed another university degree reported significantly higher levels of concern than those without a prior degree. Australian students reported lower concern about societal vulnerability compared to a previously reported cohort of Japanese students.
Our study suggests current education of future health care students does not promote adequate levels of awareness of the health-related challenges posed by disasters, particularly among older members of the community. Without addressing this gap in education, the risk of negative outcomes for both unprepared first responders and older members of the community is significant. (Disaster Med Public Health Prep. 2019;13:449-455)