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Sources and implications of black carbon (BC) and mineral dust (MD) on two glaciers on the central Tibetan Plateau were estimated based on in situ measurements and modeling. The results indicated that BC and MD accounted for ~11 ± 1% and 4 ± 0% of the albedo reduction relative to clean snow, while the radiative forcing varied between 11 and 196 and 1–89 W m−2, respectively. Assessment of BC and MD contributions to the glacier melt can reach up 88 to 434 and 35 to 187 mm w.e., respectively, contributing ~9–23 and 4–10% of the total glacier melt. A footprint analysis indicated that BC and MD deposited on the glaciers originated mainly from the Middle East, Central Asia, North China and South Asia during the study period. Moreover, a potentially large fraction of BC may have originated from local and regional fossil fuel combustion. This study suggests that BC and MD will enhance glacier melt and provides a scientific basis for regional mitigation efforts.
When and where the process of state formation took place in the biblical kingdom of Judah is heavily debated. Our regional project in the southwestern part of Judah, carried out from 2007 to the present, includes the excavation of three Iron Age sites: Khirbet Qeiyafa, Tel Lachish, and Khirbet al-Ra’i. New cultural horizons and new fortification systems have been uncovered, and these discoveries have been dated by 59 radiometric determinations. The controversial question of when the kingdom was able to build a fortified city at Lachish, its foremost center after Jerusalem, is now resolved thanks to the excavation of a previously unknown city wall, dated by radiocarbon (14C) to the second half of the 10th century BCE.
Mechanical ventilation in the intensive care unit (ICU) increases the risk of hospital-acquired conditions (HACs) such as ventilator-associated pneumonia (VAP) and pressure injuries (PrI). Continuous lateral rotation therapy (CLRT) has been shown to reduce VAP and PrI incidence, but the value of switching to CLRT over standard care is presently unknown. We evaluate the cost-effectiveness of CLRT beds compared to standard care in ICUs and determine the return on investment (ROI) associated with its implementation.
A Markov model was constructed to predict health state transitions from the time of ventilation through 28 days using the healthcare sector perspective. Daily transition probabilities were extrapolated from prospective clinical studies comparing CLRT with standard care. Costs were estimated in 2014 USD. Utility scores were extracted from the published literature. Cost per quality-adjusted life-years (QALYs) was calculated and sensitivity analyses were conducted. A secondary analysis from a societal perspective with a one-year time horizon included the costs of patient and caregiver lost productivity. ROI analysis was performed to estimate the net benefit and breakeven point of the investment. Value of Information analysis was performed to determine whether further research is warranted.
From both perspectives, CLRT was dominant. From the healthcare sector perspective, the expected cost for CLRT per patient was USD 47,165 compared to standard care at USD 49,258 per patient, showing that CLRT saves cost per patient. The expected effectiveness of CLRT per patient was 0.0418 QALYs compared to 0.0416 QALYs for standard care. CLRT was dominant in 99.94 percent of Monte Carlo simulations. CLRT also reached the break-even point after 5 months. Expected Value of Perfect Information was equal to 0.019, indicating little value of additional evidence at the current level of parameter uncertainty.
CLRT is highly cost-effective compared to standard care by preventing ventilator-associated infections and PrIs in an ICU setting.
Conventional photolithography is an effective patterning technique that has enabled modern electronics and advanced micro- and nanoscale devices. However, it has limitations, including high cost, limited resolution, and poor compatibility with unconventional materials that may be soft, nonplanar, or difficult to process. There is active research ongoing to develop unconventional patterning methods such as self-organization and self-folding. Self-organization harnesses various driving forces to produce patterns without external intervention and includes methods such as self-assembly of block copolymers, capillary-driven assembly of micro-/nanoscale structures, and thin-film instabilities. Self-folding (origami)—and its cousin, kirigami—harnesses patterning and materials strategies to convert planar substrates into three-dimensional shapes in response to external stimuli. These multidisciplinary approaches open many engineering opportunities by providing new and versatile material functionalities. This article overviews the field and the topics covered in the articles in this issue of MRS Bulletin, highlighting recent progress in patterning approaches based on self-organization and self-folding.
We identified an outbreak of AmpC–producing Escherichia coli infections resistant to third-generation cephalosporins and carbapenems (CR) among 7 patients who had undergone endoscopic retrograde cholangiopancreatography at hospital A during November 2012–August 2013. Gene sequencing revealed a shared novel mutation in a blaCMY gene and a distinctive fumC/ fimH typing profile.
To determine the extent and epidemiologic characteristics of the outbreak, identify potential sources of transmission, design and implement infection control measures, and determine the association between the CR E. coli and AmpC E. coli circulating at hospital A.
We reviewed laboratory, medical, and endoscopy reports, and endoscope reprocessing procedures. We obtained cultures from endoscopes after reprocessing as well as environmental samples and conducted pulsed-field gel electrophoresis and gene sequencing on phenotypic AmpC isolates from patients and endoscopes. Cases were those infected with phenotypic AmpC isolates (both carbapenem-susceptible and CR) and identical blaCMY-2, fumC, and fimH alleles or related pulsed-field gel electrophoresis patterns.
Thirty-five of 49 AmpC E. coli tested met the case definition, including all CR isolates. All cases had complicated biliary disease and had undergone at least 1 endoscopic retrograde cholangiopancreatography at hospital A. Mortality at 30 days was 16% for all patients and 56% for CR patients. Two of 8 reprocessed endoscopic retrograde cholangiopancreatography scopes harbored AmpC that matched case isolates by pulsed-field gel electrophoresis. Environmental cultures were negative. No breaches in infection control were identified. Endoscopic reprocessing exceeded manufacturer’s recommended cleaning guidelines.
Recommended reprocessing guidelines are not sufficient.
For d ≥ 2, let Hd(n,p) denote a random d-uniform hypergraph with n vertices in which each of the
possible edges is present with probability p=p(n) independently, and let Hd(n,m) denote a uniformly distributed d-uniform hypergraph with n vertices and m edges. Let either H=Hd(n,m) or H=Hd(n,p), where m/n and
need to be bounded away from (d−1)−1 and 0 respectively. We determine the asymptotic probability that H is connected. This yields the asymptotic number of connected d-uniform hypergraphs with given numbers of vertices and edges. We also derive a local limit theorem for the number of edges in Hd(n,p), conditioned on Hd(n,p) being connected.
Let Hd(n,p) signify a random d-uniform hypergraph with n vertices in which each of the
possible edges is present with probability p=p(n) independently, and let Hd(n,m) denote a uniformly distributed d-uniform hypergraph with n vertices and m edges. We derive local limit theorems for the joint distribution of the number of vertices and the number of edges in the largest component of Hd(n,p) and Hd(n,m) in the regime
, resp. d(d−1)m/n>1+ϵ, where ϵ>0 is arbitrarily small but fixed as n → ∞. The proofs are based on a purely probabilistic approach.
Background: This study examined the use of low doses of antipsychotic medications (300 mg/day CPZeq or less) in older Asian patients with schizophrenia and its demographic and clinical correlates.
Methods: Information on hospitalized patients with schizophrenia, aged 55 years or older, was extracted from the database of the Research on Asian Psychotropic Prescription Patterns (REAP) study (2001–2009). Data on 1,452 patients in eight Asian countries and territories including China, Hong Kong, Japan, Korea, Singapore, Taiwan, India, and Malaysia were analyzed. Sociodemographic and clinical characteristics and antipsychotic prescriptions were recorded using a standardized protocol and data collection procedure.
Results: The prescription frequency for low doses of antipsychotic medications was 40.9% in the pooled sample. Multiple logistic regression analysis of the whole sample showed that patients on low doses of antipsychotic medications were more likely to be female, have an older age, a shorter length of illness, and less positive symptoms. Of patients in the six countries and territories that participated in all the surveys between 2001 and 2009, those in Japan were less likely to receive low doses of antipsychotics.
Conclusion: Low doses of antipsychotic medications were only applied in less than half of older Asian patients with schizophrenia.
Population studies show that greater red and processed meat consumption increases colorectal cancer risk, whereas dietary fibre is protective. In rats, resistant starches (a dietary fibre component) oppose colonocyte DNA strand breaks induced by high red meat diets, consistent with epidemiological data. Protection appears to be through SCFA, particularly butyrate, produced by large bowel carbohydrate fermentation. Arabinoxylans are important wheat fibre components and stimulate large bowel carbohydrate SCFA production. The present study aimed to determine whether an arabinoxylan-rich fraction (AXRF) from wheat protected colonocytes from DNA damage and changed colonic microbial composition in pigs fed with a diet high (30 %) in cooked red meat for 4 weeks. AXRF was primarily fermented in the caecum, as indicated by higher tissue and digesta weights and higher caecal (but not colonic) acetate, propionate and total SCFA concentrations. Protein fermentation product concentrations (caecal p-cresol and mid- and distal colonic phenol) were lower in pigs fed with AXRF. Colonocyte DNA damage was lower in pigs fed with AXRF. The microbial profiles of mid-colonic mucosa and adjacent digesta showed that bacteria affiliating with Prevotella spp. and Clostridial cluster IV were more abundant in both the mucosa and digesta fractions of pigs fed with AXRF. These data suggest that, although AXRF was primarily fermented in the caecum, DNA damage was reduced in the large bowel, occurring in conjunction with lower phenol concentrations and altered microbial populations. Further studies to determine the relationships between these changes and the lowering of colonocyte DNA damage are warranted.
Race, Reform, and the Regulation of the Electoral Process: Recurring Puzzles in American Democracy is the first volume in Cambridge University Press's Cambridge Studies in Election Law and Democracy series. It offers a critical reevaluation of three fundamental and interlocking themes in American democracy: the relationship between race and politics; the performance and reform of election systems; and the role of courts in regulating the political process. This edited volume features contributions from some of the leading voices in election law and social science. The authors address the recurring questions for American democracy and identify new challenges for the twenty-first century. They consider not just where elections scholarship and electoral policy are headed, but also suggest where scholarship and policy ought to go in the next two decades. The book thus provides intellectual guideposts for future scholarship and policy making.
Most of the democratic reform during the twentieth century – and certainly the most important reform – has related to the central subject of race. Because electoral reform and regulation of the political process have been viewed largely through the prism of race, election law and reform have been framed largely in rights-based terms. Consistent with the civil-rights paradigm, courts emerged as the primary regulatory agents of American democracy and served as the vehicle through which much of the reform of American representative institutions has occurred.
One of the central problems for election reform – and a central concern of elections scholarship – is political self-interest. Political lock-ups and lock-outs (Issacharoff and Pildes 1998; Cain 1999) – efforts by incumbents to entrench themselves – lead to a set of electoral rules and institutions that range from the silly to the perverse. The result is not only bad policy, but a system that is unusually resistant to change.
Political self-interest is, however, a double-edged sword (Kang 2006; Gerken 2007). Scholars familiar with its perverse consequences in the elections arena tend to lament its existence, but political self-interest is also the engine that fuels a vibrant political system. The key in the arena of election reform is to figure out how to align the interests of partisans with the interest of voters, to redirect political energies into healthier channels. The key is to harness politics to fix politics.
Stated in these terms, the idea seems unobjectionable, even banal. Of course, one thinks, we should be attentive to partisan self-interest in thinking about reform. But even though most agree with the basic idea, scholars have not been sufficiently attentive to all of its implications. This is an idea worked out in the “apps,” an idea whose significance becomes apparent only when one digs into the questions of institutional design and election reform that are the bread-and-butter of election law scholarship. We believe that the field should shift its emphasis in several ways.