Book chapters will be unavailable on Saturday 24th August between 8am-12pm BST. This is for essential maintenance which will provide improved performance going forwards. Please accept our apologies for any inconvenience caused.
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.
Isolated coarctation of the aorta can be repaired by either lateral thoracotomy or sternotomy approach with end-to-end anastomosis. Most commonly, neonates with coarctation of the aorta also have hypoplasia of the arch, requiring median sternotomy and extended end-to-side anastomosis with arch augmentation. The aim of this study was to describe our experience as the institution adopted the median sternotomy approach for repair, by reviewing complications, mortality, and reintervention.
Retrospective chart review of 66 patients aged 0–1 year who had arch repair performed by a single surgeon over an 8-year period was performed. Median age at surgery was 22 days (4–232) and median weight was 3.08 kg (1.25–8.0). Forty-one (62%) patients underwent median sternotomy.
There was 1 death from a noncardiac cause. Eighteen per cent of our patients were ≤2.5 kg. Vocal cord paresis occurred in 16% of patients under 2.5 kg and 9.5% of patients 2.5 kg or above at the time of surgery. Hypertension at 6-month follow-up was greater in patients under 2.5 kg (44%) than patients 2.5 kg or above (15%). Total surgical reintervention rate was 6%. For patients above 2.5 kg, the surgical reintervention rate was 5.4% and for patients below 2.5 kg, the surgical reintervention rate was 8.3%.
We concluded that for neonates with coarctation of the aorta and hypoplastic arch, median sternotomy is a safe surgical approach with low morbidity and mortality with the possible advantage of reduced surgical re-intervention and mortality in the population below 2.5 kg.
The Canterbury Primary Response Group (CPRG) was formed following the threats of severe acute respiratory syndrome (SARS) and avian influenza worldwide. The possible impact of these viruses alerted health care professionals that a community-wide approach was needed to manage and coordinate a response to any outbreak or potential outbreak. In Canterbury, New Zealand, the CPRG group took the responsibility to coordinate and manage the regional, out of hospital, planning and response coordination to annual influenza threats and the possible escalation to pandemic outbreaks.
To outline the formation of a primary health and community-wide planning group, bringing together not only a wide range of health providers, but also key community agencies to plan strategies and responses to seasonal influenza and possible pandemic outbreaks.
CPRG has developed a Pandemic Plan that focuses on the processes, structures, and roles to support and coordinate general practice, community pharmacies, community nursing, and other primary health care providers in the reduction of, readiness for, response to, and recovery from an influenza pandemic. The plan could reasonably apply to other respiratory-type pandemics such as SARS.
A comprehensive group of health professionals and supporting agencies meet monthly (more often if required) under the chair of CPRG to share information of the influenza-like illness (ILI) situation, virus types, and spread, as well as support strategies and response activities. Regular communication information updates are produced and circulated amongst members and primary health providers in the region.
Given that most ILI health consultations and treatments are self or primary health administered and take place outside of hospital services, it is essential for providers to be informed and consistent with their responses and knowledge of the extent and symptoms of ILI and any likelihood of a pandemic.
OBJECTIVES/SPECIFIC AIMS: Little is known about potentially obesogenic endocrine-disruptors’ effects on excessive gestational weight gain (GWG) and postpartum weight retention (PPWR), which increase risk of adverse pregnancy and postnatal outcomes. We explored associations between prenatal organophosphate (OP) pesticide exposure and increased weight both during and after pregnancy. METHODS/STUDY POPULATION: Three dimethyl (DM) and three diethyl (DE) OP metabolites were measured in spot urine samples collected at <18, 18-25, and >25 gestational weeks among 688 participants in the Generation R Study. Metabolite levels were expressed as molar concentration/gram creatinine and log10-transformed. GWG and PPWR were calculated as the difference between weight at each prenatal/postnatal visit or maximum gestational weight and pre-pregnancy weight. In covariate-adjusted regression models we assessed associations of metabolite concentrations at each prenatal visit and, where appropriate, averaged across pregnancy with early-to-mid pregnancy, mid-to-late pregnancy, late pregnancy-to-maximum, and total GWG; insufficient and excessive GWG according to Institute of Medicine guidelines; and long-term PPWR at 6 and 10 years postpartum. Based on OP pesticides’ lipophilicity and association with hypomethylation, we investigated interactions with pre-pregnancy body mass index, periconceptional folic acid supplementation, and breastfeeding duration. RESULTS/ANTICIPATED RESULTS: A 10-fold increase in late pregnancy DE metabolite concentration was associated with 1.34 kg [95% confidence interval: 0.55, 2.12] higher late pregnancy-to-maximum GWG. A 10-fold increase in mean DE metabolite concentration across pregnancy was associated with 2.41 kg [0.62, 4.20] lower PPWR at 6 years. Stratified analysis suggested that the prenatal finding was driven by women with pre-pregnancy BMI ≥25 kg/m2, while the postnatal finding was driven by women with pre-pregnancy BMI <25 kg/m2 and with inadequate folic acid supplementation. We found no associations between OP pesticide metabolites and insufficient or excessive weight gain and no interaction with breastfeeding. DISCUSSION/SIGNIFICANCE OF IMPACT: In this longitudinal analysis, we observed a positive association of OP pesticide metabolites with GWG in late pregnancy among overweight/obese women, potentially reflecting inhibition of OP pesticide detoxification by oxidative stress. Postnatally, under/normal weight women with higher OP pesticide metabolites had lower PPWR, possibly due to better metabolic function and a more healthful diet. These results suggest that there may be a critical period during the late phase of pregnancy when OP pesticide exposure may increase GWG, and this association may be amplified in overweight/obese women. Areas for future research include examination of how the interaction between OP pesticides and polymorphisms of the paraoxonase (PON1) gene, which detoxifies OP pesticides, affect GWG/PPWR; exploration of the interplay among maternal pre-pregnancy BMI, oxidative stress, and PON1 levels; and characterization of the variability of OP pesticides exposure across pregnancy using more frequent repeated urine samples.
To assess variability in antimicrobial use and associations with infection testing in pediatric ventilator-associated events (VAEs).
Descriptive retrospective cohort with nested case-control study.
Pediatric intensive care units (PICUs), cardiac intensive care units (CICUs), and neonatal intensive care units (NICUs) in 6 US hospitals.
Children≤18 years ventilated for≥1 calendar day.
We identified patients with pediatric ventilator-associated conditions (VACs), pediatric VACs with antimicrobial use for≥4 days (AVACs), and possible ventilator-associated pneumonia (PVAP, defined as pediatric AVAC with a positive respiratory diagnostic test) according to previously proposed criteria.
Among 9,025 ventilated children, we identified 192 VAC cases, 43 in CICUs, 70 in PICUs, and 79 in NICUs. AVAC criteria were met in 79 VAC cases (41%) (58% CICU; 51% PICU; and 23% NICU), and varied by hospital (CICU, 20–67%; PICU, 0–70%; and NICU, 0–43%). Type and duration of AVAC antimicrobials varied by ICU type. AVAC cases in CICUs and PICUs received broad-spectrum antimicrobials more often than those in NICUs. Among AVAC cases, 39% had respiratory infection diagnostic testing performed; PVAP was identified in 15 VAC cases. Also, among AVAC cases, 73% had no associated positive respiratory or nonrespiratory diagnostic test.
Antimicrobial use is common in pediatric VAC, with variability in spectrum and duration of antimicrobials within hospitals and across ICU types, while PVAP is uncommon. Prolonged antimicrobial use despite low rates of PVAP or positive laboratory testing for infection suggests that AVAC may provide a lever for antimicrobial stewardship programs to improve utilization.
Altered autobiographical memory (ABM) functioning has been implicated in the pathogenesis of depression and posttraumatic stress disorder and may represent one mechanism by which childhood maltreatment elevates psychiatric risk.
To investigate the impact of childhood maltreatment on ABM functioning.
Thirty-four children with documented maltreatment and 33 matched controls recalled specific ABMs in response to emotionally valenced cue words during functional magnetic resonance imaging.
Children with maltreatment experience showed reduced hippocampal and increased middle temporal and parahippocampal activation during positive ABM recall compared with peers. During negative ABM recall they exhibited increased amygdala activation, and greater amygdala connectivity with the salience network.
Childhood maltreatment is associated with altered ABM functioning, specifically reduced activation in areas encoding specification of positive memories, and greater activation of the salience network for negative memories. This pattern may confer latent vulnerability to future depression and posttraumatic stress disorder.
Recently published work as described by the authors highlighted the extent of Complement activity in bovine milk. Localised mastitis infection occurring in the mammary glands of dairy cows is readily detectable by the levels of somatic cells in milk. Thus, it is opportune to monitor Complement activity in milks in association with the animal's innate immune response to mammary infection. Preliminary screening of milk samples taken randomly showed that milk with a high somatic cell count (SCC) reduced growth of the Complement-sensitive strain E. coli O111 to a greater extent (P < 0·05) than when the marker microorganism was grown in milk heated for the purpose of inactivating Complement. A follow-up study set out to determine the effect on Complement activity when a sub-clinical mastitis infection was induced in the mammary gland of four lactating dairy cows. The effect of Str. dysgalactiae spp. dysgalactiae inoculation into selected individual udder quarters of the mammary glands of each animal was followed by monitoring of SCC levels in the milks from the segregated udder samples during subsequent milking. At 72 and 96 h post inoculation (PI), the SCCs for the challenged quarter were increased compared to normal values. At the same time, the bactericidal sequestration assay identified increased E. coli O111 inhibition that can be directly linked to greater Complement activity in those quarter milks affected by induced inflammation. Thus, it can be identified that the high SCC milks were more effective in limiting E. coli O111 growth. Milks from the unchallenged quarters in all four cows were significantly less effective at reducing growth of the assay strain (P < 0·05).
An ELISA assay targeting specific activation components of the Complement pathways confirmed that greater bacterial inhibition observed during the bactericidal sequestration assay was attributable to higher Complement activity in the milk samples from the affected quarters, i.e., with higher SCC. The induced infection was confirmed as self-limiting in three of the affected animals and their SCC returned to normal levels within 14 d PI, while the fourth cow required brief antibiotic intervention.
Adult ventilator-associated event (VAE) definitions include ventilator-associated conditions (VAC) and subcategories for infection-related ventilator-associated complications (IVAC) and possible ventilator-associated pneumonia (PVAP). We explored these definitions for children.
Pediatric, cardiac, or neonatal intensive care units (ICUs) in 6 US hospitals
Patients ≤18 years old ventilated for ≥1 day
We identified patients with pediatric VAC based on previously proposed criteria. We applied adult temperature, white blood cell count, antibiotic, and culture criteria for IVAC and PVAP to these patients. We matched pediatric VAC patients with controls and evaluated associations with adverse outcomes using Cox proportional hazards models.
In total, 233 pediatric VACs (12,167 ventilation episodes) were identified. In the cardiac ICU (CICU), 62.5% of VACs met adult IVAC criteria; in the pediatric ICU (PICU), 54.2% of VACs met adult IVAC criteria; and in the neonatal ICU (NICU), 20.2% of VACs met adult IVAC criteria. Most patients had abnormal white blood cell counts and temperatures; we therefore recommend simplifying surveillance by focusing on “pediatric VAC with antimicrobial use” (pediatric AVAC). Pediatric AVAC with a positive respiratory diagnostic test (“pediatric PVAP”) occurred in 8.9% of VACs in the CICU, 13.3% of VACs in the PICU, and 4.3% of VACs in the NICU. Hospital mortality was increased, and hospital and ICU length of stay and duration of ventilation were prolonged among all pediatric VAE subsets compared with controls.
We propose pediatric AVAC for surveillance related to antimicrobial use, with pediatric PVAP as a subset of AVAC. Studies on generalizability and responsiveness of these metrics to quality improvement initiatives are needed, as are studies to determine whether lower pediatric VAE rates are associated with improvements in other outcomes.
While maltreatment is known to impact social and emotional functioning, threat processing, and neural structure, the potentially dimorphic influence of sex on these outcomes remains relatively understudied. We investigated sex differences across these domains in a large community sample of children aged 10 to 14 years (n = 122) comprising 62 children with verified maltreatment experience and 60 well-matched nonmaltreated peers. The maltreated group relative to the nonmaltreated comparison group exhibited poorer social and emotional functioning (more peer problems and heightened emotional reactivity). Cognitively, they displayed a pattern of attentional avoidance of threat in a visual dot-probe task. Similar patterns were observed in males and females in these domains. Reduced gray matter volume was found to characterize the maltreated group in the medial orbitofrontal cortex, bilateral middle temporal lobes, and bilateral supramarginal gyrus; sex differences were observed only in the supramarginal gyrus. In addition, a disordinal interaction between maltreatment exposure and sex was found in the postcentral gyrus. Finally, attentional avoidance to threat mediated the relationship between maltreatment and emotional reactivity, and medial orbitofrontal cortex gray matter volume mediated the relationship between maltreatment and peer functioning. Similar mediation patterns were observed across sexes. This study highlights the utility of combining multiple levels of analysis when studying the “latent vulnerability” engendered by childhood maltreatment and yields tentative findings regarding a neural basis of sex differences in long-term outcomes for maltreated children.
The objectives pursued by the Film Council and the way in which it understood and articulated its mission gradually shifted and broadened over time. In this chapter, we investigate how well the Council's evolutionary development served in enabling it to satisfy the differing constituencies of interest that form part of the landscape of film provision. How did it address the various tensions between regional, national, European and international interests in an increasingly transnational film industry? To what extent were the concerns and interests of independent producers influential in shaping the Council's approach? How effective was the UKFC in negotiating and promoting competing economic and cultural objectives? Bearing in mind how the UKFC's agenda shifted over the organisation's lifetime, this chapter considers its performance in handling the main interest groups, concerns and expectations that it needed to take into account in setting out its policy agenda.
Unified Body versus ‘Monolith’
As discussed in earlier chapters, when the idea of setting up a new film support body first surfaced in the FPRG Report, the case put forward for reviewing and possibly rationalising ‘the machinery for providing Government support to film’ centred on how a new unified organisation could ‘provide strategic leadership’, ‘achieve greater coherence’ and help eliminate ‘gaps and areas of overlap in provision’ (FPRG 1998: 50). So, although the ambition that impressed itself most firmly on the organisation's initial raison d’être was that of boosting the sustainability of the UK film industry, the Council was also founded on hopes that a single body with a remit straddling both industry and culture would provide a more effective platform for delivery of public support for film.
The Council managed to take charge of an all-encompassing programme of responsibilities by devolving delivery of various aspects of its remit to partner agencies. As Tim Cagney, the UKFC's head of partnerships from 2005 to 2010, noted, these included the BFI, which covered cultural aspects of the film remit, Skillset, which provided industry training, and the English Regional Screen Agencies, which dealt with film-related development objectives at a more local level (Interview, London, February 2013).
Drawing on interviews with leading film executives, politicians and industry stakeholders, including Alan Parker, Stewart Till and Tim Bevan, this book provides an empirically grounded analysis of the rise and unexpected fall of the UK Film Council.
This book is based on findings from a research project entitled The UK Film Council (UKFC): A Case Study of Film Policy in Transition, which was led by Professor Gillian Doyle (principal investigator) and conducted by her and a team comprising co-investigators Professor Philip Schlesinger, Professor Raymond Boyle and Research Associate Dr Lisa Kelly, all based at the Centre for Cultural Policy Research (CCPR) at the University of Glasgow. We gratefully acknowledge the support of the Arts & Humanities Research Council (AHRC) (Reference AH/J00457X/1). The broad objectives of our study, which ran from September 2012 until March 2015, were to investigate the history of the UK Film Council (UKFC), to examine its effectiveness as a model of public support for film and also to analyse what lessons can be drawn from its experience.
Established in April 2000 but wound up at the end of March 2011, the UKFC was the key strategic body responsible for supporting the film industry and film culture in Britain for more than a decade. Our project investigated the UKFC's short-lived experience as lead support body for film and the fundamental questions raised, in the wake of the Council's demise, about how strategic interventions for film in the twenty-first century may be framed and put into operation.
It is important to understand the scope and limitations of the present work. The Film Council became the head of a so-called ‘family’ of partner organisations – see Appendix 1. There is a separate tale to be told about this extensive network and how it operated. The present study, however, confines itself to what we have judged to be central aspects of the UKFC's operations. There is no shortage of further work to be done.
Our investigation involved extensive fieldwork, including some fifty interviews with key policy-makers, former UKFC personnel, industry analysts, leading film-makers and other prominent film industry stakeholders. Our interviews (that, with only three exceptions, were conducted by telephone or Skype) were generally all audio-recorded face to face. All were professionally transcribed with full confidentiality observed where requested.
Mr Cohen asked the Prime Minister if he will make a statement on the Report of the Working Party on the Future of the British Film Industry.
The Prime Minister: The Report of the Working Party, chaired by Mr John Terry, was published as Cmnd. 6372 in mid-January. Since then we have given careful consideration to its analysis of the position of the film industry in this country and to its proposals. The Government accepts the value of a strong British film industry, able to take its place in a competitive international market and providing audiences, here and abroad, with an up-to-date image of our society and of the quality and power of our creative artists.
We have been particularly impressed by the two principal recommendations in the Terry Report, namely the need to strengthen the industry's financial position and the need for a single new body charged with overall responsibility for all aspects of the industry's activities.
(House of Commons Debate, 29 March 1976)
The Hollywood switch has tended to turn the British film industry on for one decade and off for the next.
(Tunstall and Machin 1999: 134)
The long forgotten Terry Report on The Future of the British Film Industry (HMSO 1976), set up by Prime Minister Harold Wilson almost forty years ago, highlighted the fact that the relationship between the British state and the film industry had at its core a concern with both the economic importance and the cultural role of film in British society. It is no surprise, then, to find that since the early part of the twentieth century that state intervention in the policy arena has, at differing moments, reflected and grappled with these often competing concerns. This chapter maps out some of the significant moments in the evolution of film policy as it relates to the business and infrastructure of the industry in the UK and takes us up to the late 1970s. Over this period, a clear pattern is evident in that the film industry and its specific relationship to Hollywood shaped various state interventions that were mostly aimed at buttressing an indigenous industry and also focused on growing and developing the UK's capacity to compete internationally.
This chapter provides an analysis of the UK Film Council's performance over its lifetime in relation to some of its key stated policy objectives and funding schemes and initiatives. It is well recognised that cultural industries, including film, produce economic and non-economic impacts but measuring these impacts can prove challenging (Bakhshi et al. 2008; Throsby 2004). Similarly, measuring the performance of public bodies whose job it is to support cultural industries is fraught with difficulty, not least because such bodies are accountable to diverse stakeholder groups and the objectives that they are, or ought to be, pursuing can be a matter for divided opinions. The conditions surrounding the inception and development of the UK Film Council made this a distinct organisation with few obvious comparators around the globe. Therefore, assessing the Film Council's performance, when we are discussing a support body with a wide remit whose sense of mission shifted over its lifetime, is by no means an easy task.
Our analysis draws extensively on secondary source statistical data and, where possible, we have used data for the years starting in 2000, when the Film Council began operating, up until 2011, when responsibility for film in the UK passed to the BFI. Mindful of the fact that historical data is subject to revision, we have relied heavily on the most up-to-date published sources in the BFI Statistical Yearbook 2014. Where comparative data over the lifetime of the UKFC is not available, we refer to the statistical yearbooks published by the UKFC from 2002 to 2010 and the BFI thereafter. Where substantive variances in methods of data collection occur, we have sought to ensure reliability by narrowing the focus to more limited periods within the 2000–11 time frame. In addition, bearing in mind that time lags may occur between the instigation of schemes and interventions and the achievement of desired impacts, some of the data used in our analysis relates to surrounding periods before the creation, and after the closure, of the Film Council.
Sources of data drawn upon include the UKFC's Group and Lottery Annual Report and Financial Statements (2000–10) and its Annual Review (2000–6).