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.
Introduction: September 2017 saw the launch of the British Columbia (BC) Emergency Medicine Network (EM Network), an innovative clinical network established to improve emergency care across the province. The intent of the EM Network is to support the delivery of evidence-informed, patient-centered care in all 108 Emergency Departments and Diagnostic & Treatment Centres in BC. After one year, the Network undertook a formative evaluation to guide its growth. Our objective is to describe the evaluation approach and early findings. Methods: The EM Network was evaluated on three levels: member demographics, online engagement and member perceptions of value and progress. For member demographics and online engagement, data were captured from member registration information on the Network's website, Google Analytics and Twitter Analytics. Membership feedback was sought through an online survey using a social network analysis tool, PARTNER (Program to Analyze, Record, and Track Networks to Enhance Relationships), and semi-structured individual interviews. This framework was developed based on literature recommendations in collaboration with Network members, including patient representatives. Results: There are currently 622 EM Network members from an eligible denominator of approximately 1400 physicians (44%). Seventy-three percent of the Emergency Departments and Diagnostic and Treatment Centres in BC currently have Network members, and since launch, the EM Network website has been accessed by 11,154 unique IP addresses. Online discussion forum use is low but growing, and Twitter following is high. There are currently 550 Twitter followers and an average of 27 ‘mentions’ of the Network by Twitter users per month. Member feedback through the survey and individual interviews indicates that the Network is respected and credible, but many remain unaware of its purpose and offerings. Conclusion: Our findings underscore that early evaluation is useful to identify development needs, and for the Network this includes increasing awareness and online dialogue. However, our results must be interpreted cautiously in such a young Network, and thus, we intend to re-evaluate regularly. Specific action recommendations from this baseline evaluation include: increasing face-to-face visits of targeted communities; maintaining or accelerating communication strategies to increase engagement; and providing new techniques that encourage member contributions in order to grow and improve content.
Characterisation of genetic diversity in a large number of European pig populations has been undertaken with EC support. The populations sampled included local (rare) breeds, national varieties of the major international breeds, commercial lines and the Chinese Meishan breed. A second phase of the project will sample a further 50 Chinese breeds. Neutral genetic markers (AFLP and microsatellites), with individual or bulk typing, were used and compared.
DNA from 59 European pig populations was extracted on samples of about 50 individuals per population. Individuals were typed for 50 microsatellites and for 148 AFLP bands. A subset of 25 populations was typed for 20 microsatellites on pools of DNA. Allele frequencies were estimated by direct allele counting for the co-dominant markers. Frequencies of AFLP negative alleles (absent bands) were obtained by taking the square root of absent band frequencies. Within-breed variability was summarised using standard statistics: expected and observed heterozygosity, mean observed and effective numbers of alleles, and F statistics. Between-breed diversity analysis was based on a bootstrapped Neighbor-Joining (NJ) tree derived from Reynolds distances (DR). The standard distance of Nei (DS) was also calculated.
Since its “depenalization” in 1993, the U.S. dollar has become possibly a more significant component of Cuba's money supply than the old peso. What are the alternatives? The euro seems inappropriate, given the inevitability of eventual normalization of relations with the United States. More advantageous would be to restore the Cuban peso, though this would involve unifying the bifurcated economic structure and the dual monetary and exchange rate systems. The Cuban government has yet to announce its plans. This study argues that an appropriate mix of exchange rate, monetary, fiscal, and income or wage and salary policies should support a rehabilitation of the Cuban peso.
And thus it was with many things that I’m not going to repeat: commerce, market-determined prices in certain sectors, for certain activities; a proliferation of self-employment.…
And these are the opinions we have had about these things over the years,
never imagining that we would have to learn to live with them for a period
of time that is very difficult to predict, and that depends on many factors.
Fidel Castro, 23 April 1997
During the approximately 30 years in which the exercise of entrepreneurship in a market-oriented setting was effectively prohibited, Cuba actually created a nation of entrepreneurs. Although the intention was to convert Cuba into a “school for socialism,” the reality is that Cuba has also been, in part, a school for market-oriented entrepreneurship. This, indeed, is one of the more surprising and significant paradoxes of the Cuban Revolution. The nature of Cuba’s planned economy itself has inadvertently promoted widespread entrepreneurial values, attitudes, behavior, and savoir-faire, as citizens of necessity have had to buy and sell, truck and barter, hustle and “network” to improvise solutions to their personal economic problems. While entrepreneurial talents have developed broadly among the population, their exercise, until 1993, was restricted to the important but low-level everyday tasks of sustenance and survival, often carried out in the shadow or underground economy or on the black market. But when the space available for entrepreneurial activity was increased with the liberalization of microenterprise beginning in September 1993, the expansion and diversification of microentrepreneurial activity was impressive.
The heritable components of many traits in which livestock producers strive for improvement comprise a number of genetic loci. Many workers have now reported the identification of such quantitative trait loci (QTL) using model crosses between divergent breeds or lines in combination with whole genome scans using mapped DNA markers. Such methods rely on two or three generation pedigrees in order to be able to trace the inheritance of markers and the QTL. However, it is not yet clear if such QTL have application in commercial pig populations. The AFLP™ technology is a very efficient method for identifying markers segregating in any population. We have previously reported the successful use of the AFLP™technology and bulk segregant analysis (BSA) for the detection of markers associated with pig coat colour, a monogenic trait (Plastow et al 1998). We set out to determine whether these methods could be used for the detection of loci associated with quantitative traits directly in commercial populations.
PSR J0337+1715 is a millisecond radio pulsar in a hierarchical stellar triple system with two white dwarfs. This system is a unique and excellent laboratory in which to test the strong equivalence principle (SEP) of general relativity. An initial SEP-violation test was performed using direct 3-body numerical integration of the orbit in order to model the more than 25000 pulse times of arrival (TOAs) from three radio telescopes: Arecibo, Green Bank and Westerbork. In this work I present our efforts to quantify the effects of systematics in the TOAs and timing residuals, which limit the precision of an SEP test. In particular, we apply Fourier-based techniques to the timing residuals in order to isolate the effects of systematics that can masquerade as an SEP violation.
The millisecond pulsar PSR J0337+1715 is in a mildly relativistic hierarchical triple system with two white dwarfs. This offers the possibility of testing the universality of free fall: does the neutron star fall with the same acceleration as the inner white dwarf in the gravity of the outer white dwarf? We have carried out an intensive pulsar timing campaign, yielding some 27000 pulse time-of-arrival (TOA) measurements with a median uncertainty of 1.2 μs. Here we describe our analysis procedure and timing model.
An important source, available to the historian, which helps explain the nature of the society of South Central France in the late ninth and early tenth century is the Life of St. Gerald of Aurillac, written by Abbot Odo of Cluny. It is important for a number of reasons. In the first place, it was written during a period when French royal capitularies reflect a kingly authority restricted to an area north of the Loire and thus are unable to throw much light on conditions in the Midi. In the second place, when it was composed local narrative chronicles seem no longer to have been written south of the Loire, while those still being penned north of it, like Flodoard's Annals, seem to contain little information concerning this part of France. In short, the Life of St. Gerald of Aurillac fills an important gap in our information between the narrative found in the Annales Bertiniani, composed by Hincmar of Rheims, who seems well informed on events taking place in the Midi, and that found in the early eleventh-century chronicle of Ademar of Chabannes.
In the modern world, biotic diversity is typically higher in low-latitude tropical regions where there is abundant insolation (light and heat) and low thermal seasonality. Because these factors broadly covary with latitude, separating their possible effects on species diversity is difficult. The Eocene was a much more equable world, however, with low temperature seasonality extending into lower-insolation higher, cooler latitudes, allowing us to test these factors by comparing insect species diversity in (1) modern, temperate, low-insolation, highly seasonal Harvard Forest, Massachusetts, U.S.A., 42°29'N; (2) modern, tropical, high-insolation, low-seasonality La Selva, Costa Rica, 10°26'N, and; (3) Eocene, temperate, low-insolation, yet low-seasonality McAbee, British Columbia, Canada, above 50°N paleolatitude. We found insect diversity at McAbee to be more similar to La Selva than to Harvard Forest, with high species richness of most groups and decreased diversity of ichneumon wasps, indicating that seasonality is key to the latitudinal diversity gradient. Further, midlatitude Eocene woody dicot diversities at McAbee, Republic (Washington, U.S.A.), and Laguna del Hunco (Argentina) are also high, similar to modern tropical samples, higher than at the modern midlatitude Harvard Forest. Modern correlations between latitude, species diversity, and seasonal climates were established some time after the Eocene.
The scorpionfly (Mecoptera) superfamily Panorpoidea underwent an Eocene radiation, replacing the extinct Mesozoic orthophlebiid grade and reaching its greatest family-level diversity: Panorpidae, Panorpodidae, Austropanorpidae, Holcorpidae, Dinopanorpidae, and a new family proposed here, the Eorpidae. Only the Panorpidae and Panorpodidae survived the Eocene and persist to the present day. This cluster of family extinctions is exceptional within Cenozoic insects. The Eorpidae includes at least one new genus and three new species described here from four localities of the early Eocene Okanagan Highlands of British Columbia, Canada, and Washington, U.S.A.: Eorpa ypsipeda n. gen. n. sp. (McAbee and possibly Falkland, BC, Canada; and Republic, WA, U.S.A.), Eorpa elverumi n. gen. n. sp. (Republic), and Eorpa jurgeni n. gen. n. sp. (Quilchena, BC). Some of the other fragmentary and poorly preserved specimens might represent further new species. We propose that the apex of Panorpoid family diversity ended by pressures from post-Eocene icehouse world climatic stress and the rise to ecological dominance of ants, some of which would have provided strong competition in scavenging for dead arthropods.
On 2011 July 14, a transient X-ray source, Swift J1822.3–1606, was detected by Swift BAT via its burst activities. It was subsequently identified as a new magnetar upon the detection of a pulse period of 8.4 s. Using follow-up RXTE, Swift, and Chandra observations, we have determined a spin-down rate of Ṗ ~ 3 × 10−13, implying a dipole magnetic field of ~ 5 × 1013 G, second lowest among known magnetars, although our timing solution is contaminated by timing noise. The post-outburst flux evolution is well modelled by surface cooling resulting from heat injection in the outer crust, although we cannot rule out other models. We measure an absorption column density similar to that of the open cluster M17 at 10′ away, arguing for a comparable distance of ~1.6 kpc. If confirmed, this could be the nearest known magnetar.
We conducted an intervention study to assess the impact of the use of an alcohol-chlorhexidine-based hand sanitizer on surgical site infection (SSI) rates among neurosurgical patients in Ho Chi Minh City, Vietnam.
A quasi-experimental study with an untreated control group and assessment of neurosurgical patients admitted to 2 neurosurgical wards at Cho Ray Hospital between July 11 and August 15, 2000 (before the intervention), and July 14 and August 18, 2001 (after the intervention). A hand sanitizer with 70% isopropyl alcohol and 0.5% Chlorhexidine gluconate was introduced, and healthcare workers were trained in its use on ward A in September 2000. No intervention was made in ward B. Centers for Disease Control and Prevention definitions of SSI were used. Patient SSI data were collected on standardized forms and were analyzed using Stata software (Stata).
A total of 786 patients were enrolled: 377 in the period before intervention (156 in ward A and 221 in ward B) and 409 in the period after intervention (159 in ward A and 250 in ward B). On ward A after the intervention, the SSI rate was reduced by 54% (from 8.3% to 3.8%; P = .09), and more than half of superficial SSIs were eliminated (7 of 13 vs 0 of 6 in ward B; P = .007). On ward B, the SSI rate increased by 22% (from 7.2% to 9.2%; P = .8). In patients without SSI, the median postoperative length of stay and the duration of antimicrobial use were reduced on ward A (both from 8 to 6 days; P <.001) but not on ward B.
Our study demonstrates that introduction of a hand sanitizer can both reduce SSI rates in neurosurgical patients, with particular impact on superficial SSIs, and reduce the overall postoperative length of stay and the duration of antimicrobial use. Hand hygiene programs in developing countries are likely to reduce SSI rates and improve patient outcomes.
Of 33,111 patients admitted to a large hospital in Vietnam from November 2000 through July 2001, a total of 303 were undergoing hemodialysis and had pyrogenic reactions (ie, fever and/or rigors). Ten case patients (3.3%) had documented bacteremia; pathogens were largely waterborne microorganisms. Pyrogenic reactions in case patients might have occurred because of suboptimal water quality or inadequate dialyzer reprocessing procedures.