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.
The aim of this study was to describe individuals seeking care for injury at a major emergency department (ED) in southern Puerto Rico in the months after Hurricane Maria on September 20, 2017.
After informed consent, we used a modified version of the Natural Disaster Morbidity Surveillance Form to determine why patients were visiting the ED during October 16, 2017–March 28, 2018. We analyzed visits where injury was reported as the primary reason for visit and whether it was hurricane-related.
Among 5 116 patients, 573 (11%) reported injury as the primary reason for a visit. Of these, 10% were hurricane-related visits. The most common types of injuries were abrasions, lacerations, and cuts (43% of all injury visits and 50% of hurricane-related visits). The most common mechanisms of injury were falls, slips, trips (268, 47%), and being hit by/or against an object (88, 15%). Most injury visits occurred during the first 3 months after the hurricane.
Surveillance after Hurricane Maria identified injury as the reason for a visit for about 1 in 10 patients visiting the ED, providing evidence on the patterns of injuries in the months following a hurricane. Public health and emergency providers can use this information to anticipate health care needs after a disaster.
Total hip and knee arthroplasty (THKA) patients are at risk of venous thromboembolism (VTE). Guidelines recommend 10–35 days of pharmacoprophylaxis, but this may induce bleeding resulting in increased healthcare costs. This study assessed whether using intermittent pneumatic compression (IPC) for VTE prophylaxis is associated with reduced healthcare costs compared to anticoagulants.
Studies related to VTE and prophylaxis in THKA were identified by a structured search of the PubMed database. VTE incidence and cost data were Australia specific or, if not available, taken from other developed healthcare systems. A Markov model was used to estimate the incidence of deep vein thrombosis (DVT), pulmonary embolism (PE), death, post-thrombotic syndrome, as well as minor and major bleeding and heparin-induced-thrombocytopenia, to assess the budget impact of different VTE prophylaxis strategies. The time horizon was one year, low-molecular-weight-heparin (LMWH) was used as the reference intervention, and effectiveness data were obtained from meta-analyses.
A total of 102,459 THKA were performed in Australia in 2015. The twelve-day incidence of DVT and PE using LMWH prophylaxis were 4.48 percent and 0.25 percent, respectively, with minor and major bleeding occurred in 9.9 percent (within twelve days) and 1.9 percent (within 10 days) of the patients, respectively. The incidence of VTE was not different between LMWH and IPC after THKA. The model estimated that the total cost of post-operative care for THKA was AUD 101.7 million (USD 77 million) in 2015. A one percent-point change from LMWH to IPC prophylaxis (n=1025 patients) would reduce the total healthcare costs by AUD 317,361 (USD 240,274) per year (or AUD 310 (USD 235) per patient), primarily through reduced bleeding events (-72 minor and -3 major bleeds). Sensitivity analysis including 500 simulations demonstrated a likelihood of 100 percent for IPC to reduce both costs and bleeding events compared to LMWH. Similarly, a one percent-point change from dabigatran and rivaroxaban to IPC also resulted in total healthcare savings of AUD 320,580 (USD 242,711) and AUD 702,584 (USD 531,926) per year, respectively, with two-thirds and ninety-nine percent of the simulations favored IPC over dabigatran for bleeding and cost savings, respectively.
Using IPC for VTE prophylaxis after THKA has the potential to substantially reduce total healthcare costs compared to anticoagulants, primarily through reduced bleeding events. IPC is suitable for all patients, but may be particularly cost-effective in the immediate postoperative period or in patients at high-risk of bleeding.
A large collection of maize macro-specimens has been gathered from archaeological sites across the American continent, but only a few have been directly dated by accelerator mass spectrometry (AMS). We recently conducted two new excavations in several rock shelters of Tehuacán valley (San Marcos, Coxcatlán, and Purrón) and uncovered 132 non-manipulated macro-specimens of maize suitable for morphological and paleogenomic analysis, including many complete cobs, stalks, internodes, and leaves. Direct AMS dates for 43 samples found in San Marcos or Coxcatlán confirm the previously reported chronologies for these sites. By contrast, a cob found in Purrón was dated to 3060±30 before present (3360–3180 cal BP) (2σ), demonstrating that maize was present at that site at least 1500 calendar years earlier than previously expected, and suggesting that other specimens of similar age are still likely to be found in the southeastern region of the Tehuacán valley. A global comparison of macro-specimen chronology across the continent shows that the current archaebotanical record does not yet reflect the chronology of dispersal from central Mexico to northern or southern regions, opening the possibility for finding the missing links in subsequent expeditions within Mexico and Central America.
Taxation is accepted as a fact of modern life, despite recurring political conflict over the nature and direction of fiscal policies. Most financiers regard obligations issued by the state as a safe investment option. Neither taxation nor state obligations were taken for granted during much of the history of public finance, however, at least not before the early 1800s. The ‘tax state’ developed in fits and starts, driven by the exigencies of warfare, which provided the main rationale for raising state income. Although wartime fiscal innovations eventually facilitated the rise of an efficient military state, the options available for implementing such improvements and preferences for specific fiscal or financial instruments varied greatly across early modern states. Focusing on the ‘long’ eighteenth century, this introduction presents a framework for assessing these differences and introduces the other articles in this special issue.
Based on an extensive survey of French primary sources and a discussion of the recent literature on fiscal policy in France and Europe during Louis XIV's wars, this article revisits the rationale behind the first experiment with paper money undertaken by finance minister Michel Chamillart, comparing it to other belligerents’ strategies, in particular England's, to adjust their monetary regime to the challenges of funding long wars of attrition. The article shows how concerns about economic activity, coinage and the need to finance the war deficit led to a series of debasements of the French currency, the establishment of a bank in the form of a Caisse des emprunts and the introduction of mint bills, which became legal tender and caused the first experience of fiat money inflation in history. Whereas Chamillart's personal shortcomings have been recently suggested as the cause of Louis XIV's humbling in the War of the Spanish Succession, I argue on the contrary that the introduction of paper money in 1704 was key to the capacity of France to sustain its military effort, but that a succession of military defeats against a more powerful coalition led to inflation. I also argue that the introduction of paper money saved the Caisse des emprunts and its bonds which helped sustain the war effort up until the peace. By situating the use of paper money within the broader question of the exercise of power in the absolute monarchy, this article examines the formation of fiscal policy, paying attention to the ways in which government sought advice from experts. It concludes by calling for further studies on policy- and decision-making under Louis XIV.
The literature on the financial revolution and the rise of the English fiscal-military state frequently gives the impression that a singular set of reforms emanating from the Glorious Revolution of 1688 changed the entire landscape of English army finances, allowing a fundamental shift from patchwork solutions based on short-term credit and managed through a system of wholesale venality to a solid system of long-term funded loans raised on an impersonal market. This article focuses on the crucial role that merchant networks and the personal connections of financial intermediaries continued to play in international troop payments arranged by the English state through the Dutch Republic. Even when the English or Dutch treasuries could find the necessary money to pay and provision the troops in time, getting the money to the military commanders in the field or to their distant suppliers often depended on long and complex credit lines. Short-term loans acquired in making military expenditure – consisting of unpaid bills to suppliers, payments advanced by officials and officers, and temporary loans contracted by financial intermediaries – as well as the widespread reliance on commercial credit in the form of bills of exchange as a way to transfer funds effectively formed the life thread of army finance. The ability to finance the military in times of exploding costs and permanent emergencies without defaulting rested not only on the capacity to draw on financial resources at home, but also on the strength of commercial and financial networks abroad. In doing so, closeness to the centres of emerging international financial capitalism seems to have been of greater importance than a specific set of institutional innovations.
This article offers an architectural blueprint for the study of economic connections between warfare in the early modern period and the long-term growth of Europe's competing national economies. It surveys and critically investigates the concepts derived mainly from economic theory and the statistical evidence accessible in primary and secondary sources for the investigation of this meta-problem for students of economic theory.
Qing China represents a counterfactual to the early modern European history of fiscal expansion in the wake of warfare. In response to the staggering costs of suppressing the White Lotus Rebellion (1796–1804), the Jiaqing Emperor sought to solve the empire's fiscal problems by tightening bureaucratic control over an overstretched system of treasury finance. However, Jiaqing's policy of austerity and retrenchment was not simply an expedient in times of fiscal strain, but deeply rooted in ideological struggles over taxation that began in the eighteenth century. It was an expression of hardline fiscal conservatism, which held fixed revenue quotas sacrosanct and which I call quota-ism. This policy had dire consequences for the ability of the Qing regime to respond to external shocks and to fulfill its sovereign tasks – war, river conservancy and famine relief. It contributed to the bankruptcy of Qing government finance by the time of the Opium War.
The aim of the present study was to describe the clinical course, laboratory tests, and the cardiac involvement in rheumatic carditis patients in functional class III and IV, submitted to pulse therapy combined with oral prednisone.
A total of 120 patients with severe carditis due to acute rheumatic fever were treatment with three cycles of pulse therapy combined with oral corticosteroids. The patients were followed up from the hospital admission until the end of the treatment and returned after 30, 60, and 90 days to control. The patients were evaluated by clinical, laboratory, and transthoracic echocardiogram.
In total, 23 (19.2%) patients at first attack of rheumatic fever and 97 (80.8%) with recurrent carditis were evaluated. Cardiac surgery was performed in 8 (6.6%) patients. The patients showed improved laboratory and radiological parameters (p<0.001) and were discharged, 74 (61.7%) in functional class I and 46 (38.3%) in functional class II. Hospitalisation time ranged from 21 to 176 days, with a mean of 69.1 days. Reduction of left atrium and ventricle diameters was observed, measured by means of transthoracic echocardiography, at hospital admission and discharge (p<0.001). None of the patients experienced rebound.
The pulse therapy was effective in controlling severe rheumatic carditis and the oral corticosteroid prevented rebound episodes. Prolonged hospital stay was required for the clinical stabilisation of patients and to avoid the interruption of medication.
Division VI of the International Astronomical Union deals with Interstellar Matter, and incorporates Commission 34. It gathers astronomers studying the diffuse matter in space between the stars, ranging from primordial intergalactic clouds via dust and neutral and ionised gas in galaxies to the densest molecular clouds and the processes by which stars are formed. There are approximately 730 members. The working groups in Planetary Nebulae and Cosmochemistry have served us well in organising periodic seminars in these subject areas. However, the Organising Committee has recognised that other developing areas of the ISM are not properly represented in the current organisation. In January 1997, the Division formed a new ISM working group on Star Forming Regions including cross-divisional representation to monitor progress in their fields and to help develop proposals for future IAU Symposia or Colloquia. In the future, especially in view of the rapid developments in spaceborne X-ray and IR astronomy, Division VI also hopes to form other working groups on the Hot ISM and the Extragalactic ISM.
Human activities have increasingly affected biodiversity in the Mediterranean Sea. Data on the distribution and abundance of species allows researchers to assess the possible degradation of wild populations. These data could act as a baseline to assess the magnitude of the effects of human activities on a bioindicator species. The distribution and relative abundance of the south-western populations of the endemic Astroides calycularis in the South Iberian Peninsula were studied to establish a baseline for future studies. The rocky shoreline was studied at a depth range of 0–12 m, including more than 650 km of Spain's Andalusian coastline. The species was present in 135 of the 585 dive points sampled. ANOVA analysis showed differences in depth in the four provinces studied, and there was no interaction between the two factors. As human activities on the Mediterranean coast are reducing the A. calycularis populations, a baseline on marine populations is greatly recommended for monitoring, assessment, and management studies, especially for endangered or bioindicator species. This baseline could be useful as a reference tool to assess the effects of human activities on marine biodiversity, including global change.
Olive oil is considered to be one of the most healthy dietary fats. However, several types of olive oils are present in the market. A key question for the consumer is: What of the olive oils is the best when concerning nutritional purposes? With the data available at present, the answer is: the Virgin Olive Oil (VOO), rich in phenolic compounds. On November 2011, the European Food Safety Authority released a claim concerning the benefits of daily ingestion of olive oil rich in phenolic compounds, such as VOO. In this review, we summarised the key work that has provided the evidence of the benefits of VOO consumption on other types of edible oils, even olive oils. We focused on data from randomised, controlled human studies, which are capable of providing the evidence of Level I that is required for performing nutritional recommendations at population level.
This work deals with the effect of the concentration of microsphere of silicon oxide (MS) in SBS-modified asphalt.
A series of blends having 2, 4, 6, 8 and 10 % w/w of MS were prepared from a SBS-modified asphalt having 3 % weight/weight of SBS and known amount of MS. Samples were characterized by fluorescence microscopy, to get an idea of the polymer distribution in the blend; and by conventional tests such as penetration, soft point, density and viscosity, to investigate on the thermo-mechanical resistance of such a blends. It was observed that an increase in the MS resulted in a decreased of the soft point and density, an increased the viscosity, and did no affect the penetration of the sample. Therefore, it was concluded that SBS-MS-modified asphalt is an interesting material for producing polymer-modified asphalt layers.
In this study, a general kinematic control law for automatic multi-configuration of four-wheel active drive/steer robots is proposed. This work presents models of four-wheel drive and steer (4WD4S) robotic systems with all-wheel active drive and steer simultaneously. This kinematic model comprises 12 degrees of freedom (DOFs) in a special design of a mechanical structure for each wheel. The control variables are wheel yaw, wheel roll, and suspension pitch by active/passive damper systems. The pitch angle implies that a wheel's contact point translates its position over time collinear with the robot's lateral sides. The formulation proposed involves the inference of the virtual z-turn axis (robot's body rotation axis) to be used in the control of the robot's posture by at least two acceleration measurements local to the robot's body. The z-turn axis is deduced through a set of linear equations in which the number of equations is equal to the number of acceleration measurements. This research provides two main models for stability conditions. Finally, the results are sustained by different numerical simulations that validate the system with different locomotion configurations.
Aelurostrongylus abstrusus (Strongylida, Angiostrongylidae) and Troglostrongylus brevior (Strongylida, Crenosomatidae) are regarded as important lungworm species of domestic felids, with the latter considered an emerging threat in the Mediterranean region. The present study aimed to assess their concurrent development in the mollusc Helix aspersa (Pulmonata, Helicidae). Thirty snails were infested with 100 first-stage larvae (L1) of A. abstrusus and T. brevior, isolated from a naturally infested kitten. Larval development was checked by digesting five specimens at 2, 6 and 11 days post infestation. Larvae retrieved were morphologically described and their identification was confirmed by specific PCR and sequencing. All H. aspersa snails were positive for A. abstrusus and T. brevior, whose larval stages were simultaneously detected at each time point. In addition, snails were exposed to outdoor conditions and examined after overwintering, testing positive up to 120 days post infestation. Data herein presented suggest that A. abstrusus and T. brevior develop in H. aspersa snails and may eventually co-infest cats. Data on the morphology of both parasitic species in H. aspersa provide additional information on their development and identification, to better understand the population dynamics of these lungworms in receptive snails and paratenic hosts.