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An invaluable reference for graduate students and academic researchers, this book introduces the basic terminology, methods and theory of the physics of flow in porous media. Geometric concepts, such as percolation and fractals, are explained and simple simulations are created, providing readers with both the knowledge and the analytical tools to deal with real experiments. It covers the basic hydrodynamics of porous media and how complexity emerges from it, as well as establishing key connections between hydrodynamics and statistical physics. Covering current concepts and their uses, this book is of interest to applied physicists and computational/theoretical Earth scientists and engineers seeking a rigorous theoretical treatment of this topic. Physics of Flow in Porous Media fills a gap in the literature by providing a physics-based approach to a field that is mostly dominated by engineering approaches.
A Concise History of Albania charts the history of Albania and its people, within their Balkan and European contexts. It shows the country's journey from its ancient past, still shrouded in mystery and controversy, through its difficult transition from a particularly brutal form of communism to an evolving form of democracy and a market economy. Bernd Fischer and Oliver Schmitt challenge some of the traditional narratives concerning the origins of the Albanians, and the relations between Albanians and their Balkan neighbours. This authoritative and up-to-date single-volume history analyses the political, social, economic, and cultural developments which led to the creation of the Albanian state and the modern nation, as well as Albania's more recent experience with authoritarianism, war, and communism. It greatly contributes to our understanding of the challenges facing contemporary Albanians, as well as the issues confronting the region as a whole as it attempts to grapple with one of the last remaining significant ethnic issues in the Balkans.
Political scientists have increasingly deployed conjoint survey experiments to understand multidimensional choices in various settings. In this paper, we show that the average marginal component effect (AMCE) constitutes an aggregation of individual-level preferences that is meaningful both theoretically and empirically. First, extending previous results to allow for arbitrary randomization distributions, we show how the AMCE represents a summary of voters’ multidimensional preferences that combines directionality and intensity according to a probabilistic generalization of the Borda rule. We demonstrate why incorporating both the directionality and intensity of multi-attribute preferences is essential for analyzing real-world elections, in which ceteris paribus comparisons almost never occur. Second, and in further empirical support of this point, we show how this aggregation translates directly into a primary quantity of interest to election scholars: the effect of a change in an attribute on a candidate’s or party’s expected vote share. These properties hold irrespective of the heterogeneity, strength, or interactivity of voters’ preferences and regardless of how votes are aggregated into seats. Finally, we propose, formalize, and evaluate the feasibility of using conjoint data to estimate alternative quantities of interest to electoral studies, including the effect of an attribute on the probability of winning.
While deep brain stimulation (DBS) for movement disorders is now considered an evidence-based pillar in the management of medication refractory Parkinson’s disease (PD), essential tremor (ET), and dystonia, some healthcare providers remain hesitant to embrace the management of DBS patients because DBS programming is perceived as complicated, time-consuming, and highly technical. Adding to this “intimidation factor” is that in recent years two new manufacturers, Abbott and Boston Scientific, joined pioneer Medtronic in the (US) DBS market in 2016 and 2019, respectively. At first glance, having three different DBS platforms does not seem to simplify matters.
This report describes a cluster of patients infected by Serratia marcescens in a metropolitan neonatal intensive care unit (NICU) and a package of infection control interventions that enabled rapid, effective termination of the outbreak.
Design:
Cross-sectional analytical study using whole-genome sequencing (WGS) for phylogenetic cluster analysis and identification of virulence and resistance genes.
Setting:
NICU in a metropolitan tertiary-care hospital in Sydney, Australia.
Patients:
All neonates admitted to the level 2 and level 3 neonatal unit.
Interventions:
Active inpatient and environmental screening for Serratia marcescens isolates with WGS analysis for identification of resistance genes as well as cluster relatedness between isolates. Planning and implementation of a targeted, multifaceted infection control intervention.
Results:
The cluster of 10 neonates colonized or infected with Serratia marcescens was identified in a metropolitan NICU. Two initial cases involved devastating intracranial infections with brain abscesses, highlighting the virulence of this organism. A targeted and comprehensive infection control intervention guided by WGS findings enabled termination of this outbreak within 15 days of onset. WGS examination demonstrated phylogenetic linkage across the cluster, and genomic unrelatedness of later strains identified in the neonatal unit and elsewhere.
Conclusions:
A comprehensive, multipronged, infection control package incorporating close stakeholder engagement, frequent microbiological patient screening, environmental screening, enhanced cleaning, optimization of hand hygiene and healthcare worker education was paramount to the prompt control of Serratia marcescens transmission in this neonatal outbreak. WGS was instrumental in establishing relatedness between isolates and identification of possible transmission pathways in an outbreak setting.
It has been suggested that psychosocial factors are related to survival time of inpatients with cancer. However, there are not many studies examining the relationship between spiritual well-being (SWB) and survival time among countries. This study investigated the relationship between SWB and survival time among three East Asian countries.
Methods
This international multicenter cohort study is a secondary analysis involving newly admitted inpatients with advanced cancer in palliative care units in Japan, South Korea, and Taiwan. SWB was measured using the Integrated Palliative Outcome Scale (IPOS) at admission. We performed multivariate analysis using the Cox proportional hazards model to identify independent prognostic factors.
Results
A total of 2,638 patients treated at 37 palliative care units from January 2017 to September 2018 were analyzed. The median survival time was 18.0 days (95% confidence interval [CI] 16.5–19.5) in Japan, 23.0 days (95% CI 19.9–26.1) in Korea, and 15.0 days (95% CI 13.0–17.0) in Taiwan. SWB was a significant factor correlated with survival in Taiwan (hazard ratio [HR] 1.27; 95% CI 1.01–1.59; p = 0.04), while it was insignificant in Japan (HR 1.10; 95% CI 1.00–1.22; p = 0.06), and Korea (HR 1.02; 95% CI 0.77–1.35; p = 0.89).
Significance of results
SWB on admission was associated with survival in patients with advanced cancer in Taiwan but not Japan or Korea. The findings suggest the possibility of a positive relationship between spiritual care and survival time in patients with far advanced cancer.
Paediatric chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) effects 0.5–3.28% of children. NICE guidance recommends Activity Management, Graded Exercise Therapy or Cognitive Behavioural Therapy for fatigue (CBT-f). Approximately 15% of patients do not achieve full recovery within one year with current treatments. Acceptance and Commitment Therapy (ACT) is an effective treatment in many chronic illnesses. There are no studies investigating ACT for paediatric CFS/ME. This feasability study aimed to assess if ACT is a feasible and acceptable alternative treatment when current treatment has not led to recovery.
Methods
This feasability cohort study aimed to enrol a minimum of 12 participants aged 11–18 yearswith CFS/ME attending the Royal United Hospitals Bath NHS Foundation Trust Specialist Paediatric CFS/ME Service, who were still symptomatic after 12 months or 12 sessions of standard treatment and were offered six to 12 sessions of ACT. Retention and recruitment data were analysed. Participants were asked to complete questionnaires before, during and after treatment. A selection of participants and their parents were interviewed about their experience of the study. Interviews were analysed using thematic analysis.
Results
19 participants (95% of those approached) were recruited. Only 4 participants of this hard-to-reach group did not complete treatment.
In almost all sessions participants reported that they felt ‘totally’ listened to in post session questionnaires (31/33 sessions).
Preliminary interviews (n = 12) indicate acceptability of ACT, with all young people and their parents stating that they thought ACT should be offered to this population. Participants particularly commented that the absence of thought challenging (used in CBT-f) was a positive element of ACT. Participant's openness to try new approaches and altruistic desire to be in a study was noted.
Conclusion
Recruitment data indicate that it is feasible to recruit and retain 11–18-year-olds with CFS/ME to a study offering ACT. Interviews with participants and parents were broadly positive suggesting ACT is an acceptable treatment in this population.
Results indicated that it is both feasible and acceptable to offer ACT to 11–18-year-olds with CFS/ME using this protocol, supporting the prospect of an RCT in this area.
We present outcomes of a newly developed Community Rehabilitation team (MhIST) using the context of Jen's personal story. Jen is a 31-year-old student and freelance journalist. This story encompasses her journey from inpatient rehabilitation services to the community, completed with support from MhIST.
Methods
“For nearly four years, I was sectioned under the Mental Health Act as an inpatient in hospital. As I had been denied my fundamental liberties for so long, the prospect of leaving hospital for good and enjoying total freedom was both exhilarating and terrifying. How would I fare in the community, living on my own? Would I be lonely? Would I relapse? Would I survive?”
Upon leaving hospital, I immediately received intensive support from MhIST. They were the bridge between the gulf that was hospital and the community. Since leaving hospital, I have been relishing my freedom. I enjoy meeting up with my friends after so long apart. I have volunteered at The Storyhouse, a local arts venue. The Spider Project – a non-clinical community mental health service in Chester - has also provided me with fulfilling activities from yoga to creative writing. The MHIST team have not only kept me well but, most importantly, helped me thrive. Leaving hospital has been an adventure. It has been a joy to regain my independence and freedom. To live rather than to exist. Life is amazing. Long may it continue.”
Results
MhIST provides an intensive rehabilitation and recovery service, delivering bespoke packages of care to individuals. This is achieved using key working and a shared team approach, outcome focused goal-based interventions, weekly reflective/formulation meetings, and a focus on social rehabilitation. Patients referred to MhIST will have a high level of complexity plus severe, treatment refractory symptoms, with impaired social, interpersonal and occupational function and high support needs. They may have co-occurring mental health conditions including substance misuse or neurodevelopmental disorders.
MhIST is a new service and has been active for around 6 months. The first 10 patients referred have been from acute wards (3), community mental health teams (1), and inpatient rehabilitation wards (6). 60% of patients are currently housed in independent accommodation.
Conclusion
Jen's story narrates the experience she encountered during transition from inpatient rehabilitation services to the community. This was completed with support from MhIST, a new community rehabilitation service which provides an intensive rehabilitation and recovery service.
The purpose of this study aims to explore the relationships between business portfolio reconfiguration and firm performance in developing countries as well as the moderating roles played by organizational slack, capabilities and ownership structure. By using the perspectives of dynamic capabilities, resources-based view and social network, this study proposes that there is a U-shaped relationship between business portfolio reconfiguration and firm performance. Furthermore, while R&D capability, marketing capability and foreign ownership are expected to positively moderate this U-shaped relationship, organizational slack, state and domestic ownership may potentially make this U-shaped relationship less pronounced. We draw our observations from Shanghai and Shenzhen Stock Exchanges in China from 2008 to 2017, and obtain 26,151 firm-year observations, which are consisted of 3,508 publicly traded companies. The results generally support our hypotheses, and some theoretical and practical implications are extracted from this study.
Worldwide, there are limited data on the prevalence of postpartum anaemia and iron status. The aims of the present study were to assess the prevalence of anaemia and iron deficiency (ID) by three iron indicators 14 weeks postpartum, their relations to haemoglobin (Hb) and associations with ethnicity and clinical factors in a multi-ethnic population. We conducted a population-based cohort study of 573 women followed from early pregnancy. The prevalence of postpartum anaemia (Hb <12·0 g/dl) was 25 %. ID prevalence varied from 39 % by serum ferritin (SF <15 μg/l), to 19 % by soluble transferrin receptor (sTfR >4·4 mg/l) and 22 % by total body iron (TBI < 0 mg/kg). The mean Hb concentration was 12·8 g/dl in women with no ID, 12·6 g/dl in those with ID by SF only and 11·6 g/dl in those with ID by SF, sTfR and TBI. ID by sTfR and TBI defined by the current threshold values probably identified a more severe iron-deficient population compared with ID assessed by SF. Compared with Western Europeans, the prevalence of anaemia was at least the double in ethnic minorities (26–40 % v. 14 %; P < 0·01–0·05), and the prevalence of ID by sTfR and TBI, but not of ID by SF < 15 μg/l, was significantly higher in some minority groups. After adjustment for covariates, only South Asians had lower Hb and higher sTfR concentration. Insufficient iron intake, gestational anaemia or ID, and postpartum haemorrhage were associated with lower postpartum Hb concentration and poorer iron status.
The Health Service Executive National Clinical Programme for Eating Disorders (NCPED) launched a Model of Care for Eating Disorder Services in Ireland in 2018. Currently, one adult and two child and adolescent eating disorder services are operational out of a total of sixteen recommended. The three objectives of this paper are to describe the early (1) referral pattern, (2) level of service activity and (3) the level of service user satisfaction.
Method:
Monthly submitted service activity data from each service to the NCPED between March 2018 and October 2020 were retrospectively analysed. One hundred and fifty-nine carers and service users completed an experience of service questionnaire (ESQ). A descriptive analysis of referral pattern, level of service activity and ESQ was performed. A thematic analysis was performed on three qualitative questions on the ESQ.
Results:
There was substantial referral numbers to eating disorder services by 18 months (n = 258). The main referral source was community mental health teams. The majority (n = 222, 86%) of referrals were offered an assessment. The most common age profile was 10–17 years of age (n = 120, 54.1%), and anorexia nervosa was the most common disorder (n = 96, 43.2%). ESQ results demonstrate that most service users were satisfied with their service, and the main themes were carer involvement, staff expertise, therapeutic alliance and service access.
Conclusions:
This preliminary service activity and service user satisfaction data highlight several issues, including trends when setting up a regional eating disorder service, potential pitfalls of pragmatic data collection and the need for adequate information-technology infrastructure.
The dating of pollen grains is emerging as the method of choice for lacustrine climate archives that contain few datable macrofossils. Due to the need for high-purity pollen concentrates, new methods are constantly being developed to precisely separate pollen grains. Flow cytometry represents a promising alternative to conventional approaches, enabling the identification of pollen grains through fluorescence and rapid separation for radiocarbon analysis using accelerator mass spectrometry, which has so far been limited to sediments with a high proportion of conifer pollen. We present a revised method for processing large sediment samples, resulting in high-purity pollen and spore concentrates. Using this approach small- to medium-sized pollen and bryophyte spores were isolated from Lake Van sediment samples (Eastern Anatolia, Turkey) in sufficient purity for radiocarbon dating. However, a systematic age discrepancy between pollen and bryophyte spore concentrates was noted. By adapting the chemical and cytometric methods, pure pollen concentrates can be created for sediments with low organic content enabling age determination of climate archives with a low proportion of large pollen or low pollen concentration.
This study investigates indicators of disorganized caregiving among caregivers of children who have a familial predisposition of schizophrenia spectrum psychosis (SZ) or bipolar disorder (BP), and whether indicators of disorganized caregiving are associated with the caregivers’ and children’s level of functioning as well as the children’s internalizing and externalizing behavior problems. Indicators of disorganized caregiving were assessed with the Caregiving Helplessness Questionnaire (CHQ). Level of functioning was evaluated using the Children’s Global Assessment Scale and the Personal and Social Performance Scale, while dimensional psychopathology were measured with the Child Behavior Checklist. 185 caregivers belonging to a SZ combined group (i.e., SZ-I + SZ co-caregiver), 110 caregivers to a BP combined group (i.e., BP-I + BP co-caregiver), and 184 caregivers to a population-based control group provided data on CHQ. Having a history of SZ or BP or being a co-caregiver to a parent with SZ or BP was associated with higher levels of experiences of helplessness and fear. Higher scores on helplessness were associated with lower level of functioning among caregivers and children and with children having externalizing/internalizing behavior problems. These results emphasize the need for interventions addressing indicators of disorganized caregiving in families with SZ or BP.
Processual models of the early state envisioned hierarchical societies with stable social and political structures. More recent research, however, has questioned this vision. Here, the authors explore Middle Horizon (AD 700–1000) Wari state iconography to provide an example of early state social and political organisation from the Central Andes. Social network analysis (SNA) of human figures (‘agents’) depicted in Wari art identifies links between individual agents, as visualised on objects and between the objects’ findspots. The results suggest that the Wari state was more heterarchical than previously imagined. Similar applications of SNA could be used to explore the iconographic evidence of other early, pre-literate states around the world.
This chapter on the Re-constructing the construction of Laval: Studying EU law as a social interpretive process focuses on one of the most controversial ECJ rulings in recent decades. Trying to understand how this particular ruling became so controversial, this chapter presents an analytical approach that views the construction of EU law as an interpretive process, which concerns not only the meaning of a specific ruling, but also its importance in terms of setting crucial precedence and in terms of having impact on European society. The chapter argues that to understand how Laval became so important, we must study the case as a protracted process of social, legal and political construction, in which a diverse set of actors – such as lawyers, legal scholars, politicians and trade unionist – all contributed to enchanting the case’s significance both before and after the ruling itself. Tracing this interpretive process, the chapter shows how the political context (of EU enlargement and Services Directive) and the legal context (of other somewhat related rulings) were knitted together to make Laval a symbolic stake in a struggle regarding the future of the European Union. Doing so, the chapter illustrates how a methodological approach which centers less on the ruling itself, but more on its social and political construction, can shed new light on how EU law is created. At the same time, the chapter takes the study of the Laval case as an opportunity to discuss the underlying principles of this processual approach, the challenges of its practical implementation and its limitations.
This paper presents the first sociophonetic study of Sanapaná (Enlhet-Enenlhet), spoken by around one thousand people in Paraguay. It examines the effects of L2 (Spanish/Guaraní) fluency and loss of L1 exposure on vowel quality and within-category variability of /e, o/ productions in the Sanapaná /e, a, o/ system. Data from eleven native Sanapaná speakers suggest that age and multilingualism may have little explanatory power by themselves. Speakers living in a majority-L2 environment show greater within-category variability and increased convergence of /e, o/ toward the L2 high vowels /i, u/ than daily users of Sanapaná. This suggests that decreased L1 exposure is the main factor driving language shift-related change in Sanapaná. I explain these findings in an exemplar-theoretic framework. Although the number of speakers sampled is limited, these data provide a valuable addition to our knowledge of sociolinguistic variation in small, underrepresented communities.
Taiwan launched its Stewardship Code in 2016 and modified it in 2020. Although patterned after the UK model, it differs in many aspects. Taiwan adopts the voluntary opt-in model. After becoming signatories of the Code, institutional investors are expected to perform stewardship duties according to its Principles and Guidelines. Taiwan has a ‘comply or explain’ policy and no sanctions for non-compliance. Would an institutional investor act as a good steward of investee companies while pursuing the overall interests of various fund provider types, i.e., shareholders, clients and beneficiaries? An inherent difficulty is how overall interests can properly be ensured while making investment decisions and performing stewardship duties. Another major issue is whether there are monitoring mechanisms to ensure that the Code can produce the expected effects. The author suggests that the Code will identify its objectives first. A system for evaluating the performance and disclosure quality of institutional investors may be a good way of ensuring that the Code produces optimal value. The Taiwan Securities and Futures Investors Protection Center acts as an alternative form of good stewardship.