We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save 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 saving content to .
To save content items to your Kindle, first ensure coreplatform@cambridge.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 saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved 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.
How do borderland dwellers living along militarised frontiers negotiate regimes of state security and their geopolitical location in everyday life? What might 'freedom' mean to those who do not resist captivity engendered by borders? Focusing on the predicaments of a double-minority, Freedom in Captivity examines the affective attachments, political imaginaries, and ethical claims-making among the Shia Muslims of Kargil. In contrast to calls for freedom in the Kashmir Valley, Shias on the frontiers of Kashmir have sought belonging to India. Yet they do not entirely succumb to its hegemonic ideological boundaries. Departing from the dominant focus on physical cross-border mobility, this book is an invitation to reimagine borderlands as cartographies of ideas, cutting across spatial scales. Based on original ethnographic research conducted between 2008 and 2021, this monograph offers a unique long durée insight into the lives of people residing at the intersections of the biggest states in Asia.
This Element looks at the relationship between heritage and design by way of a case study approach. It offers up ten distinct portraits of a range of heritage makers located in Goa, a place that has been predicated on its difference, both historical and cultural, from the rest of India. A former Portuguese colonial enclave (1510–1961) surrounded by what was formerly British India (1776–1947), the author attempts to read Goa's heritage as a form of place-ness, a source of inspiration for further design work that taps into the Goa of the twenty-first century. The series of portraits are visual, literary, and sensorial, and take the reader on a heritage tour through a design landscape of villages, markets, speciality foods, photography festivals, tailors and clothing, architecture and decorative museums. They do so in order to explore heritage futures as increasingly dependent on innovation, design, and the role of the individual.
Accompanying the announcement of the largest-ever round of auctioning of coal blocks in India in June 2020 were stories of resistance from a relatively nondescript region of central India: the Hasdeo Aranya forests. The media outlets – regional, national, and even global – were replete with news of letters from sarpanchs (Alam, 2020; Kaiser, 2020), petitions from the gram sabhas (Mishra, 2020b), reports of organized community resistance (Dasgupta, 2020; MS, 2020), and even interventions from the state government of Chhattisgarh (Drolia and John, 2020; P. Singh, 2020) and the political elites like the former Union Environment Minister Jairam Ramesh (The Wire, 2020). The community resistance of 20 villages of one of the most impoverished states of India threatened to put a spanner into the prime minister's plans of ‘Atmanirbhar Bharat’ (a self-reliant India) and dreams of becoming the world's largest exporter of coal (Gupta and Regan, 2020; PTI, 2020). The Guardian characterized Hasdeo Aranya as the ‘battleground’ where the ‘war’ for coal pitted ‘indigenous people, ancient trees, elephants and sloth bears against the might of bulldozers, trucks and hydraulic jacks’ (Ellis-Petersen, 2020).
However, descriptors such as war, battleground, and conflict are perhaps the least likely to be associated with the area based on traveller accounts. As one travels on NH130 around 300 kilometres from the state capital of Raipur, one is greeted by the relative calm and the resplendent beauty of the expansive Hasdeo-Bango reservoir (one of the longest, widest, and oldest multipurpose irrigation projects in Chhattisgarh, irrigating approximately 300,000 hectares of agricultural farms downstream) at the beginning of Hasdeo Aranya forests. For another ∼40 kilometres on the highway that skirts the Hasdeo Aranya forests’ periphery, the dense forest canopy that almost entirely blocks sunlight appears as a welcome relief to weary travellers. However, regular signboards indicating the need to be careful of ‘elephants’ and ‘sloth bears’ discourage casual tourists from stepping out to bask in the beauty of the surroundings. It is almost entirely possible to miss any signs of habitation at the first visit beyond the occasional wooden huts by the roadside, a couple of teashops, and the forest range office with its green signboards camouflaged with the surroundings.
Aging leads to progressive deterioration of physiological function and predisposes to pathological processes. Common geriatric syndromes (such as depression, dementia, falls, mobility impairment, delirium, and osteoporosis), along with age-related impairment in appetite, absorption, and food intake, affect nutrition, symptom presentation, and response to therapy of common gastrointestinal (GI) disorders in the elderly. Age-associated changes in drug metabolism and polypharmacy can result in potential interactions and side effects of drugs used in the treatment of GI diseases, which in turn complicates their management. Polypharmacy, which is common in the elderly, can also exacerbate digestive symptoms. Elderly patients with neurocognitive decline often have atypical presentation of their GI disorders. These factors can make the diagnosis of GI diseases in the elderly more challenging, as they may require different management approaches. In this chapter, we discuss the common GI disorders that affect the elderly with special focus on age-related pathophysiology and clinical implications.
Reproductive Biology of Angiosperms: Concepts and Laboratory Methods will cater to the needs of undergraduate and graduate students pursuing core and elective courses in life sciences, botany, and plant sciences. The book is designed according to the syllabi followed in major Indian universities. It provides the latest and detailed description of structures and processes involved in reproduction in higher plants. The inclusion of colour photographs and illustrations will be an effective visual aid to help readers. Interesting and significant findings of the latest research taking place in the field of reproductive biology are also provided in boxes. At the end of each chapter, the methodology of hands-on exercises is presented for the implementation and practice of theoretical concepts.
FOLD-RM is an automated inductive learning algorithm for learning default rules for mixed (numerical and categorical) data. It generates an (explainable) answer set programming (ASP) rule set for multi-category classification tasks while maintaining efficiency and scalability. The FOLD-RM algorithm is competitive in performance with the widely used, state-of-the-art algorithms such as XGBoost and multi-layer perceptrons, however, unlike these algorithms, the FOLD-RM algorithm produces an explainable model. FOLD-RM outperforms XGBoost on some datasets, particularly large ones. FOLD-RM also provides human-friendly explanations for predictions.
In the Singhbhum Craton of the Indian shield, the Remal granite-gneiss preserves felsic magmatic fabrics onto which a low-temperature segregation layering has been superposed. Planar, sub-horizontal to gently dipping layers (Sign1) comprise K-feldspar megacrysts, plagioclase and quartz, with the base of each layer defined by segregations of biotite. Sign2 consists of trough cross-bedded layers composed of K-feldspar phenocrysts, plagioclase and quartz with biotite schlieren defining the base of each layer. Microstructural features such as concentrically arranged mineral inclusions in K-feldspar phenocrysts and graphic intergrowth textures testify to the magmatic origin of these fabrics, with insignificant subsequent metamorphic reconstitution. The tectonic fabric S1 has developed sub-parallel to localized greenschist-facies mylonite bands, and is defined by weakly aligned flakes of biotite. Crystallographic preferred orientations away from the mylonitized domains show a strong alignment of K-feldspar, quartz and biotite parallel to the magmatic fabric due to efficient segregation during magmatic flow. Quartz crystallographic preferred orientations within the mylonitized domains show a strong preferred orientation and dextral asymmetry. Temperature constraints from synkinematic chlorites along with estimates of deformation temperature from quartz crystallographic preferred orientations indicate that mylonitization occurred at the lower limits of quartz crystal plasticity. The results of combined thermodynamic and multiphysics modelling studies show that felsic magmas can undergo significant convective motion for a wide range of crystallinities and water contents before solidification. Additionally, segregation layering resembling a gneissosity can develop at low temperatures owing to localized mylonitization and concomitant dissolution–precipitation of biotite.
Clinical observations and subjective judgements have traditionally been used to evaluate patients with muscular and neurological disorders. As a result, identifying and analyzing functional improvements are difficult, especially in the absence of expertise. Quantitative assessment, which serves as the motivation for this study, is an essential prerequisite to forecast the task of the rehabilitation device in order to develop rehabilitation training. This work provides a quantitative assessment tool for muscle weakness in the human upper limbs for robotic-assisted rehabilitation. The goal is to map the assessment metrics to the recommended rehabilitation exercises. Measurable interaction forces and muscle correlation factors are the selected parameters to design a framework for muscular nerve cell condition detection and appropriate limb trajectory selection. In this work, a data collection setup is intended for extracting muscle intervention and assessment using MyoMeter, Goniometer and surface electromyography data for upper limbs. Force signals and human physiological response data are evaluated and categorized to infer the relevant progress. Based upon the most influencing muscles, curve fitting is performed. Trajectory-based data points are collected through a scaled geometric Open-Sim musculoskeletal model that fits the subject’s anthropometric data. These data are found to be most suitable to prescribe relevant exercise and to design customized robotic assistance. Case studies demonstrate the approach’s efficacy, including optimally synthesized automated configuration for the desired trajectory.
To assess the job and training satisfaction of junior doctors working in Mental Health placements in Derbyshire; to highlight areas of good practice and identify areas that need improvement to enhance their working experience.
Methods
This is an ongoing Cycle of Quality Improvement to address Juniors Doctors enjoyment of work and job satisfaction. On a 25 point questionnaire we sought feedback as open response, graded response and free text. Questions were formulated using suggestions from Royal College of Psychiatrists Supported and Valued Review and BMA Fatigue and Facilities Charter. Advised areas of improvement from the previous 2017 Quality Improvement project were also reviewed and incorporated into the questionnaire design.
All junior trainees (including Core Psychiatry trainees, Foundation trainees, GP trainees and junior trust grade doctors) working between December 2020 to April 2021 in Derbyshire Healthcare NHS Foundation Trust were sent the questionnaire.
Official end of placement feedback from January-December 2020 was also compared to our findings.
Results
15 doctors completed the questionnaire.
Areas of trainee-reported satisfaction included training on management of common psychiatric conditions (73%), weekly teaching sessions (100%), ability to organise leave (100%).
Areas of dissatisfaction included training on management of psychiatric emergencies (40%), poor regularity of supervision (53%), inadequate access to phlebotomy services (66%), ability to take adequate breaks (66%) and ability to fulfil training requirements (40%).
Discrepancies were noted in responses to similar questions in our questionnaire compared to the official end of placement feedback, with greater trainees answering with negative responses in this project.
Conclusion
This project highlighted areas of high satisfaction for trainees and showed specific areas for improvement. Trainees responses have been reviewed with Educators and Trust Management for collaborative solutions, pilot schemes and future QI projects identified.
Observer bias was noted, with greater numbers of doctors answering similar questions negatively when feedback was anonymous, suggesting that they may be giving more honest answers when their identity is concealed.
To examine the relationship between self-reported level of workplace support (WS) and various mental health outcomes in HCPs and non-HCPs at different time-points during the COVID-19 pandemic, and to examine whether improved WS is associated with improved mental health outcomes over time. Lastly, to identify what support healthcare professionals (HCPs) perceive to be most helpful.
Methods
Cohort survey study at baseline (July-September 2020) and follow-up (approximately four months later).
Setting
HCPs working in primary or secondary care, from UK and other countries, and non-HCP controls from primarily London-based universities.
Participants
1574 HCPs and 147 non-HCPs (academic and research staff at London-based universities). The inclusion criteria for the study were: 1) aged 18 or older, 2) electronic consent given, and 3) identified as HCP or non-healthcare academic staff or self-declared non-HCPs.
Main outcome measures
Presence of generalized anxiety disorder (assessed using the GAD-7), clinical insomnia (ISI), major depressive disorder (PHQ-9), well-being (SWEMWBS), and burnout (emotional exhaustion and depersonalization; EEDP2Q). Qualitative data exploring what support HCPs perceive as most useful was gathered using free-text inputs.
Results
At baseline and follow-up, consistently, compared to those who felt unsupported, those who felt supported had significantly reduced risk (odds) of generalized anxiety disorder (baseline: 59% [95% CI of OR, 0.29 to 0.57], follow-up: 41% [0.38 to 0.92]), clinical insomnia (51% [0.34 to 0.69], 66% [0.20 to 0.55]), major depressive disorder (58% [0.31 to 0.58], 54% [0.31 to 0.74]), emotional exhaustion (65% [0.26 to 0.46], 61% [0.27 to 0.56]) and depersonalization (58% [0.28 to 0.61], 68% [0.21 to 0.50]).
At follow-up, self-reported improved WS (vs. baseline) was associated with significantly improved GAD-7 (adjusted difference. −1.73 [-2.54 to −0.91]), ISI (-0.96 [-1.88 to −0.04]), PHQ−9 (-1.32 [-2.16 to −0.49]), SWEMWBS (0.97 [0.37 to 1.57]) and EEDP2Q (burnout) (-1.30 [-1.82 to −0.79]) scores, independent of baseline level of support.
Five themes were identified constituting WS: ‘managerial support’ was the largest sub-theme.
Conclusion
A consistent association was observed between level of WS and the mental health of HCPs and non-HCPs. Improved WS was associated with improved mental health scores over a four-month period during the pandemic.
This Service Survey is a part of a Quality improvement project which aims to :1- To assess the extent of the problem regarding accessing Adult ADHD assessment and treatment by getting the views of clinicians.2- Evaluate negative impact on care coordinators of the delay in accessing timely and effective diagnosis and treatment of ADHD; This will: a-Increase understanding of the care needed by this patient group. b-Clarify current practice and any difficulties staff face in condition management when diagnosis not confirmed i.e. outline training needs. c-Determine if waiting time for diagnosis results in iatrogenic harm (deterioration driven by ‘unmet need’). 3-Inform the development of an alternative pathway of care; thus: a-Reduce inequality of healthcare access for those with this neurodevelopmental condition. b-Reduce stigma. c-Improve service user health and well-being. d-Support families and carers. e-Reduce social costs to individual and community. f-Support community staff and increase knowledge and effectiveness.
Methods
Methods of the service survey part:
1. Service survey: Sent to 21 consultants who are working in Adult CMHT.
2. Service Satisfaction survey for all of the Redcar & Cleveland Affective disorder team's clinical staff members (18).
Results: Consultants Service Survey
11 consultants responded out of 21 (52%)
Approximate number of the diagnosed ADHD patients / team varied between 7–80 patients.
Wait time for an ADHD assessment varied between 12 -30 months.
Number of patients/ team waiting for assessments by the specialist team 2- 27 patients.
50% of the consultants reported significant delays between referral to the services and initiation of treatment 6–36 months.
All consultants reported commencing treatment of ADHD, if a patient already had the diagnosis.
9/11 (82%) consultants reported making the initial diagnosis and treating ADHD patients in CMHTs. However, all consultant reported the need for further training in assessment and management of ADHD patients.
6/11 (55%) consultants stated that ADHD patients should be managed in CMHTs provided they are care coordinated by another clinician.
Clinical Staff Satisfaction Survey
All 3 staffs responded out of 18 staff, reported un satisfaction with the current service provision.
Conclusion
1. The current service model is not able to meet the increasing demand for the services and leading to significant delay in accessing appropriate treatment.
2. There is a need to improve competencies of community mental health teams to manage these patients.
3. This survey will be used to model a new care pathway.
1. To evaluate clinicians’ experiences of the newly implemented remote ASD assessment process (due to COVID-19), including the long-term sustainability and potential standardisation of this approach; 2. To establish areas for improvement in this process and make further recommendations.
Methods
Members of the Neurodevelopmental MDT completed an online survey, whereby feedback was collected regarding the use of the Child Observation of Social Communication (COSC), which had been adapted for online use from the standardised Autism Diagnostic Observation (ADOS) Schedule by a senior Psychologist[.Participants also responded to questions on other assessment domains, including the Developmental, Dimensional and Diagnostic interview, feedback and formulation meetings. Questions included their comfort with performing the assessment, theirs views on the quality of care provided and any difficulties they faced. Survey data were collected on two occasions: between November and December 2020 and between July and August 2021.
Results
Positive Experiences
63% of respondents in November-December 2020 reported that COSC was a good alternative whilst standardised ADOS was unavailable. This increased to 100% in July-August 2021. Quality of care delivered by COSC was rated to be the same as ADOS in 70% of participants November-December 2020; 25% felt quality of care delivered by COSC was better than ADOS in July-August 2021. 73% of participants reported they would continue to use the remote assessment in the November-December 2020 survey. This increased to 88% in July-August 2021. 33% of the clinicians were very comfortable with administering the COSC in July-August 2021, 56% were somewhat comfortable.
Negative Experiences
27% of the clinicians reported being somewhat uncomfortable with administering the COSC assessment in November-December 2020; 11% remained somewhat uncomfortable in July-August 2021. 30% of the participants rated the quality of care delivered by COSC worse than ADOS in November-December 2020. 37.5% rated this to be worse in July-August 2021. 77% of the respondents had technical or organisational difficulties, which could result in missing non-verbal cues during the assessment.
Conclusion
Clinicians’ experiences improved over time and with practice (34% had delivered over 10 COSC assessments in July-Aug 2021). A hybrid model may increase the quality of care of the approach, as well as careful selection of cases which would be suitable for an online assessment. There is scope for the continued use of the remote ASD pathway, taking into account patient and clinician preferences, however patient feedback will be necessary as a next step in this evaluation.
This QIP aims to improve communication and information sharing between the community LD team, administration team, service providers and wider stakeholders, to ensure patient safety. The primary objective is to evaluate local initiatives to improve communication between MDT professionals and wider stakeholders. The secondary objective is to improve patient safety and staff satisfaction.
Methods
The COVID-19 pandemic created unprecedented communication challenges within the workforce and highlighted areas requiring review; this included information sharing among internal and external teams, collaborative teamworking, support in absence of senior clinical leadership and transition pathways from Child and Adolescent Mental Health Services to adult LD services. The QIP was initiated in March 2021.
The discovery process included an initial consultation exploring practitioners’ experiences, areas for development and to share ideas for good practice.
We used QI methodology, following ‘plan-do-study-action’ cycles, to analyse change. Change ideas included a single point of contact for internal and external queries, regular complex case management meetings, development of a referral process and clinical review for complex cases along with teaching sessions.
Qualitative feedback from the team pre- and post-intervention, at baseline and regular follow-up intervals, in the form of monthly team meetings, emails, focus-groups and semi-structured interviews.
Results
A full thematic map was created after initial consultation; themes included communication improvement between teams and external agencies, timely support for complex case management, improving transition processes and development of robust clinical review processes.
Qualitative feedback has been collated, analysed and final recommendations to be shared with the MDT professionals
Conclusion
Preliminary results have shown improvements in communication among the MDT, stakeholders, and external agencies.
The consultation process highlighted that there is a substantial need for standardisation and consistency within communicative practices to promote enhanced care delivery and improved patient outcomes.
Prophylaxis against spontaneous bacterial peritonitis (SBP) is recommended for select patients with cirrhosis, but long-term antibiotic therapy has risks. We evaluated concordance with guideline recommendations in 179 veterans with cirrhosis; 55% received guideline-concordant management of SBP prophylaxis. Despite stable guideline recommendations since 2012, guideline adherence remains low.
A dynamically consistent scaling of mean skin friction in zero-pressure-gradient turbulent boundary layers and fully developed pipe and channel flows, is derived. Theoretical arguments are based on transfer of kinetic energy from mean flow to large eddies of turbulence. A single new velocity scale $M/\nu$ is shown to be dynamically relevant for scaling skin friction in all flows; $M$ is the planar kinematic momentum rate of the shear flow and $\nu$ is fluid kinematic viscosity. An asymptotic $-1/2$ power scaling law (in $M$–$\nu$ scaling) is shown to be universally applicable. It is observed that the semi-empirical finite-$Re$ skin friction model, resulting from the asymptotic scaling law, applies well to individual flows, but fails to describe all flows in a universal fashion. This non-universality could be due to the differences in flow boundary conditions at finite Reynolds numbers and flow geometry, that affect the outer-layer structures in these flows. It is argued that these differences may be simply absorbed by considering differences in the shapes of mean velocity profiles amongst these flows. An empirical correction to $M$–$\nu$ scaling is proposed based on Clauser's shape factor $G$. It is demonstrated that data from all flows in this new, semi-empirical $M$–$\nu$–$G$ scaling collapse remarkably well onto a single universal curve. The corresponding universal finite-$Re$ model in $M$–$\nu$–$G$ scaling is shown to describe this curve to an excellent accuracy. These results underscore the importance of a dynamically consistent approach towards revealing universality of skin friction scaling in wall turbulence.
Global biodiversity is at a heightened risk of extinction and we are losing species faster than at any other time. It is important to understand the threats that drive a species towards extinction in order to address those drivers. In this paper, we assess our knowledge of the threats faced by 24 Himalayan Galliformes species by undertaking a review of the threats reported in the published literature and the supporting evidence that the threat is having an impact on the species’ populations. Only 24 papers were deemed suitable to be included in the study. We found that biological resource use and agriculture and aquaculture are the predominant threats to the Galliformes in the Greater Himalaya but the evidence available in the studies is quite poor as only one paper quantified the impact on species. This study shows that major gaps exist in our understanding of threats to species, and it is imperative to fill those gaps if we want to prevent species from going extinct.
The burden of healthcare-associated infections (HAIs) is higher in low- and middle-income countries, but HAIs are often missed because surveillance is not conducted. Here, we describe the identification of and response to a cluster of Burkholderia cepacia complex (BCC) bloodstream infections (BSIs) associated with high mortality in a surgical ICU (SICU) that joined an HAI surveillance network.
Setting:
A 780-bed, tertiary-level, public teaching hospital in northern India.
Methods:
After detecting a cluster of BCC in the SICU, cases were identified by reviewing laboratory registers and automated identification and susceptibility testing outputs. Sociodemographic details, clinical records, and potential exposure histories were collected, and a self-appraisal of infection prevention and control (IPC) practices using assessment tools from the World Health Organization and the US Centers for Disease Control and Prevention was conducted. Training and feedback were provided to hospital staff. Environmental samples were collected from high-touch surfaces, intravenous medications, saline, and mouthwash.
Results:
Between October 2017 and October 2018, 183 BCC BSI cases were identified. Case records were available for 121 case patients. Of these 121 cases, 91 (75%) were male, the median age was 35 years, and 57 (47%) died. IPC scores were low in the areas of technical guidelines, human resources, and monitoring and evaluation. Of the 30 environmental samples, 4 grew BCC. A single source of the outbreak was not identified.
Conclusions:
Implementing standardized HAI surveillance in a low-resource setting detected an ongoing Burkholderia cepacia outbreak. The outbreak investigation and use of a multimodal approach reduced incident cases and informed changes in IPC practices.
Background: Mutations in the slow skeletal muscle troponin T (TNNT1) gene cause a congenital nemaline myopathy resulting in death from respiratory insufficiency in early infancy. We report on four French Canadians with a novel congenital TNNT1 myopathy. Methods: Patients underwent lower extremity and paraspinal MRI, quadriceps biopsy and genetic testing. TNNT1 expression in muscle was assessed by quantitative PCR and immunoblotting. Wild type or mutated TNNT1 mRNAs were co-injected with morpholinos in a zebrafish knockdown model to assess for rescue of the morphant phenotype. Results: Four patients shared a novel missense homozygous mutation in TNNT1. They developed from childhood slowly progressive limb-girdle weakness with spinal rigidity and contractures. They suffered from restrictive lung disease and recurrent episodes of rhabdomyolysis. Older patients remained ambulatory into their sixties. Lower extremity MRI showed symmetrical myopathic changes. Paraspinal MRI showed diffuse fibro-fatty involution. Biopsies showed multi-minicores. Nemaline rods were seen in half the patients. TNNT1 mRNA expression was similar in controls and patients, while levels of TNNT1 protein were reduced in patients. Wild type TNNT1 mRNA rescued the zebrafish morphants but mutant transcripts failed to do so. Conclusions: This study expands the spectrum of TNNT1-related myopathy to include a milder clinical phenotype caused by a functionally-confirmed novel mutation.