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.
No established risk prediction tool exists in United Kingdom and Irish Paediatric Cardiology practice for patients undergoing cardiac catheterisation. The Catheterisation RISk score for Paediatrics is used primarily in North American practice to assess risk prior to cardiac catheterisation. Validating the utility and transferability of such a tool in practice provides the opportunity to employ an already established risk assessment tool in everyday practice.
To ascertain whether the Catheterisation RISk score for Paediatrics assessment tool can accurately predict complications within United Kingdom and Irish congenital catheterisation practice.
Clinical and procedural data including National Institute for Cardiovascular Outcomes Research derived outcome data from 1500 patients across five large congenital cardiology centres in the United Kingdom and Ireland were retrospectively collected. Catheterisation RISk score for Paediatrics were then calculated for each case and compared with the observed procedural outcomes. Chi-square analysis was used to determine the relationship between observed and predicted events.
Ninety-eight (6.6%) patients in this study experienced a significant complication as qualified by National Institute for Cardiovascular Outcomes Research classification. 4% experienced a moderate complication, 2.3% experienced a major complication and 0.3% experienced a catastrophic complication resulting in death. Calculated Catheterisation RISk score for Paediatrics scores correlated well with all observed adverse events for paediatric patients across all CRISP categories. The association was also transferable to adult congenital heart disease patients in lower Catheterisation RISk score for Paediatrics categories (CRISP 1–3).
The Catheterisation RISk score for Paediatrics score accurately predicts significant complications in congenital catheterisation practice in the United Kingdom and Ireland. Our data validated the Catheterisation RISk score for Paediatrics assessment tool in five congenital centres using National Institute for Cardiovascular Outcomes Research-derived outcome data.
An individual’s network ties are crucial to their well-being and life outcomes, and an emerging literature connects these network effects to the persistence or mitigation of group-based inequality. At the same time, we know very little about how the contexts in which relationships are formed shape individual-level and group-level networks. This leaves our understanding of network-based mechanisms of inequality separate from the contexts in which relationships are formed and operate. This chapter sets forth a model that combines context, ego and global network structure, and inequality arising from network effects into one causal chain. We review evidence on how different characteristics of context – population size and composition, number and kinds of social foci, and organizational practices – contribute to the structure of social networks. We then review research demonstrating how those network features, as well as the overall structure of relationships, contribute to distributions of outcomes in the population. The chapter concludes with applications of the model using examples from student behavior in schools and from evidence about migration. We suggest that network scholars and scholars of inequality build this more expansive perspective into their work in order to better understand mechanisms of inequality.
To determine the impact of a healthy food and drink policy on hospital staff and visitors’ food purchasing behaviours, and their awareness and support for the changes introduced.
Two repeated cross-sectional surveys, consisting of intercept interviews and observations of food items purchased, were conducted before (March–July 2018) and after (April–June 2019) the target date for implementation of thirteen food and drink practices (31 December 2018). Food purchases were coded as ‘Everyday’ (healthy) or ‘Occasional’ (unhealthy).
Ten randomly selected New South Wales public hospitals, collection sites including hospital entrances and thirteen hospital cafés/cafeterias.
Surveys were completed by 4808 hospital staff and visitors (response rate 85 %). The majority were female (63 %), spoke English at home (85 %) and just over half had completed tertiary education (55 %).
Significant increases from before to after the implementation target date were found for policy awareness (23 to 42 %; P < 0·0001) and support (89 to 92 %; P = 0·01). The proportion of ‘Everyday’ food purchases increased, but not significantly (56 to 59 %; P = 0·22); with significant heterogeneity between outlets (P = 0·0008). Overall, younger, non-tertiary-educated adults, visitors and those that spoke English at home were significantly less likely to purchase ‘Everyday’ food items. Support was also significantly lower in males.
The findings provide evidence of strong policy support, an increasing awareness of related changes and a trend towards increased ‘Everyday’ food purchasing. Given the relatively early phase of policy implementation, and the complexity of individual food purchasing decisions, longer-term follow-up of purchasing behaviour is recommended following ongoing implementation efforts.
Conflict across African states has often been linked to ethnic-based biases in government, and exclusive policies. However, the domestic politics of developing states, and the elites who contest for power therein, have often been overlooked when explaining the patterns and risk of disorder and violence. We consider how African leaders practice politics in whom to represent, and at what level. These choices have consequences as how regimes accommodate political elites creates different competitive conditions which, in turn, create incentives and opportunities for political violence. Using a dataset on cabinet appointments over twenty years, we find that high levels of elite political inclusion and mal-apportionment in positions is consistently associated with increases in non-state violence. Power distribution levels among those groups included in senior positions account for more political violence than that which stems from exclusive politics.
The franciscana dolphin (Pontoporia blainvillei) is a coastal dolphin endemic to the western South Atlantic Ocean. The dolphin is listed as vulnerable in the IUCN Red List, with incidental catches in gillnet fisheries the greatest conservation concern for this species. Insights into the feeding habits of this dolphin are essential to understand its distribution, movements and use of habitat, which are fundamental for effective management of the species. The feeding habits of franciscana dolphins were investigated from analyses of stomach contents of animals incidentally caught by two fishing operations from southern and northern regions of the southern Brazilian coast. In this study we investigate the existence of intrapopulation (sexual maturity and sex-related) variation in the diet of the franciscana dolphin, evaluating the spatial (northern and southern geographic areas) and seasonal influences. The analyses were based on Linear and Generalized Linear Models (LM and GLM). The majority of identified prey species were bottom-dwelling teleosts and the squid Doryteuthis sanpaulensis. The most important prey differed spatially and seasonally between northern and southern regions of the study area, and our results revealed significant differences between sexes and sexual maturity stages, mainly related to prey species sizes. This variation might indicate differences in prey selection, availability or habitat use patterns among these groups. In any case, these dietary differences are likely to minimize intraspecific competition for food resources, and/or indicate spatio-temporal variation in prey availability.
The present study aimed to determine the 3-month incidence of relapse and associated factors among children who recovered under the Optimising treatment for acute MAlnutrition (OptiMA) strategy, a MUAC-based protocol. A prospective cohort of children successfully treated for acute malnutrition was monitored between April 2017 and February 2018. Children were seen at home by community health workers (CHWs) every 2 weeks for 3 months. Relapse was defined as a child who had met OptiMA recovery criteria (MUAC ≥ 125 mm for two consecutive weeks) but subsequently had a MUAC < 125 mm at any home visit. Cumulative incidence and incidence rates per 100 child-months were estimated. Multivariable survival analysis was conducted using a shared frailty model with a random effect on health facilities to identify associated factors. Of the 640 children included, the overall 3-month cumulative incidence of relapse was 6⋅8 % (95 % CI 5⋅2, 8⋅8). Globally, the incidence rate of relapse was 2⋅5 (95 % CI 1⋅9, 3⋅3) per 100 child-months and 3⋅7 (95 % CI 1⋅9, 6⋅8) per 100 child-months among children admitted with a MUAC < 115 mm. Most (88⋅6 %) relapses were detected early when MUAC was between 120 and 124 mm. Relapse was positively associated with hospitalisation, with an adjusted hazard ratio (aHR) of 2⋅06 (95 % CI 1⋅01, 4⋅26) for children who had an inpatient stay at any point during treatment compared with children who did not. The incidence of relapse following recovery under OptiMA was relatively low in this context, but the lack of a standard relapse definition does not allow for comparison across settings Closer follow-up with caretakers whose children are admitted with MUAC < 115 mm or required hospitalisation during treatment should be considered in managing groups at high risk of relapse. Training caretakers to screen their children for relapse at home using MUAC could be more effective at detecting early relapse, and less costly, than home visits by CHWs.
Ibsen engaged with many of the dominant scientific ideas of his time, especially those in the natural sciences, such as evolution and heredity. This chapter explores such scientific contexts and shows how and why Ibsen oscillated between respecting science, medicine and technology’s role in humanity’s progress and disparaging their destructive capabilities. The discussion also points out how science underpins some of Ibsen’s revolutionary innovations in theatrical form and content: his explorations of Zola’s naturalism, his dramatization of Darwin’s ideas, his foregrounding of the family unit as the subject of drama, his depiction of the constant tension between the twin forces of heredity and environment, and his radical scenographic vision of nature and landscape.
This chapter explores what was distinctive about the French response to Ibsen. It discusses key points and examples that illustrate Ibsen’s complex relationship to France and French history, politics, and culture, and how Ibsen and French culture have subtly influenced one another for nearly 150 years. To Ibsen, France stood for revolutionary idealism. The chapter gives an overview of Ibsen’s breakthrough in France in a succession of modes, from realist to naturalist to symbolist, and discusses the theatrical and cultural contexts that shaped the translations, productions and reception of his plays. Examples of specific productions reveal there was another side to the French Ibsen, as he was often adapted to the boulevard theatres in ways that radically altered the plays, for instance by dampening their feminism.
Patient preferences in schizophrenia (SCZ), including identification of key goals and outcomes for treatment and relative importance of certain treatment goals to patients, have been assessed by several studies. However, there continues to be a lack of sufficient evidence on US patient attitudes and perceptions towards treatment goals and pharmacotherapy options in SCZ, especially taking into context long-acting injectable antipsychotics (LAIs) in this disease area. This lack of evidence is further pronounced in caregivers of individuals with SCZ. The objective of this analysis was to characterize patients with SCZ on LAIs vs patients on oral antipsychotics (OAPs) and evaluate the treatment goals of patients in each group.
This was a real-world, cross-sectional survey of US psychiatrists, patients =18 years old with a diagnosis of SCZ, and caregivers. Data was collected using the Disease Specific Programme (DSP) methodology, which has been previously published. Psychiatrists (n=120) completed detailed record forms for next 8 consecutive outpatients and 2 inpatients matching inclusion criteria, including non-interventional clinical and subjective assessments. The same patients and their caregivers, if present, were invited by their psychiatrist to voluntarily complete a separate survey.
Of 1135 patients on treatment where the physician provided survey data; 251 were on an LAI, and 884 were on an OAP. Mean (SD) time to SCZ diagnosis for those on an LAI was 10.3 (12.0) years vs 7.8 (10.5) years for those on OAPs. More patients in the LAI vs OAP group were being treated as an inpatient (27.1% vs 15.7%, respectively; p<0.0001). Patients on an LAI reported being on their current medication regimen for less time (mean 1.7 years) vs those on OAPs (mean 2.5 years) (p=0.0093). More patients on LAIs were unemployed due to disability vs those on OAPs (56.1% vs 39.5%, respectively), and less patients on LAIs were able to work part-time or full-time (21.1% or 4.1%) vs those on OAPs (23.2% or 11.4%). More patients on an LAI had a caregiver vs those on OAPs (37.3% vs 26.1%, respectively; p=0.0011). Regarding the most important treatment goals reported by patients, both groups reported similar preferences for decrease in disease symptoms (62% on LAI vs 65% on OAPs) and thinking more clearly (53% on LAI vs 46% on OAPs); however, a numerically higher proportion of LAI patients reported that the current medication helped decrease hospitalizations due to relapse vs those on OAPs (38% vs 32%, respectively).
Given the characteristics of patients participating in this real-world survey, those on LAIs exhibited qualities which indicate a higher severity of illness vs those on OAPs. Results suggest that treatment with LAIs is still mainly being provided to patients later in the disease course and/or who have adherence problems, despite a growing body of evidence of utility in younger patients earlier in the course of illness.
Otsuka Pharmaceutical Development & Commercialization, Inc. and Lundbeck LLC
Objectives for this survey are to determine similarities or differences in treatment goals reported by psychiatrists, patients with schizophrenia (SCZ) and caregivers in the US, as well as whether goals differed by patients currently on an oral antipsychotic (OAP) or long-acting injectable (LAI), and whether goals differed by age.
This was a real-world, cross-sectional survey of US psychiatrists, patients =18 years old diagnosed with SCZ, and caregivers. Data was collected using the Disease Specific Programme (DSP) methodology. Psychiatrists (n=120) completed detailed record forms for next 8 outpatients and 2 inpatients matching inclusion criteria. The same patients and their caregivers, if present, were invited by their psychiatrist to voluntarily complete a separate survey.
Responses on treatment goals were collected from psychiatrists for all patients included in the analysis (n=1161), patients (n= 542) and caregivers (n=130). Among 3 top goals, psychiatrists, patients and caregivers concurred that “decrease in disease symptoms” is most important (63%, 64%, 68% respectively). For psychiatrists and caregivers, second was “decrease in hospitalization for relapse” (41%, and 38% respectively), whereas for patients, it was “thinking clearly” (47%). Of the 3 least important goals, psychiatrists, patients and caregivers agreed with “sexual problems” (59%, 43%, 44%, respectively) and “weight gain” (38%, 44%, 38%, respectively).
When asked which goals were met by current medication, patients responded “decrease in disease symptoms” (68%) and “thinking clearly” (39%). However, caregivers responded “thinking clearly” (30%) was not met by current medication. Caregivers most important goals, “decrease in disease symptom” (70%) and “decrease in hospitalization for relapse” (41%), were met. Additional analyses of patients on OAPs and LAIs, did not show differences in goals. However, “decrease in disease symptoms” was numerically more important for patients on LAIs vs OAPs according to psychiatrists (68% vs 62%) and caregivers (77% vs 70% respectively). Caregivers responded “decrease in hospitalization for relapse” was met for 63% patients currently on an LAI and 35% OAP. No major differences in treatment goals were observed by patient age (18–35 vs 36–65 vs >65 years).
There is consensus among US psychiatrists, patients and caregivers on the most important treatment goal “decrease in disease symptoms”, regardless of patients’ current medication or age. For patients, “thinking more clearly” was second, compared with “decrease in hospitalization due to relapse”, for psychiatrists and caregivers. All agreed that least important treatment goals, related to AEs, were “weight gain” and “sexual problems”. More caregivers agreed “decrease in hospitalization for relapse” was met by patients on LAIs vs OAPs. These findings may help with discussions between psychiatrists, patients and caregivers.
Lundbeck LLC and Otsuka Pharmaceutical Development & Commercialization, Inc.
It can be argued, based upon a limited range of surviving evidence, that the land-locked centre of Buchan formed a distinctive upland zone functioning alongside and interwoven with the surrounding lower lands during the thirteenth century. The area can be characterised as less densely settled and engaged in extensive pastoral farming regimes that contrasted with contemporary arable farming of a more intensive nature on the lower-lying lands. Subsequent demographic and agricultural changes have rendered that former environment invisible and the limited documentary sources of the thirteenth century have compounded its mystery. Although a relatively remote upland area, its economy was at least as successful per capita than the rich grain lands surrounding it. Rather than representing a place of secondary importance, it may well have been instrumental in fuelling Aberdeen’s rich thirteenth-century export trade of sheep products to the Low Countries and, perhaps, shared a symbiotic relationship with the lower, arable lands.
An effective lower bound on the entropy of some explicit quadratic plane Cremona transformations is given. The motivation is that such transformations (Hénon maps, or Feistel ciphers) are used in symmetric key cryptography. Moreover, a hyperbolic plane Cremona transformation g is rigid, in the sense of , and under further explicit conditions some power of g is tight.
No co-productive narrative synthesis of system-level facilitators and barriers to personal recovery in mental illness has been undertaken.
To clarify system-level facilitators and barriers to personal recovery of people with mental illness.
Qualitative study guided by thematic analysis. Data were collected through one focus group, which involved seven service users and three professionals. This group had 11 meetings, each lasting 2 h at a local research institute, between July 2016 to January 2018.
The analysis yielded three themes: barriers inhibiting positive interaction within personal relationship networks, roots of barriers from mental health systems and the social cultural context, and possible solutions to address the roots. Barriers were acknowledged as those related to sense of safety, locus of control within oneself and reunion with self. The roots of barriers were recognised within mental health services, including system without trauma sensitivity, lack of advocacy support and limited access to psychosocial approaches. Roots from social cultural context were also found. There were no narratives relating to facilitators. A possible solution was to address the roots from systems. Social cultural change was called for that makes personalised goals most valued, with an inclusive design that overcomes stigma, to achieve an open and accepting community.
The analysis yielded system-level barriers specific to each recovery process. Roots of barriers that need transformation to facilitate personal recovery were identified within mental health services. Social interventions should be further explored to translate the suggested social cultural changes into action.
Individuals with lower limb amputation experience reduced ankle push-off work in the absence of functional muscles spanning the joint, leading to decreased walking performance. Conventional energy storage and return (ESR) prostheses partially compensate by storing mechanical energy during midstance and returning this energy during the terminal stance phase of gait. These prostheses can provide approximately 30% of the push-off work performed by a healthy ankle–foot during walking. Novel prostheses that return more normative levels of mechanical energy may improve walking performance. In this work, we designed a Decoupled ESR (DESR) prosthesis which stores energy usually dissipated at heel-strike and loading response, and returns this energy during terminal stance, thus increasing the mechanical push-off work done by the prosthesis. This decoupling is achieved by switching between two different cam profiles that produce distinct, nonlinear torque–angle mechanics. The cams automatically interchange at key points in the gait cycle via a custom magnetic switching system. Benchtop characterization demonstrated the successful decoupling of energy storage and return. The DESR mechanism was able to capture energy at heel-strike and loading response, and return it later in the gait cycle, but this recycling was not sufficient to overcome mechanical losses. In addition to its potential for recycling energy, the DESR mechanism also enables unique mechanical customizability, such as dorsiflexion during swing phase for toe clearance, or increasing the rate of energy release at push-off.
An audience follows a park ranger into the woods looking for wolves … A young Danish prince contemplates a skull in a dug-up grave … A wheelchair-bound blind man spars verbally with the carer who is about to leave him … A woman with a deformed spine is murdered by a fanatical doctor who wants to dissect her corpse … A bald, cancer-ridden woman recites the poetry of Donne as she lies dying … Two pairs of couples in Regency dress dance a waltz as the lights gradually fade …
Theatre has engaged with science since its beginnings in Ancient Greece. The intersection of the two disciplines has been the focus of increasing interest to scholars and students. The Cambridge Companion to Theatre and Science gives readers a sense of this dynamic field, using detailed analyses of plays and performances covering a wide range of areas including climate change and the environment, technology, animal studies, disease and contagion, mental health, and performance and cognition. Identifying historical tendencies that have dominated theatre's relationship with science, the volume traces many periods of theatre history across a wide geographical range. It follows a simple and clear structure of pairs and triads of chapters that cluster around a given theme so that readers get a clear sense of the current debates and perspectives.