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Questions have been raised regarding differences in the standards of care that patients receive when they are admitted to or discharged from in-patient units at weekends.
To compare the quality of care received by patients with anxiety and depressive disorders who were admitted to or discharged from psychiatric hospital at weekends with those admitted or discharged during the ‘working week’.
Retrospective case-note review of 3795 admissions to in-patient psychiatric wards in England. Quality of care received by people with depressive or anxiety disorders was compared using multivariable regression analyses.
In total, 795 (20.9%) patients were admitted at weekends and 157 (4.8%) were discharged at weekends. There were minimal differences in quality of care between those admitted at weekends and those admitted during the week. Patients discharged at weekends were less likely to be given sufficient notification (48 h) in advance of being discharged (OR = 0.55, 95% CI 0.39–0.78), to have a crisis plan in place (OR = 0.65, 95% CI 0.46–0.92) or to be given medication to take home (OR = 0.45, 95% CI 0.30–0.66). They were also less likely to have been assessed using a validated outcome measure (OR = 0.70, 95% CI 0.50–0.97).
There is no evidence of a ‘weekend effect’ for patients admitted to psychiatric hospital at weekends, but the quality of care offered to those who were discharged at weekends was relatively poor, highlighting the need for improvement in this area.
Previous genetic association studies have failed to identify loci robustly associated with sepsis, and there have been no published genetic association studies or polygenic risk score analyses of patients with septic shock, despite evidence suggesting genetic factors may be involved. We systematically collected genotype and clinical outcome data in the context of a randomized controlled trial from patients with septic shock to enrich the presence of disease-associated genetic variants. We performed genomewide association studies of susceptibility and mortality in septic shock using 493 patients with septic shock and 2442 population controls, and polygenic risk score analysis to assess genetic overlap between septic shock risk/mortality with clinically relevant traits. One variant, rs9489328, located in AL589740.1 noncoding RNA, was significantly associated with septic shock (p = 1.05 × 10–10); however, it is likely a false-positive. We were unable to replicate variants previously reported to be associated (p < 1.00 × 10–6 in previous scans) with susceptibility to and mortality from sepsis. Polygenic risk scores for hematocrit and granulocyte count were negatively associated with 28-day mortality (p = 3.04 × 10–3; p = 2.29 × 10–3), and scores for C-reactive protein levels were positively associated with susceptibility to septic shock (p = 1.44 × 10–3). Results suggest that common variants of large effect do not influence septic shock susceptibility, mortality and resolution; however, genetic predispositions to clinically relevant traits are significantly associated with increased susceptibility and mortality in septic individuals.
This chapter provides an overview of the use of affect-based interventions to change behavior. Affect is defined in terms of affect proper and affect processing; both of these terms are used regularly in research on affect interventions. The evidence of direct modification of these affect constructs is then reviewed. Based on this evidence, step-by-step guides to techniques focusing on changing two key aspects of affective processing are provided: changing affective attitudes and anticipated affect. The guides to these techniques include typical means of delivery, target audience, behaviors, enabling or inhibiting factors, training and skills required, intensiveness, typical materials needed, and typical examples of implementation. In addition, application of implementation intentions, fear appeals, evaluative conditioning, and exercise games as other ways to change affect as a means to changing behavior are reviewed. Finally, two additional intervention pathways that could have impact on behavior change are reviewed: direct modification of other sources of behavioral influence (e.g., traditional social cognitive factors) in order to overcompensate for the impact of affect and self-regulation of the intensity of the affect experience as a means of inhibiting its impact.
The Colonial Revival house is an unavoidable context in cinematic and televisual representation. The ubiquity of Colonial Revival architecture – in the American landscape and in film and television – means that as a signifier it is both too empty and too full; there would appear to be too little and too much to say about this subject. The problem of Colonial Revival architecture itself is that it is an architecture of surfaces, appearances, facades, exteriors: it is a skin, the skin, we might say, of national fantasy. For not only is the term Colonial Revival in architectural history a loose, floating, perhaps even radically empty signifier (empty perhaps – as well – because overfull with too many contents), in actual architectural materiality, the term names the look of a house's exterior but indicates very little about the disposition of its interior spaces.
In a book dedicated to thinking about the house in American cinema, I have argued that when we look at houses on screen we are looking at what I call a ‘spectacle of property’. Whatever the nature or style or dimensions of the houses we see on-screen, when we look at a cinematic image of a house, we are in thrall to and enthralled by property, its images and its image-ness (Rhodes 2017). Cinema turns cinemagoers into shortterm tenants, whom I call ‘spectator tenants’ – subjects who (in the traditional context of theatrical moviegoing) ‘pay for the right to occupy a space in order to gaze up at a space they can never occupy’ (Rhodes 2017: 13 [italics in original]). This looking is structured slightly differently and receives different inflections according to the style of architecture that is being looked at. In the case of Colonial Revival architecture, an architecture of ubiquity, we seem to be looking at the omnipresent and inescapable nature of the property relation itself, a relation that houses and structures our intimate relationship to capitalism. Moreover, this architecture's emptiness, the lack of connection between its surfaces and its interiors, its malleability, plasticity, nominalism of reference and endless iteration (it is a ‘revival’ style, after all) mean that its architecture and moving images provide refracted but highly concrete embodiment of the endless fungibility of property relations in twentieth-century capitalism.
We evaluated whether a diagnostic stewardship initiative consisting of ASP preauthorization paired with education could reduce false-positive hospital-onset (HO) Clostridioides difficile infection (CDI).
Single center, quasi-experimental study.
Tertiary academic medical center in Chicago, Illinois.
Adult inpatients were included in the intervention if they were admitted between October 1, 2016, and April 30, 2018, and were eligible for C. difficile preauthorization review. Patients admitted to the stem cell transplant (SCT) unit were not included in the intervention and were therefore considered a contemporaneous noninterventional control group.
The intervention consisted of requiring prescriber attestation that diarrhea has met CDI clinical criteria, ASP preauthorization, and verbal clinician feedback. Data were compared 33 months before and 19 months after implementation. Facility-wide HO-CDI incidence rates (IR) per 10,000 patient days (PD) and standardized infection ratios (SIR) were extracted from hospital infection prevention reports.
During the entire 52 month period, the mean facility-wide HO-CDI-IR was 7.8 per 10,000 PD and the SIR was 0.9 overall. The mean ± SD HO-CDI-IR (8.5 ± 2.0 vs 6.5 ± 2.3; P < .001) and SIR (0.97 ± 0.23 vs 0.78 ± 0.26; P = .015) decreased from baseline during the intervention. Segmented regression models identified significant decreases in HO-CDI-IR (Pstep = .06; Ptrend = .008) and SIR (Pstep = .1; Ptrend = .017) trends concurrent with decreases in oral vancomycin (Pstep < .001; Ptrend < .001). HO-CDI-IR within a noninterventional control unit did not change (Pstep = .125; Ptrend = .115).
A multidisciplinary, multifaceted intervention leveraging clinician education and feedback reduced the HO-CDI-IR and the SIR in select populations. Institutions may consider interventions like ours to reduce false-positive C. difficile NAAT tests.
St Andrews was of tremendous significance in medieval Scotland. Its importance remains readily apparent in the buildings which cluster the rocky promontory jutting out into the North Sea: the towers and walls of cathedral, castle and university provide reminders of the status and wealth of the city in the Middle Ages. As a centre of earthly and spiritual government, as the place of veneration forScotland's patron saint and as an ancient seat of learning, St Andrews was the ecclesiastical capital of Scotland. This volume provides the first full study of this special and multi-faceted centre throughout its golden age. The fourteen chapters use St Andrews as a focus for the discussion of multiple aspects of medieval life in Scotland. They examine church, spirituality, urban society andlearning in a specific context from the seventh to the sixteenth century, allowing for the consideration of St Andrews alongside other great religious and political centres of medieval Europe.
Michael Brown is Professor of Medieval Scottish History, University of St Andrews; Katie Stevenson is Keeper of Scottish History and Archaeology, National Museums Scotland and Senior Lecturer in Late Medieval History, University of St Andrews.
Contributors: Michael Brown, Ian Campbell, David Ditchburn, Elizabeth Ewan, Richard Fawcett, Derek Hall, Matthew Hammond, Julian Luxford, Roger Mason, Norman Reid, Bess Rhodes, Catherine Smith, Katie Stevenson, Simon Taylor, Tom Turpie.
The optimal perioperative feeding strategies for neonates with CHD are unknown. In the present study, we describe the current feeding practices across a multi-institutional cohort.
Inclusion criteria for this study were as follows: all neonates undergoing cardiac surgery admitted to the cardiac ICU for ⩾24 hours preoperatively between October, 2013 and July, 2014 in the Pediatric Cardiac Critical Care Consortium registry.
The cohort included 251 patients from eight centres. The most common diagnoses included the following: hypoplastic left heart syndrome (17%), coarctation/aortic arch hypoplasia (18%), and transposition of the great arteries (22%); 14% of the patients were <37weeks of gestational age. The median total hospital length of stay was 21 days (interquartile range (IQR) 14–35) and overall mortality was 8%. Preoperative feeding occurred in 133 (53%) patients. The overall preoperative feeding rates across centres ranged from 29 to 79%. Postoperative feeds started on median day 2 (IQR 1–4); for patients with hypoplastic left heart syndrome postoperative feeds started on median day 4. Postoperative feeds were initiated in 89 (35%) patients before extubation (range across centres: 21–61%). The median cardiac ICU discharge feeding volume was 108 cc/kg/day, varying across centres. The mean discharge weight was 280 g above birth weight, ranging from +100 to 430 g across centres. A total of 110 (44%) patients had discharge feeding tubes, ranging from 6 to 80% across centres, and 40/110 patients had gastrostomy/enterostomy tubes placed. In addition, eight (3.2%) patients developed necrotising enterocolitis – three preoperatively and five postoperatively.
In this cohort, neonatal feeding practices and outcomes appear to vary across diagnostic groups and institutions. Only half of the patients received preoperative enteral nutrition; almost half had discharge feeding tubes. Multi-institutional collaboration is necessary to determine feeding strategies associated with best clinical outcomes.
The multicomponent Dry Creek site, located in the Nenana Valley, central Alaska, is arguably one of the most important archaeological sites in Beringia. Original work in the 1970s identified two separate cultural layers, called Components 1 and 2, thought to date to the terminal Pleistocene and suggesting that the site was visited by Upper Paleolithic huntergatherers between about 13,000 and 12,000 calendar years before present (cal B.P.). The oldest of these became the typeassemblage for the Nenana complex. Recently, some have questioned the geoarchaeological integrity of the site's early deposits, suggesting that the separated cultural layers resulted from natural postdepositional disturbances. In 2011, we revisited Dry Creek to independently assess the site's age and formation. Here we present our findings and reaffirm original interpretations of clear separation of two terminal Pleistocene cultural occupations. For the first time, we report direct radiocarbon dates on cultural features associated with both occupation zones, one dating to 13,485-13,305 and the other to 11,060-10,590 cal B.P.