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Research suggests that there have been inequalities in the impact of the coronavirus disease 2019 (COVID-19) pandemic and related non-pharmaceutical interventions on population mental health. We explored generational, sex, and socioeconomic inequalities during the first year of the pandemic using nationally representative cohorts from the UK.
Methods
We analysed data from 26772 participants from five longitudinal cohorts representing generations born between 1946 and 2000, collected in May 2020, September–October 2020, and February–March 2021 across all five cohorts. We used a multilevel growth curve modelling approach to investigate generational, sex, and socioeconomic differences in levels of anxiety and depressive symptomatology, loneliness, and life satisfaction (LS) over time.
Results
Younger generations had worse levels of mental and social wellbeing throughout the first year of the pandemic. Whereas these generational inequalities narrowed between the first and last observation periods for LS [−0.33 (95% CI −0.51 to −0.15)], they became larger for anxiety [0.22 (0.10, 0.33)]. Generational inequalities in depression and loneliness did not change between the first and last observation periods, but initial depression levels of the youngest cohort were worse than expected if the generational inequalities had not accelerated. Women and those experiencing financial difficulties had worse initial mental and social wellbeing levels than men and those financially living comfortably, respectively, and these gaps did not substantially differ between the first and last observation periods.
Conclusions
By March 2021, mental and social wellbeing inequalities persisted in the UK adult population. Pre-existing generational inequalities may have been exacerbated with the pandemic onset. Policies aimed at protecting vulnerable groups are needed.
We explore the long-term environmental and human history of a small outer coast archipelago on the Northwest Coast in western Canada. Using relative sea-level change, we reconstruct ancient landscapes to design archaeological surveys that document a rich archaeological record spanning at least 11 000 years and demonstrate the cultural centrality of this geographically marginal landscape.
BACKGROUND: IGTS is a rare phenomenon of paradoxical germ cell tumor (GCT) growth during or following treatment despite normalization of tumor markers. We sought to evaluate the frequency, clinical characteristics and outcome of IGTS in patients in 21 North-American and Australian institutions. METHODS: Patients with IGTS diagnosed from 2000-2017 were retrospectively evaluated. RESULTS: Out of 739 GCT diagnoses, IGTS was identified in 33 patients (4.5%). IGTS occurred in 9/191 (4.7%) mixed-malignant GCTs, 4/22 (18.2%) immature teratomas (ITs), 3/472 (0.6%) germinomas/germinomas with mature teratoma, and in 17 secreting non-biopsied tumours. Median age at GCT diagnosis was 10.9 years (range 1.8-19.4). Male gender (84%) and pineal location (88%) predominated. Of 27 patients with elevated markers, median serum AFP and Beta-HCG were 70 ng/mL (range 9.2-932) and 44 IU/L (range 4.2-493), respectively. IGTS occurred at a median time of 2 months (range 0.5-32) from diagnosis, during chemotherapy in 85%, radiation in 3%, and after treatment completion in 12%. Surgical resection was attempted in all, leading to gross total resection in 76%. Most patients (79%) resumed GCT chemotherapy/radiation after surgery. At a median follow-up of 5.3 years (range 0.3-12), all but 2 patients are alive (1 succumbed to progressive disease, 1 to malignant transformation of GCT). CONCLUSION: IGTS occurred in less than 5% of patients with GCT and most commonly after initiation of chemotherapy. IGTS was more common in patients with IT-only on biopsy than with mixed-malignant GCT. Surgical resection is a principal treatment modality. Survival outcomes for patients who developed IGTS are favourable.
Documented prevalence of alcohol misuse among older adult patients at Birmingham Heartlands Hospital is significantly lower than the national prevalence. We aimed to evaluate our alcohol misuse screening protocol for older adults to identify possible shortcomings. Hospital protocol is to screen all adults for alcohol misuse in the accident and emergency (A&E) department using the Fast Alcohol Screening Test (FAST). One hundred consecutive consenting in-patients aged 65–94 admitted via A&E subsequently undertook an additional alcohol screening test (Michigan Alcoholism Screening Test-Geriatric version; MAST-G). Results of the two tests were compared.
Results
FAST screening was completed for 71 patients and none were FAST-positive for alcohol misuse, yet using MAST-G, 18 patients scored positively for alcohol misuse. FAST screening failed to identify 8 patients with a documented history of alcohol misuse.
Clinical implications
Older adult alcohol misuse prevalence is significantly underreported using FAST. Screening older adults for alcohol problems requires a different approach to screening the general population.
On April 15, 2013, two improvised explosive devices (IEDs) exploded at the Boston Marathon and 264 patients were treated at 26 hospitals in the aftermath. Despite the extent of injuries sustained by victims, there was no subsequent mortality for those treated in hospitals. Leadership decisions and actions in major trauma centers were a critical factor in this response.
Methods
The objective of this investigation was to describe and characterize organizational dynamics and leadership themes immediately after the bombings by utilizing a novel structured sequential qualitative approach consisting of a focus group followed by subsequent detailed interviews and combined expert analysis.
Results
Across physician leaders representing 7 hospitals, several leadership and management themes emerged from our analysis: communications and volunteer surges, flexibility, the challenge of technology, and command versus collaboration.
Conclusions
Disasters provide a distinctive context in which to study the robustness and resilience of response systems. Therefore, in the aftermath of a large-scale crisis, every effort should be invested in forming a coalition and collecting critical lessons so they can be shared and incorporated into best practices and preparations. Novel communication strategies, flexible leadership structures, and improved information systems will be necessary to reduce morbidity and mortality during future events. (Disaster Med Public Health Preparedness. 2015;9:489–495)
Several instances a disastrous and even fatal effects to valuable pearorchards from being attacked by the Psylla have come under my observation, as well as entirely satisfactory results from treating the trees.
The life-history and habits of injurious insects must be accurately determined before we can know just how to deal with them. A knowledge of the habits of such insects will also often enable the farmer to so manage his land crops that the insects are placed under unfavourable and even destructive conditions.
Get out of the light, Lawrence Friedman has told legions of legal historians – and go down to the cellar. Upstairs you will find only the history of appellate law. There, in floodlit reading rooms, celestial metaphors take flight – those judicial luminaries and penumbral rights, that omnipresence in the sky. Yet the law of society – the law as we live it – is not the work of common law judges or even elected lawmakers, who leave their tracks above ground. It is instead the shadow of that law, cast across the streets and shops and tenements of town. The stuff of the law, and especially the criminal law, concerns those dredged up from the bottom of society. And they leave their tracks in the cellar.
So down he went. Three decades ago Lawrence Friedman and his student Robert Percival followed those tracks to the basements of Oakland. In that grubby port town, squatting across San Francisco Bay from its shimmering big sister, they started to dig. From precinct to courthouse to prison to press, they unearthed the shards of a whole system of criminal justice. Then they rebuilt it in living detail – the entire anatomy of crime detection and punishment in Alameda County between 1870 and 1910. They called their work The Roots of Justice – for it was in every sense a history from the bottom.
Research in unconventional medicine requires a number of different questions to build up a “mosaic” of evidence. Choice of research design depends on the question being asked and is independent of the therapy under investigation. Despite the doubts of some practitioners, randomized trials are of value for determining certain questions in alternative medicine.
Whole grains are known to influence postprandial glucose response and insulin demand and are inversely associated with diabetes risk. Genetic variation of the transcription factor-7-like 2 encoding gene (TCF7L2) is assumed to promote an early insulin secretory defect and has been consistently attributed to the risk of developing type 2 diabetes. The present study examined the hypothesis that the protective effect of whole grains might be attenuated in the presence of the rs7903146 risk-conferring T-allele. We employed a case–cohort study of 2318 randomised individuals and 724 incident type 2 diabetes cases from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam cohort. Multivariate Cox regression was used to estimate relative risks of diabetes including product terms testing for the genotype-specific effect modification of dietary whole grain. Dietary intake of whole grains was assessed by a validated FFQ. The TCF7L2 rs7903146 T-allele was associated with type 2 diabetes (hazard ratio = 1·51; 95 % CI 1·21, 1·87) and modified the inverse association between whole-grain intake and diabetes risk (P = 0·016 for interaction). While whole-grain intake was inversely associated with diabetes risk among rs7903146 CC homozygote carriers (hazard ratio for 50 g portion per d = 0·86; 95 % CI 0·75, 0·99), the T-allele negated the protective effect of whole-grain intake (hazard ratio among T-allele carriers for 50 g portion per d = 1·08; 95 % CI 0·96, 1·23). These data provide evidence that the beneficial effect of whole-grain intake on diabetes risk is modified by TCF7L2 rs7903146.
Collegiate-based emergency medical systems (CBEMS) are a unique model for the delivery of prehospital care. The National Collegiate Emergency Medical Services Foundation (NCEMSF) was founded to serve as a resource for CBEMS groups. The purpose of this investigation is to describe the current state of CBEMS organizations.
Methods:
The NCEMSF maintains a Web-based, data collection system to gather data on CBEMS organizations. Collegiate-based emergency medical services are defined as emergency medical services in a university or college campus setting. The abstracted data from the NCEMSF registry were analyzed using descriptive statistics.
Results:
The NCEMSF registry contained data on 175 groups, and 145 groups were identified as providing CBEMS. The levels of service provided by the groups were: (1) first responder, 8.3%; (2) basic life support (BLS) 66.2%; (3) intermediate life support (ILS) 4.8%; (4) advanced life support (ALS), 9.7%; and (5) combination BLS/ALS, 8.3%. Transport capabilities were provided by 31.7% of the CBEMS. The average response time was estimated at 2.6 minutes (95% confidence interval (CI), 2.35–2.91 minutes). Early defibrillation using a automated external defibrillator (AED) or ALS was available by 75.9% (95% CI, 68.8–83.0) of CBEMS. Service to the community beyond the campus was provided by 21.3% of CBEMS groups. Forty-eight percent of the services operate 24 hours/day, seven days/week. The average call volume per year was 568 responses (95% CI, 315–820), and the groups averaged 29 (95% CI, 25–34) members. During the past five years, an average of 4.3 new CBEMS groups were formed per year. Eleven of the CBEMS are based at international schools.
Fourier local correlation tracking (FLCT) was applied to time series of the normal magnetic field in vector magnetograms of NOAA AR 8210, from 17:13–21:29 UT on 1998 May 1, to derive photospheric flows. These flows, combined with both the observed horizontal magnetic field and an inferred horizontal potential magnetic field, can be used to derive the flux of free magnetic energy across the photosphere. Here, we present the formalism used, as well as a map of the time-averaged free energy flux. Over the time interval covered by the magnetograms, ${\sim} 10^{31}\,$erg of free magnetic energy flowed upward across the photosphere, a significant fraction of the energy typically released in large flares coronal mass ejections (CMEs). A flare and coronal mass ejection began at 22:30 UT. We acknowledge the kind support of AFOSR's MURI program.
The recommended post grazing stubble height for dairy cows in a rotational grazing system in spring is 8 to 10 cm. However, this height leads to much stem elongation and reduction in sward quality in mid and late season. Consequently, pastures require topping in June/July to maintain grass quality and reduce sward deterioration, particularly in rejected areas around dung pats. O'Riordan (1989) suggested that a leader/follower rotational grazing system with ewes following dairy cows could improve pasture utilisation and eliminate the need for topping. This was confirmed by Swift et al. (1991) who also demonstrated that grazing at one ewe with twin lambs per cow improved the utilisation of grass and allowed for acceptable ewe and lamb performance without apparently decreasing cow grazing days or milk output.
The objective of this work was to examine the effects of leader/follower rotational grazing with dairy cows and lambed ewes on grass tillering in a cool, wet western environment.
We discuss an ordinary differential equation which describes how the pressure in a coronal loop may evolve in time under the influence of a uniform, but time varying heating rate.
Solar flares are currently understood as the explosive release of energy stored in the form of stressed magnetic fields. In many cases, the released energy seems to take the form of large numbers of electrons accelerated to high energies (the nonthermal electron “thick target” model), or alternatively plasma heated to very high temperatures behind a rapidly moving conduction front (the “thermal” model). The transport of this energy into the remaining portion of the atmosphere results in violent mass motion and strong emission across the electromagnetic spectrum. Radiation processes play a crucial role in determining the ensuing plasma motion.
One important phenomenon observed during flares is the appearance in coronal magnetic loops of large amounts of upflowing, soft X-ray emitting plasma at temperatures of 1−2×107 [K]. It is believed that this is due to chromospheric evaporation, the process of heating cool (T - 104[K]) chromospheric material beyond its ability to radiate. Detailed calculations of thick target heating show that if nonthermal electrons heat the chromosphere directly, then the evaporation process can result in explosive upward motion of X-ray emitting plasma if the heating rate exceeds a threshold value. In such a case, upflow velocities approach an upper limit of roughly 2.35 cs as the heating rate is increased beyond the threshold, where cs is the sound speed in the evaporated plasma. This is known as explosive evaporation. If the flare heating rate is less than the threshold, evaporation takes place indirectly through thermal conduction of heat deposited in the corona by the energetic electrons. Upflows in this case are roughly 10 to 20% of the upper limit. Evaporation by thermal model heating always takes place through thermal conduction, and the computed upflow speeds seem to be about 10% to 20% of the upper limit, independent of the energy flux.
The pressure increase in the evaporated plasma for either the thick target or thermal model leads to a number of interesting phenomena in the flare chromosphere. The sudden pressure increase initiates a downward moving “chromospheric condensation”, an overdense region which gradually decelerates as it accretes material and propagates into the gravitationally stratified chromosphere. Solutions to an equation of motion for this condensation shows that its motion decays after about one minute of propagation into the chromosphere. When the front of this downflowing region is supersonic relative to the atmosphere ahead of it, a radiating shock will form. If the downflow is rapid enough, the shock strength should be sufficient to excite UV radiation normally associated with the transition region, and furthermore, the radiating shock will be brighter than the transition region. These results lead to a number of observationally testable relationships between the optical and ultraviolet spectra from the condensation and radiating shock.
I cannot begin this brief paper respecting our honored friend, the late President (who was also the founder) of this Society, without expressing my sense of personal bereavement in connection with his death. His unfailing vivacity, his amiable temper, his generous recognition of contemporary scholars in the same field with himself, and his loyal friendship, may well cause us to lament that his genial presence will no more be with us. He had long been a living, visible link, binding us to Germany, the land of scholars, the country which to many of us is an intellectual fatherland. Circumstances—or, what is the same thing, the leadings of Providence—conspired to fit him for that cosmopolitan place and versatile activity which characterized him. A Swiss by birth, but of German extraction, besides his early training in South Germany he studied at the three universities of Tübingen, Halle, and Berlin. Born and bred in the Reformed branch of the Protestant family, he was thus brought into intercourse in his youth with such men as Neander, Tholuck, and Müller, the great lights of the liberal, evangelical—I will not say party, for they were of no party, but class, among the Lutherans. His theological studies were not less diversified than his personal associations.
Of late the Alogi (so-called) have been the subject of renewed discussion in Germany. The topic is handled by Dr. A. Harnack in his able and elaborate article on “Monarchianism” in Herzogand Plitt's Encyclopædia (vol. x.), and in his “Dogmengeschichte” (second edition, 1888). It is considered at length in the first half of the first volume of Zahn's “History of the New Testament Canon” (1888). This last publication has called out a polemical review from Harnack, in which the Alogi forms one of the prominent themes. In Zahn's brief pamphlet in reply to Harnack, however, this particular topic is not taken up. The subject, as all are aware, is interesting as a branch of the history of Christology in the second century. It is especially important now for its connection with the debate respecting the authorship of the Fourth Gospel.
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