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This work compares dose-volume constraints (DVCs) and tumour control predictions based on the average intensity projection (AVIP) to those on each phase of the four-dimensional computed tomography.
Materials and methods:
In this prospective study plans generated on an AVIP for nine patients with locally advanced non-small-cell lung cancer were recalculated on each phase. Dose-volume histogram (DVH) metrics extracted and tumour control probabilities (TCP) were calculated. These were evaluated by Bland–Altman analysis and Pearson Correlation.
Results:
The largest difference between clinical target volume (CTV) on the individual phases and the internal CTV (iCTV) on the AVIP was seen for the smallest volume. For the planning target volume, the mean of each metric across all phases is well represented by the AVIP value. For most patients, TCPs from individual phases are representative of that on the AVIP. Organ at risk metrics from the AVIP are similar to those seen across all phases.
Findings:
Utilising traditional DVH metrics on an AVIP is generally valid, however, additional investigation may be required for small target volumes in combination with large motion as the differences between the values on the AVIP and any given phase may be significant.
The Tennessee Department of Health (TDH) investigated a hepatitis A virus (HAV) outbreak to identify risk factors for infection and make prevention recommendations.
Design:
Case series.
Setting:
Community hospital.
Participants:
Healthcare workers (HCWs) or patients with laboratory-confirmed acute HAV infection during October 1, 2018–January 10, 2019.
Methods:
HCWs with suspected or confirmed hepatitis A infections were interviewed to assess their exposures and activities. Patient medical records and hospital administrative records were reviewed to identify common exposures. We conducted a site investigation to assess knowledge of infection control practices among HCWs. Serum specimens from ill persons were tested for HAV RNA by polymerase chain reaction (PCR) and genotyped.
Results:
We identified 6 HCWs and 2 patients with laboratory-confirmed HAV infection. All cases likely resulted from exposure to a homeless patient with a history of recreational substance use and undiagnosed HAV infection. Breaches in hand hygiene and use of standard precautions were identified. HAV RNA was detected in 7 serum specimens and all belonged to an identical strain of HAV genotype 1b.
Conclusions:
A hepatitis A outbreak among hospital patients and HCWs resulted from exposure to a single patient with undiagnosed HAV infection. Breakdowns in infection control practices contributed to the outbreak. The likelihood of nosocomial transmission can be reduced with proper hand hygiene, standard precautions, and routine disinfection. During community outbreaks, medical providers can better prevent ongoing transmission by including hepatitis A in the differential diagnosis among patients with a history of recreational substance use and homelessness.
OBJECTIVES/GOALS: Juvenile idiopathic arthritis (JIA) is the most common childhood rheumatologic disease childhood and a cause of pain and potential disability. JIA has a strong genetic component and no known cure. The goal of this study is to evaluate allele-dependent effects of a novel JIA risk variant at 1q24.3. METHODS/STUDY POPULATION: JIA patients meeting criteria for the two most common disease subtypes (oligoarticular and RF neg polyarthritis) were genotyped using the Immunochip, an Illumina array with dense coverage of the HLA region and 186 other loci previously reported in autoimmune diseases. Phase I association findings (Hinks, 2013) and Phase II analysis (unpublished) of an expanded cohort (4,271 JIA and 14,390 controls) identified new risk loci, including rs78037977 at 1q24.3. We prioritized rs78037977 and predicted possible impacted mechanisms based on Bayesian predictions of attributable risk, the surrounding chromatin landscape, and transcription factor binding data. A luciferase reporter assay was used to assess allele-dependent enhancer activity. RESULTS/ANTICIPATED RESULTS: rs78037977 is located between FASLG and TNFSF18 at chromosome 1q24.3 is associated with JIA (p = 6.3x10−09), and explains 94% of the posterior probability at this locus; no other SNPs in linkage disequilibrium (r2>0.6). The chromatin landscape around rs78037977 contains H3K4Me1 and H3K27Ac marks, which are indicative of enhancer activity. Further, >160 transcription factors have chromatin immunoprecipitation followed by sequencing (ChIP-seq) peaks overlapping rs78037977 in various cellular contexts. In luciferase reporter assays, the region around rs78037977 containing the reference A allele had ~2-fold increased enhancer activity compared to the non-reference allele. DISCUSSION/SIGNIFICANCE OF IMPACT: This work provides in vitro evidence to support allele-dependent enhancer activity of a novel JIA-risk variant at 1q24.3. Our ongoing work investigates the effect of the DNA-containing region of rs78037977 on gene expression and differential transcription factor binding at rs78037977.
Bastin et al. propose a dual-process model to understand memory deficits. However, results from state-trace analysis have suggested a single underlying variable in behavioral and neural data. We advocate the usage of unidimensional models that are supported by data and have been successful in understanding memory deficits and in linking to neural data.
To investigate an outbreak of Burkholderia cepacia complex and describe the measures that revealed the source.
SETTING
A 629-bed, tertiary-care, pediatric hospital in Houston, Texas.
PATIENTS
Pediatric patients without cystic fibrosis (CF) hospitalized in the pediatric and cardiovascular intensive care units.
METHODS
We investigated an outbreak of B. cepacia complex from February through July 2016. Isolates were evaluated for molecular relatedness with repetitive extragenic palindromic polymerase chain reaction (rep-PCR); specific species identification and genotyping were performed at an independent laboratory. The investigation included a detailed review of all cases, direct observation of clinical practices, and respiratory surveillance cultures. Environmental and product cultures were performed at an accredited reference environmental microbiology laboratory.
RESULTS
Overall, 18 respiratory tract cultures, 5 blood cultures, 4 urine cultures, and 3 stool cultures were positive in 24 patients. Among the 24 patients, 17 had symptomatic infections and 7 were colonized. The median age of the patients was 22.5 months (range, 2–148 months). Rep-PCR typing showed that 21 of 24 cases represented the same strain, which was identified as a novel species within the B. cepacia complex. Product cultures of liquid docusate were positive with an identical strain of B. cepacia complex. Local and state health departments, as well as the CDC and FDA, were notified, prompting a multistate investigation.
CONCLUSIONS
Our investigation revealed an outbreak of a unique strain of B. cepacia complex isolated in clinical specimens from non-CF pediatric patients and from liquid docusate. This resulted in a national alert and voluntary recall by the manufacturer.
Epidemiological studies have established an association between obesity, insulin resistance, type 2 diabetes and a number of cancer types. Research has focused predominantly on altered endocrine factors, growth factors and signalling pathways, with little known in man about the immune involvement in the relevant pathophysiological processes. Moreover, in an era of exciting new breakthroughs in cancer immunotherapy, there is also a need to study the safety and efficacy of immunotherapeutics in the complex setting of inflammatory-driven obesity-associated cancer. This review addresses key immune cell subsets underpinning obesity-associated inflammation and describes how such immune compartments might be targeted to prevent and treat obesity-associated cancer. We propose that the modulation, metabolism, migration and abundance of pro- and anti-inflammatory cells and tumour-specific T cells might be therapeutically altered to both restore immune balance, alleviating pathological inflammation, and to improve anti-tumour immune responses in obesity-associated cancer.
DEMOCRATIC AUTHORITY AS REPUDIATION OF SELF-AUTHORIZATION
Any form of government might hold authority for a given population at a particular time, and any form of government might also secure authority over it. Very evidently, for many populations and very much of the time, no form of government at all enjoys the first or can elicit the second. Authority over is behavioral – a matter of power; but authority for is inherently normative. It requires belief, attitude, and sentiment, and though power may generate it or issue from it, it can never in itself be simply a fact of power and is never reducible to a repertoire of behavior. What makes democracy such a hazardous category in contemporary political assessment (in striking contrast to three centuries ago) is precisely what makes it so seductive to deploy for that purpose: its constant flickering equivocation between the positive and the normative. The latent dual pretension of contemporary democracy is that under it and it alone, the personnel who govern, the people who hold power, do so solely because they provenly hold authority for their power to do so, whereas under democracy and democracy alone, those they govern can rely on being ruled without any particular human beings holding authority over them. The ideological allure of this combination thus adroitly synthesizes the blitheness of anarchy with the security of civil order. Actually existing democracies, unsurprisingly, have a more checkered record either of authority for or authority over the populations they enfold.
The very idea of a state requires authority over a given territory and population. Those states unable to achieve it have failed not merely in contemporary political nomenclature but all too palpably and by criteria they cannot coherently disavow. The extraordinarily complex articulations of the state idea which still provide the most obtrusive and consequential format for human collective life across those areas of the globe where such life occurs on any scale and enjoys a format of significant extent undoubtedly vary dramatically.
George H. Butler was a Gilded Age writer, diplomat, and soldier, who was also a poster boy for what Richard Stott identifies as the “jolly fellow.” Butler parlayed a witty writing style to enter journalism, and with the help of his influencial uncle, Benjamin Butler, he obtained a diplomatic posting as consul general to Egypt. Overly fond of alcohol, George Butler participated in several newsworthy fights, often involving deadly force. His life serves as an archetype for out-of-control manliness, which was contrary to gender expectations of polite society in 1870s America.
This article addresses the so-called ‘apocalyptic reading of Paul’, taking the representative work of J. Louis Martyn and Martinus C. de Boer as its primary focus. The chief contention is that the ‘apocalyptic reading’ does not resemble the historical phenomenon of Jewish apocalyptic literature, although the scope of this article has been intentionally limited to Galatians. The present study is composed of two halves. The first half offers a critique of what it means for Paul to be an apocalyptic thinker according to Martyn and de Boer. Their emphasis is on discontinuity, duality and dichotomy, which coheres neither with first-century apocalyptic literature and its antecedents, nor with the letter to the Galatians. Their nuanced notion of apocalyptic has led to an unnecessary bifurcation between apocalyptic and covenant (not to mention Heilsgeschichte) in the interpretation of Paul. However, this article suggests that the dichotomy has been misplaced, both in relation to the discontinuity that Paul does articulate (i.e. with the law), and the dichotomy reflected in apocalyptic literature, namely, the division between the present evil age and the glorious age to come. Thus, it is argued that Martyn and de Boer's focus on discontinuity hardly constitutes apocalyptic in a first-century historical sense. Rather, their specific emphasis owes its articulation to the theology of Karl Barth. After arguing that the ‘apocalyptic reading’ lacks historical precision (and possibly theological forthrightness), the second half of the study argues that some neglected features of Galatians, such as suffering and persecution, cohere with the apocalyptic character of the letter, and are common features of apocalyptic broadly. In fact, the division between apocalyptic and covenant in scholarship on Galatians is bridged by the themes of conflict and crisis. This is because apocalyptic hope often arises in the absence of the realisation of covenantal promises and expectations; a covenantal disconnect is created and aggravated by crises and hardships of various sorts, hence the need for apocalyptic hope. Suffering therefore ties together the strands of apocalyptic and covenant in Galatians. If Martyn and de Boer's ‘apocalyptic reading’ was truly apocalyptic in a first-century historical sense, it would have integrated the imagery of suffering and persecution found in the letter.
Despite evidence for the effectiveness of structured psychological
therapies for bipolar disorder no psychological interventions have been
specifically designed to enhance personal recovery for individuals with
recent-onset bipolar disorder.
Aims
A pilot study to assess the feasibility and effectiveness of a new
intervention, recovery-focused cognitive–behavioural therapy (CBT),
designed in collaboration with individuals with recent-onset bipolar
disorder intended to improve clinical and personal recovery outcomes.
Method
A single, blind randomised controlled trial compared treatment as usual
(TAU) with recovery-focused CBT plus TAU (n = 67).
Results
Recruitment and follow-up rates within 10% of pre-planned targets to
12-month follow-up were achieved. An average of 14.15 h (s.d. = 4.21) of
recovery-focused CBT were attended out of a potential maximum of 18 h.
Compared with TAU, recovery-focused CBT significantly improved personal
recovery up to 12-month follow-up (Bipolar Recovery Questionnaire mean
score 310.87, 95% CI 75.00–546.74 (s.e. = 120.34), P =
0.010, d=0.62) and increased time to any mood relapse
during up to 15 months follow-up (χ2 = 7.64,
P<0.006, estimated hazard ratio (HR) = 0.38, 95%
CI 0.18–0.78). Groups did not differ with respect to medication
adherence.
Conclusions
Recovery-focused CBT seems promising with respect to feasibility and
potential clinical effectiveness. Clinical- and cost-effectiveness now
need to be reliably estimated in a definitive trial.
This article establishes the significance of elections held in the annexed
departments of the Napoleonic Empire from 1802 to 1813. It thus represents an
original, and perhaps surprising, contribution to recent debate on the nature of
Napoleonic imperialism, in which attention has shifted from core to periphery, and
away from purely military matters. The electoral process under this authoritarian
regime has been alternately neglected or derided, especially where the newly created
departments of the Low Countries and parts of Germany and Italy are concerned.
However, extensive archival research demonstrates that it was taken extremely
seriously by both regime and voters, especially outside metropolitan France. These
‘First European Elections', as they may be dubbed, took place in regular fashion
right across the Empire and are studied here on a transnational basis, which also
involves the metropolitan departments. Though open to all adult males at the primary
level, they were not exercises in democracy, but they did create some rare political
space which local people were not slow to exploit for their own purposes. Above all,
they served as a means of integrating ‘new Frenchmen’, particularly members of
indigenous elites, into the Napoleonic system.
Schistosomiasis is the generic name given to diseases caused by parasitic blood flukes of the genus Schistosoma. An older name, still widely used in Africa, is bilharzia. Of the three major species that commonly infect humans, two occur predominantly in Africa:
S. mansoni, a cause of intestinal schistosomiasis, also found in Brazil and the Caribbean; and
S. haematobium, the cause of urinary schistosomiasis, also found in the Middle East.
The third major species, S. japonicum, causes another form of intestinal schistosomiasis but is found only in the Far East. A minor species, S. intercalatum, causes infection but insignificant disease in small areas of Central Africa.
Schistosomiasis is typically a chronic infection. Adult worms slowly accumulate from early childhood over a period of 10 to 20 years, and the deposition of eggs in the tissues leads to fibrosis in the intestines and liver (S. mansoni) or the urinary tract (S. haematobium). Mild or moderate symptoms occur in most infected children: severe disease develops in later life in only a minority of these individuals. For detailed reviews of different aspects, the reader is referred to books edited by Jordan et al. (1993) and Mahmoud (2001).
This article presents results from the first 3 rounds of an international intercomparison of measurements of Δ14CO2 in liter-scale samples of whole air by groups using accelerator mass spectrometry (AMS). The ultimate goal of the intercomparison is to allow the merging of Δ14CO2 data from different groups, with the confidence that differences in the data are geophysical gradients and not artifacts of calibration. Eight groups have participated in at least 1 round of the intercomparison, which has so far included 3 rounds of air distribution between 2007 and 2010. The comparison is intended to be ongoing, so that: a) the community obtains a regular assessment of differences between laboratories; and b) individual laboratories can begin to assess the long-term repeatability of their measurements of the same source air. Air used in the intercomparison was compressed into 2 high-pressure cylinders in 2005 and 2006 at Niwot Ridge, Colorado (USA), with one of the tanks “spiked” with fossil CO2, so that the 2 tanks span the range of Δ14CO2 typically encountered when measuring air from both remote background locations and polluted urban ones. Three groups show interlaboratory comparability within l% for ambient level Δ14CO2. For high CO2/low Δ14CO2 air, 4 laboratories showed comparability within 2%. This approaches the goals set out by the World Meteorological Organization (WMO) CO2 Measurements Experts Group in 2005. One important observation is that single-sample precisions typically reported by the AMS community cannot always explain the observed differences within and between laboratories. This emphasizes the need to use long-term repeatability as a metric for measurement precision, especially in the context of long-term atmospheric monitoring.
Nineteenth-century imperialism presented challenges and opportunities to the non-western world. To most states it was a threat, to several a role model. Embracing the “western way of war” required massive investments, plus dramatic political, educational, and social changes. Most attempts to do so were at best partially successful, many a waste of resources.
A few states, like Ethiopia in the 1880s and 1890s, created new military systems that allowed powerful resistance to western imperialism. Elsewhere reformed armies enhanced the coercive powers of the state, reducing opposition to further change. Bandit leaders in the Balkans and Manchuria found their lairs less secure, Taiping rebels were mowed down by Ch’ing (Qing) soldiers who were armed with Enfield rifles, while in Morocco a few Krupp guns guaranteed that the sultan’s annual mahalla would collect tribute quickly.
China’s tzu ch’iang yun-tung (ziqiang yundong), or Self-Strengthening Movement, is a good example of this proposition. A reaction to the the twin disasters of the First OpiumWar (1839–42) and the Taiping Rebellion (1850–64), this movement was the first sustained effort to improve the Ch’ingmilitary. Self-strengthening represented more than the purchase of British rifles or hiring a few military advisors; it called for China to improve revenue collection, construct arsenals and shipyards, and to train more efficient soldiers and sailors.