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Although rare, coronary artery anomalies can have significant clinical implications. Total anomalous origin of the coronary arteries from the pulmonary artery (TCAPA) represents a rare subtype of coronary artery anomaly for which little is known. The aim of this review was to characterise the presentation, utilised diagnostic modalities, associated cardiac lesions, and treatment strategies in patients with TCAPA.
A systematic review was performed for cases of TCAPA using PubMed, Embase, and Web of Science. Keywords searched included “total anomalous origin of the coronary arteries from the pulmonary artery,” “single ostium anomalous coronary artery from the pulmonary artery,” and “anomalous origin of both coronary arteries from the pulmonary artery.”
Fifty-seven cases of TCAPA were identified in 50 manuscripts. Fifty-eight per cent of patients were male and the median age at presentation was 10 days (mean 1.71 ± 6.6 years, range 0 days–39 years). Most patients were symptomatic at the time of presentation; cyanosis (n = 22) and respiratory distress (n = 14) were the most common symptoms. Cases were most commonly diagnosed at autopsy (n = 26, 45.6%), but operative intervention was pursued in 22 cases (45.6%); aortic re-implantation (n = 14) and a Takeuchi-type repair (n = 7) were the most common routes of repair.
The clinical presentation of patients with TCAPA was found to be variable, likely related to the presence of associated cardiac lesions. TCAPA should be considered in patients with suspected anomalous origin of the left coronary artery from the pulmonary artery for the serious consequences that can occur if not promptly corrected.
Vaginal cancer is a rare malignancy that poses a challenge to treat and cure, as surgical excision requires life-changing procedures because of the proximity and involvement of rectum, bladder and anus. We report in this case study the successful delivery of stereotactic ablative radiotherapy (SABR) for a patient with vaginal cancer after previous radiotherapy.
A 71-year-old white female who presented with dyspareunia and irritative urinary symptoms proven by biopsy was our candidate patient. Subsequent PET/CT revealed a hypermetabolic 3 cm lesion at the 12–1 o’clock position in the distal vagina involving the clitoris. The patient was initially treated with volumetric-modulated arc therapy (VMAT) with simultaneous integrated boost technique to the involved nodes, and later upon recurrence treated with SABR using 30 Gy in six fractions.
To our knowledge, this is the first report of a vaginal cylinder used to physically distance organs at risk from the treatment target and also as a localising device with image guidance for the delivery of SABR using an external beam.
Personal protective equipment (PPE) is worn by prehospital providers (PHPs) for protection from hazardous exposures. Evidence regarding the ability of PHPs to perform resuscitation procedures has been described in adult but not pediatric models. This study examined the effects of PPE on the ability of PHPs to perform resuscitation procedures on pediatric patients.
This prospective study was conducted at a US simulation center. Paramedics wore normal attire at the baseline session and donned full Level B PPE for the second session. During each session, they performed timed sets of psychomotor tasks simulating clinical care of a critically ill pediatric patient. The difference in time to completion between baseline and PPE sessions per task was examined using Wilcoxon signed-rank tests.
A total of 50 paramedics completed both sessions. Median times for task completion at the PPE sessions increased significantly from baseline for several procedures: tracheal intubation (+4.5 s; P = 0.01), automated external defibrillator (AED) placement (+9.5 s; P = 0.01), intraosseous line insertion (+7 s; P < 0.0001), tourniquet (+8.5 s; P < 0.0001), intramuscular injection (+21-23 s, P < 0.0001), and pulse oximetry (+4 s; P < 0.0001). There was no significant increase in completion time for bag-mask ventilation or autoinjector use.
PPE did not have a significant impact on PHPs performing critical tasks while caring for a pediatric patient with a highly infectious or chemical exposure. This information may guide PHPs faced with the situation of resuscitating children while wearing Level B PPE.
What drives individuals toward a career in politics? Prior research on political ambition has often focused on socio-demographic variables while generally ignoring the importance of individual personality differences. Yet personality consistently predicts political knowledge, interest and participation, suggesting that individual differences may matter in addition to resources and the social environment. To this end, we assess the impact of both the HEXACO and Dark Triad models of personality in predicting nascent political ambition (that is, the initial desire to run for elected office) while controlling for well-established socio-demographic variables (for example, gender, income). Overall, we find considerable support for the predictive power of personality, especially the traits of honesty-humility, extraversion and narcissism. These results have important implications for understanding the kinds of people who are interested in a political career.
Covering a broad optical spectrum, ternary InxGa1−xAs nanowires, grown by bottom-up methods, have been receiving increasing attention due to the tunability of the bandgap via In composition modulation. However, inadequate knowledge about the correlation between growth and properties restricts our ability to take advantage of this phenomenon for optoelectronic applications. Here, three different InGaAs nanowires were grown under different experimental conditions and atom probe tomography was used to quantify their composition, allowing the direct observation of the nanowire composition associated with the different growth conditions.
Little is known about the experience of family caregivers of adults with cystic fibrosis (CF). This information is important for the identification of caregivers at risk for burden.
This was a longitudinal analysis of survey data obtained from caregivers of adult CF patients participating in an early intervention palliative care trial. Caregivers completed the validated Brief Assessment Scale for Caregivers (BASC) repeatedly over a 28-month period. Mixed-effects modeling evaluated multivariate associations with positive and negative caregiver perceptions over time.
Of the 54 caregivers, 47.9% were spouses. The mean age was 50.9 years (SD = 13.2); 72.2% were women; 75.9% were married; and 63.0% were employed. At baseline, the BASC revealed large variations in positive and negative perceptions of caregiving. Although average scores over time were unchanging, variation was greater across caregivers than within caregivers (0.49 vs. 0.27, respectively). At baseline, the positive impact of caregiving in the sample was higher than the negative impact. Multivariate analysis revealed that patients' baseline pulmonary function and their full-time employment status predicted caregiver burden over time.
Significance of results:
Caregivers of CF patients varied in their positive and negative caregiving experiences, although burden levels in individual caregivers were stable over time. When the disease was advanced, caregivers of CF patients experienced more overall burden but also more positive impact. This suggests that the role of caregivers may become more meaningful as disease severity worsens. In addition, full-time patient employment was associated with lower caregiver burden regardless of disease severity. This suggests that burden in CF caregivers may be predicted by financial strain or benefits conferred by patient employment. These associations require further investigation to determine whether highly burdened caregivers can be identified and assisted using tailored interventions.
The microstructural evolution of precipitation in two model alloys, Fe–NiAl and Fe–NiAl–Cu, was investigated during aging at 500°C for different times using atom probe tomography (APT). The APT results reveal that the addition of Cu effectively increases the number density of NiAl precipitates. This is attributed to Cu promoting the nucleation of NiAl particles by increasing the chemical driving force and decreasing the interfacial energy. The NiAl precipitates of the Fe–NiAl–Cu alloy grow and coarsen at a slower rate than that of the Fe–NiAl alloy, mainly due to the slower diffusion rate of the Cu atoms. The mechanical properties of the two alloys were characterized by Vickers hardness and tension tests. It was found that the addition of Cu results in the formation of core–shell precipitates with a Cu-rich core and a NiAl shell, leading to a dramatic improvement of peak hardness and strength. The effect of Cu on precipitation strengthening is discussed in terms of chemical strength and coherency strength.
Preference-based measures of health-related quality of life play a key role in the calculation of Quality-Adjusted Life Years (QALYs) for Health Technology Assessment (HTA). The Child Health Utility 9D (CHU9D) is a new preference-based instrument designed specifically for application in children and adolescents (aged 7 to 17 years). This study aimed to compare Chinese and Australian adolescent population preferences for CHU9D health states using profile case best worst scaling (BWS) methods.
Fifty CHU9D health states (blocked into five survey versions) were generated for valuation using a fractional factorial design. Study participants were recruited through an online panel company in Australia, and through primary and secondary schools in China. A latent class modelling framework was adopted for econometric analysis.
A total of 1,982 respondents (51 percent female) in Australia and 902 respondents (43 percent female) in China provided useable survey responses. Latent class analysis indicated the existence of preference heterogeneity for both population groups. In the Australian sample, respondents in Class I placed the most importance on the mental health dimensions of the CHU9D (for example, Worried and Annoyed) and the least importance on daily activities (for example, Activities, Daily routine, Sleep), whilst respondents in Class II placed equal weights on all attributes. In the Chinese sample, respondents in Class I placed the most importance on the Activities dimension of the CHU9D and the least importance on the Annoyed dimension, whist Class II placed the most importance on the Schoolwork dimension and the least importance on Pain.
This study has provided important cross-country insights into the use of profile case BWS methods to elicit health state preferences with young people for application in HTA in children and adolescents. The differential latent classes identified between Australia and China highlights the necessity to derive country-specific adolescent scoring algorithms for the CHU9D instrument for application in HTA.
The effect of gamma radiation in vacuum on the isothermal crystallization kinetics of syndiotactic polystyrene (sPS) was investigated via differential scanning calorimetry (DSC), Fourier transform infrared spectroscopy (FTIR), and x-ray diffraction (XRD). Amorphous sPS samples were irradiated in vacuum, heated to 310 °C, cooled down to crystallization temperatures (Tcs) from 220 to 260 °C, and annealed for different times. Upon reheating, overlapping endothermic melting peaks depicted the various crystallization forms, α, β, and β′. The endotherms were resolved using Gaussian functions relating enthalpy changes to the endothermic envelope. Isothermal crystallization kinetic data were analyzed using Avrami's model with Gaussian functions. The extent of crystallization of β and β′ forms increased with increasing crystallization time and temperature, while that of α form decreased. Crystallization half-time followed a modified Arrhenius equation. Crystallization activation energies for the β and β′ forms of sPS increased with increasing radiation doses. The results are compared to those of air irradiated sPS reported in the literature.
Multiagent systems have been considered as a potential solution for developing adaptive systems. In this research, a cellular self-organizing (CSO) approach is proposed for developing such multiagent adaptive systems. The design of CSO systems however is difficult because the global effect emerges from local actions and interactions that are often hard to specify and control. In order to achieve high-level flexible and robustness of CSO systems and retain the capability of specifying desired global effects, we propose a field-based regulative control mechanism, called field-based behavior regulation (FBR). FBR is a real-time, dynamical, distributed mechanism that regulates the emergence process for CSO systems to self-organize and self-reconfigure in complex operation environments. FBR characterizes the task environment in terms of “fields” and extends the system flexibility and robustness without imposing global control over local cells or agents. This paper describes the model of CSO systems and FBR, and demonstrates their effectiveness through simulation-based case studies.
This paper investigates the limited attainment of adult compared to child language acquisition in terms of learned attention to morphological cues. It replicates Ellis and Sagarra in demonstrating short-term learned attention in the acquisition of temporal reference in Latin, and it extends the investigation using eye-tracking indicators to determine the extent to which these biases are overt or covert. English native speakers learned adverbial and morphological cues to temporal reference in a small set of Latin phrases under experimental conditions. Comprehension and production data demonstrated that early experience with adverbial cues enhanced subsequent use of this cue dimension and blocked the acquisition of verbal tense morphology. Effects of early experience of verbal morphology were less pronounced. Eye-tracking measures showed that early experience of particular cue dimensions affected what participants overtly focused upon during subsequent language processing and how this overt study resulted in turn in covert attentional biases in comprehension and in productive knowledge.
We characterize the electric properties of single-walled carbon nanotube (SWNT) dispersed in the polymethyl methacrylate (PMMA) composites. In the melt-blended sample, the SWNTs – originally semiconducting – became predominantly metallic. The interaction of the PMMA and SWNT is investigated by the polarized Raman studies. The structure changes in the PMMA and SWNT shows that the anisotropic interactions play important role in SWNT electronic density of states (DOS) changes. The increased metallic SWNT percentage is confirmed by the conductivity and dielectric constant measurements of composite and neat PMMA.
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