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To determine the utility of the Sofia SARS rapid antigen fluorescent immunoassay (FIA) to guide hospital-bed placement of patients being admitted through the emergency department (ED).
Cross-sectional analysis of a clinical quality improvement study.
This study was conducted in 2 community hospitals in Maryland from September 21, 2020, to December 3, 2020. In total, 2,887 patients simultaneously received the Sofia SARS rapid antigen FIA and SARS-CoV-2 RT-PCR assays on admission through the ED.
Rapid antigen results and symptom assessment guided initial patient placement while confirmatory RT-PCR was pending. The sensitivity, specificity, positive predictive values, and negative predictive values of the rapid antigen assay were calculated relative to RT-PCR, overall and separately for symptomatic and asymptomatic patients. Assay sensitivity was compared to RT-PCR cycle threshold (Ct) values. Assay turnaround times were compared. Clinical characteristics of RT-PCR–positive patients and potential exposures from false-negative antigen assays were evaluated.
For all patients, overall agreement was 97.9%; sensitivity was 76.6% (95% confidence interval [CI], 71%–82%), and specificity was 99.7% (95% CI, 99%–100%). We detected no differences in performance between asymptomatic and symptomatic individuals. As RT-PCR Ct increased, the sensitivity of the antigen assay decreased. The mean turnaround time for the antigen assay was 1.2 hours (95% CI, 1.0–1.3) and for RT-PCR it was 20.1 hours (95% CI, 18.9–40.3) (P < .001). No transmission from antigen-negative/RT-PCR–positive patients was identified.
Although not a replacement for RT-PCR for detection of all SARS-CoV-2 infections, the Sofia SARS antigen FIA has clinical utility for potential initial timely patient placement.
Investigations at the Native American site complex of Stark Farms in Mississippi, USA, have yielded numerous examples of metal artifacts of European origin. Our study suggests that they derive from contact between the AD 1540–1541 winter encampment of the Spanish Hernando de Soto expedition and the local Indigenous polity. The artifacts display a wide range of modifications, uses, and depositional contexts congruent with hybrid practices. We argue that the early colonial setting of Stark Farms requires a different perspective on cultural mixing than is often applied in studies of European colonialism. This is highlighted by the strongly improvisational nature of the modification of the metal objects, embodying a political climate in which European incursions were precarious and in which hybridity and power were heterogeneous and fluid.
To examine socio-economic inequalities in decreases in household sugar purchasing in Great Britain (GB).
Longitudinal, population-based study.
Data were obtained from the GB Kantar Fast-Moving Consumer Goods (FMCG) panel (2014–2017), a nationally representative panel study of food and beverages bought and brought into the home. We estimated changes in daily sugar purchases by occupational social grade from twenty-three food groups, using generalised estimating equations (household-level clustering).
British households who regularly reported food and beverages to the GB Kantar FMCG (n 28 033).
We found that lower social grades obtained a lower proportion of sugar from healthier foods and a greater proportion of sugar from less healthy foods and beverages. In 2014, differences in daily sugar purchased between the lowest and the highest social grades were 3·9 g/capita/d (95 % CI 2·9, 4·8) for table sugar, 2·4 g (95 % CI 1·8, 3·1) for sugar-sweetened beverages, 2·2 g (95 % CI 1·5, 2·8) for chocolate and confectionery and 1·0 g (95 % CI 0·7, 1·3) for biscuits. Conversely, the lowest social grade purchased less sugar from fruits (2·1 g (95 % CI 1·5, 2·8)) and vegetables (0·7 g (95 % CI 0·5, 0·8)) than the highest social grade. We found little evidence of change in social grade differences between 2014 and 2017. These results suggest that recent overall declines in sugar purchases are largely equally distributed across socio-economic groups.
This suggests that recent population-level policy activity to reduce sugar consumption in GB does not appear to exacerbate or reduce existing socio-economic inequalities in sugar purchasing. Low agency, population-level policies may be the best solution to improving population diet without increasing inequalities.
The sparse record of Cretaceous crocodyliforms in Australia comprises only three species, all within the genus Isisfordia. Isisfordia duncani Salisbury et al., 2006 is from the Albian–Turonian Winton Formation of Queensland, and both Isisfordia molnari Hart et al., 2019 and Isisfordia selaslophensis Etheridge, 1917 have been described from opalized material from the Cenomanian Griman Creek Formation of New South Wales. Here, we describe new cranial and postcranial material, including the most complete crocodyliform skeleton from the Cretaceous of New South Wales, which is assigned to Isisfordia cf. I. selaslophensis. We also reappraise previously described crocodyliform material from the same locality. We find that much of this material displays features that are consistent with Isisfordia.
This chapter explores the dynamics of ancient cross-cultural interactions via a case study from the Severan period. Aelian’s brief narrative of the Mesopotamian hero Gilgamos is a story that connects four cultural traditions: Chaldean, Persian, Greek, and Roman. Included in Book 12 of the De natura animalium, the story tells how the Babylonian king’s fear of being usurped led him to imprison his daughter, who secretly gave birth to a son, Gilgamos, by a man of no distinction. Palace guards threw the baby from the acropolis of Babylon, whereupon the infant Gilgamos was rescued by an eagle. Ostensibly the story celebrates the eagle’s capacity for philanthropia, or devotion to humans, but Aelian is up to much more, as the Gilgamos tale opens up questions of cultural legitimacy, the need for evidentiary proof of belonging, and even the role of writing in the complex processes of cultural transformation. Aelian ultimately rejects legitimacy conferred by nature and opts instead for the adoption even of what is illegitimate, untrue, or unverifiable if it represents a valuable medium of cultural interconnectivity.
Although recent U.S. Supreme Court decisions respecting corporate religious liberty have been heavily criticized, this chapter argues that corporate religious freedom is not the novel or radical development that critics decry. What is new, rather, is an increasingly intense opposition to any special legal accommodation of religious commitments. Indeed, upon close examination, the familiar criticisms do not for the most part actually turn on anything peculiar to the corporate form. They are better understood as manifestations of an emerging, deep-seated opposition to the traditional American commitment to religious freedom as a distinctive legal right. And this opposition is itself part of a broader effort to repudiate the vestiges of an older religious or biblical conception of American community, as described in Robert Bellah’s influential scholarship on American “civil religion,” in favor of a different conception that we might describe as “secular” or “progressive.”
The science of studying diamond inclusions for understanding Earth history has developed significantly over the past decades, with new instrumentation and techniques applied to diamond sample archives revealing the stories contained within diamond inclusions. This chapter reviews what diamonds can tell us about the deep carbon cycle over the course of Earth’s history. It reviews how the geochemistry of diamonds and their inclusions inform us about the deep carbon cycle, the origin of the diamonds in Earth’s mantle, and the evolution of diamonds through time.