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Early identification of patients colonized with multidrug-resistant organisms (MDROs) facilitates infection control interventions. We assessed a Public Health Risk Model’s ability to predict carbapenem-resistant Enterobacterales and other MDROs.
Methods:
We retrospectively analyzed a medical intensive care unit patient cohort screened at time of admission for MDRO carriage (1/2017–1/2018). Encounters were linked to Illinois Hospital Discharge Data and assigned a public health risk model probability score. We compared the model’s performance to traditional screening strategies that use variables locally available to clinicians at time of admission (i.e., transfer from other hospital, tracheostomy, gastrostomy, pressure ulcer). Model discrimination was evaluated by quantifying the area under the curve (AUC). For each approach, we assessed sensitivity, specificity, and number needed to screen (NNS) to detect one MDRO carrier.
Results:
Model probability calculation was successful in 1237/1250 (98.9%) admissions. The model identified carbapenem-resistant Enterobacterales colonization well (AUC 0.82) and generalized to predict colonization with other healthcare-associated MDROs, including carbapenem-resistant Pseudomonas aeruginosa (AUC 0.82) and vancomycin-resistant enterococci (AUC 0.76). The model did not predict MDROs with known local community reservoirs, i.e., third-generation cephalosporin-resistant Enterobacterales (AUC 0.61) and methicillin-resistant Staphylococcus aureus (AUC 0.59). At the same NNS, the model had higher sensitivity compared to use of traditional screening strategies (68% versus 41%).
Conclusion:
A risk model using patient-level healthcare exposure data from a state public health dataset identified critically ill patients likely to harbor healthcare-associated MDROs at the time of admission.
Pulsed gravity currents are generated by the sequential release of dense material into a lighter ambient. We investigate the dynamics of pulsed gravity currents using physical scale experiments, two-dimensional depth-averaged shallow water equation (SWE) based models and three-dimensional lattice Boltzmann method (LBM) simulations. Integrating these results we show for the first time that short duration pulsed releases generate intrusive layers, which accelerate front propagation relative to an instantaneously released current of the same total volume. Conversely, a long delay time between pulses produces a current that propagates slower than an equivalent instantaneous release. This finding is supported by physical experiments and depth-resolving LBM simulations. The depth-resolving simulations show that intrusions in pulsed flows experience less drag resistance than those generated by instantaneous releases. The depth-averaged model considered in the present study does not accurately capture the intrusive flow dynamics of pulsed currents. However, the limitations of the finite-depth SWE model may be mitigated by extensions to incorporate entrainment and density stratification. The results also motivate further research into the impact of buoyancy Reynolds number and channel slope on the propagation of pulsed currents.
Bystander cardiopulmonary resuscitation (CPR) has been shown to be associated with increased rates of survival from non-traumatic out-of-hospital cardiac arrest (OHCA). GoodSAM is a platform integrated into the computer-assisted dispatch system. The software allows the telecommunicator to send a link to the caller’s smart phone. Once activated, the telecommunicator can see and hear the patient, and obtain breathing and heart rates using the camera and microphone on the caller’s phone. The telecommunicator can use the platform to identify cardiac arrest and provide real-time compression feedback. It was hypothesized that telecommunicator use of video telecommunication would be associated with increased rates of pre-arrival CPR.
Methods:
This was a retrospective review of all cardiac arrest resuscitations performed from July 2021 through February 2022 in the San Antonio Fire Department (SAFD) Emergency Medical Services (EMS) system – the seventh largest city in the United States. Data source was the Office of the EMS Medical Director (OMD) Cardiac Arrest Registry. Inclusion criteria included cardiac arrests for which resuscitation was attempted. Exclusion criteria were cardiac arrest was witnessed by EMS personnel, or missing data. Dataset included: location of arrest, presumed etiology of the arrest, if dispatch CPR instructions were given; caller compliance; type of CPR performed; who witnessed the arrest; and who performed the CPR prior to EMS. Patients were dichotomized as to whether video telecommunication was used by the paramedic telecommunicator. A case was recorded as having received pre-arrival CPR if the initial CPR was performed by anyone other than the responding unit.
Results:
A total of 779 cases were included in the study. Primary outcome, in the cases where video telecommunication was utilized, 46/74 (62%) received pre-arrival CPR, versus 324/705 (46%) without the use of video telecommunication, with an overall difference of 16.2% (95% CI, 4.6% to 27.9%; P = .008). When using video telecommunication, a larger proportion of the persons performing pre-arrival CPR were family members when compared to the cases where video telecommunication was not used (35% versus 17%).
Conclusion:
Using video telecommunication to perform paramedic clinical dispatch telemedicine was associated with an increased rate of pre-arrival CPR. Further research will be required to show outcome-related results to determine if dispatch video and audio telemedicine can be used to increase survival in patients suffering OHCA.
In general, research demonstrates that deprivation, education, health, and well-being are determinants of volunteering, and that volunteering can play an important role in building stronger communities and provides many benefits for individual health and well-being. This study concentrates on the effects of physical and mental health and well-being as predictors when the aspect of socio-economic impact has been minimised. It utilises a unique data set from a UK Housing Association community with generally high levels of deprivation. Data were analysed using bivariate probit regression. In contrast to previous findings, physical health and mental health were not significantly related to volunteering. The key finding was that mental well-being was significantly related to informal volunteering.
We extracted around two million vowel tokens from a sample of sixty-four speakers (b. 1886–1965; 35M/29F; 16 African Americans/48 non-African Americans) across eight states in the American South in an NSF-funded project. We have validated automatic measurements with manual inspection of alignment samples and find that 87 percent of alignments are successful and another 6 percent are partially successful. This large body of tokens (big data) complements existing sociophonetic research by providing a more thorough, detailed picture of the phonetics of American English. We find that (1) there is a much wider range of realization for vowels than is typically represented, and (2) there is no central tendency for any vowel. Using spatial methods drawn from technical geography, we find that all distributions of tokens in vowel space are nonlinear. This suggests that traditional reliance on finding average acoustic properties of a vowel may be unrepresentative of what most speakers actually do. (3) Distributional patterns for vowels are fractal. When we break up the overall dataset into subgroups (e.g., male/female), the same nonlinear distributional pattern appears but with varying locations of highest density of tokens. These findings complement existing sociophonetic research and demonstrate methods by which variation can both be represented and analyzed.
We investigate the convective stability of a thin, infinite fluid layer with a rectangular cross-section, subject to imposed heat fluxes at the top and bottom and fixed temperature along the vertical sides. The instability threshold depends on the Prandtl number as well as the normalized flux difference ($f$) and decreases with the aspect ratio ($\epsilon$), following a $\epsilon f^{-1}$ power law. Using a three-dimensional (3-D) initial value and two-dimensional eigenvalue calculations, we identify a dominant 3-D mode characterized by two transverse standing waves attached to the domain edges. We characterize the dominant mode’s frequency and transverse wavenumber as functions of the Rayleigh number and aspect ratio. An analytical asymptotic solution for the base state in the bulk is obtained, valid over most of the domain and increasingly accurate for lower aspect ratios. A local stability analysis, based on the analytical base state, reveals oscillatory transverse instabilities consistent with the global instability characteristics. The source term for this most unstable mode appears to be interactions between vertical shear and horizontal temperature gradients.
Dry permafrost underlain by ice-cemented permafrost has been reported in several locations in Antarctica. Initially thought to be relic ice, it is now understood that this subsurface ice is in equilibrium with the surface conditions, although it is not in equilibrium with the atmosphere. We use year-round data from University Valley in the Dry Valleys and Elephant Head in the Ellsworth Mountains to investigate the seasonal variations in water vapour flux that control the depth to the ice table under dry permafrost. Our analysis shows that the mean annual water vapour density of the soil surface exceeds the atmospheric value by a factor of up to ~2 due to summer snow. The attenuation and phase shift of the annual temperature cycle with depth result in colder temperatures at the ice table than at the surface of the soil in summer. We conclude that this temperature gradient, combined with the summer snow, provides the flux of water to the ice table necessary to maintain the ice. In University Valley, reducing the snow days by 40% moves the stability depth of the ice table from 42 to 66 cm. Increasing the snow days by 60% shifts the ice table to 17 cm. These variations can explain the observed gradient in the depth to the ice table in University Valley.
Hormone exposure in utero affects male- and female-typical behavior in animals, and these effects may persist in the next generation. Prenatal exposure to diethylstilbestrol (DES), a potent estrogen and endocrine disruptor, has been associated with a tendency toward greater heterosexual behavior in women, but the association in the next generation has not been studied. We evaluated the associations of maternal prenatal DES exposure with sexual behavior, sexual identity, and gender identity in 982 female offspring participating in the National Cancer Institute’s DES Third Generation Study, a cohort born to mothers who were prenatally exposed and unexposed to DES. Odds ratio (OR) and 95% confidence intervals (CIs) were estimated from logistic regression models that included birth year. The ORs were 0.71 (CI 0.46–1.1) for DES in relation to non-heterosexual compared with heterosexual behavior, and 0.99 (CI 0.55–1.8) for non-heterosexual identity, compared with heterosexual identity. Results were similar after additional adjustment for education. Only three individuals reported a gender identity distinct from what was reported by the mother at cohort inception, preventing meaningful quantitative analysis of DES and gender identity. These data do not provide evidence of differences in sexual behavior and sexual identity in female offspring of mothers with and without prenatal exposure to DES.
Embedding climate resilient development principles in planning, urban design, and architecture means ensuring that transformation of the built environment helps achieve carbon neutrality, effective adaptation, and well-being for people and nature. Planners, urban designers, and architects are called to bridge the domains of research and practice and evolve their agency and capacity, developing methods and tools consistent across spatial scales to ensure the convergence of outcomes towards targets. Shaping change necessitates an innovative action-driven framework with multi-scale analysis of urban climate factors and co-mapping, co-design, and co-evaluation with city stakeholders and communities. This Element provides analysis on how urban climate factors, system efficiency, form and layout, building envelope and surface materials, and green/blue infrastructure affect key metrics and indicators related to complementary aspects like greenhouse gas emissions, impacts of extreme weather events, spatial and environmental justice, and human comfort. This title is also available as open access on Cambridge Core.
Irregular war, like war, remains an enduring feature of security studies both as they relate to internal state security and sovereignty as well as to international relations. Irregular war may not always appear to hold political purposes; many today seem driven by religious ideology, but the institution of theocratic governance has a politics of its own. Thus, like regular war, irregular war is subordinate to a political purpose. Whether they occur on the periphery of regular wars or perform roles to keep state competition from escalating into conflict, irregular wars are often intricately tied to their regular counterparts. While two broad theories of counterinsurgency both claim to have prescriptions for winning an irregular fight, one – the good governance approach – is plagued by problems of implementation at the governmental level, and the other – coercion – entails unreasonable brutality against both insurgent and population, often unbefitting a liberal counterinsurgent force.
While the academic study of International Relations immediately following the World Wars was focused on the causes of war and the conditions of peace, the diversification of IR in the mid twentieth century led to the creation of a discrete subfield of security studies. For the remainder of the twentieth century, this subfield focused exclusively on the problem of war – conventional and nuclear – between nation-states. But the end of the Cold War and the proliferation of multiple, opaque, and transnational security risks opened an intellectual space within security studies for a re-envisioning of the analytical approaches to security, as well as to a widening of the agenda. Security was no longer linked exclusively to war but also to a wider range of issues, and security was no longer exclusively conceptualized as the continued existence of the state but applied also to a multitude of actors.
This chapter looks at how energy fits into our understanding of international security as part of the widening of the security agenda. First, we define exactly what energy security means. Then we look at what theories of international security predict around energy security before moving on to a case study of the Middle East as an energy supplier. The chapter rounds out with a look at how the great powers in today’s international system are approaching the energy challenge.
Rational choice theory is a social theory of decision-making that assumes individuals, groups, organizations, and states are strategic actors and thus make rational choices based on their preferences, available information, and the expected outcomes of their actions. The theory is based on the Enlightenment idea that individuals are autonomous and should seek their own self-interest, and that we can determine how an individual should behave by understanding how they might best maximize the utility of their decisions. Game theory is an approach within the rational choice framework that models mathematically the mutual best responses of each player according to their preference orderings.
The concept of human security was first introduced formally in the 1994 UNDP Report and signaled a significant shift of focus from state security to the security of individual human beings and human communities. Unlike the abstract and theoretical debates within academia around that time about deepening and widening the definition of security, the human security approach was born from within the policy world and was policy-oriented. In the thirty years since its introduction, human security has undergone a series of reformulations, come under serious criticism, and inspired significant policy initiatives and numerous debates. Nevertheless, it remains the most formidable contender against traditional state-centered thinking around national and international security. In this chapter, we will look at the emergence and evolution of the human security approach, its core components, and its relationship with other important notions such as human development and responsibility to protect.
Peace Science research is interested in understanding the causal relationships between independent and dependent variables. Based on prior knowledge or existing theories, they develop hypotheses about the strength and direction of impact of independent variables on dependent variables, whether they be arms races and war, economic stability and civil war, or democracy and peace. Quantitative methods provide researchers with a way of confirming or disconfirming these hypotheses.
Critical Security Studies (CSS) is a diverse and multidisciplinary field that approaches traditional security studies through a critical lens and examines the ways in which security discourses and practices reify and reinforce existing power relations and contribute to the marginalization, oppression, and precarity of various groups of people. CSS scholars ask whose security we center when we talk “Security,” and whose security we neglect or sacrifice, what issues are present/absent, who is afforded agency, and who appear only as voiceless victims. They examine the ways in which security and power are intertwined so that evoking security can generate power, enable various kinds of interventions, perpetuate relations of domination and subjugation, and reproduce social hierarchies. Many CSS scholars adopt an interpretivist methodology and normative approach to scientific knowledge; they are interested in analysis not just for the sake of it but for bringing about change to the status quo.