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Myocarditis represents a diverse group of inflammatory diseases affecting the heart muscle, with both infectious and non-infectious etiologies. Among the non-infectious causes, drug-induced hypersensitivity reactions are rare but serious. Isoniazid, a cornerstone in tuberculosis treatment, is known for its hepatotoxicity but has rarely been documented to cause hypersensitivity myocarditis.
Case report:
We present a case of a 15-year-old girl from Eastern Turkmenistan who was admitted to our emergency department with altered consciousness and seizure activity. She was diagnosed with status epilepticus and treated accordingly. The patient, with no prior medical history, was found to have hypotensive shock and myocarditis upon further examination. A detailed history revealed she had ingested 45 tablets of expired isoniazid in a suicide attempt. She was treated with pyridoxine and supportive therapies, resulting in a gradual recovery.
Conclusion:
This case underscores the critical need to consider drug-induced hypersensitivity myocarditis in the differential diagnosis of myocarditis, especially in patients with recent medication use. Prompt recognition and appropriate treatment with pyridoxine, steroid, and supportive cardiac care can be lifesaving. This case also highlights the importance of awareness regarding the potential cardiotoxic effects of isoniazid overdose.
Haemodynamic instability is common after surgical repair of CHDs in infants and children. Monitoring cardiac output in addition to traditional circulation parameters could improve the postoperative care of these patients. Echocardiography and transpulmonary thermodilution are the two most common methods for measuring cardiac output in infants.
Objectives:
To compare the results of cardiac output measurements using echocardiography and a transpulmonary thermodilution setup after paediatric cardiac surgery.
Methods:
Forty children, scheduled for elective repair of a ventricular septal defect or of an atrio-ventricular septal defect using cardiopulmonary bypass, were enrolled in this prospective, observational study. Cardiac output was simultaneously measured using echocardiography and a commercially available transpulmonary thermodilution method (PiCCO™) at 18 h after the end of surgery.
Results:
At 18 h after surgery, PiCCO™ gave a mean of 3.0% higher cardiac output than echocardiography. This difference was not statistically significant. 95% of the observations fell within –50.0 to 82.6%.
Conclusion:
The methods were found to have a good agreement on average, with no statistically significant difference between them. However, the spread of the results was large. It is questionable whether the methods can be used interchangeably in clinical practice.
‘Inhalants’ have been associated with poorer mental health in adolescence, but little is known of associations with specific types of inhalants.
Aims
We aimed to investigate associations of using volatile substances, nitrous oxide and alkyl nitrates with mental health problems in adolescence.
Method
We conducted a cross-sectional analysis using data from 13- to 14-year-old adolescents across England and Wales collected between September 2019 and March 2020. Multilevel logistic regression examined associations between lifetime use of volatile substances, nitrous oxide and alkyl nitrates with self-reported symptoms of probable depression, anxiety, conduct disorder and auditory hallucinations.
Results
Of the 6672 adolescents in the study, 5.1% reported use of nitrous oxide, 4.9% volatile solvents and 0.1% alkyl nitrates. After accounting for multiple testing, adolescents who had used volatile solvents were significantly more likely to report probable depressive (odds ratio = 4.59, 95% CI 3.58, 5.88), anxiety (odds ratio = 3.47, 95% CI 2.72, 4.43) or conduct disorder (odds ratio = 7.52, 95% CI 5.80, 9.76) and auditory hallucinations (odds ratio = 5.35, 95% CI 4.00, 7.17) than those who had not. Nitrous oxide use was significantly associated with probable depression and conduct disorder but not anxiety disorder or auditory hallucinations. Alkyl nitrate use was rare and not associated with mental health outcomes. Adjustment for use of other inhalants, tobacco and alcohol resulted in marked attenuation but socioeconomic disadvantage had little effect.
Conclusion
To our knowledge, this study provides the first general population evidence that volatile solvents and nitrous oxide are associated with probable mental health disorders in adolescence. These findings require replication, ideally with prospective designs.
Twenty years ago, the British Journal of Psychiatry published an editorial regarding racism and psychiatry. Three decades ago, the journal published a lecture by Professor Michael Sheperd about Kraepelin's contributions to racist degeneration theories. A century ago, Albert Einstein visited the Brazilian Academy of Sciences, where he was hosted by Juliano Moreira [1872–1933], one of the most distinguished Brazilian scientists of that time. The only son of a former enslaved woman, he is regarded as one of the founding fathers of scientific psychiatry in Brazil. Moreira may have been a case of ‘exceptional racism’, the strategy of praising outstanding people from oppressed groups as a way of denying or covering up processes of structural racism.
Multi-player pursuit-evasion games are crucial for addressing the maneuver decision problem arising in the cooperative control of multi-agent systems. This paper presents a cooperative defense strategy involving cooperation and confrontation among the target, attacker, and multiple defenders based on location information only. The primary objective of the attacker is to capture the target while avoiding being captured by multiple defenders. Meanwhile, the target is confined to a restricted area and can only move within its boundaries. The proposed cooperative defense strategy aims to prevent the attacker from capturing the target while minimizing the time required to neutralize the threat. Therefore, the multiple defenders are classified into two categories: the primary defender and the auxiliary defenders. The primary defender is to prevent the attacker from approaching the target by predicting the intention of the attacker. On the other hand, the auxiliary defenders adopt a surround-shrink-capture strategy to reduce the time consumption to capture the attacker. Numerical simulations have been conducted to validate the effectiveness of the proposed strategy.
We have established trophoblast cell lines, from parthenogenesis-derived buffalo blastocysts. The buffalo trophoblast cells were cultured continuously over 200 days and 21 passages. These cells were observed by phase-contrast microscopy for their morphology and characterized by reverse transcriptase polymerase chain reaction and immunofluorescence against trophoblast-specific markers and cytoskeletal proteins. Trophoblast cells showed positive staining for CDX2, a marker of these cells at both blastocyst and cell line levels. Epithelial morphology of these cells was revealed by positive staining against cytokeratins and tubulin but not against vimentin and dolichos biflorus agglutinin. Gene expression profiles of many important placenta-specific genes were studied in the primary trophectoderm outgrowths, which were collected on days 0, 5, 9, 12 and 15 of culture and trophoblast cell line at passages 12–15. Therefore, the trophoblast cell line derived can potentially be used for in vitro studies on buffalo embryonic development.
In this article, we describe and explain patterns of variation in acceptance of amn’t in varieties of Scots, drawing upon data from the Scots Syntax Atlas. Partly in line with findings from Bresnan (2001), we show that amn’t is much more widely accepted in inversion environments (amn’t I?) than in declaratives (I amn’t), but nevertheless, amn’t in declaratives is still accepted in certain regions of Scotland. We combine the productivity-based explanation of the amn’t gap in Yang (2016, 2017) with new insights into the syntax of Scots negation from Thoms et al. (2023) to provide a predictive account of the attested variation.
A viscous, lubrication-like response can be triggered in a thin film of fluid squeezed between a rigid flat surface and the tip of an incoming projectile. We develop a scaling for this viscous approach stage of fluid-mediated normal impact, applicable to soft impactors. Under the assumption of mediating fluid being incompressible, the impacting solid displays two limit regimes: one dominated by elasticity, and the other by inertia. The transition between the two is predicted by a dimensionless parameter, which can be interpreted as the ratio between two time scales that are the time that it takes for the surface waves to warn the leading edge of the impactor of the forthcoming impact, and the characteristic duration of the final viscous phase of the approach. Additionally, we elucidate why nearly incompressible solids feature (a) substantial ‘gliding’ prior to contact at the transition between regimes, (b) the largest size of entrapped bubble between the deformed tip of the impactor and the flat surface, and (c) a sudden drop in entrapped bubble radius past the transition between regimes. Finally, we argue that the above time scale ratio (a dimensionless number) can govern the different dynamics reported experimentally for a fluid droplet as a function of its viscosity and surface tension.
Parental mentalization, as the ability to understand mental states (e.g., desires) behind their children’s actions, may play a relevant role in the prevention of future externalizing problems. We conducted a meta-analysis to examine the relationship between parental mentalization and children’s externalizing problems. Six electronic databases were searched for studies, published in English or Spanish, linking empirically those two variables. Participants included caregivers and children between 0 and 18 years. The filtering process yielded 42 studies with 52 effect sizes. Random-effect analysis revealed higher parental mentalization associated with fewer externalizing problems, with an effect size of r = −.19 (95% CI [−.25, −.13]). Due to high heterogeneity (I2 = 83.750), further analyses were conducted to explore factors affecting such association. Parenting experience and children’s developmental stage moderated the relationship, but approaches to operationalize mentalization (MM or PRF), sample type (clinical/at-risk vs. community), and reporting figure (primary caregiver vs. other informants) did not. The study highlights the significance of parental mentalization as a potential contributor to the prevention of externalizing behaviors among infants, children, and adolescents. Our findings may underscore practical implications for equipping caregivers with mentalization skills, helping them to answer appropriately to their children needs.
Due to the flexibility obtained through both materials and structures, soft robots have wide potential applications in complicated internal and external environments. This paper presents a new soft crawling robot with multiple locomotion patterns that integrate inchworm motion and various turning motions. First, the conceptual design of the proposed robot is presented by introducing thick-panel origami into the synthesis of a crawling robot, resulting in a Waterbomb-structure-inspired hybrid mechanism. Second, all locomotion patterns of the robot are precisely described and analyzed by screw theory in an algebraic manner, which include inchworm motion, restricted planar motion, quantitative turning motion, and marginal exploration motion. Then, the output motion parameter for each locomotion pattern is analytically modeled as a function of the robotic dimensional parameters, and the robot can thus be designed and controlled in a customized way for the expected output motion. Finally, the theoretical analysis and derivations are validated by simulation and physical prototype building, which lay the foundations for the design and manufacture of small-scale soft crawling robots with precise output motions in a complex planar environment.
When young people leave the musical world of their school environment, a lack of clear routes into adult musical engagement brings a risk of wasted ability, motivation and enjoyment, which arguably undermines the value of music education. This study explored the factors that influence continued musical participation among young British adults who had been actively engaged in school music. Musical participation is defined in this research as group music-making in either a formal or informal setting. Participants (n = 102) completed an online questionnaire or were interviewed (n = 6) about their past and present musical experiences along with future expectations for music-making. The stark headline finding was that while 87% of participants had intended to continue with music-making beyond school, only 48% had found groups to join. Nonetheless, 78% expected to continue with music-making in the future. Our research therefore suggests that any break from musical participation need not be permanent for individuals who have established strong musical identities through their early experiences. To conclude, we present a model of lifelong musical participation that illustrates the influences, motivations and choices that contribute to sustained musical engagement.
In this study, we aim to estimate the risk of developing clinical multidrug-resistant organism (MDRO) infection with carbapenem-resistant Enterobacterales (CRE), methicillin-resistant Staphylococcus aureus (MRSA), or vancomycin-resistant enterococci (VRE) in colonized patients compared with non-colonized admitted to high-risk areas with a main focus on CRE colonization/infection.
Design and setting:
Retrospective cohort study conducted at a tertiary care facility.
Methods:
This study included patients enrolled in active surveillance testing (AST) for CRE, MRSA, or VRE during the year 2021. Development of relevant invasive infection within 365 days of the AST result was collected as the primary outcome. The association between MDRO colonization and infection was calculated using the risk ratio. The prevalence of CRE organisms and carbapenemase genes is presented.
Results:
A total of 19,134 ASTs were included in the analysis (4,919 CRE AST, 8,303 MRSA AST, and 5,912 VRE AST). Patient demographics were similar between colonized and non-colonized groups. Colonization was associated with an increased risk of infection in the 3 cohorts (CRE, MRSA, and VRE), with risk ratios reported as 4.6, 8.2, and 22, respectively. Most patients (88%) develop CRE infection with the same colonizing carbapenemase gene. Oxa-48/NDM Klebsiella pneumoniae was the most common organism detected in CRE infection.
Conclusions:
The study demonstrated that colonization with CRE, MRSA, or VRE is a risk factor for developing infections caused by the respective bacteria. The high percentage of match between carbapenemase genes detected in colonization and infection indicates that screening results might be used to inform infection management and treatment.
We consider the following problem: the drift of the wealth process of two companies, modelled by a two-dimensional Brownian motion, is controllable such that the total drift adds up to a constant. The aim is to maximize the probability that both companies survive. We assume that the volatility of one company is small with respect to the other, and use methods from singular perturbation theory to construct a formal approximation of the value function. Moreover, we validate this formal result by explicitly constructing a strategy that provides a target functional, approximating the value function uniformly on the whole state space.
This article presents an anatomical variation of the very high take-off right coronary artery from the ascending aorta. Clinical care is complicated by the patient’s double outlet right ventricle and right aortic arch associated with this situation.
This study examines the origin and distribution of clay minerals of the pedological horizons of Kori Ouallam watershed (south-western Niger). It is based on field sampling campaigns and a series of laboratory analyses. A total of 49 samples were analysed, 28 from surface horizons (0–10 cm depth) and 21 from pedological profiles (0–1 m depth). The samples were analysed by X-ray diffraction on bulk and clay (<2 μm) fractions, X-ray fluorescence spectrometry, laser granulometry, organic matter and calcium carbonate content, macroscopic observations (binocular loupe) and scanning electron microscopy equipped with an energy-dispersive spectrometry system. The pedological horizons are characterized by low organic matter contents (<1%) and no calcium carbonate. The particle-size distribution shows net textural differentiation, with a predominance of sandy loam to sandy clay loam textures in the upper horizons and clay loam to clay in the deep horizons. The main major oxides were SiO2 (46.3–89.0%), Al2O3 (5.0–24.2%) and Fe2O3 (1.0–27.9%). Kaolinite (64–98%) is the predominant clay mineral at all horizons, associated with low to moderate proportions of illite (1–34%) and traces of chlorite. Kaolinite is essentially inherited from the parent rock, whereas illite results from chemical alteration by bisialitization of the primary minerals initially rich in potassium feldspar contained in the parent rock. However, soil texture and organic matter vary independently with clay mineralogy. An extended study of all of the pedological facies that make up south-western Niger, combined with supplementary analyses, would further improve our understanding of clay mineralogy in the Sahelian zone.
The Ethics Committee at Memorial Sloan Kettering Cancer Center (MSK) developed a Bioethics Ambassador Program (BAP); a yearlong educational program to assist clinical and non-clinical staff develop the skills to identify and address common burgeoning ethical issues that can arise during the provision of care to patients with cancer. The goal was to provide greater awareness of the role and services of Ethics, particularly at the institution’s geographically-diverse outpatient care centers and to better-instill a culture of preventative ethics. This article discusses the design and implementation of the first two years of the program and analyzes its strengths, weaknesses, and impact on MSK.
Emerging evidence suggests that routine physical activity may improve exercise capacity, long-term outcomes, and quality of life in individuals with Fontan circulation. Despite this, it is unclear how active these individuals are and what guidance they receive from medical providers regarding physical activity. The aim of this study was to survey Fontan patients on personal physical activity behaviours and their cardiologist-directed physical activity recommendations to set a baseline for future targeted efforts to improve this.
Methods:
An electronic survey assessing physical activity habits and cardiologist-directed guidance was developed in concert with content experts and patients/parents and shared via a social media campaign with Fontan patients and their families.
Results:
A total of 168 individuals completed the survey. The median age of respondents was 10 years, 51% identifying as male. Overall, 21% of respondents spend > 5 hours per week engaged in low-exertion activity and only 7% spend > 5 hours per week engaged in high-exertion activity. In all domains questioned, pre-adolescents reported higher participation rates than adolescents. Nearly half (43%) of respondents reported that they do not discuss activity recommendations with their cardiologist.
Conclusions:
Despite increasing evidence over the last two decades demonstrating the benefit of exercise for individuals living with Fontan circulation, only a minority of patients report engaging in significant amounts of physical activity or discussing activity goals with their cardiologist. Specific, individualized, and actionable education needs to be provided to patients, families, and providers to promote and support regular physical activity in this patient population.
Numerous flying and swimming creatures use the ground effect to boost their propulsive performance, with the ‘ground’ referring to either a solid boundary or a free surface. While our knowledge of how a solid boundary affects biolocomotion is relatively comprehensive, the ground effect of a free surface is not fully understood. To address this limitation, we conduct a numerical investigation on the propulsion performance of a flapping plate under a free surface, subject to a range of control parameters. When the Froude number ($Fr$) is very low (i.e. little surface deformation), the effects of a free surface are similar to those of a solid boundary, with enhanced thrust and input power but little change in efficiency. However, as $Fr$ increases (i.e. more surface deformation), our results reveal an optimal $Fr$ of approximately 0.6, where the free surface induces a more streamlined flow around the flapping plate, effectively reducing the added mass. This results in a significant decrease in input power and greatly enhanced efficiency.