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To assess whether antibiotic duration (AD) and one-year antibiotic-free days (AFD) are associated with key in-hospital and post-discharge outcomes among critically ill adults.
Design:
Prospective observational study.
Setting:
611-bed, quaternary care academic medical center in the United States.
Patients:
126 critically ill adults (mean age 68.1 ± 15.6 yr, 51.6% male, median APACHE II score 20.5 [IQR 15–25]); 71.4% met sepsis criteria.
Methods:
Secondary infection was defined as ≥3 consecutive antibiotic days within a year after the index sepsis admission. Multivariate analyses adjusted for age, APACHE II score, BMI, and glucocorticosteroid dose. Time-to-event analysis employed Cox proportional hazards modeling; cumulative infection burden was assessed via nonparametric tests using normalized antibiotic exposure (AD as a proportion of days alive).
Results:
Within 30 days, longer AD correlated with increased hospital stay; each additional antibiotic day added ∼0.93 hospital days (P < 0.001) in adjusted linear regression. AD did not predict one-year mortality (OR 1.01, P = 0.739) or readmission (OR 1.01, P = 0.771). Normalized antibiotic exposure significantly differed by cumulative secondary infection episodes (P = 0.0033), with higher exposure among patients experiencing two or more secondary infections (P = 0.026 and P = 0.036, respectively). Cox regression showed a significant association between AD and time to first secondary infection (HR 1.10, 95% CI: 1.04–1.15, P = 0.001), indicating that longer AD predisposed to secondary infection or recurrent antibiotic use.
Conclusions:
Extended AD, in critically ill patients, prolongs hospitalization without reducing mortality or readmission rates. These findings highlight the importance of robust antibiotic stewardship practices, where shorter, targeted regimens may minimize unintended complications.
People living with mental illness report a broad spectrum of nutrition risks, beyond malnutrition, but appropriate and adequately validated nutrition risk screening tools for mental health settings are lacking. This study aimed to develop a nutrition-risk screening tool, the NutriMental Screener, and to perform preliminary feasibility and validity testing. In an international, stakeholder engaging approach, a multifaceted nutrition-risk screening tool for mental health services was developed by means of workshops with international stakeholders and two online surveys. Feasibility of the NutriMental screener was tested as part of a research study in Switzerland with 196 participants, evenly distributed across the three study groups (sixty-seven outpatients and sixty-five inpatients with psychotic or depressive disorders as well as sixty-four controls without mental illness). The NutriMental screener consists of ten items covering different nutritional issues that indicate the need for referral to a dietitian or clinical nutritionist. Almost all patients (94·7 %) reported at least one nutrition risk by means of the NutriMental screener. Prevalence for nutrition risks via NutriMental screener was higher in patients than in controls. Almost every second patient expressed a desire for nutritional support (44·7 %). After further validity testing is completed, there is the potential for the NutriMental Screener to replace malnutrition screening tools as routine screening in various mental health settings aiming to organise nutritional therapy prescriptions in a more targeted and efficient manner.
Tongue base mucosectomy identified cancer in 78 per cent of cancers of unknown primary in a recent meta-analysis. The carbon dioxide laser is an alternative technique if there is no access to a robot. This study aimed to describe the steps for undertaking tongue base mucosectomy using the carbon dioxide laser and its diagnostic utility in cancers of unknown primary.
Method
This was a prospective feasibility study utilising carbon dioxide laser for tongue base mucosectomy in cancers of unknown primary. Data collected included demographic data and p16 status.
Results
There were 14 cancers of unknown primary with 86 per cent p16 positivity on immunohistochemistry. Laser tongue base mucosectomy alone identified the cancer primary in 7 of 12 (58 per cent) cancers of unknown primary among p16 positive tumours and 0 of 2 (0 per cent) among p16 negative tumours. Combining bilateral tonsillectomy with laser tongue base mucosectomy resulted in identification of the primary cancer in 8 of 12 (67 per cent) p16 positive tumours.
Conclusion
In centres without a robot, tongue base mucosectomy using the carbon dioxide laser is a viable alternative, especially in combination with bilateral tonsillectomy in p16 positive cases.
Advances in endoscopic technology have allowed transnasal oesophagoscopy to be used for a variety of diagnostic and therapeutic procedures.
Method
A review of the literature was carried out to look into the extended role of transnasal oesophagoscopy within otolaryngology, using the Embase, Cinahl and Medline databases.
Results
There were 16 studies showing that transnasal oesophagoscopy is safe and cost effective and can be used for removal of foreign bodies, tracheoesophageal puncture, laser laryngeal surgery and balloon dilatation.
Conclusion
This study presents a summary of the literature showing that transnasal oesophagoscopy can be used as a safe and cost-effective alternative or adjunct to traditional rigid endoscopes for therapeutic procedures.
The rocky shores of the north-east Atlantic have been long studied. Our focus is from Gibraltar to Norway plus the Azores and Iceland. Phylogeographic processes shape biogeographic patterns of biodiversity. Long-term and broadscale studies have shown the responses of biota to past climate fluctuations and more recent anthropogenic climate change. Inter- and intra-specific species interactions along sharp local environmental gradients shape distributions and community structure and hence ecosystem functioning. Shifts in domination by fucoids in shelter to barnacles/mussels in exposure are mediated by grazing by patellid limpets. Further south fucoids become increasingly rare, with species disappearing or restricted to estuarine refuges, caused by greater desiccation and grazing pressure. Mesoscale processes influence bottom-up nutrient forcing and larval supply, hence affecting species abundance and distribution, and can be proximate factors setting range edges (e.g., the English Channel, the Iberian Peninsula). Impacts of invasive non-native species are reviewed. Knowledge gaps such as the work on rockpools and host–parasite dynamics are also outlined.
In several recently published phylogenetic analyses, two Lower Devonian taxa, Doliodus and Pucapampella, both fall on the chondrichthyan stem, very close to the base of ‘conventionally defined chondrichthyans’ (i.e., forms possessing tessellated mineralization of the cartilaginous endoskeleton). These two taxa nevertheless exhibit strongly discordant morphologies from each other. A summary of the anatomical data concerning these taxa is presented here, including new, as well as previously published, findings. A new family Pucapampellidae is erected, containing Pucapampella and a newly recognized genus from South Africa. Morphological evidence is summarized for the monophyly of crown elasmobranchs (sharks and rays), holocephalans (chimaeras) and other chondrichthyans. Based on these data, Doliodus and pucapampellids both fall outside the chondrichthyan crown, but their relative phylogenetic positions on the chondrichthyan stem are unclear. Pucapampellid interrelationships are particularly hard to assess because little is known beyond their cranial and visceral arch morphology and also because pucapampellids possess a suite of ontogenetically primitive (and thus potentially neotenic) features. By contrast, the phylogenetic position of Doliodus seems less elusive; it possessed an ‘acanthodian-like’ complex of dermal spines, including pectoral fin spines, prepectoral, admedian, and prepelvic spines, and possibly dorsal and pelvic fin spines, in conjunction with numerous ‘chondrichthyan-like’ endoskeletal features and a heterodont ‘sharklike’ dentition. Doliodus can be viewed as a quintessential component of the evolutionary transition between ‘acanthodians’ and ‘conventionally defined chondrichthyans’, leaving little doubt that the chondrichthyan total group includes ‘acanthodians’ (now widely perceived to be a paraphyletic group, populating the basal part of the chondrichthyan stem). Although Doliodus has been resolved as a basal member of the ‘conventionally defined chondrichthyans’, it could occupy a more basal position on the chondrichthyan stem.
There is an increasing incidence of overweight/obesity and mental health disorders in young adults and the two conditions often coexist. We aimed to investigate the influence of antenatal and postnatal factors that may underlie this association with a focus on maternal prenatal smoking, socio-economic status and gender. Data from the Western Australian Pregnancy Cohort (Raine) Study (women enrolled 1989–1991) including 1056 offspring aged 20 years (cohort recalled 2010–2012) were analyzed (2015–2016) using multivariable models for associations between offspring depression scores (DASS-21 Depression-scale) and body mass index (BMI), adjusting for pregnancy and early life factors and offspring behaviours. There was a significant positive relationship between offspring depression-score and BMI independent of gender and other psychosocial covariates. There was a significant interaction between maternal prenatal smoking and depression-score (interaction coefficient=0.096; 95% CI: 0.006, 0.19, P=0.037), indicating the relationship between depression-score and BMI differed according to maternal prenatal smoking status. In offspring of maternal prenatal smokers, a positive association between BMI and depression-score (coefficient=0.133; 95% CI: 0.05, 0.21, P=0.001) equated to 1.1 kg/m2 increase in BMI for every 1standard deviation (8 units) increase in depression-score. Substituting low family income during pregnancy for maternal prenatal smoking in the interaction (interaction coefficient=0.091; 95% CI: 0.01, 0.17, P=0.027) showed a positive association between BMI and depression score only among offspring of mothers with a low family income during pregnancy (coefficient=0.118; 95% CI: 0.06, 0.18, P<0.001). There were no significant effects of gender on these associations. Whilst further studies are needed to determine whether these associations are supported in other populations, they suggest potentially important maternal behavioural and socio-economic factors that identify individuals vulnerable to the coexistence of obesity and depression in early adulthood.
Brain tumors are the most common solid tumors in children in Canada. While technological advances have increased their survival rates, survivors of childhood brain tumors (SCBT) often develop obesity, which can reduce lifespan and quality of life. While adiposity is a known factor for cardiometabolic disorders in the general population, adiposity patterns in SCBT have not been determined. This study aims to investigate how adiposity patterns differ between SCBT and non-cancer controls, and how lifestyle and treatment factors may contribute to these patterns. Methods: Fifty-nine SCBT and 108 non-cancer controls were recruited from the clinics at McMaster Children’s Hospital. Sociodemographic and lifestyle details were collected using standardized tools to assess diet, physical activity, and sleep. Brain tumor type, location and treatment details were obtained from medical records. Total and visceral adiposity were determined by total fat mass (FM) as well as waist-to-hip (WHR) and waist-to-height ratio (WHTR). Results: SCBT have higher total and visceral adiposity, while BMI is similar to controls. Female SCBT who received radiotherapy and/or chemotherapy have higher adiposity. A dietary pattern of white bread and fried foods with low dark bread was positively associated with adiposity. Lower physical activity levels, but not sleep durations, were associated with higher adiposity. Conclusion: SCBT have higher visceral and total adiposity than non-cancer controls. Sex, chemoradiotherapy, high fat diet, and physical inactivity, can contribute to these adiposity patterns. These results provide multiple points of entry to design interventions that reduce adiposity, and may improve long-term outcomes in SCBT.
Rare scales of agnathan thelodonts Paralogania ludlowiensis and Thelodus sp. cf. T. parvidens, or alternatively Thelodus macintoshi, and acanthodian fishes Nostolepis striata, Gomphonchus sp., Gomphonchoporus sp. aff. G. hoppei, and Machaeraporus stonehousensis (Legault) n. gen., plus acanthodian fin spines, teeth and tooth whorls have been identified from the upper Moydart and Stonehouse formations near Arisaig, Nova Scotia. The assemblage agrees well with the late Silurian (uppermost Ludlow–Přídolí) age assigned to these strata based on invertebrate assemblages, and the vertebrate taxa show affinity with British and Baltic faunas of this age. All vertebrate-bearing strata were deposited in various positions off the western shores of the Avalonia terrane during or after its collision with Laurentia.
During the past several years, the US federal government has increased its role in preparing for and responding to natural and manmade disasters. The support and services that federal agencies provide to communities to address the psychological impact of trauma on citizens of all ages are valuable assets before and after a disaster. We used trauma theory to analyze disaster behavior health, assess the needs of at-risk populations, and identify the resources that the Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, offers to the nation to assist communities in the psychological recovery process. (Disaster Med Public Health Preparedness. 2014;0:1–5)
The incidence of obesity and type 2 diabetes mellitus (T2DM) is increasing, and new experimental models are required to investigate the diverse aspects of these polygenic diseases, which are intimately linked in terms of aetiology. Feline T2DM has been shown to closely resemble human T2DM in terms of its clinical, pathological and physiological features. Our aim was to develop a feline model of diet-induced weight gain, adiposity and metabolic deregulation, and to examine correlates of weight and body fat change, insulin homeostasis, lipid profile, adipokines and clinical chemistry, in order to study associations which may shed light on the mechanism of diet-induced metabolic dysregulation. We used a combination of partially hydrogenated vegetable shortening and high-fructose corn syrup to generate a high-fat–high-fructose diet. The effects of this diet were compared with an isoenergetic standard chow, either in the presence or absence of 1·125 % dietary monosodium glutamate (MSG). Dual-energy X-ray absorptiometry body imaging and a glucose tolerance test were performed. The present results indicate that dietary MSG increased weight gain and adiposity, and reduced insulin sensitivity (P < 0·05), whereas high-fat–high-fructose feeding resulted in elevated cortisol and markers of liver dysfunction (P < 0·01). The combination of all three dietary constituents resulted in lower insulin levels and elevated serum β-hydroxybutyrate and cortisol (P < 0·05). This combination also resulted in a lower first-phase insulin release during glucose tolerance testing (P < 0·001). In conclusion, markers of insulin deregulation and metabolic dysfunction associated with adiposity and T2DM can be induced by dietary factors in a feline model.
We report a unique case of a mucocele of a pneumatised uncinate process.
Method:
Clinical, radiological and intra-operative findings are presented.
Results:
A 43-year-old woman was referred to our ENT department suffering from persistent symptoms of left-sided sinusitis. Although an initial computed tomography scan suggested a lacrimal duct mass, dacrocystography showed free flow through the nasolacrimal duct. The patient underwent surgery, revealing a mucocele within a pneumatised uncinate process.
Conclusion:
This patient's clinical, radiological and intra-operative findings illustrate how variations in sinus anatomy can pose a diagnostic challenge.
This paper describes a solid-phase microtitre plate enzyme-linked immunosorbent assay (ELISA) for the detection of antibodies to equine influenza viruses. Using egg-grown influenza viruses as the antigens attached to the solid phase, crossreactions were observed between an H7N7 equine virus (designated A1) and an H3N8 equine influenza virus (designated A2) when untreated antisera were tested. Absorption of antisera with egg-grown A/Porcine/Shope/1/33 influenza virus eliminated cross-reactive antibodies so that specific detection of anti-equine influenza A1 or A2 antibodies was possible.
Examination of horse sera following vaccination with A1 and/or A2 isolates showed that antibodies were produced against antigen associated with egg allantoic fluid as well as against virus. Such antibodies were eliminated following the absorption of antisera with porcine influenza virus. Results using sera from horses with known vaccination histories confirmed that the ELISA preferentially detected antibodies homologous to the antigen attached to the solid phase and methods to evaluate the current serological state of individual horses by relating the titres of specific antibodies against equine influenza A1 and A2 isolates are shown. This ELISA provides a simple and rapid method of assessing specific antibodies from horse sera and offers advantages over the ‘routine’ HI and SRH assessments since it gives high precision, is economical of reagents and has the capacity to handle large numbers of serum samples.
Aurora is a short-pulse high-power krypton-fluoride laser system that serves as an end-to-end technology demonstration prototype for large-scale ultraviolet laser systems of interest for short wavelength inertial confinement fusion (ICF) studies. The system is designed to employ optical angular multiplexing and serial amplification by electron-beam-driven KrF laser amplifiers to deliver 248 nm, 5-ns duration multi-kilojoule laser pulses to ICF targets using a beam train of approximately 1 km in length.
In this paper, we will discuss the goals for the system and summarize the design features of the major system components: front-end lasers, amplifier train, optical train, and the alignment and controls systems.
The as-deposited passivation quality of amorphous silicon films on crystalline silicon surfaces is dependent on deposition conditions and resulting hydrogen bonding structure. However the initial surface passivation can be significantly improved by low temperature post-deposition anneal. For example an improvement in effective lifetime from 780 μsec as-deposited to 2080 μsec post-anneal is reported in the present work. This work probes the hydrogen bonding environment using monolayer resolution Brewster angle transmission Fourier transform infrared spectroscopy of 100 Å thick films. It is found that there is significant restructuring at the a-Si:H / c-Si interface upon annealing and a gain of mono-hydride bonding at the c-Si surface is detected. Calculations show an additional 3.56 − 4.50 × 1014 cm−2 mono-hydride bonding at c-Si surface due to annealing. The estimation of the surface hydride oscillator strength in transmission mode is reported for the first time to be 7.2 × 10−18 cm on Si (100) surface and 7.5 × 10−18 cm on Si (111).
Mysticism is on the rise as a topic of cultural interestand as a part of the burgeoning interest in “spirituality” that has defined the cultural temperament of our times. This shift has had a predictable effect on the kinds of students enrolling in mainline Protestant seminaries, as well on as the interests they bring. All this would have surprised faculty members of an earlier generation. If mysticism was touched upon at all in the seminary curriculum of, say, 1980, it was a topic left to the historians; survey courses in systematic theology generally would not have ventured into such arcane territory. When referred to, sources categorized as mystical—for example, Hildegard of Bingen, Meister Eckhart, Julian of Norwich—were relegated to a shaky status at the fringes of theology; the “real” theological contributors included such great scholastics as Anselm, Aquinas, and Bonaventure. The textbooks used during this period illustrate the point: Williston Walker's standard History of the Christian Church, which appeared in its first edition in 1918 and was in steady use in many theological schools, was significantly revised by a team of historians from Union Theological Seminary only for the fourth edition of 1985. Until that time, the narrative focus moved rather quickly from an exploration of Christian origins and the early fathers to the great Protestant reformers with a relatively cursory overview of the Middle Ages and almost no reference to medieval mystics.
This paper reports the first study of breeding in the boreo-arctic barnacle Semibalanus balanoides in which latitudinal variation in timing of egg mass hardening has been examined simultaneously over the geographical scale involved, thereby excluding temporal confounding of the data. The timing of autumn egg mass hardening on the middle shore was established in 2002 and 2003 at ten stations ranging latitudinally from Trondheim (63°24′N) to Plymouth (50°18′N). To assess variation at local scale (<10 km), breeding was studied on three shores at each of two Irish locations (Cork and Galway). At Oban (Scotland) and Cork, the effect of shore height on timing of breeding was investigated. A strong influence of latitude and day length on timing of breeding was found in both 2002 and 2003. In both years, barnacles bred much earlier (when day length was longer) at high rather than low latitudes. No significant effect of environmental temperature or insolation on timing of breeding was detected. Shores no more than 10 km apart showed minimal difference in middle shore breeding date (<4 days). However, upper shore barnacles bred significantly earlier (by 7–13 days) than middle shore animals. The data indicate that breeding is controlled by period of daily darkness, with high shore animals encountering longer effective ‘nights’ because of the opercular closure response to emersion (which will reduce light penetration to tissues). Predictions concerning the effects of global changes in climate and cloud cover on breeding and population distribution are made. It is suggested that increased cloud cover in the northern hemisphere is likely to induce earlier breeding, and possibly shift the present southern limit of Semibalanus southwards.
Gilliland et al. (2000) have reported HST photometric observations of 34000 stars in the globular cluster 47 Tuc, showing an absence of close-in giant planets in that cluster relative to their frequency in the solar neighborhood. Here we describe the methods of time-series analysis that were used to search the 47 Tuc data for transits by giant extrasolar planets, and the means by which these methods were validated.