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The coronavirus disease 2019 (COVID-19) pandemic highlighted the importance of robust infection prevention and control (IPAC) practices to maintain patient and staff safety. However, healthcare workers (HCWs) face many barriers that affect their ability to follow these practices. We identified barriers affecting HCW adherence to IPAC practices during the pandemic in British Columbia, Canada.
Design:
Cross-sectional web-based survey.
Setting:
Acute care, long-term care or assisted living, outpatient, mental health, prehospital care, and home care.
Participants:
Eligible respondents included direct-care providers and IPAC professionals working in these settings in all health authorities across British Columbia.
Methods:
We conducted a web-based survey from August to September 2021 to assess respondent knowledge and attitudes toward IPAC within the context of the COVID-19 pandemic. Respondents were asked to rate the extent to which various barriers affected their ability to follow IPAC practices throughout the pandemic and to make suggestions for improvement.
Results:
The final analysis included 2,488 responses; 36% of respondents worked in acute care. Overall, perceptions of IPAC practice among non-IPAC professionals were positive. The main self-perceived barriers to adherence included inadequate staffing to cover absences (58%), limited space in staff rooms (57%), multibed rooms (51%), and confusing messages about IPAC practices (51%). Common suggestions for improvement included receiving more support from IPAC leadership and clearer communication about required IPAC practices.
Conclusions:
Our findings highlight frontline HCW perspectives regarding priority areas of improvement for IPAC practices. They will inform policy and guideline development to prevent transmission of COVID-19 and future emerging infections.
Laser-plasma instabilities (LPI) play a detrimental role in energy coupling to the target in inertial confinement fusion (ICF). The recent development of applied strong magnetic fields for use in ICF and laboratory astrophysics experiments has opened opportunities to investigate the role of external magnetic fields on LPIs. Recent numerical studies have shown that stimulated Raman scattering (SRS) can be mitigated by external magnetic fields in the kinetic regime of the instability and warrant systematic experimental studies to validate modelling. To this end, we design experiments at the OMEGA-EP laser facility to investigate the effect of an external perpendicular $B$-field of 5–30 T on the backscattered light spectrum from a gas-jet target. We present measurements from a proof-of-principle experiment, where the backward-SRS (BSRS) is in the kinetic regime, for which the magnetization is expected to produce the greatest effects on instability growth. New simulations motivated by this experiment are used to inform the proposal of an upgraded experimental design. Our simulation predictions show that the new design is suited to experimentally demonstrating BSRS mitigation by an external magnetic field, despite the magnetization effects on the hydrodynamics, as well as the inherent temporal and spatial variations in plasma conditions.
A G4C2 repeat extension in the first intron of C9ORF72 is the most common cause of familial frontotemporal dementia with and without motoneuron disease or atypical Parkinsonism. We recently found that the characteristic p62 positive/TDP43 negative neuronal cytoplasmic inclusions (NCIs) mainly seen in cerebellum und hippocampus consist of different dipeptide repeat proteins (DPRs) generated by an ATG independent translation of stable sense and antisense transcripts of the extended intron.
After creating specific antibodies against all potential DPRs resulting from different reading frames, we investigated their regional and cellular distribution pattern in the central nervous system of autopsy cases with C9ORF72 mutation by immunohistochemistry.
Aggregates of all DPRs were seen in neuronal cell bodies and processes. Glycine-alanine and glycine-prolin DPRs dominated. NCIs were abundant in all neocortical areas, in the hippocampal formation and in cerebellum, less frequent in subcortical nuclei, and rare in brain stem and spinal cord following a rostro-caudal gradient. Different DPRs were found in the same NCI. The regional distribution pattern of NCIs was similar in all clinical subtypes, and did not directly correlate with neurodegeneration. DPRs and TDP43 that usually also aggregates in C9ORF72 mutation cases were rarely co-localized in the same NCI. In case of co-localization DPR proteins formed a central core surrounded by TDP43.
The detection of DPR inclusions directly connects the mutation with specific neuropathological alterations. The formation of DPR inclusions seems to precede the formation of TDP43 inclusions. If there is a neurotoxic effect of DPRs, DPR inclusions might be neuroprotective.
Brain amyloid-β protein (Aβ) deposition is a key pathology of Alzheimer's disease (AD). Cholinergic degeneration, including reductions in α7 nicotinic acetylcholine receptors (α7-nAChR), is also known as a pathophysiology of AD. Recent imaging studies have shown cognitively normal subjects with Aβ depositions, indicating a missing link between Aβ deposition and cognitive decline.
Objectives
To clarify relationships among the Aβ burden, α7-nAChR availability, and cognitive declines in AD.
Aims
To measure brain Aβ deposition and α7-nAChR availability in the same patients with AD using positron emission tomography (PET).
Methods
Twenty AD patients and age-matched 20 healthy adults were studied. The α7-nAChR availability and Aβ deposition were evaluated using PET with [11C]MeQAA and [11C]PIB, respectively. Levels of specific binding were estimated by a simplified reference tissue method (BPND) for [11C]MeQAA and a tissue ratio method (SUVR) for using [11C]PIB. The values were compared with clinical measures of various cognitive functions using regions of interest (ROIs)-based and statistical parametric mapping (SPM) analyses.
Results
[11C]MeQAA BPND levels were extensively lower in the cholinergic projection regions of AD. There was a significant negative correlation between [11C]PIB SUVR and [11C]MeQAA BPND in the nucleus basalis of Mynert (NBM). The NBM [11C]PIB SUVR was negatively correlated with the [11C]MeQAA BPND level in the anterior and posterior cingulate cortices, whereas the relation within the same region showed weak correlation. Also we found significant correlation between cognitive decline and [11C]MeQAA BPND levels in the NBM.
Conclusions
Aβ deposition-linked α7-nAChR dysfunction may account for cognitive decline in AD.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
It has been said that nearly 30% of the patients with Alzheimer’ disease (AD) manifest loss of appetite, which might increase cognitive impairments and the incidence of neuropsychiatric symptoms, and malnutrition. As a result, a vicious cycle decreases functionality and quality of life in patients with AD. Cholinesterase inhibitors (ChEIs) is the first-line drugs in the treatment of AD. On the one hand, appetite or weight loss can be seen due to gastrointestinal side effects in the treatment of ChEIs. On the other hand, there are some reports in clinical-settings that patients with AD treated with rivastigmine transdermal patch showed the improvement of appetite loss.
Objectives
To evaluate the efficacy of rivastigmine transdermal patch in AD patients with poor appetite.
Methods
In this 16-weeks, multicenter prospective study, patients with mild to moderate AD, who manifest loss of appetite and began to receive rivastigmine transdermal patch therapy, were enrolled. The amount of food, total time-eating, body weight, Mini Mental State Examination (MMSE) and Neuropsychiatric Inventory (NPI) were evaluated.
Results
The amount of food eaten by treated patients significantly increased 10.5% at 8 weeks after the initiation of rivastigmine transdermal patch therapy.
Comments
This preliminary results might show favourable effects of rivastigmine transdermal patch therapy on AD patients with loss of appetite.
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.
Strontium-rich epidote, including epidote-(Sr) and epidote with major amounts of Sr (i.e. epidote containing up to 17.3 wt.% SrO), was found in pumpellyite schist and epidote blueschist in a tectonic block in the serpentinite mélange of the Kurosegawa Zone, central Kyushu, Japan.The tectonic block is 20 m wide and made primarily of lawsonite blueschist, with subordinate amounts of pumpellyite schist and epidote blueschist. The pumpellyite schist typically occurs at the edge of the block and is composed mainly of pumpellyite with subordinate amounts of strontium-poorepidote, albite and chlorite, and thin veins of fine-grained calcite and clinopyroxene. Epidote-(Sr) forms rims around strontium-poor epidote, fills fractures in strontium-poor epidote and also occurs interstitially between pumpellyite aggregates and along the boundaries between pumpellyiteand calcite-clinopyroxene veins. The epidote blueschist is found between the pumpellyite schist and lawsonite blueschist, and consists mainly of sodic amphibole, epidote and titanite, with albite veining. Strontium-rich epidote occurs as rims, replacing Sr-poor epidote near the albite vein.The bulk strontium contents of the rocks are as follows: lawsonite blueschist (200 ppm), epidote blueschist (2800 ppm) and pumpellyite schist (~10,700 ppm). The chemical and petrological characteristics of the Sr-rich epidote-bearing metabasites suggest that the infiltration of a metamorphicfluid promoted extensive Sr metasomatism during the later stages of high-pressure metamorphism.
A comprehensive study of ice-crystal fabrics and textures was conducted on the Dome F (Antarctica) ice core. Crystal ,-axis orientations, crystal sizes and crystal shape were measured on thin sections with an automatic ice-fabric analyzer. The general feature of textural and fabric development through a 2500 m long core was obtained by a 20 m interval study. Crystal size steadily increases with depth except for depths of about 500,1800, 2000, 2200 and 2300 m, at which depths crystal size decreases suddenly. There is a clear correlation between crystal-size and ´18O values. Crystals tend to elongate horizontally with depth, and the aspect ratio (long axis vs short axis of a grain) increases twofold at 1600 m depth and fluctuates below that depth. The .-axis orientation fabrics gradually change with depth from a random orientation pattern near the surface to a strong vertical single maximum at 2500 m. These are very similar to those from the GRIP (Greenland) core The observations of crystal shape and the fabric measurements indicate that nucleation-recrystallization does not take place at Dome F.
We compared the cost-effectiveness (CE) of an active case-finding (ACF) programme for household contacts of tuberculosis (TB) cases enrolled in first-line treatment to routine passive case-finding (PCF) within an established national TB programme in Peru. Decision analysis was used to model detection of TB in household contacts through: (1) self-report of symptomatic cases for evaluation (PCF), (2) a provider-initiated ACF programme, (3) addition of an Xpert MTB/RIF diagnostic test for a single sputum sample from household contacts, and (4) all strategies combined. CE was calculated as the incremental cost-effectiveness ratio (ICER) in terms of US dollars per disability-adjusted life years (DALYs) averted. Compared to PCF alone, ACF for household contacts resulted in an ICER of $2155 per DALY averted. The addition of the Xpert MTB/RIF diagnostic test resulted in an ICER of $3275 per DALY averted within a PCF programme and $3399 per DALY averted when an ACF programme was included. Provider-initiated ACF of household contacts in an urban setting of Lima, Peru can be highly cost-effective, even including costs to seek out contacts and perform an Xpert/MTB RIF test. ACF including Xpert MTB/RIF was not cost-effective if TB cases detected had high rates of default from treatment or poor outcomes.
An automatic ice fabric analyser has been developed which precisely determines both c- and a-axes of the individual grains in a thin polycrystalline ice specimen by the use of X-ray Laue method (eg Cullity 1956). The method of analysis is computer-aided indexing of the zone-axes in X-ray Laue patterns. Crystal orientations can be automatically determined by the analyser with an error of approximately 0.6_. Time for analysing one specimen containing 100 grains is approximately three hours at present.
Glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) are the incretin hormones secreted from the intestine in response to enteral feeding to stimulate insulin secretion. We investigated the relationship serum GIP and GLP-1 levels with gestational age, and insulin secretion in preterm infants. Serum GIP and GLP-1 levels were measured at birth and at 1, 2 and 4 weeks after birth in 30 infants, including 12 born before 30th week of gestation (early group) and 18 born after 30th week of gestation (late group). Blood glucose and serum insulin levels were measured, and the quantitative insulin sensitivity check index (QUICKI) was also calculated. The levels of GLP-1 at 2 and 4 weeks were significantly higher in the early group than those in the late group. The levels of GIP were not significantly different between two groups. At 4 weeks, serum insulin level was significantly higher and QUICKI was significantly lower in the early group. Furthermore, GLP-1 levels were significantly correlated with QUICKI and the serum insulin levels in all infants at 4 weeks. In preterm infants, enteral feeding to premature intestine may be associated with GLP-1 secretion. GLP-1 is also related to stimulated insulin secretion in early postnatal period.
Enhancement of the quality of laser wake-field accelerated (LWFA) electron beams implies the improvement and controllability of the properties of the wake waves generated by ultra-short pulse lasers in underdense plasmas. In this work we present a compendium of useful formulas giving relations between the laser and plasma target parameters allowing one to obtain basic dependences, e.g. the energy scaling of the electrons accelerated by the wake field excited in inhomogeneous media including multi-stage LWFA accelerators. Consideration of the effects of using the chirped laser pulse driver allows us to find the regimes where the chirp enhances the wake field amplitude. We present an analysis of the three-dimensional effects on the electron beam loading and on the unlimited LWFA acceleration in inhomogeneous plasmas. Using the conditions of electron trapping to the wake-field acceleration phase we analyse the multi-equal stage and multiuneven stage LWFA configurations. In the first configuration the energy of fast electrons is a linear function of the number of stages, and in the second case, the accelerated electron energy grows exponentially with the number of stages. The results of the two-dimensional particle-in-cell simulations presented here show the high quality electron acceleration in the triple stage injection–acceleration configuration.
This paper describes the SPICA array at Akeno, and discusses recent efforts made to improve the angular resolution of the array, concentrating on the determination of the departure of the shower front from a plane. Future research plans are also outlined.
Herpes simplex virus (HSV) is one of the most commonly identified infectious aetiologies of encephalitis in North America and Europe. The epidemiology of encephalitis beyond these regions, however, is poorly defined. During 2009–2012 we enrolled 313 patients in a multicentre prospective study of encephalitis in Peru, 45 (14·4%) of whom had confirmed HSV infection. Of 38 patients with known HSV type, 84% had HSV-1 and 16% had HSV-2. Patients with HSV infection were significantly more likely to present in the summer months (44·4% vs. 20·0%, P = 0·003) and have nausea (60·0% vs. 39·8%, P = 0·01) and rash (15·6% vs. 5·3%, P = 0·01) compared to patients without HSV infection. These findings highlight differences in the epidemiology and clinical presentation of HSV encephalitis outside of the Northern Hemisphere that warrant further investigation. Furthermore, there is an urgent need for improved HSV diagnostic capacity and availability of intravenous acyclovir in Peru.
A simplified procedure of synthesizing nano-sized hollow silicate particles (NHSPs) of 80-200 nm in average diameter and approximately 30 nm in wall thickness via (soft template) soluble-poly(methacrylic acid) sodium salt (NaPMA) is presented here. The process is easily scalable and can be carried out at ambient temperature. When deposited as thin (nanolayer) film, NHSPs show good transparency in visible spectra range and good sorption of CO2 for thermal energy efficiency especially in the field of thermal insulation application.
Design and fabrication of hollow silicate micro-/ nanoparticles (HSMNP) with varied sizes and morphologies are of great interest especially in developing new generation of thermal insulation materials for building applications. Efficient energy use, simply called energy-saving, involves efforts to reduce the amount of energy required and recover wasted energy. This is important since building constitutes a substantial part in the total global energy consumption. Therefore, the current study is aimed at developing new HSMNP for thermal insulation application.
The existence of Pt7Cu ordering phase (intermetallic compound) was investigated by ab initio calculations and high voltage electron microscopy (HVEM) focusing on irradiation-induced ordering. The Pt7Cu ordering phase (cF32, prototype Ca7Ge) was predicted at 0 K through density functional theory (DFT), and using cluster expansion (CE) method and grand canonical Monte Carlo (GCMC) simulation, the ordering temperature of fcc-based Pt7Cu ordering phase was estimated to be above room temperature. The formation of Pt7Cu ordering phase was confirmed by a short-time irradiation for 3.6×103 s at 600 K. MeV electron irradiation can reduce drastically the annealing time for the ordering in the Pt-Cu alloy system, indicating that the combination of the prediction by ab initio calculations and HVEM can offer the unique opportunity to investigate the existence of ordering phase in alloys.
Preparation of a sigma-CrFe single-phase specimen was achieved by arc melting of pure Fe and Cr, cold rolling, and subsequent annealing at 973 K or 1073 K in vacuum. Cold rolling before annealing is effective for the annealing-induced formation of sigma-CrFe from the bcc solid-solution phase. The phase stability and the structural change from sigma-CrFe to a bcc solid-solution phase under fast electron irradiation were investigated by in situ transmission electron microscope (TEM) observation in the temperature range between 22 K and 473 K by using an ultra-high voltage electron microscope (UHVEM). The phase transition of sigma-CrFe by fast electron irradiation was found to occur at a particular temperature.
Evidence suggests that breastfeeding during infancy lowers the risk of metabolic syndrome (MS) and its attendant risk factors in adult life. To investigate the influence of feeding type on the risk factors of MS, we assessed insulin sensitivity and lipid and apolipoprotein metabolism in preterm infants. Blood samples were collected from preterm infants at the time of discharge. Infants were separated into two groups: a breast milk (BM) group receiving ⩾90% of their intake from BM, and a mixed-fed (MF) group receiving ⩾50% of their intake from formula. The following indices were then compared between the two groups. Blood glucose and serum insulin levels were used to calculate the quantitative insulin sensitivity check index (QUICKI). We also measured serum total cholesterol (TC), low-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc), apolipoprotein-A1 (apoA1) and apolipoprotein-B (apoB) levels, and the ratios of TC/HDLc, LDLc/HDLc and apoB/apoA1. The mean gestational age was 32.9 weeks at birth, and blood samples were collected at a mean corrected age of 37.4 weeks. There were 22 infants in the BM group and 19 in the MF group. QUICKI was significantly higher in the BM group. TC, HDLc and apoA1 were not significantly different between the groups, but LDLc and apoB levels were significantly higher in the BM group. The TC/HDLc, LDLc/HDLc and apoB/apoA1 ratios were significantly higher in the BM group. In preterm infants, the type of feeding exposure in the early postnatal period may influence glucose, lipid and apolipoprotein metabolism, and affect markers of MS.
The prevalence and epidemiological traits of human immunodeficiency virus (HIV)/hepatitis B virus (HBV) infections in high-risk populations (HRPs) remained unclarified in Japan. We determined the prevalence of HIV, HBV and Treponema pallidum (TP) and the viral genotypes in HRPs who attended primary sexually transmitted infection (STI) clinics in Osaka province during 2006–2011. Of 7898 specimens, 133 (1·7%) were HIV positive, which was significantly higher than the figures reported by Japanese Red Cross (0·0019%) and public health centres (0·27%) in Japan. The frequency of HIV-1 subtype B was 88·7%, followed by CRF01_AE (2·3%) and C (0·8%), which were almost identical to the national trend. HBV seroprevalence was surprisingly high in the HIV-positive group (63·2%), which was significantly higher than that in the HIV-negative group (25·6%). By contrast, there was no statistical correlation between HIV and TP infection. Interestingly, the distinct HBV genotypes Ae and G were prevalent in the HIV-positive population (60·0% and 20·0%, respectively), although both were rarely detected during nationwide surveillance. The transmission of HIV and HBV appeared to occur largely within a closed community early in life. Of note, about one-quarter of HIV-positive cases would have remained untested if health professionals had not motivated individuals to undergo HIV testing. This is the first evidence-based assessment of HIV positivity and HIV/HBV co-infection in HRPs at primary STIs in Japan and the effect of the involvement of health professionals in the diagnosis of HIV infections in asymptomatic carriers. The genotyping of HBV provided valuable information for understanding HIV epidemical traits.