We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Low vitamin D associated with high parathyroid hormone (PTH) is common in HIV infection. We determined the association between total 25(OH)D and PTH in adolescents living with HIV, in Zambia and Zimbabwe. Adolescents (11–19 years) perinatally infected with HIV and established on antiretroviral therapy for ≥ 6 months were recruited into a cross-sectional study. Socio-demographic and clinical characteristics were recorded, anthropometry measured and fasted serum concentrations of 1,25(OH)2D, total 25(OH)D and intact PTH measured. The association between total 25(OH)D and PTH was examined using natural cubic spline regression. 842 participants (female: 53·2%) with a median age of 15·5 (IQR: 13·2–17·9) years were enrolled. Median antiretroviral therapy duration was 9·8 (IQR: 6·3–12·3) years, and 165/841 had an HIV viral-load >60 copies/ml. Stunting (height-for-age z-score <–2) and underweight (weight-for-age z-score <–2) were observed in 29·9 and 30·0%, respectively. Three-quarters reported daily Ca intakes <150 mg/d. The mean (sd) concentrations of total 25(OH)D and 1,25(OH)2D were 66·1(16·5) nmol/l and 210·6 (70·4) pmol/l, respectively, and median PTH level was 4·3 (IQR: 3·3–5·5) pmol/l. There was an inverse non-linear relationship between total 25(OH)D and PTH, 25(OH)D levelling off at 74·6 nmol/l (95 % CI: 74·5, 75·2). Results were consistent in those taking tenofovir disoproxil fumarate and virally unsuppressed participants. In this population with extremely low habitual Ca intakes, the lack of association between 25(OH)D and PTH when 25(OH)D exceeded 75 nmol/l potentially suggests that levels of 25(OH)D >75 nmol/l may need to be achieved to improve bone health; investigation is needed in future research studies.
Mössbauer spectra of 9 glauconite samples from Upper Cretaceous and Lower Tertiary strata in the South Island of New Zealand contain a broad shoulder due to low intensity absorption continuous between 1.0 and 2.5 mm/sec when the absorber is at room temperature; the shoulder is absent, and sharp peaks are apparent in spectra taken with the absorber at 80°K. The data suggest that electron transfer occurs between adjacent Fe3+ and Fe2+ ions at room temperature. The low temperature spectra indicate that all Fe in the glauconites is in octahedral coordination. Fe3+ and Fe2+ ions occur in both eis and trans sites; Fe3+ shows a strong preference for eis sites whereas Fe2+ shows an even stronger preference for trans sites.
The partially variable oxidation state of Fe in glauconite is interpreted in terms of a geochemical model for glauconitization of a degraded or incomplete progenitor phyllosilicate. The model involves exchange of Fe2+ for other cations which temporarily stabilize the progenitor, followed by Fe2+-Fe3+ charge transfer reactions. Each reaction results from the system's tendency towards equilibrium. The model is supported by the observation that artificially leached glauconite increases both its Fe3+ and its Fe2+ content when placed in a solution containing Fe2+ as the only Fe ion present.
The cause of pH and ionic strength-dependent proton and hydroxyl adsorption onto kaolinite is specific binding at edge Al and Si sites, and it can be modeled as a function of temperature with a triple layer model (TLM) of the mineral-solution interface. Exchange of Al for protons and hydroxyls is observed at low pH, with a stoichiometry approaching 1:3 (Al:H+). Adsorption of organic acids from dilute solutions depends on: 1) solution pH; 2) the functionality of the acid; and, to a lesser extent, 3) temperature. Such adsorption may occur primarily at Al sites exposed on kaolinite edges, as indicated by sorption experiments on the constituent oxides, where negligible sorption was observed on SiO2 (quartz), but was significant on Al2O3 (corundum) surfaces. Under similar conditions, oxalate adsorbs more strongly than acetate or formate to aluminol sites.
The aim of this paper is to develop the theory of weighted Diophantine approximation of rational numbers to p-adic numbers. Firstly, we establish complete analogues of Khintchine’s theorem, the Duffin–Schaeffer theorem and the Jarník–Besicovitch theorem for ‘weighted’ simultaneous Diophantine approximation in the p-adic case. Secondly, we obtain a lower bound for the Hausdorff dimension of weighted simultaneously approximable points lying on p-adic manifolds. This is valid for very general classes of curves and manifolds and have natural constraints on the exponents of approximation. The key tools we use in our proofs are the Mass Transference Principle, including its recent extension due to Wang and Wu in 2019, and a Zero-One law for weighted p-adic approximations established in this paper.
Recent research at Jaketown, a Late Archaic earthwork site in the Lower Mississippi Valley, suggests that the culture-historical framework used to interpret Jaketown and contemporary sites in the region obscures differences in practices across sites. As an alternative, we propose a framework focused on variation in material culture, architecture, and foodways between Jaketown and Poverty Point, the regional type site. Our analysis indicates that people used Poverty Point Objects and imported lithics at Jaketown by 4525–4100 cal BP—earlier than elsewhere in the region. By 3450–3350 cal BP, people intensively occupied Jaketown, harvesting a consistent suite of wild plants. Between 3445 and 3270 cal BP, prior to the apex of earthwork construction at Poverty Point, the community at Jaketown built at least two earthworks and multiple post structures before catastrophic flooding sometime after 3300 cal BP buried the Late Archaic landscape under alluvium. These new data lead us to conclude that the archaeological record of the Late Archaic Lower Mississippi Valley does not reflect a uniform regional culture. Rather, relationships between Jaketown and Poverty Point indicate a multipolar history in which communities selectively participated in larger social phenomena—such as exchange networks and architectural traditions—while maintaining diverse, localized practices.
To determine whether food security, diet diversity and diet quality are associated with anthropometric measurements and body composition among women of reproductive age. The association between food security and anaemia prevalence was also tested.
Design:
Secondary analysis of cross-sectional data from the Healthy Life Trajectories Initiative (HeLTI) study. Food security and dietary data were collected by an interviewer-administered questionnaire. Hb levels were measured using a HemoCue, and anaemia was classified as an altitude-adjusted haemoglobin level < 12·5 g/dl. Body size and composition were assessed using anthropometry and dual-energy x-ray absorptiometry.
Setting:
The urban township of Soweto, Johannesburg, South Africa.
Participants:
Non-pregnant women aged 18–25 years (n 1534).
Results:
Almost half of the women were overweight or obese (44 %), and 9 % were underweight. Almost a third of women were anaemic (30 %). The prevalence rates of anaemia and food insecurity were similar across BMI categories. Food insecure women had the least diverse diets, and food security was negatively associated with diet quality (food security category v. diet quality score: B = –0·35, 95 % CI –0·70, –0·01, P = 0·049). Significant univariate associations were observed between food security and total lean mass. However, there were no associations between food security and body size or composition variables in multivariate models.
Conclusions:
Our data indicate that food security is an important determinant of diet quality in this urban-poor, highly transitioned setting. Interventions to improve maternal and child nutrition should recognise both food security and the food environment as critical elements within their developmental phases.
Projected climate warming and wettening will have a major impact on the state of glaciers and seasonal snow in High Arctic regions. Following up on a historical simulation (1957–2018) for Svalbard, we make future projections of glacier climatic mass balance (CMB), snow conditions on glaciers and land, and runoff, under Representative Concentration Pathways (RCP) 4.5 and 8.5 emission scenarios for 2019–60. We find that the average CMB for Svalbard glaciers, which was weakly positive during 1957–2018, becomes negative at an accelerating rate during 2019–60 for both RCP scenarios. Modelled mass loss is most pronounced in southern Svalbard, where the equilibrium line altitude is predicted to rise well above the hypsometry peak, leading to the first occurrences of zero accumulation-area ratio already by the 2030s. In parallel with firn line retreat, the total pore volume in snow and firn drops by as much as 70–80% in 2060, compared to 2018. Total refreezing remains largely unchanged, despite a marked change in the seasonal pattern towards increased refreezing in winter. Finally, we find pronounced shortening of the snow season, while combined runoff from glaciers and land more than doubles from 1957–2018 to 2019–60, for both scenarios.
Introduction. Smoking cessation after a cancer diagnosis can significantly improve treatment outcomes and reduce the risk of cancer recurrence and all-cause mortality. Aim. We sought to measure the association between cancer diagnosis and subsequent smoking cessation. Methods. Data was sourced from the Population Assessment of Health and Tobacco (PATH) study, a representative population-based sample of United States adults. Our analytic sample included all adult smokers at Wave I, our baseline. The exposure of interest was either a tobacco-related cancer diagnosis, nontobacco-related cancer diagnosis, or no cancer diagnosis (the referent) reported at Wave II or III. The primary outcome was smoking cessation after diagnosis, at Wave IV. Results/Findings. Our sample was composed of 7,286 adult smokers at the baseline representing an estimated 40.9 million persons. Smoking cessation rates after a diagnosis differed after a tobacco-related cancer (25.9%), a nontobacco-related cancer (8.9%), and no cancer diagnosis (17.9%). After adjustment, diagnosis with a tobacco-related cancer was associated with a higher odds of smoking cessation (OR 1.83, 95% CI 1.00-3.33) compared to no cancer diagnosis. Diagnosis with a nontobacco-related cancer was not significantly linked to smoking cessation (OR 0.52, 95% CI 0.48-1.45). Conclusion. Diagnosis with a tobacco-related cancer is associated with greater odds of subsequent smoking cessation compared to no cancer diagnosis, suggesting that significant behavioral change may occur in this setting.
Gravitational waves from coalescing neutron stars encode information about nuclear matter at extreme densities, inaccessible by laboratory experiments. The late inspiral is influenced by the presence of tides, which depend on the neutron star equation of state. Neutron star mergers are expected to often produce rapidly rotating remnant neutron stars that emit gravitational waves. These will provide clues to the extremely hot post-merger environment. This signature of nuclear matter in gravitational waves contains most information in the 2–4 kHz frequency band, which is outside of the most sensitive band of current detectors. We present the design concept and science case for a Neutron Star Extreme Matter Observatory (NEMO): a gravitational-wave interferometer optimised to study nuclear physics with merging neutron stars. The concept uses high-circulating laser power, quantum squeezing, and a detector topology specifically designed to achieve the high-frequency sensitivity necessary to probe nuclear matter using gravitational waves. Above 1 kHz, the proposed strain sensitivity is comparable to full third-generation detectors at a fraction of the cost. Such sensitivity changes expected event rates for detection of post-merger remnants from approximately one per few decades with two A+ detectors to a few per year and potentially allow for the first gravitational-wave observations of supernovae, isolated neutron stars, and other exotica.
Adolescent diet, physical activity and nutritional status are generally known to be sub-optimal. This is an introduction to a special issue of papers devoted to exploring factors affecting diet and physical activity in adolescents, including food insecure and vulnerable groups.
Setting
Eight settings including urban, peri-urban and rural across sites from five different low- and middle-income countries.
Design:
Focus groups with adolescents and caregivers carried out by trained researchers.
Results:
Our results show that adolescents, even in poor settings, know about healthy diet and lifestyles. They want to have energy, feel happy, look good and live longer, but their desire for autonomy, a need to ‘belong’ in their peer group, plus vulnerability to marketing exploiting their aspirations, leads them to make unhealthy choices. They describe significant gender, culture and context-specific barriers. For example, urban adolescents had easy access to energy dense, unhealthy foods bought outside the home, whereas junk foods were only beginning to permeate rural sites. Among adolescents in Indian sites, pressure to excel in exams meant that academic studies were squeezing out physical activity time.
Conclusions:
Interventions to improve adolescents’ diets and physical activity levels must therefore address structural and environmental issues and influences in their homes and schools, since it is clear that their food and activity choices are the product of an interacting complex of factors. In the next phase of work, the Transforming Adolescent Lives through Nutrition consortium will employ groups of adolescents, caregivers and local stakeholders in each site to develop interventions to improve adolescent nutritional status.
Background: Infection prevention surveillance for cross transmission is often performed by manual review of microbiologic culture results to identify geotemporally related clusters. However, the sensitivity and specificity of this approach remains uncertain. Whole-genome sequencing (WGS) analysis can help provide a gold-standard for identifying cross-transmission events. Objective: We employed a published WGS program, the Philips IntelliSpace Epidemiology platform, to compare accuracy of two surveillance methods: (i.) a virtual infection practitioner (VIP) with perfect recall and automated analysis of antibiotic susceptibility testing (AST), sample collection timing, and patient location data and (ii) a novel clinical matching (CM) algorithm that provides cluster suggestions based on a nuanced weighted analysis of AST data, timing of sample collection, and shared location stays between patients. Methods: WGS was performed routinely on inpatient and emergency department isolates of Enterobacter cloacae, Enterococcus faecium, Klebsiella pneumoniae, and Pseudomonas aeruginosa at an academic medical center. Single-nucleotide variants (SNVs) were compared within core genome regions on a per-species basis to determine cross-transmission clusters. Moreover, one unique strain per patient was included within each analysis, and duplicates were excluded from the final results. Results: Between May 2018 and April 2019, clinical data from 121 patients were paired with WGS data from 28 E. cloacae, 21 E. faecium, 61 K. pneumoniae, and 46 P. aeruginosa isolates. Previously published SNV relatedness thresholds were applied to define genomically related isolates. Mapping of genomic relatedness defined clusters as follows: 4 patients in 2 E. faecium clusters and 2 patients in 1 P. aeruginosa cluster. The VIP method identified 12 potential clusters involving 28 patients, all of which were “pseudoclusters.” Importantly, the CM method identified 7 clusters consisting of 27 patients, which included 1 true E. faecium cluster of 2 patients with genomically related isolates. Conclusions: In light of the WGS data, all of the potential clusters identified by the VIP were pseudoclusters, lacking sufficient genomic relatedness. In contrast, the CM method showed increased sensitivity and specificity: it decreased the percentage of pseudoclusters by 14% and it identified a related genomic cluster of E. faecium. These findings suggest that integrating clinical data analytics and WGS is likely to benefit institutions in limiting expenditure of resources on pseudoclusters. Therefore, WGS combined with more sophisticated surveillance approaches, over standard methods as modeled by the VIP, are needed to better identify and address true cross-transmission events.
Funding: This study was supported by Philips Healthcare.
Space Infrared Telescope for Cosmology and Astrophysics (SPICA), the cryogenic infrared space telescope recently pre-selected for a ‘Phase A’ concept study as one of the three remaining candidates for European Space Agency (ESA's) fifth medium class (M5) mission, is foreseen to include a far-infrared polarimetric imager [SPICA-POL, now called B-fields with BOlometers and Polarizers (B-BOP)], which would offer a unique opportunity to resolve major issues in our understanding of the nearby, cold magnetised Universe. This paper presents an overview of the main science drivers for B-BOP, including high dynamic range polarimetric imaging of the cold interstellar medium (ISM) in both our Milky Way and nearby galaxies. Thanks to a cooled telescope, B-BOP will deliver wide-field 100–350 $\mu$m images of linearly polarised dust emission in Stokes Q and U with a resolution, signal-to-noise ratio, and both intensity and spatial dynamic ranges comparable to those achieved by Herschel images of the cold ISM in total intensity (Stokes I). The B-BOP 200 $\mu$m images will also have a factor $\sim $30 higher resolution than Planck polarisation data. This will make B-BOP a unique tool for characterising the statistical properties of the magnetised ISM and probing the role of magnetic fields in the formation and evolution of the interstellar web of dusty molecular filaments giving birth to most stars in our Galaxy. B-BOP will also be a powerful instrument for studying the magnetism of nearby galaxies and testing Galactic dynamo models, constraining the physics of dust grain alignment, informing the problem of the interaction of cosmic rays with molecular clouds, tracing magnetic fields in the inner layers of protoplanetary disks, and monitoring accretion bursts in embedded protostars.
Determining infectious cross-transmission events in healthcare settings involves manual surveillance of case clusters by infection control personnel, followed by strain typing of clinical/environmental isolates suspected in said clusters. Recent advances in genomic sequencing and cloud computing now allow for the rapid molecular typing of infecting isolates.
Objective:
To facilitate rapid recognition of transmission clusters, we aimed to assess infection control surveillance using whole-genome sequencing (WGS) of microbial pathogens to identify cross-transmission events for epidemiologic review.
Methods:
Clinical isolates of Staphylococcus aureus, Enterococcus faecium, Pseudomonas aeruginosa, and Klebsiella pneumoniae were obtained prospectively at an academic medical center, from September 1, 2016, to September 30, 2017. Isolate genomes were sequenced, followed by single-nucleotide variant analysis; a cloud-computing platform was used for whole-genome sequence analysis and cluster identification.
Results:
Most strains of the 4 studied pathogens were unrelated, and 34 potential transmission clusters were present. The characteristics of the potential clusters were complex and likely not identifiable by traditional surveillance alone. Notably, only 1 cluster had been suspected by routine manual surveillance.
Conclusions:
Our work supports the assertion that integration of genomic and clinical epidemiologic data can augment infection control surveillance for both the identification of cross-transmission events and the inclusion of missed and exclusion of misidentified outbreaks (ie, false alarms). The integration of clinical data is essential to prioritize suspect clusters for investigation, and for existing infections, a timely review of both the clinical and WGS results can hold promise to reduce HAIs. A richer understanding of cross-transmission events within healthcare settings will require the expansion of current surveillance approaches.
Salmonella enterica serovar Wangata (S. Wangata) is an important cause of endemic salmonellosis in Australia, with human infections occurring from undefined sources. This investigation sought to examine possible environmental and zoonotic sources for human infections with S. Wangata in north-eastern New South Wales (NSW), Australia. The investigation adopted a One Health approach and was comprised of three complimentary components: a case–control study examining human risk factors; environmental and animal sampling; and genomic analysis of human, animal and environmental isolates. Forty-eight human S. Wangata cases were interviewed during a 6-month period from November 2016 to April 2017, together with 55 Salmonella Typhimurium (S. Typhimurium) controls and 130 neighbourhood controls. Indirect contact with bats/flying foxes (S. Typhimurium controls (adjusted odds ratio (aOR) 2.63, 95% confidence interval (CI) 1.06–6.48)) (neighbourhood controls (aOR 8.33, 95% CI 2.58–26.83)), wild frogs (aOR 3.65, 95% CI 1.32–10.07) and wild birds (aOR 6.93, 95% CI 2.29–21.00) were statistically associated with illness in multivariable analyses. S. Wangata was detected in dog faeces, wildlife scats and a compost specimen collected from the outdoor environments of cases’ residences. In addition, S. Wangata was detected in the faeces of wild birds and sea turtles in the investigation area. Genomic analysis revealed that S. Wangata isolates were relatively clonal. Our findings suggest that S. Wangata is present in the environment and may have a reservoir in wildlife populations in north-eastern NSW. Further investigation is required to better understand the occurrence of Salmonella in wildlife groups and to identify possible transmission pathways for human infections.
The Kongsfjord basin in northwest Svalbard is the site of a number of interdisciplinary studies concerned with the effect of fresh water from seasonal snow and glacier melt on the physical and biological environment. We use an energy-balance model coupled with a subsurface snow model to simulate the long-term climatic mass-balance evolution of the glaciers and the seasonal snow development of nonglacierized parts of the Kongsfjord basin. Runoff from both glacierized and nonglacierized parts of the basin is simulated to quantify the fresh water flux to the fjord. The model is calibrated with long-term mass-balance data measured at four glaciers, and with automatic weather station data. The simulated area-averaged climatic mass balance for the whole basin is positive (+0.23 m w.e. a−1) over the period 1980–2016; however, the trend for net mass balance is not statistically significant over the simulation period, despite the observed ongoing summer warming. Refreezing equals 0.24 m w.e. a−1, which is equivalent to 17% of the total mass gain from precipitation and moisture deposition. Total runoff comprises contributions from seasonal snow in the nonglacierized area (16%) and glacier discharge (84%). Model time series shows a significant increasing trend for annual glacier runoff (6.83 × 106 m3 a−1) over the simulation period.
Neck dissection is associated with post-operative shoulder dysfunction in a substantial number of patients, affecting quality of life and return to work. There is no current UK national practice regarding physiotherapy after neck dissection.
Method
Nine regional centres were surveyed to determine their standard physiotherapy practice pre- and post-neck dissection, and to determine pre-emptive physiotherapy for any patients.
Results
Eighty-nine per cent of centres never arranged any pre-emptive physiotherapy for any patients. Thirty-three per cent of centres offered routine in-patient physiotherapy after surgery. No centres offered out-patient physiotherapy for all patients regardless of symptoms. Seventy-eight per cent offered physiotherapy for patients with any symptoms, with 11 per cent offering physiotherapy for those with severe dysfunction only. Eleven per cent of centres never offered physiotherapy for any dysfunction.
Conclusion
The provision of physiotherapy is most commonly reactive rather than proactive, and usually driven by patient request. There is little evidence of pre-arranged physiotherapy for patients to treat or prevent shoulder dysfunction in the UK.
For certain singularly perturbed two-component reaction–diffusion systems, the bifurcation diagram of steady-state spike solutions is characterized by a saddle-node behaviour in terms of some parameter in the system. For some such systems, such as the Gray–Scott model, a spike self-replication behaviour is observed as the parameter varies across the saddle-node point. We demonstrate and analyse a qualitatively new type of transition as a parameter is slowly decreased below the saddle node value, which is characterized by a finite-time blow-up of the spike solution. More specifically, we use a blend of asymptotic analysis, linear stability theory, and full numerical computations to analyse a wide variety of dynamical instabilities, and ultimately finite-time blow-up behaviour, for localized spike solutions that occur as a parameter β is slowly ramped in time below various linear stability and existence thresholds associated with steady-state spike solutions. The transition or route to an ultimate finite-time blow-up can include spike nucleation, spike annihilation, or spike amplitude oscillation, depending on the specific parameter regime. Our detailed analysis of the existence and linear stability of multi-spike patterns, through the analysis of an explicitly solvable non-local eigenvalue problem, provides a theoretical guide for predicting which transition will be realized. Finally, we analyse the blow-up profile for a shadow limit of the reaction–diffusion system. For the resulting non-local scalar parabolic problem, we derive an explicit expression for the blow-up rate near the parameter range where blow-up is predicted. This blow-up rate is confirmed with full numerical simulations of the full PDE. Moreover, we analyse the linear stability of this solution that blows up in finite time.
Two broad aims drive weed science research: improved management and improvedunderstanding of weed biology and ecology. In recent years, agriculturalweed research addressing these two aims has effectively split into separatesubdisciplines despite repeated calls for greater integration. Although someexcellent work is being done, agricultural weed research has developed avery high level of repetitiveness, a preponderance of purely descriptivestudies, and has failed to clearly articulate novel hypotheses linked toestablished bodies of ecological and evolutionary theory. In contrast,invasive plant research attracts a diverse cadre of nonweed scientists usinginvasions to explore broader and more integrated biological questionsgrounded in theory. We propose that although studies focused on weedmanagement remain vitally important, agricultural weed research wouldbenefit from deeper theoretical justification, a broader vision, andincreased collaboration across diverse disciplines. To initiate change inthis direction, we call for more emphasis on interdisciplinary training forweed scientists, and for focused workshops and working groups to developspecific areas of research and promote interactions among weed scientistsand with the wider scientific community.