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Quality improvement and patient safety (QIPS) competencies are increasingly important in emergency medicine (EM) and are now included in the CanMEDS framework. We conducted a survey aimed at determining the Canadian EM residents’ perspectives on the level of QIPS education and support available to them.
Methods
An electronic survey was distributed to all Canadian EM residents from the Royal College and Family Medicine training streams. The survey consisted of multiple-choice, Likert, and free-text entry questions aimed at understanding familiarity with QIPS, local opportunities for QIPS projects and mentorship, and the desire for further QIPS education and involvement.
Results
Of 535 EM residents, 189 (35.3%) completed the survey, representing all 17 medical schools; 77.2% of respondents were from the Royal College stream; 17.5% of respondents reported that QIPS methodologies were formally taught in their residency program; 54.7% of respondents reported being “somewhat” or “very” familiar with QIPS; 47.2% and 51.5% of respondents reported either “not knowing” or “not having readily available” opportunities for QIPS projects and QIPS mentorship, respectively; 66.9% of respondents indicated a desire for increased QIPS teaching; and 70.4% were interested in becoming involved with QIPS training and initiatives.
Conclusions
Many Canadian EM residents perceive a lack of QIPS educational opportunities and support in their local setting. They are interested in receiving more QIPS education, as well as project and mentorship opportunities. Supporting residents with a robust QIPS educational and mentorship framework may build a cohort of providers who can enhance the local delivery of care.
A large outbreak of Legionnaires’ disease occurred at a California state prison in August 2015. We conducted environmental and epidemiological investigations to identify the most likely source of exposure and characterise morbidity. Sixty-four inmates had probable Legionnaires’ disease; 14 had laboratory-confirmed legionellosis. Thirteen (17%) inmates were hospitalised; there were no deaths. Ill inmates were more likely to be ⩾65 years old (P < 0.01), have the chronic obstructive pulmonary disease (P < 0.01), diabetes mellitus (P = 0.02), hepatitis C infection (P < 0.01), or end-stage liver disease (P < 0.01). The case-patients were in ten housing units throughout the prison grounds. All either resided in or were near the central clinical building (for appointments or yard time) during their incubation periods. Legionella pneumophila serogroup 1 was cultured from three cooling towers on top of the central medical clinic (range, 880–1200 cfu/ml). An inadequate water management program, dense biofilm within the cooling towers, and high ambient temperatures preceding the outbreak created an ideal environment for Legionella sp. proliferation. All state prisons were directed to develop local operating procedures for maintaining their cooling towers and the state health department added a review of the maintenance plans to their environmental inspection protocol.
We investigated a mixed outbreak of Legionnaires' disease (LD) and Pontiac fever (PF) at a military base to identify the outbreak's environmental source as well as known legionellosis risk factors. Base workers with possible legionellosis were interviewed and, if consenting, underwent testing for legionellosis. A retrospective cohort study collected information on occupants of the buildings closest to the outbreak source. We identified 29 confirmed and probable LD and 38 PF cases. All cases were exposed to airborne pathogens from a cooling tower. Occupants of the building closest to the cooling tower were 6·9 [95% confidence interval (CI) 2·2–22·0] and 5·5 (95% CI 2·1–14·5) times more likely to develop LD and PF, respectively, than occupants of the next closest building. Thorough preventive measures and aggressive responses to outbreaks, including searching for PF cases in mixed legionellosis outbreaks, are essential for legionellosis control.
The aim of this study was to evaluate the anti-trypanosomal effect of treatment with 3′-deoxyadenosine (cordycepin) combined with deoxycoformycin (pentostatin: inhibitor of the enzyme adenosine deaminase) in vitro by using mice experimentally infected with Trypanosoma evansi. In vitro, a dose-dependent trypanocidal effect of cordycepin was observed against the parasite. In the in vivo trials, the two drugs were used individually and in combination of different doses. The drugs when used individually had no curative effect on infected mice. However, the combination of cordycepin (2 mg kg−1) and pentostatin (2 mg kg−1) was 100% effective in the T. evansi-infected groups. There was an increase in levels of some biochemical parameters, especially on liver enzymes, which were accompanied by histological lesions in the liver and kidneys. Based on these results we conclude that treatment using the combination of 3′-deoxyadenosine with deoxycoformycin has a curative effect on mice infected with T. evansi. However, the therapeutic protocol tested led to liver and kidney damage, manifested by hepatotoxicity and nephrotoxicity.
Although usually thought of as external environmental stressors, a significant heritable component has been reported for measures of stressful life events (SLEs) in twin studies.
Method
We examined the variance in SLEs captured by common genetic variants from a genome-wide association study (GWAS) of 2578 individuals. Genome-wide complex trait analysis (GCTA) was used to estimate the phenotypic variance tagged by single nucleotide polymorphisms (SNPs). We also performed a GWAS on the number of SLEs, and looked at correlations between siblings.
Results
A significant proportion of variance in SLEs was captured by SNPs (30%, p = 0.04). When events were divided into those considered to be dependent or independent, an equal amount of variance was explained for both. This ‘heritability’ was in part confounded by personality measures of neuroticism and psychoticism. A GWAS for the total number of SLEs revealed one SNP that reached genome-wide significance (p = 4 × 10−8), although this association was not replicated in separate samples. Using available sibling data for 744 individuals, we also found a significant positive correlation of R2 = 0.08 in SLEs (p = 0.03).
Conclusions
These results provide independent validation from molecular data for the heritability of reporting environmental measures, and show that this heritability is in part due to both common variants and the confounding effect of personality.
Among the cestodes, Echinococcus granulosus, Echinococcus multilocularis and Taenia solium represent the most dangerous parasites. Their larval stages cause the diseases cystic echinococcosis (CE), alveolar echincoccosis (AE) and cysticercosis, respectively, which exhibit considerable medical and veterinary health concerns with a profound economic impact. Others caused by other cestodes, such as species of the genera Mesocestoides and Hymenolepis, are relatively rare in humans. In this review, we will focus on E. granulosus and E. multilocularis metacestode laboratory models and will review the use of these models in the search for novel drugs that could be employed for chemotherapeutic treatment of echinococcosis. Clearly, improved therapeutic drugs are needed for the treatment of AE and CE, and this can only be achieved through the development of medium-to-high throughput screening approaches. The most recent achievements in the in vitro culture and genetic manipulation of E. multilocularis cells and metacestodes, and the accessability of the E. multilocularis genome and EST sequence information, have rendered the E. multilocularis model uniquely suited for studies on drug-efficacy and drug target identification. This could lead to the development of novel compounds for the use in chemotherapy against echinococcosis, and possibly against diseases caused by other cestodes, and potentially also trematodes.
Isolates of Trypanosoma cruzi from human patients, domestic and sylvatic animals and vector insects were obtained in different areas of Argentina. Electrophoretic patterns of enzymes from extracts of 95 isolates were analysed. On the basis of zymograms providing information on 10 loci, 12 zymodemes are described according to their genotypes. Data presented show fixed heterozygosity, absence of segregation of genotypes, significant departures from Hardy–Weinberg equilibrium, and over-represented genotypes. This evidence supports the hypothesis that sexual reproduction is very restricted or absent in this parasite. The proportion of polymorphic loci is 80%. The expected mean heterozygosity per locus (He) is 0·43, while the observed value (Ho) is 0·24. Differences between these values may be explained by accepting a basically clonal structure for T. cruzi. The data matrix of 12 zymodemes using 28 characters was analysed using a Wagner parsimony algorithm. Two equally most parsimonious unrooted trees were generated; both have 39 steps. The results show clusters clearly separated according to the geographical origin of the stocks. There are some indications of some correlations between genetic composition of the parasite and the clinical picture of the infection in human patients.
This paper reviews the state of the art in model-based systems and qualitative reasoning, and considers where the field will be in 20 years time. It highlights six areas where developments in model-based systems in general, and in qualitative reasoning in particular, have the potential to provide significant computer-based help. The paper also examines where further technological developments might be needed in order to achieve these qualitative futures.
Using a new multi-dimensional contact mechanics system, it was recently shown that the experimentally measured tangential to normal stiffness ratio of a contact can be described as a function of the bulk Poisson's ratio of the material as predicted by Mindlin [1-3]. This system has been utilized to measure the normal and tangential elastic contact stiffness of a series of porous low-k films, with increasing starting porogen content. These results indicate a transition from a material-controlled elastic behavior to a structure-controlled elastic behavior as the porosity of the film is increased. These structural effects and their potential influence on the mechanical response to forces imposed on integrated circuits are discussed. The experimental details and apparatus are introduced and described.
We present early results from the analysis of HST imaging observations for several pairs of interacting galaxies. We include two cases that were specifically chosen to represent a strong early (young) encounter and a weak late (old) encounter. The goals of the project include a determination of the timing, frequency, strength, and characteristics of the young star clusters formed in these two limiting cases of tidal encounters.
This paper describes experimental measurements of the linear viscoelastic behavior of the surface of low-density (LD) polyethylene in contact with a pyramidal Berkovich diamond indenter. The experiments were carried out at two different temperatures, 15.9 and 27.2 °C, between frequencies of 0.1 and 800 Hz. Using the shift of the loss tangent between the two temperatures at frequencies lower than 20 Hz and an Arrhenius equation, an activation energy of 105 ± 2 kJ/mol was obtained. This value is in good agreement with the bulk value of the a relaxation of LD polyethylene reported in the literature.
It has been proposed that with the appropriate models, instrumented indentation test (IIT) data can be reduced to yield the uniaxial stress-strain behavior of the test material. However, very little work has been done to directly compare the results from uniaxial tension and spherical indentation experiments. In this work, indentation and uniaxial tension experiments have been performed on the aluminum alloy 6061-T6. The purpose of these experiments was to specifically explore the accuracy with which the analytical models can be applied to IIT data to predict the uniaxial stress-strain behavior of the aluminum alloy.
A commonly used technique to compute mechanical properties from indentation tests is the Oliver and Pharr method. Using dimensional analysis and finite element modeling, this paper investigates errors when the Oliver and Pharr method is used to compute thin film properties.
Advanced materials are being designed and tested for high-stress, high-cycle ball bearing applications. Important information about the tribological performance of these materials is gained through rolling contact fatigue (RCF) measurements. No such data have been reported to date for hybrid bearings consisting of titanium carbide (TiC)-coated REX20 steel balls and REX20 steel raceways. Chemical vapor deposition (CVD) was used for depositing the TiC coating. In this paper, we present the first report of the effects of RCF tests on this particular combination of hybrid bearings. Post-test characterizations of these bearings are discussed. Our investigations include plan-view and cross-sectional scanning electron microscopy, chemical compositional analyses, X-ray diffraction, and nano-indentation measurements. Results of these investigations provide a detailed understanding of the TiC coating on REX20 steel balls following extended rolling contact.
Depth-sensing indentation involves applying a specific force-time history on a rigid indenter while continuously monitoring the displacement of the indenter into the surface. Frequency specific depth-sensing indentation testing entails adding a small harmonic force on the indenter and measuring the harmonic response of the indenter at the excitation frequency. While often taken for granted, understanding the dynamics behind these frequency specific measurements is of vital importance in the determination of quantitative mechanical properties. This paper will focus on the dynamics of a variety of depth-sensing indentation systems and how these dynamics affect such parameters as detecting the point of surface contact, environmental sensitivity, dynamic frequency range, and the range over which contact stiffnesses and moduli can be accurately measured.