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Clinical trials often struggle to recruit enough participants, with only 10% of eligible patients enrolling. This is concerning for conditions like stroke, where timely decision-making is crucial. Frontline clinicians typically screen patients manually, but this approach can be overwhelming and lead to many eligible patients being overlooked.
Methods:
To address the problem of efficient and inclusive screening for trials, we developed a matching algorithm using imaging and clinical variables gathered as part of the AcT trial (NCT03889249) to automatically screen patients by matching these variables with the trials’ inclusion and exclusion criteria using rule-based logic. We then used the algorithm to identify patients who could have been enrolled in six trials: EASI-TOC (NCT04261478), CATIS-ICAD (NCT04142125), CONVINCE (NCT02898610), TEMPO-2 (NCT02398656), ESCAPE-MEVO (NCT05151172), and ENDOLOW (NCT04167527). To evaluate our algorithm, we compared our findings to the number of enrollments achieved without using a matching algorithm. The algorithm’s performance was validated by comparing results with ground truth from a manual review of two clinicians. The algorithm’s ability to reduce screening time was assessed by comparing it with the average time used by study clinicians.
Results:
The algorithm identified more potentially eligible study candidates than the number of participants enrolled. It also showed over 90% sensitivity and specificity for all trials, and reducing screening time by over 100-fold.
Conclusions:
Automated matching algorithms can help clinicians quickly identify eligible patients and reduce resources needed for enrolment. Additionally, the algorithm can be modified for use in other trials and diseases.
Drip irrigation and mulching were tested to minimize unproductive water loss through evaporation and weed interference. A field experiment was conducted during spring season of 2020 and 2021 in split plot design with three replications. The study includes six treatment combinations of drip irrigation methods (surface drip and subsurface drip irrigation) and mulching (black plastic, paddy straw and no mulch) along with one conventional furrow irrigation without mulching (as control) in main plots. Four weed control treatments (atrazine 1000 g a.i./ha as pre-emergence, two hand weedings at 30 and 60 days after sowing [DAS], weed free and weedy for whole crop growth period) were kept in the subplots. The combination of drip irrigation and mulches significantly enhanced leaf area index and crop biomass at 60 DAS than furrow irrigation. Integration of subsurface drip irrigation with plastic mulching resulted in the lowest weed density and biomass among main plots. Drip irrigation coupled with plastic and straw mulching resulted in 86 and 50% reduction in weed density and biomass, respectively, as compared to no mulching. Integration of subsurface drip with paddy straw mulch and black plastic mulch resulted in 17.1 and 15.5% higher maize grain yield, respectively, as compared to furrow irrigation. The highest irrigation water productivity (3.58 kg/m3) was observed in combination of subsurface drip and paddy straw mulch followed by combination of subsurface drip and black plastic mulch (3.51 kg/m3). Overall, straw mulching in drip irrigation system proved economical in terms of maize productivity.
The aviation industry’s efforts to reduce carbon emissions have driven the rapid development and scale-up of sustainable aviation fuels (SAFs). SAFs have the potential to significantly reduce CO2 lifecycle emissions by up to 80% in comparison to Jet A and other conventional fossil-derived jet fuels. For multiple logistical and practical reasons, it is preferable to ensure that SAFs are ‘essentially identical’ (also referred to as ‘drop-in SAF’) to conventional jet fuel in terms of their performance, durability and compatibility with existing hardware systems. Because the majority of SAFs are not identical (non-drop-in) to conventional jet fuel, they have not been approved for use in their neat (100%) form. Instead, these non-identical SAFs are named synthetic blend components (SBC) as they are blended with conventional fuels to different extents per ASTM D7566-23a. It should be noted that there are on-going efforts to develop non-drop in SAF specifications to broaden their proliferation and maximise the aviation industries’ ability to reduce CO2 lifecycle emissions. One very important area of focus is the compatibility of SAFs with engine and fuel system seals, specifically understanding the dynamics of elastomeric seals. To address this, a novel approach has been developed to measure seal dynamics in flowing fuel. This technique has been applied to study the dynamic seal behaviour of four industrially relevant elastomer seals commonly employed in aviation fuel systems. The study involved three test fuels: (i) conventional fossil-derived Jet A, neat hydroprocessed esters and fatty acids (HEFA) SAF, and neat alcohol to jet (ATJ) SAF. Notably, both HEFA and ATJ fuels contain 0% aromatics, in contrast to Jet A, which typically contains around 17% aromatics by volume. The novel fuel-elastomer test rig used in this study was designed to simulate a practical scenario in which fuel flows through the inner surface of a pre-loaded static O-ring. The results of these tests demonstrate that the behaviour of different nitrile elastomers is unique to their formulation, and in all cases, the behaviour in HEFA and ATJ SAF differs significantly from that in Jet A. However, new fuel approval tests may only list one type of elastomer for evaluation, for example the ‘Fit-for-Purpose’ test in ASTM D4054-22 Tier 2 lists one specific nitrile. The findings of this study highlight the complexities of fuel-elastomer interactions within nominally identical chemical families and emphasise the potential risks of assessing compatibility based on tests conducted with a single member of a chemical family.
We evaluated whether universal chlorhexidine bathing (decolonization) with or without COVID-19 intensive training impacted COVID-19 rates in 63 nursing homes (NHs) during the 2020–2021 Fall/Winter surge. Decolonization was associated with a 43% lesser rise in staff case-rates (P < .001) and a 52% lesser rise in resident case-rates (P < .001) versus control.
Tight focusing with very small f-numbers is necessary to achieve the highest at-focus irradiances. However, tight focusing imposes strong demands on precise target positioning in-focus to achieve the highest on-target irradiance. We describe several near-infrared, visible, ultraviolet and soft and hard X-ray diagnostics employed in a ∼1022 W/cm2 laser–plasma experiment. We used nearly 10 J total energy femtosecond laser pulses focused into an approximately 1.3-μm focal spot on 5–20 μm thick stainless-steel targets. We discuss the applicability of these diagnostics to determine the best in-focus target position with approximately 5 μm accuracy (i.e., around half of the short Rayleigh length) and show that several diagnostics (in particular, 3$\omega$ reflection and on-axis hard X-rays) can ensure this accuracy. We demonstrated target positioning within several micrometers from the focus, ensuring over 80% of the ideal peak laser intensity on-target. Our approach is relatively fast (it requires 10–20 laser shots) and does not rely on the coincidence of low-power and high-power focal planes.
We identify a set of essential recent advances in climate change research with high policy relevance, across natural and social sciences: (1) looming inevitability and implications of overshooting the 1.5°C warming limit, (2) urgent need for a rapid and managed fossil fuel phase-out, (3) challenges for scaling carbon dioxide removal, (4) uncertainties regarding the future contribution of natural carbon sinks, (5) intertwinedness of the crises of biodiversity loss and climate change, (6) compound events, (7) mountain glacier loss, (8) human immobility in the face of climate risks, (9) adaptation justice, and (10) just transitions in food systems.
Technical summary
The Intergovernmental Panel on Climate Change Assessment Reports provides the scientific foundation for international climate negotiations and constitutes an unmatched resource for researchers. However, the assessment cycles take multiple years. As a contribution to cross- and interdisciplinary understanding of climate change across diverse research communities, we have streamlined an annual process to identify and synthesize significant research advances. We collected input from experts on various fields using an online questionnaire and prioritized a set of 10 key research insights with high policy relevance. This year, we focus on: (1) the looming overshoot of the 1.5°C warming limit, (2) the urgency of fossil fuel phase-out, (3) challenges to scale-up carbon dioxide removal, (4) uncertainties regarding future natural carbon sinks, (5) the need for joint governance of biodiversity loss and climate change, (6) advances in understanding compound events, (7) accelerated mountain glacier loss, (8) human immobility amidst climate risks, (9) adaptation justice, and (10) just transitions in food systems. We present a succinct account of these insights, reflect on their policy implications, and offer an integrated set of policy-relevant messages. This science synthesis and science communication effort is also the basis for a policy report contributing to elevate climate science every year in time for the United Nations Climate Change Conference.
Social media summary
We highlight recent and policy-relevant advances in climate change research – with input from more than 200 experts.
Background: Multimodal approaches are often used to prevent transmission of antimicrobial-resistant pathogens among patients in healthcare settings; understanding the effect of individual interventions is challenging. We designed a model to compare the effectiveness of hand hygiene (HH) with or without decolonization in reducing patient colonization with carbapenem-resistant Enterobacterales (CRE). Methods: We developed an agent-based model to represent transmission of CRE in an acute-care hospital comprising 3 general wards and 2 ICUs, each with 20 single-occupancy rooms, located in a community of 85,000 people. The model accounted for the movement of healthcare personnel (HCP), including their visits to patients. CRE dynamics were modeled using a susceptible–infectious–susceptible framework with transmission occurring via HCP–patient contacts. The mean time to clearance of CRE colonization without intervention was 387 days (Zimmerman et al, 2013). Our baseline included a facility-level HH compliance of 30%, with an assumed efficacy of 50%. Contact precautions were employed for patients with CRE-positive cultures with assumed adherence and efficacy of 80% and 50%, respectively. Intervention scenarios included decolonization of culture-positive CRE patients, with a mean time to decolonization of 3 days. We considered 2 hypothetical intervention scenarios: (A) decolonization of patients with the baseline HH compliance and (B) decolonization with a slightly improved HH compliance of 35%. The hospital-level CRE incidence rate was used to compare the results from these intervention scenarios. Results: CRE incidence rates were lower in intervention scenarios than the baseline scenario (Fig. 1). The baseline mean incidence rate was 29.1 per 10,000 patient days. For decolonization with the baseline HH, the mean incidence rate decreased to 14.5 per 10,000 patient days, which is a 50.2% decrease relative to the baseline incidence (Table 1). The decolonization scenario with a slightly improved HH compliance of 35% produced a relative reduction of 71.9% relative to the baseline incidence. Conclusions: Our analysis shows that decolonization, combined with modest improvement in HH compliance, could lead to large decreases in pathogen transmission. In turn, this model implies that efforts to identify and improve decolonization strategies for better patient safety in health care may be needed and are worth exploring.
An attempt has been made to illustrate the evolution of pelitic granulite from south of the Balaram-Abu road, which lies in the South Delhi Terrane (SDT) of the Aravalli-Delhi Mobile Belt (ADMB), using geochemistry and geochronology. The current work offers a plausible explanation for the protolith of pelitic granulite, nature of the sediments and its provenance. The elemental geochemistry of the pelitic granulites reveals that the protolith is an arkosic to shaley type. The rare earth elements pattern shows that there is a negative Eu anomaly and a small excess of LREE over HREE. This means that the source of sediments probably has the same elements as the upper crust. However, the amounts of Sr, Nd and Pb vary a lot, which shows that the sediments supplied from two different types of sources (felsic and mafic) in different proportions from a Proterozoic terrain. The monazite geochronology indicates that the metamorphic overprint occurred between 797 Ma and 906 Ma. Additionally, the ages correlate to the debris that was formed between the 1188 Ma and 1324 Ma from magmatic/sedimentary sources for pelitic granulite. The present research provides a more in-depth understanding of the evolutionary history of the pelitic granulite that comprises the SDT in the ADMB region during the Proterozoic era.
Sustainability of maize production systems is threatened by poor economic returns and resource intensiveness. Therefore, an experiment was conducted at the ICAR-Indian Agricultural Research Institute, New Delhi during 2016–17 to 2017–18 to assess the effect of tillage and microbial inoculantsintegrated phosphorus (P) management on productivity, quality, economic outcome and energy dynamics of maize. Three tillage practices viz., CT–R (conventional tillage with no residue), ZT–R (zero tillage with no residue) and ZT + R (zero tillage with wheat crop residue at 2.5 Mg/ha) were assigned in main plots and five P management practices viz., P1 (control–NK as per recommendation, but no P), P2 (17.2 kg P/ha), P3 (17.2 kg P/ha + PSB), P4 (17.2 kg P/ha + compost inoculants) and P5 (34.4 kg P/ha) were allocated in subplots in three times replicated split-plot design. The maximum grain yield (5.96 Mg/ha), protein content (9.13%), protein yield (546 kg/ha) and gross energy returns (209 × 103 MJ/ha) were recorded under ZT + R while higher benefit: cost ratio (B: C ratio – the amount of economic gain per unit investment) (1.53) and energy efficiency (12.5) was noticed under ZT–R. Among the P management practices, the application of 34.4 kg P/ha recorded the highest grain yield (6.45 Mg/ha), protein content (9.34%), protein yield (603 kg/ha), B: C ratio (1.65) and energy efficiency (10.1). The results suggested that the application of P at the rate of 34.4 kg/ha under ZT + R is an economically robust approach for the quality maize production in semi-arid region.
Persons with Alzheimer’s disease and related dementias (ADRD) are prone to receiving reduced quality of care. We compared the quality of room cleaning of rooms with ADRD residents and rooms with non-ADRD residents in nursing homes using an ultraviolet (UV) marker. ADRD status was associated with greater failure of UV marker removal (odds ratio, 1.68; 95% confidence interval, 1.04–2.71; P = .03).
We summarize what we assess as the past year's most important findings within climate change research: limits to adaptation, vulnerability hotspots, new threats coming from the climate–health nexus, climate (im)mobility and security, sustainable practices for land use and finance, losses and damages, inclusive societal climate decisions and ways to overcome structural barriers to accelerate mitigation and limit global warming to below 2°C.
Technical summary
We synthesize 10 topics within climate research where there have been significant advances or emerging scientific consensus since January 2021. The selection of these insights was based on input from an international open call with broad disciplinary scope. Findings concern: (1) new aspects of soft and hard limits to adaptation; (2) the emergence of regional vulnerability hotspots from climate impacts and human vulnerability; (3) new threats on the climate–health horizon – some involving plants and animals; (4) climate (im)mobility and the need for anticipatory action; (5) security and climate; (6) sustainable land management as a prerequisite to land-based solutions; (7) sustainable finance practices in the private sector and the need for political guidance; (8) the urgent planetary imperative for addressing losses and damages; (9) inclusive societal choices for climate-resilient development and (10) how to overcome barriers to accelerate mitigation and limit global warming to below 2°C.
Social media summary
Science has evidence on barriers to mitigation and how to overcome them to avoid limits to adaptation across multiple fields.
The Diwani hills are located SE of Balaram–Abu Road in the Banaskantha district of north Gujarat. The crystalline rocks of the Diwani hill area are a diverse assemblage of Precambrian metamorphic and igneous rocks. These rocks are petrologically more complex and date back to the Aravallis or earlier. The mineralogical assemblages such as grt–sp–opx–qz of these rocks indicate their origin in anhydrous or dry conditions, implying metamorphism under pyroxene granulite facies. These granulitic rocks were subjected to Delhi orogenic deformation and were later intruded by the Erinpura granite. Textural and microstructural relationships, mineral chemistry, P–T–X pseudosection modelling and the oxidation state of pelitic granulites from the Diwani hill area of north Gujarat are all part of the current approach. The winTWQ program and pseudosection modelling in the NCKFMASHTO model system utilizing Perple_X software were used to restrict the P–T evolution of these pelitic granulites. The unification of these estimates shows that the pelitic granulites reached their pressure and temperature maxima at 8.6 kbar and 770 °C, respectively. The oxygen fugacity (log fO2) versus temperature computations at 6.2 kbar revealed log fO2–T values of −13.0 and 765 °C, respectively. The electron microprobe dating of monazite grains separated from the granulites of the Diwani hills yields ages ranging from 769 Ma to 855 Ma. The electron microprobe dating presented here from the Diwani hills provides evidence for a Neoproterozoic (Tonian) metamorphic event in the Aravalli–Delhi Mobile Belt.
Anthracnose caused by Colletotrichum truncatum is a major soybean disease in India. Genetic resistance is the viable option to combat yield losses due to this disease. In the current study, 19 soybean genotypes were evaluated for anthracnose disease resistance at five locations (Medziphema, Palampur, Dharwad, Jabalpur and Indore) for three consecutive years (2017–2019) to identify stable and superior genotypes as resistant sources and to elucidate genotype (G) × environment (E) interactions. Genotype effect, environment effect and G × E interactions were found significant (P < 0.001) where G × E interactions contributed highest (42.44) to the total variation followed by environment (29.71) and genotype (18.84). Through Weighted Average of Absolute Scores (WAASB) stability analysis, PS 1611 (WAASB score = 0.33) was found to be most stable and through WAASBY superiority analysis NRC 128 (WAASBY score = 94.31) and PS 1611 (WAASBY score = 89.43) were found to be superior for mean performance and stability. These two genotypes could be candidate parents for breeding for durable and stable anthracnose resistance. Through principal component analysis, disease score was found to be positively associated with relative humidity, wind speed at 2 m above ground level, effect of temperature on radiation use efficiency and global solar radiation based on latitude and Julian day. Among the five locations, Indore was found to be highly discriminative with the highest mean disease incidence and could differentiate anthracnose-resistant and susceptible genotypes effectively, therefore can be considered an ideal location for breeding for field resistance against anthracnose disease.
In spite of continuous refinements in tympanoplasty techniques, results are variable, and it is not uncommon to see a discharging eardrum even after a good graft uptake. This study aimed to evaluate the efficacy of total annulus excision tympanoplasty in comparison with conventional underlay tympanoplasty.
Method
This was a double blinded, randomised, controlled trial performed at a tertiary care centre. After inclusion and exclusion criteria were met, 56 patients were enrolled and randomised, and 28 patients were allocated to each group (group A (conventional tympanoplasty) and group B (total annulus excision)). Patients and evaluators were blind to the procedure performed.
Results
Patients in group B (total annulus excision) showed better graft uptake and no discharge with better gains in air conduction thresholds (p < 0.05) when compared with group A (conventional tympanoplasty).
Conclusion
In view of the advantages it offers, total annulus excision tympanoplasty may be preferred over the conventional techniques in patients with central perforations.
To assess benefits of surgical intervention at an early age and focus on surgical techniques using exclusively autologous cartilage grafts.
Methods
Five children aged 8–15 years, treated between March 2016 and 2020, underwent augmentation rhinoplasty using autologous cartilage, with post-operative follow up ranging from 1.5 to 2 years. Photographs and Rhinoplasty Outcome Evaluation questionnaire scores were examined.
Results
Augmentation was achieved without complications. No restricted skin or mucosal pockets were encountered. Patients showed improved confidence and perspective with regard to self-image, and were less socially self-conscious. There was significant improvement in all Rhinoplasty Outcome Evaluation questionnaire scores.
Conclusion
Early surgery allows augmentation with easier release of skin and mucosal pockets, and without the tension otherwise encountered if primary augmentation is performed at a later age. It offers a chance to improve confidence and self-perception in a growing child conscious about their appearance, which may make them socially withdrawn. Autologous cartilage gives better results than bone grafts, and is comparable with silicone but without its complications.
This paper reports an integration of dual band microstrip antenna with thin film amorphous silicon solar cell which creates a wearable system to harvest microwave energy. The multiple layers in the encapsulation of the thin film solar cell are used as a substrate for microstrip antenna. The rectifier and matching circuit are designed on cotton jeans material and the whole system is mechanically supported by the foam of 5 mm thick. The performance of the antenna is studied for the mechanical bending condition. The device has maintained good power conversion efficiency. The efficiency of the voltage doubler is tested by varying radio frequency power levels from −30 to10 dBm. The voltage doubler conversion efficiency at 1.85 and 2.45 GHz are 58 and 43%, respectively, for a load of 7.5 kΩ for an input power level of −5 dBm.
Schizophrenia, which is linked to a range of physical health conditions, might share intrinsic inflammatory disease pathways with type-two diabetes mellitus (T2DM). Psychotropic medication has presented a major confounder in examining this association. First-episode psychosis (FEP) patients present an interesting cohort to study this potential association, being generally younger with less comorbidity, and with limited exposure to antipsychotic medication.
Aims
To assess whether FEP, which could be described as ‘developing schizophrenia’, is associated with prediabetes, or ‘developing diabetes’, to determine whether intrinsic disease links could cause the conditions to develop in unison.
Methods
Using PRISMA criteria, we searched Embase, Medline, PsychInfo, Web of Science, and Google Scholar to 6th January 2016. We assessed case-control studies with biochemical assessment of prediabetic states in FEP patients alongside matched controls.
Results
Twelve studies were included, involving 1137 participants. Several measurements examined prediabetes, including fasting plasma glucose, impaired glucose tolerance, and insulin resistance. Pooled analysis found FEP to be related to impaired glucose tolerance (mean difference 1.31 [0.37, 2.25]), insulin resistance (mean difference 0.30 [0.18, 0.42]), and the number of patients with impaired glucose tolerance (odds ratio 5.44 [2.63–11.27]).
Conclusion
Our findings suggest a potential link between prediabetic markers, in particular impaired glucose tolerance and insulin resistance, and FEP. However, we cannot establish causality, and the studies contributing to this review were at some risk of bias. Nevertheless, the findings might help to explain the increased prevalence of T2DM in patients with schizophrenia and could have implications for the management of schizophrenia patients.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
A cross-sectional study was conducted from 2014 to 2017 in 13 organised pig farms located in eight states of India (Northern, North-Eastern and Southern regions) to identify the risk factors, pathotype and antimicrobial resistance of Escherichia coli associated with pre- and post-weaning piglet diarrhoea. The data collected through questionnaire survey were used to identify the risk factors by univariable analysis, in which weaning status, season, altitude, ventilation in the shed, use of heater/cooler for temperature control in the sheds, feed type, water source, and use of disinfectant, were the potential risk factors. In logistic regression model, weaning and source of water were the significant risk factors. The piglet diarrhoea prevalence was almost similar across the regions. Of the 909 faecal samples collected (North – 310, North-East – 194 and South – 405) for isolation of E. coli, pathotyping and antibiotic screening, 531 E. coli were isolated in MacConkey agar added with cefotaxime, where 345 isolates were extended spectrum β-lactamase (ESBL) producers and were positive for blaCTX-M-1 (n = 147), bla TEM (n = 151), qnrA (n = 98), qnrB (n = 116), qnrS (n = 53), tetA (n = 46), tetB (n = 48) and sul1 (n = 54) genes. Multiple antibiotic resistance (MAR) index revealed that 14 (2.64%) isolates had MAR index of 1. On the virulence screening of E. coli, 174 isolates harboured alone or combination of Stx1, Stx2, eaeA, hlyA genes. The isolates from diarrhoeic and post-weaning samples harboured higher number of virulence genes than non-diarrhoeic and pre-weaning. Alleviating the risk factors might reduce the piglet diarrhoea cases. The presence of multidrug-resistant and ESBL-producing pathogenic E. coli in piglets appears a public health concern.
A cross-sectional study on six dairy farms was conducted to ascertain the occurrence of carbapenem-resistant Escherichia coli in calves. Two-hundred and seventy-nine isolates of E. coli were recovered from 90 faecal samples from apparently healthy (45) and diarrhoeal (45) calves. The isolates were screened for phenotypic susceptibility to carbapenems and production of metallo β-lactamase, as well as five carbapenemase resistance genes by PCR, and overexpression of efflux pumps. Eighty-one isolates (29.03%) were resistant to at least one of three carbapenem antibiotics [meropenem (23.30%), imipenem (2.15%) and ertapenem (1.43%)], and one isolate was positive for the blaVIM gene which was located on an Incl1 plasmid of a novel sequence type (ST 297) by multilocus sequence typing. The majority (83.95%) of isolates had an active efflux pump. Calves housed on concrete floors were approximately seven times more likely to acquire meropenem-resistant isolates than those housed on earthen floors (95% CI 1.27–41.54). In India, carbapenem drugs are not used in food animal treatment, hence carbapenem-resistant strains in calves possibly originate from the natural environment or human contact and is of public health importance. To our knowledge, this is the first report of blaVIM carbapenemases gene in calves from India.