To send 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 sending content to .
To send content items to your Kindle, first ensure email@example.com
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 sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent 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.
This study reviews patient encounters at a Boston-area community hospital Psychiatric Emergency Services (PES) following the Boston Marathon bombings, with the goal of describing the impact of terrorist attacks on PES encounters.
All PES encounters for 2 months preceding and 2 months following the bombing were identified in the electronic medical record. Demographics, current and past psychiatric problems, and trauma history were assessed for all records. Encounters seen post-bombing were compared with those before the bombing.
Demographics, current and past psychiatric problems, and trauma history were not significantly different before versus after the bombing; 36 of 440 (8.2%) post-bombing encounters directly mentioned the bombings. New-onset posttraumatic stress disorder (PTSD) symptoms caused by the bombing occurred in only 4 encounters (0.9%).
PES encounters after a terrorist event are likely to mirror those seen before a terrorist event, with only a minority of encounters presenting for new PTSD or acute stress disorder.
Chemical bonding in native oxides of GaAs, before and after etching, is detected by X-Ray Photoelectron Spectroscopy (XPS). It is correlated with surface energy engineering (SEE), measured via Three Liquid Contact Angle Analysis (3LCAA), and oxygen coverage, measured by High Resolution Ion Beam Analysis (HR-IBA).
Before etching, GaAs native oxides are found to be hydrophobic with an average surface energy, γT, of 33 ± 1 mJ/m2, as measured by 3LCAA. After dilute NH4OH etching, GaAs becomes highly hydrophilic and its surface energy, γT, increases by a factor 2 to a reproducible value of 66 ± 1 mJ/m2. Using HR-IBA, oxygen coverage on GaAs is found to decrease from 7.2 ± 0.5 monolayers (ML) to 3.6 ± 0.5 ML. The 1.17 ratio of Ga to As, measured by HR-IBA, remains constant after etching.
XPS is used to measure oxidation of Ga and As, as well as surface stoichiometry on two locations of several GaAs(100) wafers before and after etching. The relative proportions of Ga and As are unaffected by adventitious carbon contamination. The 1.16 Ga:As ratio, measured by XPS, matches HR-IBA analysis. The proportions of oxidized Ga and As do not change significantly after etching. However, the initial ratio of As2O5 to As2O3, within the oxidized As, significantly decreases after etching from approximately 3:1 to 3:2.
Absolute oxygen coverage, as a function of surface processing, is determined within 0.5 ML by HR-IBA. XPS offers insight into these modifications by detecting electronic states and phase composition changes of GaAs oxides. The changes in surface chemistry are correlated to changes in hydro-affinity and surface energies measured by 3LCAA.
The association between methicillin-resistant Staphylococcus aureus (MRSA) colonisation and/or infection with increased morbidity and mortality among hospital patients has long been recognised. We sought to build on previous studies to identify modifiable risk factors associated with the acquisition of MRSA colonisation and infection by conducting a retrospective cohort study on patients admitted through the Emergency Department of an acute tertiary-care general hospital in Singapore which implemented universal on-admission MRSA screening. Patients were assigned to the acquisition or non-acquisition group depending on whether they acquired MRSA during their admission. We used logistic regression models with a patient being in the acquisition group as the binary outcome to identify factors associated with MRSA acquisition. A total of 1302 acquisition and 37 949 non-acquisition group patients were analysed. Fifteen variables were included in the multivariate model. A dose–response relationship between length of stay and odds of MRSA acquisition was observed, with a length of stay 3 weeks or more (Adj OR 11.78–57.36, all P < 0.001) being the single biggest predictor of MRSA acquisition. Other variables significantly associated with MRSA acquisition were: male gender, age 65 or greater, previous MRSA colonisation or infection, exposure to certain antibiotics and surgery, and history of diabetes.
Background: This is an updated on-line survey of the awareness and knowledge of stroke and heart disease amongst Chinese-Canadians carried out in 2017. Methods: 1001 randomnly selected Chinese-Canadians from Toronto and Vancouver area. Results: 46% were > 45 years old and male to female ratio was: 49.3 : 50.8, with native language being Cantonese in 40%, Mandarin 24% and 31% English. 82% were Canadian citizens and 31% had been in Canada < 10 years. 44% were from Mainland China, 37% Hong Kong , 6% Taiwan and 12% were borned in Canada. 85% were able to name at least one symptom of heart attack (p=0.005) while 80% were able to name at least one symptom of stroke (p=0.0008). 85% would call 911 in response to symptoms of heart attack or stroke compared to only 20% in a previous 2004 telephone survey (p=0.00001) . Conclusions: There is a dramatic improvement in the awareness and knowledge of stroke and heart disease amongst Chinese-Canadians compared to a previous telephone survey in 2004. This significant change could be due to difference in survey technique, but these improvements could also be due to the ongoing health promotion efforts by the Chinese-Canadian Council in support of the Heart & Stroke Foundation.
A comprehensive and robust computer database was built to record and analyse the medical physics on-call data in emergency radiotherapy. The probability distributions of the on-call events varying with day and week were studied.
Materials and methods:
Variables of medical physics on-call events such as date and time of the event, number of event per day/week/month, treatment site of the event and identity of the on-call physicist were input to a programmed Excel file. The Excel file was linked to the MATLAB platform for data transfer and analysis. The total number of on-call events per day in a week and per month in a year were calculated based on the physics on-call data in 2010–18. In addition, probability distributions of on-call events varying with days in a week (Monday–Sunday) and months (January–December) in a year were determined.
For the total number of medical physics on-call events per week in 2010–18, it was found that the number was similar from Sundays to Thursdays but increased significantly on Fridays before the weekend. The total number of events in a year showed that the physics on-call events increased gradually from January up to March, then decreased in April and slowly increased until another peak in September. The number of events decreased in October from September, and increased again to reach another peak in December. It should be noted that March, September and December are months close to Easter, Labour Day and Christmas, when radiation staff usually take long holidays.
A database to record and analyse the medical physics on-call data was created. Different variables such as the number of events per week and per year could be plotted. This roster could consider the statistical results to prepare a schedule with better balance of workload compared with scheduling it randomly. Moreover, the emergency radiotherapy team could use the analysed results to enhance their budget/resource allocation and strategic planning.
Dose distribution index (DDI) is a treatment planning evaluation parameter, reflecting dosimetric information of target coverage that can help to spare organs at risk (OARs) and remaining volume at risk (RVR). The index has been used to evaluate and compare prostate volumetric modulated arc therapy (VMAT) plans using two different plan optimisers, namely photon optimisation (PO) and its predecessor, progressive resolution optimisation (PRO).
Materials and methods:
Twenty prostate VMAT treatment plans were created using the PO and PRO in this retrospective study. The 6 MV photon beams and a dose prescription of 78 Gy/39 fractions were used in plans with the same dose–volume criteria for plan optimisation. Dose–volume histograms (DVHs) of the planning target volume (PTV), as well as of OARs such as the rectum, bladder, left and right femur were determined in each plan. DDIs were calculated and compared for plans created by the PO and PRO based on DVHs of the PTV and all OARs.
The mean DDI values were 0·784 and 0·810 for prostate VMAT plans created by the PO and PRO, respectively. It was found that the DDI of the PRO plan was about 3·3% larger than the PO plan, which means that the dose distribution of the target coverage and sparing of OARs in the PRO plan was slightly better. Changing the weighting factors in different OARs would vary the DDI value by ∼7%. However, for plan comparison based on the same set of dose–volume criteria, the effect of weighting factor can be neglected because they were the same in the PO and PRO.
Based on the very similar DDI values calculated from the PO and PRO plans, with the DDI value in the PRO plan slightly larger than that of the PO, it may be concluded that the PRO can create a prostate VMAT plan with slightly better dose distribution regarding the target coverage and sparing of OARs. Moreover, we found that the DDI is a simple and comprehensive dose–volume parameter for plan evaluation considering the target, OARs and RVR.
The lonely runner conjecture, now over fifty years old, concerns the following problem. On a unit-length circular track, consider
runners starting at the same time and place, each runner having a different constant speed. The conjecture asserts that each runner is lonely at some point in time, meaning at a distance at least
from the others. We formulate a function field analogue, and give a positive answer in some cases in the new setting.
Upper respiratory tract infections (URTIs) account for substantial attendances at emergency departments (EDs). There is a need to elucidate determinants of antibiotic prescribing in time-strapped EDs – popular choices for primary care despite highly accessible primary care clinics. Semi-structured in-depth interviews were conducted with purposively sampled physicians (n = 9) in an adult ED in Singapore. All interviews were analysed using thematic analysis and further interpreted using the Social Ecological Model to explain prescribing determinants. Themes included: (1) reliance on clinical knowledge and judgement, (2) patient-related factors, (3) patient–physician relationship factors, (4) perceived practice norms, (5) policies and treatment guidelines and (6) patient education and awareness. The physicians relied strongly on their clinical knowledge and judgement in managing URTI cases and seldom interfered with their peers’ clinical decisions. Despite departmental norms of not prescribing antibiotics for URTIs, physicians would prescribe antibiotics when faced with uncertainty in patients’ diagnoses, treating immunocompromised or older patients with comorbidities, and for patients demanding antibiotics, especially under time constraints. Participants had a preference for antibiotic prescribing guidelines based on local epidemiology, but viewed hospital policies on prescribing as a hindrance to clinical judgement. Participants highlighted the need for more public education and awareness on the appropriate use of antibiotics and management of URTIs. Organisational practice norms strongly influenced antibiotic prescribing decisions by physicians, who can be swayed by time pressures and patient demands. Clinical decision support tools, hospital guidelines and patient education targeting at individual, interpersonal and community levels could reduce unnecessary antibiotic use.
Applying primary health care (PHC) team-based approaches to diagnosing and treating dementia is considered best practice. Unfortunately, those living in rural and remote areas often have limited access to dementia-specific PHC services. The purpose of this scoping review was to identify and understand PHC team-based approaches for dementia care in rural settings. A search strategy was employed which included only peer-reviewed journal articles that were published from 1997 to 2017. Four databases (Embase, Medline, PsycInfo, and CINAHL) were searched from March 2017 to May 2017. Among the 10 studies included there was a variation in the degree of collaboration and interaction among the care teams. Limited information existed about collaboration strategies among care teams. An adaptation of the socio-ecological model enabled us to categorize key factors influencing collaborative team-based approaches. Combined, these findings can be used to inform both future research and the development of a rural PHC dementia model.
Energy dispersive x-ray analysis has become an extremely useful analytical tool. The technique provides for the direct observation of x-ray emission spectra, eliminating the need for a dispersive crystal. The purpose of this reported investigation was to study the use of the technique with a simple pulse height analyzing system and to develop a routine method for correcting Interferences due to adjacent element spectral overlap and matrix effects.
The analyzing system consists of a radioisotope source, a lithium drifted silicon detector, a preamplifier, an amplifier, two single channel analyzers and two digital ratemeters. In order to obtain results suitable for quantative measurement, a two-step empirical method was employed for the correction of peak overlapping and matrix effects. If two peaks in a spectrum overlap at their tails, one can set up a channel width of the analyzer to a region where there are no overlapping pulses. It is then possible to calibrate the ratio of the intensity obtained from this channel to that obtained from the whole peak in its pure state, i.e. without the appearance of a neighbor peak. The actual intensity of the peak in the overlapping spectrum is, therefore, the observed counts multiplied by the ratio. The next step is the correction of matrix effect by means of conventional empirical methods using standard samples. Two types of the samples, Zn-Cu powder mixtures and Ee-Cu in aqueous solutions, were studied to illustrate this method. The usefulness of applying the analyzing system and technique to industrial measurements, either on-line or batch, will also be discussed.
OBJECTIVES/SPECIFIC AIMS: We hypothesize that VL testing varies by geographic sub-region, country, age, gender, mode of transmission, year of diagnosis, and country of origin; and also that a higher prevalence of VL testing may be associated with higher prevalence of population-level VL suppression. Our primary aim is to determine country- and regional-level factors that are associated with viral load testing amongst HIV patients. Our secondary aim is to explore the association between prevalence of viral load testing and viral load suppression at the population level. METHODS/STUDY POPULATION: This is a retrospective analysis of de-identified individual-level data reported to the European Surveillance System (TESSy). The TESSy is a database of communicable diseases (including HIV) for the ECDC and WHO European Regional Office. It captures data from 31 European Union/European Economic Area (EU/EEA) countries and 23 non-EU/EEA countries. Stored data is from year 2000. TESSy is used for data analysis and production of outputs for public health action. The patient cohort include adults older 18 years, whose last clinic attendance was reported in 2014 or later, or whose viral load test was reported in the year of the visit or the year before the year of their last reported clinic attendance. Patient demographic data include age, sex, mode of transmission, country of origin (migrants), country of diagnosis, geographic region, last clinic attendance, viral load and therapy status. Geographic region will be categorized into East, West and Centre as per WHO guidelines. Countries will be categorized and analyzed according to their European Union (EU)-, European Economic Area (EEA)- and income (GDP)-status, using current World Bank and International Monetary Fund (IMF) guidelines. All statistical analysis will be performed in R-Studio and R i386 3.0.2. Missing data will be characterized in terms of quantity (how much is missing) and pattern (random versus non-random) and impact on covariates to be tested. Multiple data imputations would be used in cases where missing data is found to be at random. Data from external sources like UNAIDS, World Bank and IMF will also be used for comparison and validation of TESSy data for imputation of missing data. Continuous variables will be analyzed through appropriate parametric and non-parametric tests while categorical variables will be analyzed through methods of proportion. Multivariate logistic regression methods will be used to explore the associations between VL testing and VL suppression separately with age, sex, year of diagnosis, country of origin (migrants), mode of transmission, in the total population, then at country- and regional-level. The same associations will be explored using a country’s EU and EEA status (EU versus EEA versus non-EU/EEA), and income status (high versus upper middle versus lower middle versus low). DISCUSSION/SIGNIFICANCE OF IMPACT: Even though this is a retrospective analysis of a database with likely significant missing data that may affect analysis of data and interpretation of results, our study will impact all levels of HIV policy across Europe. The strengths of this study likely outweigh the limitation imposed by missing data and include potential regional-, country- and demographic-specific public health, epidemiologic and ART program policy initiatives. Also our analysis of pattern of missing data may inform a more efficient and meaningful data collection and input into TESSy database.
OBJECTIVES/SPECIFIC AIMS: The goal of this study is to measure speech fluency and brain activity before and after 5 days of behavioral speech fluency training alone (sham group) or speech training plus stimulation (active group). A 1-month follow up will also be completed. The first primary outcome measure is changes in brain activation in speech motor control/timing network. The second primary outcome measure is changes in percentage of stuttered syllables during speech sample (speech fluency). The secondary outcome measure is changes from baseline on the Overall Assessment of Speakers Experience of Stuttering (OASES), a detailed subject rating of how stuttering affects their lives. METHODS/STUDY POPULATION: This study is a between subjects, counterbalanced, sham-controlled, double-blind design. Participants will be 40 adults who stutter who will be randomized (using minimization) into either the active or sham stimulation group, with all other study procedures being the same in both groups. Participants will completed 2 days of baseline testing, 5 consecutive days of brain stimulation during speech training, 2 days of post-testing, and a 1-month follow up. All outcome measures will be completed immediately before and after the 5 days of brain stimulation, as well as at follow-up. as of submission, 10 subjects have completed the study. Data collection is ongoing. RESULTS/ANTICIPATED RESULTS: Expected results. Questions this study aims to answer: 1) Does a more intensive training period lead to decreased stuttering? We expect that both groups will show improvements in speech fluency immediately after training. We expect that those in the active group will continue to exhibit improved speech fluency at 1 month follow up. 2) Does a more intensive training period lead to changes in brain activity? We expect that both groups will exhibit increased activity in auditory/motor regions immediately after training. We expect that the active group will continue to exhibit an increase in activity in these regions at 1 month follow up. DISCUSSION/SIGNIFICANCE OF IMPACT: This is the first RCT study involving brain stimulation in adults who stutter. We expect to provide preliminary evidence for the effectiveness of tDCS as an augmentative agent for increased speech fluency in adults who stutter during a brief, intensive training paradigm. We also expect to be able to provide information on the effects of tDCS on brain activity in speech and auditory-motor regions of the brain. The findings will add to the growing body of literature suggesting that developmental stuttering is a neurodevelopmental disorder with roots in timing and rhythmic aspects of speech motor control and auditory-motor integration.
The Pain Catastrophizing Scale (PCS) measures three aspects of catastrophic cognitions about pain—rumination, magnification, and helplessness. To facilitate assessment and clinical application, we aimed to (a) develop a short version on the basis of its factorial structure and the items’ correlations with key pain-related outcomes, and (b) identify the threshold on the short form indicative of risk for depression.
Social centers for older people.
664 Chinese older adults with chronic pain.
Besides the PCS, pain intensity, pain disability, and depressive symptoms were assessed.
For the full scale, confirmatory factor analysis showed that the hypothesized 3-factor model fit the data moderately well. On the basis of the factor loadings, two items were selected from each of the three dimensions. An additional item significantly associated with pain disability and depressive symptoms, over and above these six items, was identified through regression analyses. A short-PCS composed of seven items was formed, which correlated at r=0.97 with the full scale. Subsequently, receiver operating characteristic (ROC) curves were plotted against clinically significant depressive symptoms, defined as a score of ≥12 on a 10-item version of the Center for Epidemiologic Studies-Depression Scale. This analysis showed a score of ≥7 to be the optimal cutoff for the short-PCS, with sensitivity = 81.6% and specificity = 78.3% when predicting clinically significant depressive symptoms.
The short-PCS may be used in lieu of the full scale and as a brief screen to identify individuals with serious catastrophizing.
For a long time, secondary ion mass spectrometry (SIMS) was the only technique allowing impurity concentrations below 1 at% to be precisely measured in a sample with a depth resolution of few nanometers. For example, SIMS is the classical technique used in microelectronics to study dopant distribution in semiconductors and became, after radiotracers were forsaken, the principal tool used for atomic transport characterization (diffusion coefficient measurements). Due to the lack of other equivalent techniques, sometimes SIMS could be used erroneously, especially when the analyzed solute atoms formed clusters, or for interfacial concentration measurements (segregation coefficient measurements) for example. Today, concentration profiles measured by atom probe tomography (APT) can be compared to SIMS profiles and allow the accuracy of SIMS measurements to be better evaluated. However, APT measurements can also carry artifacts and limitations that can be investigated by SIMS. After a summary of SIMS and APT measurement advantages and disadvantages, the complementarity of these two techniques is discussed, particularly in the case of experiments aiming to measure diffusion and segregation coefficients.
Informed by Stern and colleagues’ value-belief-norm theory and their earlier empirical work, we examined levels and predictors of cognitive and behavioural environmental concern (EC) of university students in a Canadian postsecondary context. Data for this study were obtained through completion of self-administered questionnaires from a sample of 421 undergraduate students attending a public university in Saskatchewan, a province heavily focused on expanding resource extraction. The study used a descriptive, correlational, and cross-sectional methodology. Statistical analysis was performed in three parts: (a) univariate description of students’ cognitive and behavioural EC indicators; (b) bivariate associations to assess the nature and direction of the relationships between EC measures; and (c) multivariate analyses to test the causal structure of the theoretical model. Results showed no widespread acceptance of the ‘New Ecological Paradigm’. Students were slightly more prone to place responsibility for environmental protection at the door of government and industry than themselves. Respondents practised a range of environmentally supportive behaviours (ESB) with varying intensities. Hierarchical multiple regression analyses provided support for several of the theory’s propositions in predicting generalised and specific environmental beliefs and ESB. Findings highlighted the complex relationships between personal background, academic and cognitive variables and ESB. That formal instruction on the environment influenced cognitive and behavioural EC, both directly and indirectly, suggests it is essential universities have formal curricula that expose students to the types of environmental knowledge, awareness, and critical thinking skills to promote environmental literacy and address unsustainable lifestyles and attitudes. Institutional interventions, including universities’ role as ‘effective change agents’, are discussed.
Archivists and art librarians are well versed in developing activities and projects using archives and library materials in object-based learning activities and engaging artists and creative practitioners with archives and special collections. But what does framing the uses of archives as creative activity really mean for the way in which we work on a practical level? I expand this question from the initial blog post I wrote: Possibilities of archives (storyingthepast.wordpress.com). Can we, like the creative practitioners we engage with, be truly creative – and if so, what could this look like? It is a pertinent question because creativity, in part, enables us to progress and innovate as the archive and library sectors continue to evolve.
I take an interdisciplinary approach to developing workshops as demonstrative case studies, with intersections from archival theory, education, and the visual arts; I first outline what creativity could look like when developing Creative Workshops from within an archival context. I also outline and reflect on how being creative can be beneficial to our profession as well as to the wider arts communities who engage with art archives and special collections.
To determine the efficacy of 2 types of antimicrobial privacy curtains in clinical settings and the costs involved in replacing standard curtains with antimicrobial curtains.
A prospective, open-labeled, multicenter study with a follow-up duration of 6 months.
This study included 12 rooms of patients with multidrug-resistant organisms (MDROs) (668 patient bed days) and 10 cubicles (8,839 patient bed days) in the medical, surgical, neurosurgical, orthopedics, and rehabilitation units of 10 hospitals.
Culture samples were collected from curtain surfaces twice a week for 2 weeks, followed by weekly intervals.
With a median hanging time of 173 days, antimicrobial curtain B (quaternary ammonium chlorides [QAC] plus polyorganosiloxane) was highly effective in reducing the bioburden (colony-forming units/100 cm2, 1 vs 57; P < .001) compared with the standard curtain. The percentages of MDRO contamination were also significantly lower on antimicrobial curtain B than the standard curtain: methicillin-resistant Staphylococcus aureus, 0.5% vs 24% (P < .001); carbapenem-resistant Acinetobacter spp, 0.2% vs 22.1% (P < .001); multidrug-resistant Acinetobacter spp, 0% vs 13.2% (P < .001). Notably, the median time to first contamination by MDROs was 27.6 times longer for antimicrobial curtain B than for the standard curtain (138 days vs 5 days; P = .001).
Antimicrobial curtain B (QAC plus polyorganosiloxane) but not antimicrobial curtain A (built-in silver) effectively reduced the microbial burden and MDRO contamination compared with the standard curtain, even after extended use in an active clinical setting. The antimicrobial curtain provided an opportunity to avert indirect costs related to curtain changing and laundering in addition to improving patient safety.
This study reported the justification and selection of acceptable γ criteria with respect to low (6 MV) and high (15 MV) photon beams for intensity-modulated radiation therapy quality assurance (IMRT QA) using the Gafchromic external beam therapy 3 (EBT3) film.
Materials and methods
Five-field step-and-shoot IMRT was used to treat 16 brain IMRT patients using the dual-energy DHX-S linear accelerator (Varian Medical System, Palo Alto, CA, USA). Dose comparisons between computed values of the treatment planning system (TPS) and Gafchromic EBT3 film were evaluated based on γ analysis using the Film QA Pro software. The dose distribution was analysed with gamma area histograms (GAHs) generated using different γ criteria (3%/2 mm, 3%/3 mm and 5%/3 mm) for the 6 and 15 MV photon beams, to optimise the best distance-to-agreement (DTA) criteria with respect to the beam energy.
From the comparison between the dose distributions acquired from the TPS and EBT3 film, a DTA criterion of 3%/2 mm showed less dose differences (DDs) with passing rates up to 93% for the 6 MV photon beams, while for the 15 MV a relaxed DTA criterion of 5%/3 mm was consistent with the DD acceptability criteria with a 95% passing rate.
Our results suggested that high-energy photon beams required relaxed DTA criteria for the brain IMRT QA, while low-energy photon beams showed better results even with tight DTA criteria.