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Toxoplasmosis is a global health threat in which occurrence in pregnant women poses grave consequences to fetal wellbeing. Studies on prenatal Toxoplasma gondii infection are generally limited in sub-Saharan African countries, including Nigeria. The risk of transmission of toxoplasmosis is very high in Nigeria due to the favourable climatic conditions and prevailing behavioural and socio-economic factors that could aid transmission. Currently, there are no systematic and organized procedures for diagnosis and treatment of maternal toxoplasmosis in Nigeria. These conditions forecast possible unabated transmission in many areas and exponential impact on associated adverse events of the disease during pregnancy. This paper highlights the importance of early diagnosis and treatment during pregnancy which may forestall subsequent development of infection in children delivered by infected mothers. Inclusion of toxoplasmosis control policy in the routine antenatal care of pregnant women is therefore strongly recommended.
Previous studies of cranial shape have established a consistent interspecific allometric pattern relating the relative lengths of the face and braincase regions of the skull within multiple families of mammals. In this interspecific allometry, the facial region of the skull is proportionally longer than the braincase in larger species. The regularity and broad taxonomic occurrence of this allometric pattern suggests that it may have an origin near the base of crown Mammalia, or even deeper in the synapsid or amniote forerunners of mammals. To investigate the possible origins of this allometric pattern, we used geometric morphometric techniques to analyze cranial shape in 194 species of nonmammalian synapsids, which constitute a set of successive outgroups to Mammalia. We recovered a much greater diversity of allometric patterns within nonmammalian synapsids than has been observed in mammals, including several instances similar to the mammalian pattern. However, we found no evidence of the mammalian pattern within Therocephalia and nonmammalian Cynodontia, the synapsids most closely related to mammals. This suggests that the mammalian allometric pattern arose somewhere within Mammaliaformes, rather than within nonmammalian synapsids. Further investigation using an ontogenetic series of the anomodont Diictodon feliceps shows that the pattern of interspecific allometry within anomodonts parallels the ontogenetic trajectory of Diictodon. This indicates that in at least some synapsids, allometric patterns associated with ontogeny may provide a “path of least resistance” for interspecific variation, a mechanism that we suggest produces the interspecific allometric pattern observed in mammals.
In March 2017, the New Jersey Department of Health received reports of 3 patients who developed septic arthritis after receiving intra-articular injections for osteoarthritis knee pain at the same private outpatient facility in New Jersey. The risk of septic arthritis resulting from intra-articular injection is low. However, outbreaks of septic arthritis associated with unsafe injection practices in outpatient settings have been reported.
An infection prevention assessment of the implicated facility’s practices was conducted because of the ongoing risk to public health. The assessment included an environmental inspection of the facility, staff interviews, infection prevention practice observations, and a medical record and office document review. A call for cases was disseminated to healthcare providers in New Jersey to identify patients treated at the facility who developed septic arthritis after receiving intra-articular injections.
We identified 41 patients with septic arthritis associated with intra-articular injections. Cultures of synovial fluid or tissue from 15 of these 41 case patients (37%) recovered bacteria consistent with oral flora. The infection prevention assessment of facility practices identified multiple breaches of recommended infection prevention practices, including inadequate hand hygiene, unsafe injection practices, and poor cleaning and disinfection practices. No additional cases were identified after infection prevention recommendations were implemented by the facility.
Aseptic technique is imperative when handling, preparing, and administering injectable medications to prevent microbial contamination.
This investigation highlights the importance of adhering to infection prevention recommendations. All healthcare personnel who prepare, handle, and administer injectable medications should be trained in infection prevention and safe injection practices.
We review the various functional cognitive disorders (FCDs) – complaints about memory function or another cognitive process in the absence of relevant neuropathology. These are increasingly coming to the attention of psychiatrists and neurologists and FCD encompasses some newly recognised conditions in addition to classic types such as pseudodementia and psychogenic amnesia. The clinical features, neuropsychological findings and treatment are presented and discussed.
After reading this article you will be able to:
•describe clinical features of FCD and how it differs from neurodegenerative causes of cognitive impairment
•be able to subclassify cases of FCD using the proposed nosology
•understand how to discuss the diagnosis with the patient and explain how the symptoms arise.
Memory services have expanded significantly in the UK, but limited performance data have been published. The aim of this programme was to determine variation in London memory services and address this through service improvement projects. In 2016 London memory services were invited to participate in an audit consisting of case note reviews of at least 50 consecutively seen patients.
Ten services participated in the audit, totalling 590 patients. Variation was noted in neuroimaging practice, neuropsychology referrals, diagnosis subtype, non-dementia diagnoses, waiting times and post-diagnostic support. Findings from the audit were used to initiate four service improvement projects.
Memory services should consider streamlining pathways to reduce waiting times, implementing pathways for patients who do not have dementia, monitoring appropriateness of neuroimaging, and working with commissioners and primary care to ensure that access to post-diagnostic interventions is consistent with the updated National Institute for Health and Care Excellence (NICE) dementia guideline.
Endophytic bacteria have evolved to survive within plant leaf tissue while potentially providing benefits to their host. This relationship makes them uniquely applicable as agricultural biocontrol agents, sources of natural chemicals/products, plant growth promoters and mediators of phytoremediation. Foliar bacterial endophytes colonise leaf tissue through vertical transmission (i.e. through seed or pollen) or horizontal transmission (i.e. colonisation through environmental contact of the roots, wounds, stomatal infiltration, insect vectors, and airborne dispersal). The taxonomic diversity of foliar endophytes spans at least seven bacterial classes and they occupy hosts from all taxanomic groups of plants tested. Bacterial leaf endophytes can promote plant health by stimulating and producing plant hormones for growth and preventing pathogenic infection. Plant-pathogenic bacteria can be found residing within leaf tissue asymptomatically raising questions about the relationship between endophyte–host specificity. Similarly, human pathogenic enterobacteria not usually associated with plants have been found to persist as endophytes. Bioactive secondary metabolites produced by these endophytes have been broadly applicable as antifungals, antibiotics, and other compounds used for agricultural and human health. Endophyte research carries unique challenges that require novel and adaptive strategies for separation of plant and bacterial DNA. This chapter will focus on bacteria isolated from within plant leaf tissue with a focus on transmission, diversity, function and challenges associated bacterial leaf endophyte research.
Let G be a finite group and A a group of automorphisms of G. Clearly A acts as a permutation group on G#, the set of non-identity elements of G. We assume that this permutation representation is half transitive, that is all the orbits have the same size. A special case of this occurs when A acts fixed point free on G. In this paper we study the remaining or non-fixed point free cases. We show first that G must be an elementary abelian g-group for some prime q and that A acts irreducibly on G. Then we classify all such occurrences in which A is a p-group.
In (4), Seitz characterized those finite groups which have exactly one non-linear irreducible character (over the complex numbers). In this paper we are concerned with the general question of what can be deduced about a finite group G if the number of its non-linear irreducible characters m(G) is given. In particular, does the assumption that m(G) is in some sense small when compared with the order |G| impose any restrictions on the structure of G?
Let G be a discrete group with group algebra C[G] over the complex numbers C. In (5) Kaplansky essentially proves that if G has a normal abelian subgroup of finite index n, then all irreducible representations of C[G] have degree ≤n. Our main theorem is a converse of Kaplansky's result. In fact we show that if all irreducible representations of C[G] have degree ≤n, then G has an abelian subgroup of index not greater than some function of n. (The degree of a representation of C[G] for arbitrary G is defined precisely in § 3.)
Reducing emissions from deforestation and forest degradation plus the conservation of forest carbon stocks, sustainable management of forests and enhancement of forest carbon stocks in developing countries (REDD+) requires information on land-use and land-cover changes (LULCCs) and carbon emission trends from the past to the present and into the future. Here, we use the results of participatory scenario development in Tanzania to assess the potential interacting impacts on carbon stock, biodiversity and water yield of alternative scenarios where REDD+ is or is not effectively implemented by 2025, a green economy (GE) scenario and a business as usual (BAU) scenario, respectively. Under the BAU scenario, LULCCs will cause 296 million tonnes of carbon (MtC) national stock loss by 2025, reduce the extent of suitable habitats for endemic and rare species (mainly in encroached protected mountain forests) and change water yields. In the GE scenario, national stock loss decreases to 133 MtC. In this scenario, consistent LULCC impacts occur within small forest patches with high carbon density, water catchment capacity and biodiversity richness. Opportunities for maximizing carbon emission reductions nationally are largely related to sustainable woodland management, but also contain trade-offs with biodiversity conservation and changes in water availability.
Vase-shaped microfossils (VSMs) occur in dolomitic extraclasts of indeterminate provenance within the basal diamictite of the Neoproterozoic Urucum Formation (Jacadigo Group) of west-central Brazil, having an age constrained between 889±44 Ma (K-Ar; basement rocks) and 587±7 Ma (40Ar/39Ar age of early metamorphic cryptomelane in overlying manganese ore). Early isopachous carbonate cement entombed these VSMs, preserving rare direct evidence of original wall composition that is carbonaceous (now kerogenous) in practically all specimens. Some tests are siliceous or composed of a quartz-kerogen mixture; secondary replacement explains some features of these tests, but original biomineralization seems more likely for others. This interpretation, coupled with test morphology, suggests affinity to arcellinid testate amoebae. Five VSM taxa are recognized in the deposit: Cycliocyrillium simplex Porter, Meisterfeld, and Knoll, 2003, and C. torquata Porter, Meisterfeld, and Knoll, 2003, originally described in the Chuar Group (USA), and three new monospecific genera—Palaeoamphora urucumense n. gen. n. sp., Limeta lageniformis n. gen. n. sp., and Taruma rata n. gen. n. sp. Most of the taxonomically important characteristics of these VSMs occur also in extant testate amoebae, but the combinations of some characters, such as organic-walled tests having exceptionally long necks that exhibit terminal apertures (L. lageniformis n. gen. n. sp.), are evidently novel additions to the known diversity of Neoproterozoic VSMs. Evidence of glacially influenced deposition in the conformably overlying Santa Cruz Formation may indicate that the Urucum Formation slightly preceded or was penecontemporaneous with a major Neoproterozoic glaciation, although the VSM-hosting extraclasts must be older, possibly rivaling the age of the testate amoebae of the Chichkan Formation (766±7 Ma) that are currently regarded as the oldest record of protists in the geological record.
Salmonella is a leading cause of bacterial foodborne illness. We report the collaborative investigative efforts of US and Canadian public health officials during the 2013–2014 international outbreak of multiple Salmonella serotype infections linked to sprouted chia seed powder. The investigation included open-ended interviews of ill persons, traceback, product testing, facility inspections, and trace forward. Ninety-four persons infected with outbreak strains from 16 states and four provinces were identified; 21% were hospitalized and none died. Fifty-four (96%) of 56 persons who consumed chia seed powder, reported 13 different brands that traced back to a single Canadian firm, distributed by four US and eight Canadian companies. Laboratory testing yielded outbreak strains from leftover and intact product. Contaminated product was recalled. Although chia seed powder is a novel outbreak vehicle, sprouted seeds are recognized as an important cause of foodborne illness; firms should follow available guidance to reduce the risk of bacterial contamination during sprouting.
This note is motivated by Blom's work in 1989. We consider a generalized Ehrenfest urn model in which a randomly-chosen ball has a positive probability of moving from one urn to the other urn. We use recursion relations between the mean transition times to derive formulas in terms of finite sums, which are shown to be equivalent to the definite integrals obtained by Blom.
Background: Lumbar fusion for degenerative indications is associated with a great degree of practice variation. We summarize the current evidence on the comparative safety and efficacy of lumbar fusion, decompression alone, or non-operative care for degenerative indications. Methods: Literature search of electronic bibliographic databases was conducted. Comparative studies reporting validated measures of safety or efficacy were included. Treatments effects were calculated through DerSimonian and Laird random effects models. Results: We retrieved 62 studies (17 randomized controlled, 15 prospective, 15 retrospective, and 15 registries), enrolling a total 302,347 adult patients. Disability, pain, and patient satisfaction following fusion, decompression alone, or non-operative care were dependent on surgical indications and study methodology. Relative to decompression alone, the risk of reoperation following fusion was increased for spinal stenosis (relative risk [RR] 1.17, 95% CI 1.06 to 1.30, p<0.004) and decreased for spondylolisthesis (RR 0.71, 95% CI 0.59 to 0.84, p<0.001). In all indications, complications were more frequent following fusion (RR 1.88, 95% CI 1.37 to 2.58, p<0.001). Mortality and treatment modality were not associated. Conclusions: Improvements were greatest in patients undergoing fusion for spondylolisthesis while complications limited the role of fusion for spinal stenosis. The relative safety and efficacy of fusion for chronic low back pain suggested careful patient selection is required.
Major depressive disorder (MDD) is moderately heritable, however genome-wide association studies (GWAS) for MDD, as well as for related continuous outcomes, have not shown consistent results. Attempts to elucidate the genetic basis of MDD may be hindered by heterogeneity in diagnosis. The Center for Epidemiological Studies Depression (CES-D) scale provides a widely used tool for measuring depressive symptoms clustered in four different domains which can be combined together into a total score but also can be analysed as separate symptom domains.
We performed a meta-analysis of GWAS of the CES-D symptom clusters. We recruited 12 cohorts with the 20- or 10-item CES-D scale (32 528 persons).
One single nucleotide polymorphism (SNP), rs713224, located near the brain-expressed melatonin receptor (MTNR1A) gene, was associated with the somatic complaints domain of depression symptoms, with borderline genome-wide significance (pdiscovery = 3.82 × 10−8). The SNP was analysed in an additional five cohorts comprising the replication sample (6813 persons). However, the association was not consistent among the replication sample (pdiscovery+replication = 1.10 × 10−6) with evidence of heterogeneity.
Despite the effort to harmonize the phenotypes across cohorts and participants, our study is still underpowered to detect consistent association for depression, even by means of symptom classification. On the contrary, the SNP-based heritability and co-heritability estimation results suggest that a very minor part of the variation could be captured by GWAS, explaining the reason of sparse findings.
We present an analysis of changes of state, pressures and conservation responses over 20 years in the Tanzanian portion of the Coastal Forests of Eastern Africa biodiversity hotspot. Baseline data collected during 1989–1995 are compared with data from a synthesis of recently published papers and reports and new field work carried out across the region during 2010–2014. We show that biodiversity endemism values are largely unchanged, although two new species (amphibian and mammal) have been named and two extremely rare tree species have been relocated. However, forest habitat continues to be lost and degraded, largely as a result of agricultural expansion, charcoal production to supply cities with cooking fuel, logging for timber and cutting of wood for firewood and building poles. Habitat loss is linked to an increase in the number of species threatened over time. The government-managed forest reserve network has expanded slightly but has low effectiveness. Three forest reserves have been upgraded to National Parks and Nature Reserves, which have stricter protection and more effective enforcement. There has also been rapid development of village-owned forest reserves, with more than 140 now existing; although usually small, they are an important addition to the areas being managed for sustainable resource use, and also provide tangible benefits to local people. Human-use pressures remain intense in many areas, and combined with emerging pressures from mining, gas and oil exploration, many endemic species remain threatened with extinction.
The patterns of parasite sharing among hosts have important implications for ecosystem structure and functioning, and are influenced by several ecological and evolutionary factors associated with both hosts and parasites. Here we evaluated the influence of fish diet and phylogenetic relatedness on the pattern of infection by parasites with contrasting life history strategies in a freshwater ecosystem of key ecological importance in South America. The studied network of interactions included 52 fish species, which consumed 58 food types and were infected with 303 parasite taxa. Our results show that both diet and evolutionary history of hosts significantly explained parasite sharing; phylogenetically close fish species and/or species sharing food types tend to share more parasites. However, the effect of diet was observed only for endoparasites in contrast to ectoparasites. These results are consistent with the different life history strategies and selective pressures imposed on these groups: endoparasites are in general acquired via ingestion by their intermediate hosts, whereas ectoparasites actively seek and attach to the gills, body surface or nostrils of its sole host, thus not depending directly on its feeding habits.
Reports of bloodstream infections caused by methicillin-resistant Staphylococcus aureus among chronic hemodialysis patients to 2 Centers for Disease Control and Prevention surveillance systems (National Healthcare Safety Network Dialysis Event and Emerging Infections Program) were compared to evaluate completeness of reporting. Many methicillin-resistant S. aureus bloodstream infections identified in hospitals were not reported to National Healthcare Safety Network Dialysis Event.
Infect. Control Hosp. Epidemiol. 2016;37(2):205–207
To determine the impact of mucosal barrier injury laboratory-confirmed bloodstream infections (MBI-LCBIs) on central-line–associated bloodstream infection (CLABSI) rates during the first year of MBI-LCBI reporting to the National Healthcare Safety Network (NHSN)
Descriptive analysis of 2013 NHSN data
Selected inpatient locations in acute care hospitals
A descriptive analysis of MBI-LCBI cases was performed. CLABSI rates per 1,000 central-line days were calculated with and without the inclusion of MBI-LCBIs in the subset of locations reporting ≥1 MBI-LCBI, and in all locations (regardless of MBI-LCBI reporting) to determine rate differences overall and by location type.
From 418 locations in 252 acute care hospitals reporting ≥1 MBI-LCBIs, 3,162 CLABSIs were reported; 1,415 (44.7%) met the MBI-LCBI definition. Among these locations, removing MBI-LCBI from the CLABSI rate determination produced the greatest CLABSI rate decreases in oncology (49%) and ward locations (45%). Among all locations reporting CLABSI data, including those reporting no MBI-LCBIs, removing MBI-LCBI reduced rates by 8%. Here, the greatest decrease was in oncology locations (38% decrease); decreases in other locations ranged from 1.2% to 4.2%.
An understanding of the potential impact of removing MBI-LCBIs from CLABSI data is needed to accurately interpret CLABSI trends over time and to inform changes to state and federal reporting programs. Whereas the MBI-LCBI definition may have a large impact on CLABSI rates in locations where patients with certain clinical conditions are cared for, the impact of MBI-LCBIs on overall CLABSI rates across inpatient locations appears to be more modest.