Book chapters will be unavailable on Saturday 24th August between 8am-12pm BST. This is for essential maintenance which will provide improved performance going forwards. Please accept our apologies for any inconvenience caused.
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 is a copy of the slides presented at the meeting but not formally written up for the volume.
Cerium oxide (ceria) can be considered as one of the most important rare earth oxides. In conjunction with the benefits of nanotechnology, it has found enormous applications in catalysis, sensors and biomedical applications. These applications stem from its ability to switch oxidation states between +3 and +4 depending on ambient conditions. Nanoceria has been shown to impart protection to cells against the reactive oxygen species (ROS) by our group. We have also established a preferential protection of the normal cells against radiation damage as compared to the tumor cells. These stimulating properties of nanoceria make it imperative to stabilize it in various aqueous and non-aqueous solvents for practical applications. Systematic engineering of nanoceria in media like poly (ethylene glycol) (PEG), dextran and glucose can be of great importance in biological applications. Dextran and PEG have been used extensively to stabilize nanoparticles in solution. Biocompatibility of these media can be exploited to disperse nanoceria inside the body to provide cell protection. Unlike most of the reported work, where a two step synthesis and re-dispersion strategy is used, nanoceria prepared under room temperature wet chemical synthesis shows active switching of oxidation states. In the present work we report the successful synthesis of nanoceria in glucose, dextran and their effect on stability of nanoparticles in acidic and basic media. The role of polyhydroxyl group in complexing ceria and their subsequent oxidation/hydrolysis is monitored using UV-VIS spectroscopy. The nanoparticle characterization using high resolution transmission electron microscopy (HRTEM) for structure and morphology and X-ray Photoelectron Spectroscopy (XPS) for oxidation states will be reported. An effort will be made to present the quantitative analysis of various results.
Sorghum (Sorghum bicolor (L.) Moench) is an important resource to the national economy and it is essential to assess the genetic diversity in existing sorghum germplasm for better conservation, utilization and crop improvement. The aim of this study was to evaluate the level of genetic diversity within and among sorghum germplasms collected from diverse institutes in Nigeria and Mali using Single Nucleotide Polymorphic markers. Genetic diversity among the germplasm was low with an average polymorphism information content value of 0.24. Analysis of Molecular Variation revealed 6% variation among germplasm and 94% within germplasms. Dendrogram revealed three groups of clustering which indicate variations within the germplasms. Private alleles identified in the sorghum accessions from National Center for Genetic Resources and Biotechnology, Ibadan, Nigeria and International Crop Research Institute for the Semi-Arid Tropics, Kano, Nigeria shows their prospect for sorghum improvement and discovery of new agronomic traits. The presence of private alleles and genetic variation within the germplasms indicates that the accessions are valuable resources for future breeding programs.
The difference in the defect structures produced by different ion masses in a tungsten lattice is investigated using 80 MeV Au7+ ions and 10 MeV B3+ ions. The details of the defects produced by ions in recrystallized tungsten foil samples are studied using transmission electron microscopy. Dislocations of type b = 1/2 and  were observed in the analysis. While highly energetic gold ion produced small clusters of defects with very few dislocation lines, boron has produced large and sparse clusters with numerous dislocation lines. The difference in the defect structures could be due to the difference in separation between primary knock-on atoms produced by gold and boron ions.
To summarize risk factors for Clostridioides (formerly Clostridium) difficile infection (CDI) in hospitalized pediatric patients as determined by previous observational studies.
Meta-analysis and systematic review.
Studies evaluating risk factors for CDI in pediatric inpatients were eligible for inclusion.
We systematically searched MEDLINE, Web of Science, Scopus, and EMBASE for subject headings and text words related to CDI and pediatrics from 1975 to 2017. Two of the investigators independently screened studies, extracted and compiled data, assessed study quality, and performed the meta-analysis.
Of the 2,033 articles screened, 14 studies reporting 10,531,669 children met the inclusion criteria. Prior antibiotic exposure (odds ratio [OR], 2.14; 95% confidence interval [CI], 1.31–3.52) and proton pump inhibitor (PPI) use (OR, 1.33; 95% CI, 1.07–1.64) were associated with an increased risk of CDI in children. Subgroup analyses using studies reporting only adjusted results suggested that prior antibiotic exposure is not a significant risk factor for CDI. H2 receptor antagonist (H2RA) use (OR, 1.36; 95% CI, 0.31–5.98) and that female gender (OR, 0.87; 95% CI, 0.74–1.03) did not play a significant role as a risk factor for developing CDI.
Prior antibiotic exposure appears to be an important risk factor for CDI based on the combined analysis but not significant using adjusted studies. PPI use was associated with an increased risk of CDI. Judicious and appropriate use of antibiotics and PPIs may help reduce the risk of CDI in this vulnerable population.
To assess the prevalence and determinants of food insecurity among people living with HIV (PLWH) in Pune, India and its association with biomarkers known to confer increased risks of morbidity and mortality in this population.
Cross-sectional analysis assessing food insecurity using the standardized Household Food Insecurity Access Scale. Participants were dichotomized into two groups: food insecure and food secure. Logistic regression models were used to assess associations between socio-economic, demographic, clinical, biochemical factors and food insecurity.
Antiretroviral therapy (ART) centre of Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals (BJGMC–SGH), Pune, a large publicly funded tertiary and teaching hospital in western India.
Adult (≥18 years) PLWH attending the ART centre between September 2015 and May 2016 who had received ART for either ≤7d (ART-naïve) or ≥1 year (ART-experienced).
Food insecurity was reported by 40 % of 483 participants. Independent risk factors (adjusted OR; 95 % CI) included monthly family income <INR 5000 (~70 USD; 13·2; CI 5·4, 32·2) and consuming ≥4 non-vegetarian meals per week (4·7; 1·9, 11·9). High-sensitivity C-reactive protein (hs-CRP) ≥0·33 mg/dl (1·6; 1·04, 2·6) and d-dimer levels 0·19–0·31 µg/ml (1·6; 1·01, 2·6) and ≥0·32 µg/ml (1·9; 1·2, 3·2) were also associated with food insecurity.
More than a third of the study participants were food insecure. Furthermore, higher hs-CRP and d-dimer levels were associated with food insecurity. Prospective studies are required to understand the relationship between food insecurity, hs-CRP and d-dimer better.
Multiple studies have demonstrated that daily chlorhexidine gluconate (CHG) bathing is associated with a significant reduction in infections caused by gram-positive pathogens. However, there are limited data on the effectiveness of daily CHG bathing on gram-negative infections. The aim of this study was to determine whether daily CHG bathing is effective in reducing the rate of gram-negative infections in adult intensive care unit (ICU) patients.
We searched MEDLINE and 3 other databases for original studies comparing daily bathing with and without CHG. Two investigators extracted data independently on baseline characteristics, study design, form and concentration of CHG, incidence, and outcomes related to gram-negative infections. Data were combined using a random-effects model and pooled relative risk ratios (RRs), and 95% confidence intervals (CIs) were derived.
In total, 15 studies (n = 34,895 patients) met inclusion criteria. Daily CHG bathing was not significantly associated with a lower risk of gram-negative infections compared with controls (RR, 0.89; 95% CI, 0.73–1.08; P = .24). Subgroup analysis demonstrated that daily CHG bathing was not effective for reducing the risk of gram-negative infections caused by Acinetobacter, Escherichia coli, Klebsiella, Enterobacter, or Pseudomonas spp.
The use of daily CHG bathing was not associated with a lower risk of gram-negative infections. Further, better designed trials with adequate power and with gram-negative infections as the primary end point are needed.
The 2015 Supreme Court judgment in Montgomery v Lanarkshire Health Board  UKSC 11 established that consent to medical treatment requires shared decision-making based on dialogue between the clinician and patient. In this editorial, we examine what Montgomery means for standards of good psychiatric practice, and argue that it represents an opportunity for delivering best practice in psychiatric care.
The role of the seam in the ‘swing’ of a cricket ball is investigated via unsteady force and surface-pressure measurements and oil-flow visualization in a low-turbulence wind tunnel. Various seam angles of the ball and flow speeds are considered. Static tests are carried out on a new ‘SG Test’ cricket ball as well as its idealized models: a smooth sphere with one and five trips. To study the effect of surface roughness of the ball as the game progresses, force measurements are also carried out on a cricket ball that is manually roughened, on one-half and completely, to model a ball that has been in play for approximately 40 overs (240 deliveries/balls). The Reynolds number (
) is based on the free-stream speed and diameter of the respective model. A new cricket ball experiences three flow states with increase in
: no swing (NS), conventional swing (CS) and reverse swing (RS). At relatively low
, in the NS regime, the seam does not have any significant effect on the flow. The separation of the laminar boundary layer, with no subsequent reattachment, is almost axisymmetric with respect to the free-stream flow. Therefore, the ball does not experience any significant lateral force. Beyond a certain
, the boundary layer on the seam side of the ball undergoes transition. The boundary layer on the non-seam side, however, continues to undergo a laminar separation with no reattachment, thereby creating a lateral force in the direction of the seam, leading to CS. The onset of the CS regime is marked by intermittent formation of a laminar separation bubble (LSB) on the surface of the ball in the region between the laminar separation of the boundary layer and its reattachment at a downstream location. Owing to the varying azimuthal location of the seam, with respect to the front stagnation point on the ball, the transition via LSB formation is localized to a specific region over the seam side. In other regions, the boundary layer either transitions directly without the formation of an LSB, or separates on encountering the seam with no further reattachment. The spatial extent of the region where the flow directly transitions to a turbulent state increases with increase in
, while that of the LSB decreases. Interestingly, the flow dynamics is such that the magnitude of the swing force coefficient stays relatively constant with increase in
. With further increase in
, the boundary layer on the non-seam side undergoes a transition via formation of an LSB. This, along with an upstream shift of the separation point on the seam side, leads to a switch in the direction of the lateral force. It now acts away from the seam, and leads to RS. The transition from CS to RS occurs over a very narrow range of
wherein the flow intermittently switches between the two flow states. It is observed that the transition of the boundary layer on the seam side leads to an upstream shift of the separation point on the non-seam side at the onset of CS. A complementary effect is observed at the onset of RS. Experiments on a ball that is manually roughened bring out the relative effect of the seam and roughness on the transition of the boundary layer. Compared to a new ball, the magnitude of the maximum swing force coefficient for a rough ball is smaller during the CS regime, and larger during the RS regime. Unlike other models, the ball with roughened non-seam side and smooth seam side, for certain seam orientations, exhibits RS at relatively lower speeds and CS at higher speeds. The forces measured on the cricket ball are utilized to estimate the trajectory of the ball bowled at various initial speeds and seam angles. The lateral movement of the ball depends very significantly on the seam angle, surface roughness and speed of the ball at its delivery. The maximum lateral deviation of a new ball during RS is found to be less than half of that observed in CS. On the other hand, the lateral movement of a roughened ball during RS may significantly exceed its movement during CS. The range of the speed of the ball, for various seam orientations and surface roughnesses, are estimated wherein it undergoes CS, RS or one followed by the other. Optimal conditions are estimated for the desired lateral movement of the ball.
Several determinants of developing fear of falling (FoF) overlap with the consequences of diabetes mellitus (DM). We compared the prevalence and severity of FoF in older adults with and without DM and identified which FoF determinants contribute to FoF severity in older adults with DM. We used Canadian baseline data from the International Mobility in Aging Study (IMIAS) which identified 141 older adults with DM (DM-group;age:68.88±2.80years) and 620 without DM (noDM-group;age:68.81±2.68years). FoF was quantified with Falls Efficacy Scale–International (FES-I). FoF determinants were evaluated in demographic/health-related, physical, psychological, and social domains. High concern of FoF was more prevalent and of higher severity in 10/16 FES-I activities in the DM-group compared to the noDM-group. Higher FoF severity in the DM-group was associated with poor physical performance, being female, fall history, and clinical depressive symptoms. Protocols developed for screening and interventions may reduce FoF severity in this population.
Clostridium difficile infection (CDI) presents a substantial economic burden and is associated with significant morbidity. While multiple treatment strategies have been evaluated, a cost-effective management strategy remains unclear.
We conducted a systematic review to assess cost-effectiveness analyses of CDI treatment and to summarize key issues for clinicians and policy makers to consider.
We searched PubMed and 5 other databases from inception to August 2016. These searches were not limited by study design or language of publication. Two reviewers independently screened the literature, abstracted data, and assessed methodological quality using the Drummond and Jefferson checklist. We extracted data on study characteristics, type of CDI, treatment characteristics, and model structure and inputs.
We included 14 studies, and 13 of these were from high-income countries. More than 90% of these studies were deemed moderate-to-high or high quality. Overall, 6 studies used a decision-tree model and 7 studies used a Markov model. Cost of therapy, time horizon, treatment cure rates, and recurrence rates were common influential factors in the study results. For initial CDI, fidaxomicin was a more cost-effective therapy than metronidazole or vancomycin in 2 of 3 studies. For severe initial CDI, 2 of 3 studies found fidaxomicin to be the most cost-effective therapy. For recurrent CDI, fidaxomicin was cost-effective in 3 of 5 studies, while fecal microbiota transplantation (FMT) by colonoscopy was consistently cost-effective in 4 of 4 studies.
The cost-effectiveness of fidaxomicin compared with other pharmacologic therapies was not definitive for either initial or recurrent CDI. Despite its high cost, FMT by colonoscopy may be a cost-effective therapy for recurrent CDI. A consensus on model design and assumptions are necessary for future comparison of CDI treatment.
Previous research indicates that low-income individuals often struggle to consume the recommended amount of fruits and vegetables (F&V). LINK Up Illinois is a farmers’ market incentive programme that aims to increase F&V consumption among Supplemental Nutrition Assistance Program (SNAP) recipients by improving access to and affordability of locally grown foods. The present research aimed to identify barriers to F&V consumption that exist among users of the LINK Up Illinois programme.
Farmers’ markets in Chicago, Springfield, Northbrook, Woodstock, Aurora and Urbana, IL.
In 2016, a volunteer sample of 140 LINK Up Illinois users (mean age 42·5 years; 81·7 % female; 28·7 % African American; 44·0 % obese) completed a survey at participating farmers’ markets across the state. Information on demographics, food shopping behaviours, programme satisfaction, barriers to F&V consumption and frequency of F&V consumption was collected and examined.
Approximately 23 % of survey participants reported consuming F&V ≥3 times/d. The barriers to F&V consumption most often reported by survey participants were the cost of F&V (29·5 %), spoilage (18·6 %), knowing how to cook F&V (8·7 %) and not thinking about F&V when hungry (8·6 %). Results from multivariable-adjusted logistic regression models suggested that reporting one or more barriers was associated with reduced odds of consuming vegetables ≥3 times/d, but not fruits.
Cost, spoilage and knowledge of cooking are key barriers to F&V consumption that exist among LINK Up Illinois users. Strategies are needed to mitigate these barriers and increase F&V consumption in this population.
Contaminated hands of healthcare workers (HCWs) are an important source of transmission of healthcare-associated infections. Alcohol-based hand sanitizers, while effective, do not provide sustained antimicrobial activity. The objective of this study was to compare the immediate and persistent activity of 2 hand hygiene products (ethanol [61% w/v] plus chlorhexidine gluconate [CHG; 1.0% solution] and ethanol only [70% v/v]) when used in an intensive care unit (ICU).
Prospective, randomized, double-blinded, crossover study
Three ICUs at a large teaching hospital
In total, 51 HCWs involved in direct patient care were enrolled in and completed the study.
All HCWs were randomized 1:1 to either product. Hand prints were obtained immediately after the product was applied and again after spending 4–7 minutes in the ICU common areas prior to entering a patient room or leaving the area. The numbers of aerobic colony-forming units (CFU) were compared for the 2 groups after log transformation. Each participant tested the alternative product after a 3-day washout period.
On bare hands, use of ethanol plus CHG was associated with significantly lower recovery of aerobic CFU, both immediately after use (0.27 ± 0.05 and 0.88 ± 0.08 log10 CFU; P = .035) and after spending time in ICU common areas (1.81 ± 0.07 and 2.17 ± 0.05 log10 CFU; P<.0001). Both the antiseptics were well tolerated by HCWs.
In comparison to the ethanol-only product, the ethanol plus CHG sanitizer was associated with significantly lower aerobic bacterial counts on hands of HCWs, both immediately after use and after spending time in ICU common areas.
The indentation response of a 3D noninterlaced composite comprising three sets of orthogonal carbon-fibre tows in an epoxy matrix is investigated. The 3D composites have a near isotropic and ductile indentation response. The deformation mode includes the formation of multiple kinks in the tows aligned with the indentation direction and shearing of the orthogonally oriented tows. Finite element (FE) calculations are also reported wherein tows in one direction are explicitly modeled with the other two sets of orthogonal tows and the matrix pockets treated as an effective homogenous medium. The calculations capture the indentation response in the direction of the explicitly modeled tows with excellent fidelity but under-predict the indentation strength in the other directions. In contrast to anisotropic and brittle laminated composites, 3D noninterlaced composites have a near isotropic and ductile indentation response making them strong candidates for application as materials to resist impact loading.
The diagnostic role of cardiac MRI in myocarditis is evolving, however with extremely limited data in paediatrics. The goal of this study was to assess the utility of cardiac MRI in paediatric myocarditis and present a new prognostic score for risk stratification.
The present study is a retrospective investigation of children with a clinical diagnosis of myocarditis, including analysis of demographics, clinical presentation, diagnostic studies, including cardiac MRI, and outcomes.
A total of 44 patients met the inclusion criteria, of whom 20 had undergone cardiac MRI. Patients who underwent cardiac MRI were older (median 15.6 versus 11.1 years, p=0.004), had a shorter length of hospital stay (median 4.0 versus 12.5 days, p=0.004), had overall less-severe illness at presentation as evidenced by a higher left-ventricular ejection fraction on echocardiography, had lower peak brain-type natriuretic peptide, were less likely to require advanced mechanical support, and were less likely to experience cardiac death or transplant. In patients who had undergone cardiac MRI, the most common findings were increased early gadolinium enhancement (n=9) or late gadolinium enhancement (n=9). Cardiac MRI findings did not predict a worse outcome. Independent predictors of the need for heart-failure medications at 1-year follow-up included inotrope requirement, extracorporeal membrane oxygenator requirement, and antiarrhythmic requirement at presentation (p<0.05).
In paediatric myocarditis, cardiac MRI is not used uniformly, has a low yield, and does not predict worse outcomes. Future research should evaluate clinical decision-making and the cost–benefit analysis of cardiac MRI in the diagnosis of paediatric myocarditis.
Olga Deshpande, art historian in the Oriental Department, State Hermitage Museum, Saint-Petersburg, Russia,
Pamela Gutman, Honorary Associate with the Department of Art History, University of Sydney, Australia
For nearly seventy years, four Burmese stone sculptures dating to the 11th–12th centuries have been in storage at the Hermitage Museum, St Petersburg. They arrived in Russia after World War II, part of a large group of Asian art objects (from India to Japan and Indonesia) from two institutions in Berlin, the Museum für Volkerkunde and the Museum für Ostasiatische Kunst. It was only after the radical political changes in the Soviet Union in the early 1990s that, after a long period of obfuscation regarding their background, Russia and Germany were able to begin to work together, and with other specialists, on these collections.
The Burmese sculptures comprise three images depicting events from the life of the Buddha: the cutting of the hair in preparation for his life as an ascetic; the Naga King Mucalinda sheltering him from a storm in the sixth week after the Enlightenment; and the taming of the raging elephant Nālāgiri. We discussed these images at the EURASEAA 14 Conference in Dublin in September 2012 and our findings will be published in the conference proceedings. The fourth image, examined here, represents Viṣṇu on Garuḍa, Viṣṇu Garuḍāsana.
These sculptures were sent to the Museum für Volkerkunde between 1894 and 1896 by a German geologist and palaeontologist, Friedrich (Fritz) Wilhelm Nötling (1857–1928), who at the time was employed by the Geological Survey of India and was working at the Yenangyaung oil fields near Bagan. Nötling studied geology and related subjects before graduating in 1885, after which he worked as a private docent (tutor) at the University of Königsberg. In the same year, he was assigned by the Berlin Academy of Sciences to go on a mission to Palestine, and he subsequently published his first paper for the Geological Survey of Prussia in 1886. Until the University Reforms of the late 1900s, palaeontology was not taught at English universities, and the Geological Survey of India from time to time found it necessary to resort to Germany to find suitable people to fill palaeontological posts. In January 1887 Nötling sailed to Calcutta and served in the Geological Survey until 1903. He became a prolific researcher on geological, paleontological, prehistoric and ethnological subjects and published over forty papers and three books (Struwe 2006, p. 33).
We report measurement of pulse profiles at 34.5 MHz of 8 pulsars using the Decameter-wave Radio Telescope at Gauribidanur, India. The dispersion measures of these pulsars range from 3 to 35 pc cm–3. None of the pulsars show any significant interpulse emission at this frequency which conflicts with earlier claims from 25-MHz observations (Bruck and Ustimenko 1976, Bruck and Ustimenko 1977a, Bruck and Ustimenko 1979). The intrinsic pulse width of PSR 1919+21 at 34.5 MHz appears to be smaller than at higher frequencies. These observations were made during the period 1984-86 and were reported by Deshpande (1987).
We observed single pulses from PSR J0034-0721 (B0031-07) simultaneously at the MWA (185 MHz) and the GMRT (610 MHz). Correlation analyses reveal that the phase difference of the average profiles at the two frequencies differs from the phase difference observed between individual subpulses, indicating that the individual emission columns above the pulsar’s rotating carousel of sparks do not evolve in frequency in the same way that the global magnetosphere does. This hints at a possible departure from the dipolar field geometry in this pulsar’s emission region. Moreover, the discrepancy depends on the drift mode, suggestive of a way to constrain the emission heights associated with each drift mode.
Photopolarimetric observations in UBVRI bands of Seyfert galaxies NGC 2992, NGC 3081, NGC 3227 and IC 4329A were carried between 1984–87. Measurements were made with PRL polarimeter (Deshpande et al. 1985) on 1 meter telescope of Indian Institute of Astrophysics, Kavalur. Method of observations and reduction is same as discussed elsewhere (Joshi et al. 1987).
The tidal effects of disruption and merger of a massive perturber-quasar on a galaxy cluster have been studied by computer simulations using Aarseth's NBODY2 code. The model consists of a spherical N-body galaxy cluster and a point-mass perturber. A wide range of initial conditions (mass ratio of the galaxy and the perturber, the virial coefficient q of the N-body system, and the pericentric distances of orbits) have been considered.