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In this paper, a compact 4-port band-notched multi-input-multi-output (MIMO) antenna with asymmetric coplanar strip (ACS) feed is presented for ultra-wide band (UWB) applications. The MIMO antenna is comprised of four semi-elliptical radiators with ACS feed for UWB applications and it is printed on inexpensive FR4 substrate of size 48 × 52 mm2 with ɛr = 4.4 and 1.6 mm height. The impedance characteristics of the suggested MIMO antenna ranges from 2.7 to 11 GHz with a band-notched behavior from 3 to 4 GHz to reduce the interception with WiMAX applications, and the isolation level over the achieved band is more than 20 dB between any two adjacent elements. Moreover, the radiation pattern of the proposed UWB antenna is almost omnidirectional with an average realized gain of 3.5 dBi over the entire achieved frequency band. The proposed ACS-fed antenna is confirmed by fabricating and measuring it's impedance and radiation characteristics. Finally, good consistency between simulation and measured outcomes is obtained confirming the validity of the MIMO antenna for real-life UWB wireless systems.
Brushite (CaHPO4.2H2O) is an important calcium phosphate encountered in bone tissue engineering and bone cement formulation. There are many studies on the synthesis and characterization of brushite, but full-scale substitution and replacement of Ca by Sr in brushite as a key element in medical and environmental applications has not yet been explored systematically. Therefore, this study aims to evaluate the effects of substitution of Ca by Sr on the microstructural and thermal properties of brushite, including the chemical phases present, crystallization, structural water and phase stability. The chemical phases were determined by means of powder X-ray diffraction. The thermal properties were studied by thermogravimetric analysis. Crystallization and surface morphology were analysed using scanning electron microscopy. Various properties were dependent on the incorporated Sr ions. The replacement percentage of Sr may be divided into two major stages: the first from 0% to 50%; and the second from 50% up to 100%. The (CaxSr1–x)HPO4.nH2O shows that micro-scale crystals of platy brushite formed in the first stage of Sr replacement, from 0% up to 50%. As Sr might inhibit the formation of crystals, crystal nucleation rates were reduced as the Sr percentage increased. An amorphous product formed as a result of 50% Sr replacement. The second stage of Sr replacement with Sr contents >50% yielded a new crystal morphology corresponding mainly to SrHPO4.nH2O. The complete replacement of Ca by Sr transforms the brushite with platy microcrystals into SrHPO4 nanosheets.
The avian alimentary tract has evolved into different histologic structures to accommodate the physical and chemical features of several food types and flight requirements. We compared the esophagus, proventriculus, and gizzard of the domestic fowl, Gallus gallus domesticus (GGD) and kestrels, Falco tinnunculus (FT) using immunohistochemistry and scanning electron microscopy with various stains and lectins [Dolichos biflorus agglutinin (DBA) and Ricinus communis agglutinin I (RCA120)], and α-smooth muscle actin (α-SMA). The esophagus of GGD demonstrated thickened epithelium, muscularis mucosae, and inner circular longitudinal tunica muscularis layers; moderate outer longitudinal tunica muscularis layers; and a true crop. In contrast, the esophagus of FT showed a thin epithelium, no muscularis mucosae, moderate inner longitudinal and thick outer circular tunica muscularis layers, and no true crop. In the proventriculus, the nature of the secretion in GGD was neutral, but that of FT was acidic and neutral. In the gizzard, the muscle coat of GGD by α-SMA had no muscularis mucosae, unlike FT, which had muscularis mucosae. In summary, there are many histologic differences between GGD and FT to meet their different physiologic needs, such as feeding.
The catastrophic declines of three species of ‘Critically Endangered’ Gyps vultures in South Asia were caused by unintentional poisoning by the non-steroidal anti-inflammatory drug (NSAID) diclofenac. Despite a ban on its veterinary use in 2006 (India, Nepal, Pakistan) and 2010 (Bangladesh), residues of diclofenac have continued to be found in cattle carcasses and in dead wild vultures. Another NSAID, meloxicam, has been shown to be safe to vultures. From 2012 to 2018, we undertook covert surveys of pharmacies in India, Nepal and Bangladesh to investigate the availability and prevalence of NSAIDs for the treatment of livestock. The purpose of the study was to establish whether diclofenac continued to be sold for veterinary use, whether the availability of meloxicam had increased and to determine which other veterinary NSAIDs were available. The availability of diclofenac declined in all three countries, virtually disappearing from pharmacies in Nepal and Bangladesh, highlighting the advances made in these two countries to reduce this threat to vultures. In India, diclofenac still accounted for 10–46% of all NSAIDs offered for sale for livestock treatment in 2017, suggesting weak enforcement of existing regulations and a continued high risk to vultures. Availability of meloxicam increased in all countries and was the most common veterinary NSAID in Nepal (89.9% in 2017). Although the most widely available NSAID in India in 2017, meloxicam accounted for only 32% of products offered for sale. In Bangladesh, meloxicam was less commonly available than the vulture-toxic NSAID ketoprofen (28% and 66%, respectively, in 2018), despite the partial government ban on ketoprofen in 2016. Eleven different NSAIDs were recorded, several of which are known or suspected to be toxic to vultures. Conservation priorities should include awareness raising, stricter implementation of current bans, bans on other vulture-toxic veterinary NSAIDs, especially aceclofenac and nimesulide, and safety-testing of other NSAIDs on Gyps vultures to identify safe and toxic drugs.
The coronavirus disease 2019 pandemic requires urgent modification to existing head and neck cancer diagnosis and management practices. A protocol was established that utilises risk stratification, early investigation prior to clinical review and a reduction in aerosol generating procedures to lessen the risk of coronavirus disease 2019 spread.
Two-week wait referrals were stratified into low, intermediate and high risk. Low risk patients were referred back to primary care with advice; intermediate and high risk patients underwent investigation. Clinical encounters and aerosol generating procedures were minimised. A combined diagnostic and therapeutic surgical approach was undertaken where possible.
Forty-one patients were used to assess feasibility. Thirty-one per cent were low risk, 35 per cent were intermediate and 33 per cent were high risk. Thirty-three per cent were discharged with no imaging.
Implementing this protocol reduces the future burden on tertiary services, by empowering primary care physicians to re-refer low risk patients. The protocol is applicable across the UK and avoids diagnostic delay.
Community engagement is important for reaching vulnerable populations in the coronavirus disease 2019 (COVID-19) pandemic. A risk communication framework was implemented by a community-engaged research (CEnR) partnership in Southeast Minnesota to address COVID-19 prevention, testing, and socioeconomic impacts. Bidirectional communication between Communication Leaders and community members within their social networks was used by the partnership to refine messages, leverage resources, and advise policy makers. Over 14 days, messages were delivered by 24 Communication Leaders in 6 languages across 9 electronic platforms to 9882 individuals within their networks. CEnR partnerships may effectively implement crisis and emergency risk communication to vulnerable populations in a pandemic.
We describe the morphological adaptations of the tongue and gastrointestinal tract of the striped sand snake Psammophis sibilans and discuss their functional importance. Using standard histological, histochemical, and scanning electron microscopy techniques, we analyzed 11 adult snakes of both sexes. Our findings showed that the bifurcated non-papillate tongue exhibited chemoreceptive adaptions to squamate foraging behavior. The lingual apex tapered terminally with sensory spines, and the body of the tongue possesses a characteristic central odor–receptor chamber that might serve to trap and retain scent molecules. Furthermore, the intrinsic musculature showed interwoven and well-developed transverse, vertical and longitudinal muscle fibers that control contraction and retraction during probing and flicking. The esophagus displayed highly folded mucosa lined with columnar epithelium with goblet cells. In contrast, the stomach mucosa formed finger-like gastric rugae, encompassing tubular glands with dorsal gastric pits. The intestine is distinct from other vertebrates in lacking the crypts of Lieberkühn in the tunica mucosa and submucosa. The intestine mucosa is mostly arranged in interdigitating villi oriented perpendicular to the luminal surface. We extrapolated subtle variations for both acid and neutral mucopolysaccharides and glycoproteins localization as well as collagen fibers using histochemical analyses. The elaborate histo-morphological and functional adaptation of the tongue and digestive tract plays a pivotal role in foraging and feeding behavior.
The discharge letter plays a crucial role in continuity of care from secondary to primary care. We found no existing study of outpatient discharge letters, including Mental Retardation services. New Ways of Working for psychiatrists has encouraged the discharge of stable outpatients to primary care in order to provide a responsive, flexible service. This study set standards for discharge communication and identified areas for improvement.
This was a retrospective random audit of 30 service users discharged from a psychiatric outpatient clinic. Standards were set with consultant psychiatrists and general practioners. Data was collected from the service users’ last two clinic letters using a pre-developed audit tool and compared the current practice with the standards identified.
Standards for status and future planning were largely achieved with reference to current mental state (97%), current medication (90%), other LD professionals involved (95%), advice and how to re-refer (90%).Standards for historical factors were partially achieved; including summary of contact with services (70%), summary (57%) and evaluation (67%) of treatments received. Some standards were not achieved; including requesting view of primary care prior to discharge (27%), statement of capacity (23%), risk factors (23%) and relapse indicators (27%).
The audit showed areas of good practice and areas for improvement. Results were disseminated to MDT's and a template developed for outpatient discharge letters. A re-audit has commenced to ensure progress in this important information-sharing process and to enhance the delivery of safe and effective health care.
The efficacy of venlafaxine extended-release (XR) at doses between 75 mg/d and 300 mg/d has been demonstrated in patients with recurrent major depressive disorder (MDD) over 2.5 years. This analysis evaluated the long-term efficacy of venlafaxine XR ≤225 mg/d, the approved dosage in many countries.
In the primary multicenter, double-blind trial, outpatients with recurrent MDD (N=1096) were randomized to receive 10-week acute-phase treatment with venlafaxine XR (75 mg/d to 300 mg/d) or fluoxetine (20 mg/d to 60 mg/d), followed by a 6-month continuation phase. Subsequently, at the start of 2 consecutive, double-blind, 12-month maintenance phases, venlafaxine XR responders were randomized to receive venlafaxine XR or placebo. Data from the 24 months of maintenance treatment were analyzed for the combined end point of maintenance of response (ie, no recurrence of depression and no dose increase above 225 mg/d), and each component individually. Time to each outcome was evaluated with Kaplan-Meier methods using log-rank tests for venlafaxine XR-placebo comparisons.
The analysis population included 114 patients who had received venlafaxine XR doses less than or equal to 225 mg/d prior to maintenance phase baseline (venlafaxine XR: n=55; placebo: n=59). Probability estimates for maintaining response were 70% for venlafaxine XR and 38% for placebo (P=0.007), for no dose increase were 76% and 58%, respectively (P=0.019), and for no recurrence were 87% vs 65%, respectively (P=.099).
These data confirm venlafaxine XR is effective maintaining response at doses ≤225 mg/d for up to 2.5 years in patients with MDD.
Pediatric bronchial asthma as a chronic airway inflammatory disorder has a significant impact on asthmatic children both biologically and psychologically. On the other hand, parental stress and depression has been linked to pediatric asthma and claimed to play an important role in its morbidity.
Assessment of pediatric asthma biomarkers as parameters of disease severity in relation to mental disorders of an Egyptian sample of asthmatic children and their caregivers.
The current cross-sectional study comprised 60 Egyptian asthmatic children as Group I and 35 clinically healthy children of comparable age and sex as Group II. Thorough clinical evaluation and psychometric assessment were carried out for all enrolled children and their caregivers. In addition, pulmonary function testing and measurement of esinophilic count, IL-5, and total IgE were carried out for children of both studied groups.
Enrolled asthmatics had significant elevation of all studied asthma biomarkers with significant reduction of measured pulmonary functions compared to controls. Furthermore, asthmatics had significantly more encountered poor self-esteem, clinically manifest anxiety, and psychosocial impairment compared to controls. Meanwhile, parents of studied asthmatics had higher frequency of severer grades of clinically manifest isolation, anxiety, depression, and stress. Strikingly, the severer the asthma, the more the elevation of studied asthma biomarkers, the severer the asthmatic child's and caregivers’ anxiety and depression, and the more the caregivers’ isolation and stress.
Pediatric asthma biomarkers as parameters of disease severity has been proven to be linked to mental health impairment of asthmatic children and their caregivers.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Medical recruitment and retention are national problems. Psychiatry has been more affected than many specialties, as a result of stigma from the public and other healthcare professionals. The Royal College of Psychiatrists has undertaken several initiatives to redress this, notably the ‘Choose Psychiatry’ campaign. In this editorial we argue that student-led university psychiatry societies are a wonderful but frequently untapped resource to help attract the brightest and best medical students to our profession. We describe the activities of three ‘Psych Socs’ across the UK and propose next steps to continue this work.
To examine the factors that are associated with changes in depression in people with type 2 diabetes living in 12 different countries.
People with type 2 diabetes treated in out-patient settings aged 18–65 years underwent a psychiatric assessment to diagnose major depressive disorder (MDD) at baseline and follow-up. At both time points, participants completed the Patient Health Questionnaire (PHQ-9), the WHO five-item Well-being scale (WHO-5) and the Problem Areas in Diabetes (PAID) scale which measures diabetes-related distress. A composite stress score (CSS) (the occurrence of stressful life events and their reported degree of ‘upset’) between baseline and follow-up was calculated. Demographic data and medical record information were collected. Separate regression analyses were conducted with MDD and PHQ-9 scores as the dependent variables.
In total, there were 7.4% (120) incident cases of MDD with 81.5% (1317) continuing to remain free of a diagnosis of MDD. Univariate analyses demonstrated that those with MDD were more likely to be female, less likely to be physically active, more likely to have diabetes complications at baseline and have higher CSS. Mean scores for the WHO-5, PAID and PHQ-9 were poorer in those with incident MDD compared with those who had never had a diagnosis of MDD. Regression analyses demonstrated that higher PHQ-9, lower WHO-5 scores and greater CSS were significant predictors of incident MDD. Significant predictors of PHQ-9 were baseline PHQ-9 score, WHO-5, PAID and CSS.
This study demonstrates the importance of psychosocial factors in addition to physiological variables in the development of depressive symptoms and incident MDD in people with type 2 diabetes. Stressful life events, depressive symptoms and diabetes-related distress all play a significant role which has implications for practice. A more holistic approach to care, which recognises the interplay of these psychosocial factors, may help to mitigate their impact on diabetes self-management as well as MDD, thus early screening and treatment for symptoms is recommended.
Nanoparticles of high-refractive-index materials like semiconductors can achieve confinement of light at the subwavelength scale because of the excitation of Mie resonances. The nanostructures out of high-refractive-index materials have extensively been studied theoretically and realized in experiments exploring a wide range of photonic applications. Recently, transition metal dichalcogenides (TMDCs) from the family of van der Waals layered materials have been shown to exhibit tailorable optical properties along with high refractive index and strong anisotropy. We envision that TMDCs are a promising material platform for designing metasurfaces and ultra-thin optical elements: these van der Waals materials show a strong spectral response on light excitations in visible and near-infrared ranges, and metasurface properties can be controlled by nanoantenna dimensions and their arrangement. In this work, we investigate a periodic array of disk-shaped nanoantennas made of a TMDC material, tungsten disulfide WS2, placed on top of a silicon layer and oxide substrate. We show that the nanostructure resonance in TMDC disk-shaped nanoantenna array can be controlled by the variation in silicon layer thickness and have a dependence on the presence of index-match superstrate cover. We also report on the spectral features in absorption and reflection profiles of the same structure with different surrounding index.
Physical and emotional punishment of children is highly prevalent in the Asia-Pacific region. These actions predict a range of physical and emotional harms, prompting a worldwide effort to eliminate them. A key strategy in this effort is to change parental beliefs regarding the acceptability of physical and emotional punishment. The Positive Discipline in Everyday Parenting (PDEP) program was designed to change those beliefs by teaching parents about child development and strengthening their problem-solving skills. A sample of 377 parents in the Asia-Pacific region completed the program: 329 mothers and 47 fathers of children ranging in age from infancy to adolescence. The parents lived in Australia (n = 135), Japan (n = 172) or the Philippines (n = 70). In all three countries, parents’ approval of punishment in general, and physical punishment specifically, declined and they became less likely to attribute typical child behavior to intentional misbehavior. By the end of the program, at least 75% of parents in each country felt better prepared to respond nonviolently to conflict with their children.
This chapter addresses key questions about the basis of cancer susceptibility in African people, as well as the uniqueness of the population genetics and genotype–phenotype relationship that resulted during social transition. Social transition encompasses the change of lifestyle from a rural subsistence one into an urban market-oriented, technology dependent, and predominantly sedentary mode of life, as well as changes that occur in the population genetics as a result of changes from ethnically defined structured populations into panmictic populations of an urban nature, as currently seen in megacities. Although humans passed through several periods of transition in history, the current one is the most profound.
Many regions of Africa, the continent where the sun is always shining, are gradually becoming overwhelmed by genetic disorders, especially where consanguineous marriages are strongly favored over many generations. In this chapter we navigate through the genetic and phenotypic features observed in some African populations, using hereditary spastic paraplegia (HSP) as a model of neurogenetic disorders. Published data and unpublished studies on HSP are starting to disclose criteria that distinguish these populations due to an interesting mixture of environmental factors, traditions, and certain characteristics of African genomes.
Free convective flow and heat transfer of nanofluid close to the inclined plate immersed in the porous medium under the effects of uniform magnetic field and solar radiation has been studied. Boundary-layer approach, Boussinesq approximation and two-phase nanofluid model have been used for a formulation of the governing equations taking into account convective-radiative heat exchange with an environment. The local similarity method has been adopted for the analysis of the considered phenomenon. The obtained equations have been solved numerically using MATLAB software. The effects of control characteristics on profiles of velocity, temperature and nanoparticles volume fraction as well as Nusselt number have been studied in detail.