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We sought to examine the influence of clinically severe lower respiratory tract infection on pulmonary artery pressure in children having CHD with post-tricuspid left-to-right shunt, as it may have physiological and clinical implications. In a prospective single-centre observational study, 45 children with post-tricuspid left-to-right shunt and clinically severe lower respiratory tract infection were evaluated during the illness and 2 weeks after its resolution. Pulmonary artery systolic pressure was estimated non-invasively using shunt gradient by echocardiography and systolic blood pressure measured non-invasively.
Median pulmonary artery systolic pressure during lower respiratory tract infection was only mildly (although statistically significantly) elevated during lower respiratory tract infection [60 (42–74) versus 53 (40–73) mmHg, (p < 0.0001)]. However, clinically significant change in pulmonary artery systolic pressure defined as the increase of >10 mmHg was present in only 9 (20%) patients. In the absence of hypoxia or acidosis, only a small minority (9%, n = 4) showed significant pulmonary artery systolic pressure rise >10 mmHg. In the absence of hypoxia or acidosis, severe lower respiratory tract infection in patients with acyanotic CHD results in only mild elevation of pulmonary artery systolic pressure in most of the patients.
Aerosol generation during temporal bone surgery caries the risk of viral transmission. Steps to mitigate this problem are of particular importance during the coronavirus disease 2019 pandemic.
To quantify the effect of barrier draping on particulate material dispersion during temporal bone surgery.
The study involved a cadaveric model in a simulated operating theatre environment. Particle density and particle count for particles sized 1–10 μ were measured in a simulated operating theatre environment while drilling on a cadaveric temporal bone. The effect of barrier draping to decrease dispersion was recorded and analysed.
Barrier draping decreased counts of particles smaller than 5 μ by a factor of 80 in the operating theatre environment. Both particle density and particle count showed a statistically significant reduction with barrier draping (p = 0.027).
Simple barrier drapes were effective in decreasing particle density and particle count in the operating theatre model and can prevent infection in operating theatre personnel.
Dust vortices with a void at the centre are reported in this paper. The role of the spatial variation of the plasma potential in the rotation of dust particles is studied in a parallel plate glow discharge plasma. Probe measurements reveal the existence of a local potential minimum in the region of formation of the dust vortex. The minimum in the potential well attracts positively charged ions, while it repels the negatively charged dust particles. Dust rotation is caused by the interplay of the two oppositely directed ion drag and Coulomb forces. The balance between these two forces is found to play a major role in the radial confinement of the dust particles above the cathode surface. Evolution of the dust vortex is studied by increasing the discharge current from 15 to 20 mA. The local minimum of the potential profile is found to coincide with the location of the dust vortex for both values of discharge currents. Additionally, it is found that the size of the dust vortex as well as the void at the centre increases with the discharge current.
We conducted an analysis of the key factors triggering cost-sharing mechanisms to understand the status of out-of-pocket (OOP) healthcare expense in the United States (US), Europe, and emerging markets and better appreciate the implications of OOP healthcare expense on patients’ health management.
A review of literature and databases including The Organisation for Economic Co-operation and Development (OECD) and World Bank was performed to understand different cost-sharing mechanisms, factors triggering OOP expenditure and the country-wise trends of OOP expenditure. Additionally, the impact of OOP expenditure on healthcare budget and on patients in terms of medication adherence, uptake of newer therapies and generic substitution was explored.
The findings reveal that patients are concerned about rising healthcare OOP costs, and we observed an increase of 134 percent in the number of articles published on OOP from 2005 to 2017. The percentage of household spending that goes OOP as healthcare expense is higher in Brazil, Russia, India, and China (BRIC countries; ~11 percent) compared to France, Germany, Italy, United Kingdom, US, Japan, and Canada (G7 countries; ~2 percent). In addition, OOP expenditure increased with age (1.9 percent of take home income in 55-64 age group versus 1.2 percent in 18-25 age group) and is higher in the low-income population (2.8 percent of take home income versus 1 percent in high-income group). Whereas, increasing OOP expenditure reduces the overall healthcare expenditure due to generic substitution (28 percent reduction) and reduction in excessive consumption of supplementary medicines, it also reduces patient adherence (~20 percent decline in dispensed prescriptions) and may foster a reluctance to adopt newer therapies.
The population groups most impacted by increasing OOP expense are the older population, those in the low-income bracket and in poorer countries. While OOP expense may help in the effective and judicious utilization of healthcare system resources and medicines usage, its implementation requires a cautious and considered approach.
We have studied, the relationship between monthly variations of average counting rates of cosmic ray intensity (CRI) at Moscow super neutron monitoring station with mid cut-off rigidities (~2.42 GV), and the solar radio flux at 10.7cm (F10.7) and sunspot number (SSN) during the solar cycles 22 − 24. The F10.7cm (2800 MHz) and SSN is an excellent indicator of solar activity for the study period. We have investigated the patterns of long-term and mid-term periodicities of SSN and F10.7, using Fast Fourier Transform (FFT) technique. We have observed the time-lag between ascending phase of CRI with F10.7cm and SSN during solar cycles 22 − 24.
Measurements of local plasma parameters in dusty plasma are crucial for understanding
the physics issues related to such systems. The Langmuir probe, a small electrode
immersed in the plasma, provides such measurements. However, designing of a Langmuir
probe system in a dusty plasma environment demands special consideration. First, the
probe has to be miniaturized enough so that its perturbation on the ambient dust
structure is minimal. At the same time, the probe dimensions must be such that a
well-defined theory exists for interpretation of its characteristics. The associated
instrumentation must also support the measurement of current collected by the probe
with high signal to noise ratio. The most important consideration, of course, comes
from the fact that the probes are prone to dust contamination, as the dust particles
tend to stick to the probe surface and alter the current collecting area in
unpredictable ways. This article describes the design and operation of a Langmuir
probe system that resolves these challenging issues in dusty plasma. In doing so,
first, different theories that are used to interpret the probe characteristics in
collisionless as well as in collisional regimes are discussed, with special emphasis
on application. The critical issues associated with the current–voltage
characteristics of Langmuir probe obtained in different operating regimes are
discussed. Then, an algorithm for processing these characteristics efficiently in
presence of ion-neutral collisions in the probe sheath is presented.
In recent years a number of intergovernmental initiatives have been activated in order to enhance the capacity of countries to improve access to essential medicines, particularly for mental disorders. In May 2013 the 66th World Health Assembly adopted the World Health Organization (WHO) Comprehensive Mental Health Action Plan 2013–2020, which builds upon the work of WHO's Mental Health Gap Action Programme. Within this programme, evidence-based guidelines for mental disorders were developed, including recommendations on appropriate use of medicines. Subsequently, the 67th World Health Assembly adopted a resolution on access to essential medicines, which urged Member States to improve national policies for the selection of essential medicines and to promote their availability, affordability and appropriate use.
Following the precedent set by these important initiatives, this article presents eleven actions for improving access and appropriate use of psychotropic medicines.
A 4 × 4 framework mapping actions as a function of the four components of access – selection, availability, affordability and appropriate use – and across four different health care levels, three of which belong to the supply side and one to the demand side, was developed. The actions are: developing a medicine selection process; promoting information and education activities for staff and end-users; developing a medicine regulation process; implementing a reliable supply system; implementing a reliable quality-control system; developing a community-based system of mental health care and promoting help-seeking behaviours; developing international agreements on medicine affordability; developing pricing policies and a sustainable financing system; developing or adopting evidence-based guidelines; monitoring the use of psychotropic medicines; promoting training initiatives for staff and end-users on critical appraisal of scientific evidence and appropriate use of psychotropic medicines.
Activating these actions offers an unique opportunity to address the broader issue of increasing access to treatments and care for mental disorders, as current lack of attention to mental disorders is a central barrier across all domains of the 4 × 4 access framework.
The discovery of graphene based materials has led to significant advancement in several different areas. The large surface area, nanoporous structure and availability of delocalized electron network provide a unique opportunity for purification of solvents via adsorption, absorption or simple trapping. This makes graphene based materials as potential candidates for purification and desalination of water. Here we report synthesis of 3D porous network of oxidized graphene for purification of sea water. The membranes fabricated using these frameworks are hierarchically linked intrinsically defected oxidised graphene sheets by long micro-channels and capable of filtering small ions such as Na+ and Cl-. These are easy to fabricate, reusable and economically viable especially for point of use application. We finally show a fabricated device using membrane made from these 3D networks of oxidized graphene.
Various promising applications such as acoustic cloaking, sub-wavelength imaging, acoustic wave manipulation, transmission or reflection control etc. are feasible because of the ability of manipulating sounds and vibrations using artificially engineered “Acoustics meta-materials”. Recent works on space-coiling acoustic metamaterials show their extreme constitutive parameters like large refractive index, double negativity and zero mass density. Three dimensional structures have a wide application in sub-wavelength broadband acoustic wave suppression due to huge attenuation. Here we report the study of propagated and transmitted wave through 3D acoustic metamaterials structure using finite element method. Our simulations on 3D structure show a huge absorption/damping over few hundreds kilohertz frequency range.
In a quasineutral plasma, electrons undergo collective oscillations, known as plasma oscillations, when perturbed locally. The oscillations propagate due to finite temperature effects. However, the wave can lose the phase coherence between constituting oscillators in an inhomogeneous plasma (phase mixing) because of the dependence of plasma oscillation frequency on plasma density. The longitudinal electric field associated with the wave may be used to accelerate electrons to high energies by exciting large amplitude wave. However when the maximum amplitude of the wave is reached that plasma can sustain, the wave breaks. The phenomena of wave breaking and phase mixing have applications in plasma heating and particle acceleration. For detailed experimental investigation of these phenomena a new device, inverse mirror plasma experimental device (IMPED), has been designed and fabricated. The detailed considerations taken before designing the device, so that different aspects of these phenomena can be studied in a controlled manner, are described. Specifications of different components of the IMPED machine and their flexibility aspects in upgrading, if necessary, are discussed. Initial results meeting the prerequisite condition of the plasma for such study, such as a quiescent, collisionless and uniform plasma, are presented. The machine produces δnnoise/n ⩽ 1%, Luniform ~ 120 cm at argon filling pressure of ~10−4 mbar and axial magnetic field of B = 1090 G.
Guanylate kinase, a nucleoside monophosphate kinase of Brugia malayi which is involved in reversible transfer of phosphate groups from ATP to GMP, was cloned, expressed and characterized. The native molecular mass of BmGK was found to be 45 kDa as determined by size exclusion chromatography and glutaraldehyde cross-linking which revealed that the protein is homodimer in nature. This is a unique characteristic among known eukaryotic GKs. GMP and ATP served as the most effective phosphate acceptor and donor, respectively. Recombinant BmGK utilized both GMP and dGMP, as substrates showing Km values of 30 and 38 μm, respectively. Free Mg+2 (un-complexed to ATP) and GTP play a regulatory role in catalysis of BmGK. The enzyme showed higher catalytic efficiency as compared with human GK and showed ternary complex (BmGK-GMP-ATP) formation with sequential substrate binding. The secondary structure of BmGK consisted of 45% α-helices, 18% β-sheets as revealed by CD analysis. Homology modelling and docking with GMP revealed conserved substrate binding residues with slight differences. Differences in kinetic properties and oligomerization of BmGK compared with human GK can provide the way for design of parasite-specific inhibitors.
Glucose-6-phosphate dehydrogenase (G6PD), a regulatory enzyme of the pentose phosphate pathway from Brugia malayi, was cloned, expressed and biochemically characterized. The Km values for glucose-6-phosphate and nicotinamide adenine dinucleotide phosphate (NADP) were 0·25 and 0·014 mm respectively. The rBmG6PD exhibited an optimum pH of 8·5 and temperature, 40 °C. Adenosine 5′ [γ-thio] triphosphate (ATP-γ-S), adenosine 5′ [β,γ-imido] triphosphate (ATP-β,γ-NH), adenosine 5′ [β-thio] diphosphate (ADP-β-S), Na+, K+, Li+ and Cu++ ions were found to be strong inhibitors of rBmG6PD. The rBmG6PD, a tetramer with subunit molecular weight of 75 kDa contains 0·02 mol of SH group per mol of monomer. Blocking the SH group with SH-inhibitors, led to activation of rBmG6PD activity by N-ethylmaleimide. CD analysis indicated that rBmG6PD is composed of 37% α-helices and 26% β-sheets. The unfolding equilibrium of rBmG6PD with GdmCl/urea showed the triphasic unfolding pattern along with the highly stable intermediate obtained by GdmCl.
Pigeonpea is an important legume crop of the semi-arid tropics. In India, pigeonpea is mostly grown in areas prone to waterlogging, resulting in major production losses. It is imperative to identify genotypes that show tolerance at critical crop growth stages to prevent these losses. A selection of 272 diverse pigeonpea accessions was evaluated for seed submergence tolerance for different durations (0, 120, 144, 168 and 192 h) under in vitro conditions in the laboratory. All genotypes exhibited high (0·79–0·98) survival rates for up to 120 h of submergence. After 192 h of submergence, the hybrids as a group exhibited significantly higher survival rates (0·79) than the germplasm (0·71), elite breeding lines (0·68) and commercial varieties (0·58). Ninety-six genotypes representing the phenotypic variation observed during laboratory screening were further evaluated for waterlogging tolerance at the early seedling stage using pots, and survival rates were recorded for 8 days after completion of the stress treatment. Forty-nine of these 96 genotypes, representing the phenotypic variation for waterlogging tolerance, were chosen in order to evaluate their performance under natural field conditions. The following cultivated varieties and hybrids were identified as tolerant after three levels of testing (in vitro, in pots and in the field): ICPH 2431, ICPH 2740, ICPH 2671, ICPH 4187, MAL 9, LRG 30, Maruti, ICPL 20128, ICPL 332, ICPL 20237, ICPL 20238, Asha and MAL 15. These materials can be used as sources of waterlogging tolerance in breeding programmes.
Phosphoenolpyruvate carboxykinase (PEPCK, EC 184.108.40.206) is an essential regulatory enzyme of glycolysis in helminths in contrast to its role in gluconeogenesis in their host. Previously we have reported that phytochemicals from Flemingia vestita (Family: Fabaceae), genistein in particular, have vermifugal action and are known to affect carbohydrate metabolism in the cestode, Raillietina echinobothrida. In order to determine the functional differences of PEPCK from the parasite and its avian host (Gallus domesticus), we purified the parasite enzyme apparently to homogeneity, and characterized it. The native PEPCK is a monomer with a subunit molecular weight of 65 kDa. The purified enzyme displayed standard Michaelis-Menten kinetics with Km value of 42·52 μM for its substrate PEP. The Ki for the competitive inhibitors GTP, GMP, ITP and IMP for the carboxylation reaction were determined and discussed. In order to identify putative modulators from plant sources, phytochemicals from F. vestita and Stephania glabra were tested on the purified PEPCK, which resulted in alteration of its activity. From our results, we hypothesize that PEPCK may be a potential target site for anthelmintic action.
Pigeonpea is an important rainfed pulse crop grown in the rainy season that is subject to waterlogging. There are not many sources of waterlogging tolerance available; therefore the mini core pigeonpea germplasm (n=146) were screened, along with a few genotypes already reported to exhibit tolerance. Five trials were conducted starting at 40 and 50 days after sowing (DAS) in 2008, and at 40, 62 and 76 DAS in 2009. The mortality rate in any trial depended on the vapour pressure deficits (VPD) that prevailed during waterlogging and the recovery periods. There were large and highly significant variations due to genotype and to genotype×trial interactions. The heritability of individual trials ranged from 0·27 to 0·75, while it was 0·40 when all the trials were considered together. The survival counts were grouped into representative groups using a hierarchical cluster analysis, which yielded five distinctive groups. The highly tolerant group, with above-average survival means in all five trials, comprised 24 accessions. None of the previously tested or control entries appeared in this group. The sensitive entries comprised 37 accessions including ICP 7035, ICP 8338 and ICP 13562, which were known to be sensitive from previous reports. The tolerant group comprised 39 accessions, moderately tolerant 42 and moderately sensitive 18. Survival during waterlogging and a rapid recovery are considered equally important for categorizing the genotypes and their further use.
The aim of this study was to evaluate the CD4+/CD8+ ratio in peripheral blood of dogs with localized and generalized demodicosis. Sixteen dogs were examined, 8 with localized and 8 with generalized demodicosis, while 8 healthy dogs were used as controls. Peripheral blood was obtained and CD4+ and CD8+ T cells were determined by flow cytometry. Significantly higher numbers of CD8+ T cells and lower numbers of CD4+ T cells were found in dogs with generalized demodicosis compared to dogs with localized demodicosis and healthy controls. Significantly higher numbers of CD8+ T cells and lower numbers of CD4+ T cells were also found in dogs with localized demodicosis compared to healthy controls. The CD4+/CD8+ ratio was also found to be significantly lower in dogs with generalized demodicosis in comparison with dogs with localized demodicosis and healthy controls. It is concluded that significant alteration in the CD4+/CD8+ ratio may be implicated in the pathogenesis of generalized canine demodicosis.
Molecular dynamics simulations are used to evaluate the influence of Sb dopant atoms at the grain boundaries on plastic deformation of nanocrystalline Cu. Deformation is conducted under uniaxial tensile loading, and Sb atoms are incorporated as substitutional defects at the grain boundaries. The presence of randomly dispersed Sb atoms at the grain boundaries does not appreciably influence the mechanisms associated with dislocation nucleation in nanocrystalline Cu; grain boundary ledges and triple junctions still dominate as partial dislocation sources. However, the magnitude of the tensile stress associated with the partial dislocation nucleation event does increase with increasing Sb concentration and also with increasing grain size. The flow stress of nanocrystalline Cu increases with increasing Sb concentration up to 1.0 at.% Sb, with a maximum observed at a grain size of 15 nm for all Sb concentrations (0.0–2.0 at.% Sb).
We report an extremely rare case of a complete congenital third branchial arch fistula in a nine-year-old boy.
A case report and a review of the English literature concerning third branchial arch fistula of congenital origin are presented.
A nine-year-old boy presented with a history of a small opening in the middle third of the anterior neck since birth, with recurrent surrounding swelling. There was no history of surgical drainage or spontaneous rupture. Computed tomography with contrast injection into the external cervical opening revealed a patent tract from the neck skin to the base of the pyriform sinus. Complete excision of the tract up to the pyriform sinus with left hemithyroidectomy was performed. Follow up at 22 months showed no recurrence.
To our knowledge, this case represents a very rare occurrence of the congenital variety of complete third branchial arch fistula at an unusual site. This case indicates that third branchial arch fistula can be complete, and may present in the anterior neck, an unusual site. In such cases, computed tomography fistulography and injection of dye into the pyriform sinus enables intra-operative delineation of the tract.
The growing public concerns over chemical residues in animal-derived foods and threats of antibiotic-resistant bacteria have renewed interest in exploring safer alternatives to chemical feed additives in ruminant livestock. Various bioactive phytochemicals including saponins appear to be potential ‘natural’ alternatives to ‘chemical’ additives in modulating rumen fermentation favourably and animal performance. Saponins are a diverse group of glycosides present in many families of plants. The primary effect of saponins in the rumen appears to be to inhibit the protozoa (defaunation), which might increase the efficiency of microbial protein synthesis and protein flow to the duodenum. Furthermore, saponins may decrease methane production via defaunation and/or directly by decreasing the activities (i.e. rate of methanogenesis or expression of methane-producing genes) and numbers of methanogens. Saponins may also selectively affect specific rumen bacteria and fungi, which may alter the rumen metabolism beneficially or adversely. The ammonia-adsorption and modulation of digesta passage in the rumen by saponins have also been implicated in altering rumen metabolism, but their physiological responses are likely to be negligible compared with microbiological effects. The effects of saponins on rumen fermentation have not been found to be consistent. These discrepancies appear to be related to the chemical structure and dosage of saponins, diet composition, microbial community and adaptation of microbiota to saponins. There is need for systematic research based on chemical structures of saponins, nutrient composition of diets and their effects on rumen microbial ecosystem to obtain consistent results. The present paper reviews and discusses the effects and mode of action of saponins on microbial community and fermentation in the rumen, and ruminant performance.
To find out the salmonella carrier rate, 1980 samples comprising faeces, mesenteric lymph nodes, liver and spleen were collected from 812 sheep and 683 goats slaughtered for food. In all 72 salmonella strains from 51 animals (25 sheep and 26 goats) were isolated. These represented 22 salmonella serotypes. The public health significance of these findings is discussed.