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Background: While recent clinical trials have demonstrated immense efficacy of mechanical thrombectomy (MT) in the setting of acute stroke, there remains debate over the safety in performing this procedure under general anesthesia (GA). In the Saskatchewan Acute Stroke Pathway, all patients presenting with LVO have endovascular thrombectomy performed under GA. Methods: Data was retrospectively reviewed on 108 consecutive LVO in 2016-2017. All MT were done under GA. Anatomical location of LVO, pre-MT ASPECTS score, post-MT TICI scores and 90-day NIHSS and mRS were recorded. Results: Of 108 LVO, 103 went on to have MT. 44 were right anterior circulation, 50 were left anterior circulation and 9 were posterior circulation. Of 94 anterior circulation strokes, 47 (50.0%), 43 (45.7%) and 4 (4.3%) had good, moderate and poor collateral circulation respectively, and the average pre-MT ASPECTS was 8.6. The average pre-MT NIHSS was 14.7. 81/90 (90.0%) achieved thrombolysis in cerebral infarction (TICI) perfusion scale grade of 2b/3 after recanalization. Average documented 90-day NIHSS was 2.4 and mRS was 2.5. Overall mortality was 21/103 (20.4%). Conclusions: In the Saskatchewan acute stroke pathway, general anesthesia is a safe modality for MT. This adds to the body of evidence supporting GA as a viable option for sedation in MT.
Laser-induced breakdown spectroscopy has been exploited to investigate the laser-produced lead plasma with and without external magnetic field. Plasma on the lead surface was generated by focusing a beam of a Nd:YAG laser (532 nm). An external magnetic field was applied across the laser-produced plasma; its value was varied from 0.3 to 0.7 T and the time-integrated spectra were captured at different time delays. Maximum enhancement in the neutral and ionic line intensities have been observed at 130 mJ laser energy. The neutral line of Pb at 368.34 nm reveals an enhancement factor of nearly 1.3, 1.6, and 2.3 at 0.3, 0.5, and 0.7 T, whereas the Pb ionic line at 424.49 nm shows enhancement factor of approximately 2.8 and 4.2 at 0.3 and 0.7 T. The magnetic field effects on various plasma parameters such as plasma temperature, electron number density, and emission line intensities have also been investigated. The plasma parameter “β” is found to be <1 in all the experimental conditions which signifies that the enhancement in the signal intensity is due to the plasma confinement. The increase in the emission signal intensity, number density as well as plasma temperature is observed with increasing laser energy and magnetic field. The spatial and temporal behavior reveals that the plasma temperature and electron number density decrease slowly in the applied magnetic field due to the deceleration of the plasma plume. The optimized conditions for the maximum plasma confinement and the emission intensity enhancement are observed at 130 mJ laser energy at 0.7 T magnetic field.
Adenoid hypertrophy is a common cause of upper airway obstruction, and adenoidectomy is one of the most frequently performed operations in children. Topical nasal steroids can act directly on nasopharyngeal lymphoid tissue to decrease its reactive inflammatory changes and potentially reduce its size.
To study the light microscopic changes in adenoidal lymphoid tissue after one month of topical steroid use.
Twenty-six children with adenoid hypertrophy grade 3 scheduled for adenoidectomy were randomly divided into two equal groups: one group received mometasone furoate aqueous nasal spray (Nasonex) 100 mcg/day for four weeks, and a control group received nasal normal saline 0.9 per cent for four weeks. The removed adenoids were examined histopathologically.
Adenoidal tissue from the mometasone group had less reactive germinal centres and less spongiosis compared to the control group. The latter showed proliferating, reactive, variable sized and shaped lymphoid follicles, with congested blood vessels in the interfollicular areas.
The use of intranasal mometasone furoate aqueous nasal spray (Nasonex) for one month reduced adenoidal tissue reactive cellular changes and its vascularity. This is, however, a pilot study; a longer treatment period is needed to assess the effect of treatment on adenoidal size.
To investigate a Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak event involving multiple healthcare facilities in Riyadh, Saudi Arabia; to characterize transmission; and to explore infection control implications.
Cases presented in 4 healthcare facilities in Riyadh, Saudi Arabia: a tertiary-care hospital, a specialty pulmonary hospital, an outpatient clinic, and an outpatient dialysis unit.
Contact tracing and testing were performed following reports of cases at 2 hospitals. Laboratory results were confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) and/or genome sequencing. We assessed exposures and determined seropositivity among available healthcare personnel (HCP) cases and HCP contacts of cases.
In total, 48 cases were identified, involving patients, HCP, and family members across 2 hospitals, an outpatient clinic, and a dialysis clinic. At each hospital, transmission was linked to a unique index case. Moreover, 4 cases were associated with superspreading events (any interaction where a case patient transmitted to ≥5 subsequent case patients). All 4 of these patients were severely ill, were initially not recognized as MERS-CoV cases, and subsequently died. Genomic sequences clustered separately, suggesting 2 distinct outbreaks. Overall, 4 (24%) of 17 HCP cases and 3 (3%) of 114 HCP contacts of cases were seropositive.
We describe 2 distinct healthcare-associated outbreaks, each initiated by a unique index case and characterized by multiple superspreading events. Delays in recognition and in subsequent implementation of control measures contributed to secondary transmission. Prompt contact tracing, repeated testing, HCP furloughing, and implementation of recommended transmission-based precautions for suspected cases ultimately halted transmission.
This case report illustrates an unusual case of a dural arteriovenous fistula and an associated encephalocele presenting as otitis media with effusion.
A 53-year-old man presented with right-sided hearing loss and aural fullness of 2 years’ duration. Examination revealed ipsilateral post-auricular pulsatile tenderness. Computed tomography showed transcalvarial channels suggestive of dural arteriovenous fistula. Further magnetic resonance imaging demonstrated the presence of a temporal encephalocele herniating through the tegmen tympani defect, as well as the abnormal vascularity. Angiography confirmed a Cognard type I dural arteriovenous fistula, which is being managed conservatively. Surgical repair of the encephalocele was recommended but declined by the patient.
Dural arteriovenous fistula is an uncommon intracranial vascular malformation rarely seen by otolaryngologists, with pulsatile tinnitus being the usual presentation. To our knowledge, this is the first reported case of dural arteriovenous fistula presenting with conductive hearing loss and otalgia.
Objectives: The Addenbrooke’s Cognitive Examination (ACE) is a common cognitive screening test for dementia. Here, we examined the relationship between the most recent version (ACE-III) and its predecessor (ACE-R), determined ACE-III cutoff scores for the detection of dementia, and explored its relationship with functional ability. Methods: Study 1 included 199 dementia patients and 52 healthy controls who completed the ACE-III and ACE-R. ACE-III total and domain scores were regressed on their corresponding ACE-R values to obtain conversion formulae. Study 2 included 331 mixed dementia patients and 87 controls to establish the optimal ACE-III cutoff scores for the detection of dementia using receiver operator curve analysis. Study 3 included 194 dementia patients and their carers to investigate the relationship between ACE-III total score and functional ability. Results: Study 1: ACE-III and ACE-R scores differed by ≤1 point overall, the magnitude varying according to dementia type. Study 2: a new lower bound cutoff ACE-III score of 84/100 to detect dementia was identified (compared with 82 for the ACE-R). The upper bound cutoff score of 88/100 was retained. Study 3: ACE-III scores were significantly related to functional ability on the Clinical Dementia Rating Scale across all dementia syndromes, except for semantic dementia. Conclusions: This study represents one of the largest and most clinically diverse investigations of the ACE-III. Our results demonstrate that the ACE-III is an acceptable alternative to the ACE-R. In addition, ACE-III performance has broader clinical implications in that it relates to carer reports of functional impairment in most common dementias. (JINS, 2018, 24, 854–863)
Nutrient profiling (NP) is a method for evaluating the healthfulness of foods. Although many NP models exist, most have not been validated. This study aimed to examine the content and construct/convergent validity of five models from different regions: Australia/New Zealand (FSANZ), France (Nutri-Score), Canada (HCST), Europe (EURO) and Americas (PAHO). Using data from the 2013 UofT Food Label Information Program (n15342 foods/beverages), construct/convergent validity was assessed by comparing the classifications of foods determined by each model to a previously validated model, which served as the reference (Ofcom). The parameters assessed included associations (Cochran–Armitage trend test), agreement (κ statistic) and discordant classifications (McNemar’s test). Analyses were conducted across all foods and by food category. On the basis of the nutrients/components considered by each model, all models exhibited moderate content validity. Although positive associations were observed between each model and Ofcom (all Ptrend<0·001), agreement with Ofcom was ‘near perfect’ for FSANZ (κ=0·89) and Nutri-Score (κ=0·83), ‘moderate’ for EURO (κ=0·54) and ‘fair’ for PAHO (κ=0·28) and HCST (κ=0·26). There were discordant classifications with Ofcom for 5·3 % (FSANZ), 8·3 % (Nutri-Score), 22·0 % (EURO), 33·4 % (PAHO) and 37·0 % (HCST) of foods (all P<0·001). Construct/convergent validity was confirmed between FSANZ and Nutri-Score v. Ofcom, and to a lesser extent between EURO v. Ofcom. Numerous incongruencies with Ofcom were identified for HCST and PAHO, which highlights the importance of examining classifications across food categories, the level at which differences between models become apparent. These results may be informative for regulators seeking to adapt and validate existing models for use in country-specific applications.
Several Apriori algorithm implementations for mining association rules have been proposed in the literature using the Hadoop-MapReduce framework and, more recently, Spark. However, none of the works have made a detailed assessment of its performance, for example, comparing it with other implementations in various characteristics of data sets. In this work, we present a review of the main algorithms proposed for Hadoop-MapReduce and compared their implementations in a single environment under several different situations. Moreover, these algorithms had their implementations adapted to Spark, and also compared under the same circumstances. Based on the results of the experiments, we present a framework for recommending the Apriori implementation most appropriate for solving a given problem, according to the data set characteristics and minimum required support. The results show that Spark implementations overcome Hadoop-MapReduce implementations at runtime in most experiments. However, there is no single implementation that is the best in all the evaluated situations.
Microscopic myringoplasty is the most frequently performed procedure for repairing tympanic membrane perforations. The endoscopic transcanal approach bypasses the narrow ear canal segment and provides a wider view.
An open-label randomised clinical trial was conducted on 56 patients with small anterior tympanic membrane perforations. Perforations were repaired with an endoscopic push-through technique (n = 28) or a microscopic underlay technique (n = 28). Follow up was conducted using endoscopic examination and pure tone audiometry three months’ post-operatively.
Graft success rate was 92.9 per cent in the endoscopic group versus 85.7 per cent in the microscopic group. The corresponding pre-operative mean air–bone gaps were 17.4 dB and 18.5 dB, improving to 6.1 dB and 9.3 dB post-operatively (p > 0.05). Mean air–bone gap closure was 11.4 dB in the endoscopic group and 9.2 dB in the microscopic group (p > 0.05). Mean operative time and estimated blood loss were 37.0 minutes and 29 ml in the endoscopic group, versus 107 minutes and 153 ml in the microscopic group (both p < 0.05).
The endoscopic push-through technique for anterior tympanic membrane perforations is as effective as microscopic underlay myringoplasty; furthermore, it is less invasive and takes less operative time.
To assess whether pre-operative assessment with a bone conduction hearing device on a softband is an accurate predictor of performance with one of two transcutaneous hearing implants.
Cohort study comparing pre-and post-operative speech audiometry using correlation analysis.
Pre-operative pure tone audiometry and aided half optimum speech recognition thresholds were compared with post-operative aided results for each ear that had undergone implantation. Data were collected prospectively.
Full data were available in 24 ears. In 19 out of 24 ears (79 per cent), the difference between pre- and post-operative speech scores was less than 10 dB, demonstrating a good clinical correlation. The Pearson correlation coefficient was calculated at 0.66 (95 per cent confidence interval = 0.357–0.842), indicating a strong statistical correlation.
Pre-operative softband testing shows good clinical correlation and strong statistical correlation with hearing implant performance. The findings suggest there is value in using the test to predict performance and guide patients’ expectations.
Improving understanding of the pathogen-specific seasonality of enteric infections is critical to informing policy on the timing of preventive measures and to forecast trends in the burden of diarrhoeal disease. Data obtained from active surveillance of cohorts can capture the underlying infection status as transmission occurs in the community. The purpose of this study was to characterise rotavirus seasonality in eight different locations while adjusting for age, calendar time and within-subject clustering of episodes by applying an adapted Serfling model approach to data from a multi-site cohort study. In the Bangladesh and Peru sites, within-subject clustering was high, with more than half of infants who experienced one rotavirus infection going on to experience a second and more than 20% experiencing a third. In the five sites that are in countries that had not introduced the rotavirus vaccine, the model predicted a primary peak in prevalence during the dry season and, in three of these, a secondary peak during the rainy season. The patterns predicted by this approach are broadly congruent with several emerging hypotheses about rotavirus transmission and are consistent for both symptomatic and asymptomatic rotavirus episodes. These findings have practical implications for programme design, but caution should be exercised in deriving inferences about the underlying pathways driving these trends, particularly when extending the approach to other pathogens.
The pathogenesis of complex visual hallucination in patients without visual lesions, appearing with eyes open and resolving with eyes closed, has been described to be associated with increased excitation at the lateral geniculate nucleus (LGN) and pulvinar of the thalamus (Winton-Brown, 2016). This reduces thefidelity of retinogeniculate transmissions and enhances aberrant projections to the visual cortex. Loss of the central sensory filtering function of the pulvinar increases “signal to noise ratio” in visual transmission. While visual hallucinations have been reported to disappear on eye closure (Manford, 1998), visual aberration with correction with refractionfollowed by focusing on actual visual images and visual hallucinations has not heretofore been reported. Such a case is presented.
Case study: This 28-year-old, myopic, right-handed man, at 5 years of age began hallucinating vivid images of people. The visual hallucinations were triggered only with his eye open. He was myopic and without visual correction, his visual sphere would be blurred. The visual hallucinations were also blurred without visual correction. With refraction, the hallucinations became clearly in focus. He would close his eyes and the visual hallucinations disappeared but would reappear in the same position upon opening his eyes. For over 20 years, he experienced about 100 hallucinations a day. Electroencephalography (EEG) revealed continuous spikes and slow waves in bilateral temporal lobes, consistent with temporal lobe status epilepticus. After treatment with diphenylhydantoin the frequency and duration of the hallucinations markedly decreased to a second epoch every other day. However, the characteristic of the hallucinations remained the same (people).
This phenomenon may involve epilepsy induced excitation of the thalamus. This then acts to reduce the fidelity of retinogeniculate transmission and increase “signal to noise ratio” in visual transmission. This may contribute to complex visual hallucinations with eyes open. The hallucinated figures becoming clearer with eyeglasses provides support that this complex hallucination arises in the pathway from retina-LGN-cortex, not from stored visual associated cortex of top-down cortical release.
Given the above, those with visual hallucinations should be queried as to the influence of refraction on the clarity of hallucination.
We present an investigation into the influence of upstream shear on the viscous flow around a steady two-dimensional (2-D) symmetric airfoil at zero angle of attack, and the corresponding loads. In this computational study, we consider the NACA 0012 airfoil at a chord Reynolds number
in an approach flow with uniform positive shear with non-dimensional shear rate varying in the range 0.0–1.0. Results show that the lift force is negative, in the opposite direction to the prediction from Tsien’s inviscid theory for lift generation in the presence of positive shear. A hypothesis is presented to explain the observed sign of the lift force on the basis of the asymmetry in boundary layer development on the upper and lower surfaces of the airfoil, which creates an effective airfoil shape with negative camber. The resulting scaling of the viscous effect with shear rate and Reynolds number is provided. The location of the leading edge stagnation point moves increasingly farther back along the airfoil’s upper surface with increased shear rate, a behaviour consistent with a negatively cambered airfoil. Furthermore, the symmetry in the location of the boundary layer separation point on the airfoil’s upper and lower surfaces in uniform flow is broken under the imposed shear, and the wake vortical structures exhibit more asymmetry with increasing shear rate.
Immunoactivation depends upon the antigen potential to modulate T-cell repertoires. The present study has enumerated the effect of 61 kDa recombinant Leishmania donovani co-factor-independent phosphoglycerate mutase (rLd-iPGAM) on mononuclear cells of healthy and treated visceral leishmaniasis subjects as well as on THP-1 cell line. rLd-iPGAM stimulation induced higher expression of interleukin-1β (IL-1β) in the phagocytic cell, its receptor and CD69 on T-cell subsets. These cellular activations resulted in upregulation of host-protective cytokines IL-2, IL-12, IL-17, tumour necrosis factor-α and interferon-γ, and downregulation of IL-4, IL-10 and tumour growth factor-β. This immune polarization was also evidenced by upregulation of nuclear factor-κ light-chain enhancer of activated B cells p50 and regulated expression of suppressor of mother against decapentaplegic protein-4. rLd-iPGAM stimulation also promoted lymphocyte proliferation and boosted the leishmaniacidal activity of macrophages by upregulating reactive oxygen species. It also induced 1·8-fold higher release of nitric oxide (NO) by promoting the transcription of inducible nitric oxide synthase gene. Besides, in silico analysis suggested the presence of major histocompatibility complex class I and II restricted epitopes, which can proficiently trigger CD8+ and CD4+ cells, respectively. This study reports rLd-iPGAM as an effective immunoprophylactic agent, which can be used in future vaccine design.
Unavailability of irrigation water for early sowing has remained a constant problem in cold arid deserts of Ladakh. In order to get a solution to this problem, a 2-yr farmers’ participatory research trial with best bet agronomic management on artificial glacier water harvesting technology was conducted. The technology involves collecting water from natural glaciers that melt during late December. The water is diverted toward a shed constructed with stone embankments set up at regular intervals. The area is chosen where there is minimum interference of solar radiation, generally between two mountain slopes or ridge that is on the leeward side. The melted water is that melts from the natural glacier impeded by the embankments and get frozen here. This frozen water starts melting in late March and is used for both pre sowing and initial crop water requirement. It also ensures early sowing of wheat by creating additional 45-day window which leads to introduction of long- and medium-duration wheat varieties to replace decades old locally grown short-duration varieties. The work was initiated with a benchmark survey of 100 farmers to get an understanding of present irrigation scenario, crop management practices and date of sowing. Data from 99 farmer participating trial of wheat conducted after or from bench mark survey clearly indicated that the effect of water shortage can be seen on yield and yield attributing characters due to unavailability of pre sowing irrigation and water requirement at imperative growth stages and may also lead to terminal heat stress in wheat crop. Out of total number of irrigations applied, initial two irrigations can be compensated by artificial glacier water harvesting technique, leading to a revolution in the agriculture scenario of the tribal population by introduction of long- and medium-duration wheat varieties in cold arid desert of Ladakh for the very first time. It was observed that wheat seeding done in first fortnight of April gave better yields in comparison to late seeded wheat. Moreover, the long-duration varieties (LDVs) or medium-duration varieties (MDVs) sown under late condition gave better yield in comparison to locally grown short-duration varieties sown at same time. Yield potential of LDVs and MDVs of wheat under late sowing was found quite low in comparison to early-sown wheat, still when compared with the performance of locally grown wheat the yields were more even if the local varieties were sown early. The outcome of this study will help the farmers of tribal, cold arid community in harvesting better wheat yields by timely sowing of the wheat crop accompanied with better bet agronomic management practices. Government initiative is further required to ensure better outreach of complete crop management strategies to the tribal farming community of the region in order to ensure food security and improve their socioeconomic status.
Livestock health is economically important for agropastoral households whose wealth is held partly as livestock. Households can invest in disease prevention and treatment, but livestock disease risk is also affected by grazing practices that result in inter-herd contact and disease transmission in regions with endemic communicable diseases. This paper examines the relationships between communal grazing and antimicrobial use in Maasai, Chagga and Arusha households in northern Tanzania. We develop a theoretical model of the economic connection between communal grazing, disease transmission risk, risk perceptions, and antimicrobial use, and derive testable hypotheses about these connections. Regression results suggest that history of disease and communal grazing are associated with higher subjective disease risk and greater antimicrobial use. We discuss the implications of these results in light of the potential for relatively high inter-herd disease transmission rates among communal grazers and potential contributions to antimicrobial resistance due to antimicrobial use.
In this paper, a compact tri-band asymmetric coplanar strip (ACS)-fed meander-line antenna for wireless communications is proposed. Two inverted-L-shaped resonators are added to a simple meandered radiator for standard tri-band operation. Parametric studies indicate that operating frequencies of the proposed antenna are determined by the dimensions of the two inverted-L-shaped resonators. The measured results show that the proposed antenna can achieve three frequency bands; i.e. 1.48–1.63, 2.25–2.48, and 4.22–6.0 GHz. These bands can successfully cover the global positioning system L1, wireless local area network (WLAN), and HIPERLAN/2 operation bands, respectively. The proposed antenna exhibits good radiation patterns with reasonable gain and high radiation efficiency across the operating bands. In addition, the proposed antenna has compact size and simple feeding scheme, which make it suitable to be integrated within the portable device for wireless communications.