To save 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 saving content to .
To save 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 saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved 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.
Vaccination coverage for infants with CHD is unknown, yet these patients are at high risk for morbidity and mortality associated with vaccine-preventable illnesses. We determined vaccination rates for this population and identified predictors of undervaccination. We prospectively enrolled infants with CHD born between 1 January, 2012 and 31 December, 2015, seen in a single-centre cardiology clinic between 15 February, 2016 and 28 February, 2017. We assessed vaccination during the first year of life. Subjects who by age 1 year received all routine immunisations recommended during the first 6 months of life were considered fully vaccinated. We also evaluated influenza vaccination during subjects’ first eligible influenza season. We obtained immunisation histories from primary care providers and collected demographic and clinical data via a parent survey and chart review. We used multivariable logistic regression to identify predictors of undervaccination. Among 260 subjects, only 60% were fully vaccinated. Vaccination rates were lowest for influenza (64.6%), rotavirus (71.1%), and Haemophilus influenzae type b (79.3%). Cardiac surgery with cardiopulmonary bypass during the first year of life was associated with undervaccination (51.5% versus 76.4% fully vaccinated, adjusted odds ratio 2.1 [95% confidence interval 1.1–3.9]). Other predictors of undervaccination were out-of-state primary care (adjusted odds ratio 2.7 [1.5–4.9]), multiple comorbidities (≥2 versus 0–1, adjusted odds ratio 2.0 [1.1–3.6]), and hospitalisation for >25% of the first year of life (>25% versus ≤25%, adjusted odds ratio 2.1 [1.1–3.9]). Targeted quality improvement initiatives focused on improving vaccination coverage for these infants, especially surrounding cardiac surgery, are needed.
Variation in delineation of target volumes/organs at risk (OARs) is well recognised in radiotherapy and may be reduced by several methods including teaching. We evaluated the impact of teaching on contouring variation for thoracic/pelvic stereotactic ablative radiotherapy (SABR) during a virtual contouring workshop.
Materials and methods:
Target volume/OAR contours produced by workshop participants for three cases were evaluated against reference contours using DICE similarity coefficient (DSC) and line domain error (LDE) metrics. Pre- and post-workshop DSC results were compared using Wilcoxon signed ranks test to determine the impact of teaching during the workshop.
Of 50 workshop participants, paired pre- and post-workshop contours were available for 21 (42%), 20 (40%) and 22 (44%) participants for primary lung cancer, pelvic bone metastasis and pelvic node metastasis cases, respectively. Statistically significant improvements post-workshop in median DSC and LDE results were observed for 6 (50%) and 7 (58%) of 12 structures, respectively, although the magnitude of DSC/LDE improvement was modest in most cases. An increase in median DSC post-workshop ≥0·05 was only observed for GTVbone, IGTVlung and SacralPlex, and reduction in median LDE > 1 mm was only observed for GTVbone, CTVbone and SacralPlex. Post-workshop, median DSC values were >0·7 for 75% of structures. For 92% of the structures, post-workshop contours were considered to be acceptable or within acceptable variation following review by the workshop faculty.
This study has demonstrated that virtual SABR contouring training is feasible and was associated with some improvements in contouring variation for multiple target volumes/OARs.
Breastfeeding may reduce obesity risk, but this association could be confounded by breastfeeding families’ characteristics. We investigated if body composition differs at birth among infants who were either exclusively breast- or formula-fed. We hypothesized the two groups would differ in body composition, even at birth, prior to their post-natal feeding experience. Healthy primiparous carrying singleton pregnancy were recruited at 15 weeks’ gestation. PEA POD® measured body composition within 72 hours of delivery and infant feeding was prospectively captured. Out of the 1,152 infants recruited, 117 (10.2%) and 239 (20.7%) went on to be either exclusively breast- or formula-fed, respectively. Breastfed infants were heavier at birth, but their percentage fat mass (FM) was lower than that of exclusively formula-fed infants (covariate adjusted β = −1.91 percentage points of FM; 95% CI −2.82 to −1.01). Differences in intra-uterine exposures, irrespective of early diet, may partly explain an infant’s obesity risk.
The longue durée of human activity on the island of Pantelleria represents an important locus of ancient cultural interaction in the Strait of Sicily. This narrow channel in the central Mediterranean has played a major and continuous role in human relations between Italy, Sicily and North Africa since the Neolithic period. Use or control of the Pantelleria has been pivotal for a number of cultures over time, each leaving a lasting impression on the landscape and the people of the island (Figure 1). The volcanic geology of Pantelleria has determined the shape of its landscape and is responsible for the creation of the collapsed-caldera basin and lake that form the study area of this project. The Brock University Archaeological Project at Pantelleria (BUAPP) is working in the Lago di Venere area, examining past human activity on the north-eastern lake shore. A previous project in the Lago di Venere area (1998–2002) interpreted the site as a Punic and Roman sanctuary (Audino & Cerasetti 2004; Cerasetti 2006). Our project complements this and other archaeological investigations of the island's classical past, including the ongoing excavations on the Acropolis, near the main harbour, which have revealed the remains of the island's Punic and Roman centre (Schäfer et al. 2015).
The purpose of this study was to audit positioning errors during bladder image-guided radiotherapy (IGRT) and quantify survival outcomes.
Materials and methods
We carried out a retrospective review of 141 patients treated between March 2007 and July 2010 with three-dimensional conformal radiotherapy. An offline imaging protocol using kV cone beam computed tomography (CBCT) was used. Positioning errors, clinical interventions and re-planning rates were quantified. Cancer outcomes and survival were collected by review of patient notes and a registry search.
Among all, 43% of the patients required no intervention. Isocentre corrections were used for systematic bony set-up error in 13% and to improve bladder coverage in 28%. Clinical interventions to improve bladder coverage were required in 16% of the patients and repeat computed tomography planning in a further 16%. Overall, 44% of the patients demonstrated some form of organ deformation that would have resulted in inadequate dose to the bladder or significant overdose to an organ at risk if not corrected for. Post-treatment check cystoscopy was undertaken in 107 patients (76%) with 72 noted to have a complete response. Overall survival was 47·8% at 3 years.
Organ deformation during radiotherapy for bladder cancer is a significant problem for over 40% of patients. Strategies to compensate are essential to ensure optimal plan delivery.
There is a need to further our understanding of the role that the equine hindgut ecosystem plays in digestive processes and diseases. The aim of the present study was to utilise the real-time PCR technique to determine the abundance of candidate cellulolytic (Ruminococcus flavefaciens; Fibrobacter succinogenes) and non-cellulolytic (Streptococcus bovis) bacteria in lumen contents from the caecum, ventral and dorsal colon, and rectum of healthy horses (n 14). Total DNA was extracted from frozen and lyophilised lumen contents, and PCR primers and Taqman® probes were designed based on 16S rDNA sequences for specific detection of candidate bacterial species. Overall, in frozen and lyophilised digesta, there were significantly (P < 0·01) fewer candidate bacteria in the caecum than the dorsal colon and rectum. In frozen digesta, candidate bacteria levels were similar between the ventral colon, dorsal colon and rectum, but in lyophilised digesta there were significantly (P < 0·05) higher levels of bacteria in the dorsal colon and rectum. Frozen digesta contained disparate levels of candidate bacteria such that R. flavefaciens > F. succinogenes > S. bovis (P < 0·05), while in lyophilised digesta R. flavefaciens was present in significantly (P < 0·05) greater amounts than F. succinogenes and S. bovis. R. flavefaciens and F. succinogenes were abundant at significantly (P < 0·05) greater levels in lyophilised digesta v. frozen digesta, with no difference in S. bovis levels. These data indicate that for these bacteria at least, faeces are a suitable model for studying the bacterial ecosystem within the equine colon. The present study also indicates that the preservation method of digesta affects levels of bacteria detected.
This work is an extension of our previous studies carried out to investigate the possible catalytic role of minerals in the abiotic synthesis of biologically important molecules. In the presence of montmorillonite, a member of the phyllosilicate group minerals that are abundant on Earth and identified on Mars, activated RNA monomers, namely 5′-phosphorimidazolides of nucleosides (ImpNs), undergo condensation reactions in aqueous electrolyte solution producing oligomers with similar structures to short RNA fragments. Analysis of the linear trimer isomers formed in the reaction of a mixture of activated adenosine and cytidine monomers (ImpA and ImpC, respectively) employing high-performance liquid chromatography, selective enzymatic hydrolysis and matrix-assisted laser desorption/ionization mass spectroscopy molecular weight measurements demonstrate that montmorillonite catalysis facilitates the formation of hetero-isomers containing 56% A- and 44% C-monomer incorporated in their structure. The results also show that 56% of the monomer units are linked together by RNA-like 3′, 5′-phosphodiester bonds. These results follow the same trend observed in our most recent work studying the reaction of activated adenosine and uridine monomers, and support Bernal's hypothesis proposing the possible catalytic role of minerals in the abiotic processes in the course of chemical evolution.
To investigate the role of blood loss and diet in the aetiology of mild iron deficiency (MID) in premenopausal New Zealand women. Mild iron deficiency was defined as low, but not necessarily exhausted, iron stores (i.e. serum ferritin <20 μg/L) in the absence of anaemia (i.e. haemoglobin ≥120 g/L).
Cross-sectional study of a volunteer sample of premenopausal adult women. Information on habitual dietary intakes (using a specially designed and validated computerised iron food frequency questionnaire), health and demographic status, sources of blood loss (including menstrual blood loss estimated using a validated menstrual recall method), contraceptive use, height and weight, haemoglobin, serum ferritin and C-reactive protein were collected.
Dunedin, New Zealand during 1996/1997.
Three hundred and eighty-four women aged 18–40 years.
The characteristics that were associated with an increased risk of MID were: low meat/fish/poultry intake, high menstrual blood loss, recent blood donation, nose bleeds, and low body mass index. The protective factors included shorter duration of menstrual bleeding, and multivitamin–mineral supplement use in the past year.
There are a number of potentially modifiable factors that appear to influence risk of MID. Women with low menstrual blood loss may be able to decrease their risk of MID by increasing their meat/fish/poultry intake, while those with a higher menstrual blood loss may be able to decrease their risk by decreasing their menstrual blood loss, perhaps by changing their method of contraception. Women should be encouraged to maintain a healthy body weight, and those who choose to donate blood, or who experience nose bleeds, should have their iron stores monitored.
A series of experiments was conducted to determine the effects of a fibrolytic enzyme preparation (enzyme 1; E1) on the in vitro fermentation of lucerne incubated with equine faecal inocula. In experiment 1, high-temperature-dried (HT) lucerne was treated with five levels of E1 (0 to 2·4ml/g DM) and incubated at 50°C for 20h. Samples then received a simulated foregut digestion (SFD) treatment before DM and NSP analysis. In experiment 2, HT lucerne was treated with the same enzyme levels used in experiment 1. Samples were then split into two groups; plus or minus an SFD treatment before in vitro fermentation using an equine faecal inoculum. In experiment 3, fresh and wilted lucerne were treated with the same levels of E1 as experiments 1 and 2, incubated at 50°C for 20h, then fermented in vitro. For experiment 4, fresh and wilted lucerne were treated with low levels (0 to 0·008ml/g DM) of E1 before fermentation. E1 significantly (P<0·05) enhanced DM and NSP losses from HT lucerne following SFD treatment compared with the control. High levels of E1 significantly (P<0·05) enhanced the rate, but not extent, of fermentation of HT, wilted and fresh lucerne; however, low levels of E1 were ineffective. At higher application levels, E1 appears to have considerable potential to enhance the nutritive value of lucerne for horses. Information on the fermentation kinetics of the substrates was valuable; all end-point measurements showed no effect of enzyme treatment.
The joint Canadian Infectious Diseases Society and Canadian Thoracic Society guidelines for community-acquired pneumonia (CAP) recommend 48–72 hour telephone follow-up of patients discharged from the emergency department (ED). The guidelines provide no evidence supporting this practice, and neither the clinical utility nor the effectiveness of such recommendations has been assessed. Our objective was to assess the utility of a 48–72 hour telephone follow-up protocol for patients discharged from the ED with CAP.
This was a retrospective chart audit covering a 2-year period (Jan. 3, 1999 to Jan. 3, 2001) after the introduction of a clinical practice guideline (CPG) that included routine 48–72 hour telephone follow-up of patients discharged from the ED with CAP. Eligible patients were identified in the ED database, rates of referral for telephone follow-up were recorded, and 30-day outcomes (death and readmission) for patients referred versus not referred were compared.
During the study period, 867 patients were identified as being eligible for the study. The mean age was 55.7 years (range 16–98 yr), and mean pneumonia severity index (PSI) was 68.9 (range 6–187). Despite the CPG, only 148 patients (17.1%) were referred for telephone follow-up. Age, demographics, comorbidity, clinical status and pneumonia severity were similar for referred and non-referred patients. Thirty-day death (2.5%) and readmission rates (3%) were strongly related to PSI score, but did not differ significantly in the 2 comparison groups.
In this setting, physicians were poorly compliant with a routine telephone follow-up protocol. The likelihood of referral for follow-up did not correlate with pneumonia severity, and follow-up referral did not appear to affect patient outcome. These findings do not support recommendations for routine early follow-up mechanisms beyond those already existing in the community.
Schneider's first-rank symptoms are given particular weight when making a diagnosis of schizophrenia, but the nuclear syndrome, characterised by one or more first-rank symptoms, has been found previously to have no heritability.
To estimate the heritability of the nuclear syndrome.
A total of 224 twin pairs (106 monozygotic, 118 same-gender dizygotic) were ascertained from the Maudsley Twin Register in London via probands with any psychosis. Lifetime-ever first-rank symptoms were rated using the OPCRIT checklist. Probandwise concordance rates were calculated for the nuclear syndrome and a heritability estimate was derived from biometric model fitting.
Probandwise concordance rates were 13/49 (26.5%) for monozygotic and 0/45 to 2/46 (0.0–4.3%) for dizygotic pairs. The heritability estimate for the best-fitting model was 71% (95% CI 57–82).
These results indicate that the nuclear syndrome shows substantial heritability, although this is slightly lower than that for schizophrenia as defined by the DSM and ICD systems.
Reductions in red meat and increases in cereals in the diet may compromise the intake and bioavailability of Zn. In this cross-sectional study of 330 premenopausal New Zealand women aged 18–40 years, we have assessed the inter-relationships among dietary intakes (via computer-administered food-frequency questionnaire), biochemical Zn status, and anthropometric indices, and compared our results with earlier data. Fasting serum (12·00 (SD 1·36) ΜMOL/L) AND HAIR ZN (2·71 (sd 0·36) μmol/g) were lower than those for young Dunedin, New Zealand, women in 1973 (non-fasting serum Zn 18·6 (sd 4·6) μmol/l, hair Zn 2·99 (sd 0·35) μmol/g). Further, our mean serum Zn was at the 25th percentile of the US National Health and Nutrition Examination Survey (NHANES) (1976–1980) reference sample for women aged 20–44 years. Meat–poultry–fish contributed only 28 % total Zn in the present study, a level comparable with that from cereals–nuts–legumes (27 %), compared to about 40 % in 1989. Significant negative correlations existed between serum Zn and dietary [phytate]:[Zn] molar ratios (r -0·163, P<0·01); 35 % had diets with [phytate]:[Zn] >15, a level said to compromise Zn status. Mean serum Zn of a subgroup of non-oral contraceptive users free of infection was higher in the red-meat eaters (n 149) compared with non-red-meat eaters (n 48) (12·2 v. 11·8 μmol/g, P<0·05). In contrast, serum Zn was lower in those with dietary [phytate]:[Zn] ratios >15 v. <15 (i.e. 11·9 v. 12·3 μmol/l, P=0·04). We postulate that the lower biochemical Zn status of these New Zealand women may be associated in part with changes in food selection patterns, which have led to a reduction in the bioavailability of dietary Zn.