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Concurrent chemotherapy with radiotherapy is the standard treatment for locoregionally advanced nasopharyngeal cancer. Cetuximab can be used in the treatment of head and neck squamous cell carcinoma. However, the randomised studies that led to approval for its use in this setting excluded nasopharyngeal cancer. In the context of limited data for the use of cetuximab in nasopharyngeal cancer in the medical literature, this review aimed to summarise the current evidence for its use in both primary and recurrent or metastatic disease.
A literature search was performed using the keywords ‘nasopharyngeal neoplasm’, ‘cetuximab’ and ‘Erbitux’.
Twenty studies were included. There were no randomised phase III trials, but there were nine phase II trials. The use of cetuximab in the treatment of nasopharyngeal carcinoma has been tested in various settings, including in combination with induction chemotherapy and concurrent chemoradiotherapy, and in the palliative setting.
There is no evidence of benefit from the addition of cetuximab to standard management protocols, and there is some evidence of increased toxicity. There is more promise for its use in metastatic or locally recurrent settings. This review draws together the existing evidence and could provide a focus for future studies.
The COllaborative project of Development of Anthropometrical measures in Twins (CODATwins) project is a large international collaborative effort to analyze individual-level phenotype data from twins in multiple cohorts from different environments. The main objective is to study factors that modify genetic and environmental variation of height, body mass index (BMI, kg/m2) and size at birth, and additionally to address other research questions such as long-term consequences of birth size. The project started in 2013 and is open to all twin projects in the world having height and weight measures on twins with information on zygosity. Thus far, 54 twin projects from 24 countries have provided individual-level data. The CODATwins database includes 489,981 twin individuals (228,635 complete twin pairs). Since many twin cohorts have collected longitudinal data, there is a total of 1,049,785 height and weight observations. For many cohorts, we also have information on birth weight and length, own smoking behavior and own or parental education. We found that the heritability estimates of height and BMI systematically changed from infancy to old age. Remarkably, only minor differences in the heritability estimates were found across cultural–geographic regions, measurement time and birth cohort for height and BMI. In addition to genetic epidemiological studies, we looked at associations of height and BMI with education, birth weight and smoking status. Within-family analyses examined differences within same-sex and opposite-sex dizygotic twins in birth size and later development. The CODATwins project demonstrates the feasibility and value of international collaboration to address gene-by-exposure interactions that require large sample sizes and address the effects of different exposures across time, geographical regions and socioeconomic status.
Identifying options for the sustainable intensification of cropping systems in southern Africa under prevailing high climate risk is needed. With this in mind, we tested an intercropping system that combined the staple crop maize with lablab, a local but underutilised legume. Grain and biomass productivity was determined for four variants (i) sole maize (sole-maize), (ii) sole lablab (sole-lablab), (iii) maize/lablab with both crops sown simultaneously (intercropped-SP) and (iv) maize/lablab with lablab sown 28 days after the maize crop (intercropped-DP). Soil water and weather data were monitored and evaluated. The trial was conducted for two seasons (2015/2016 and 2016/2017) at two sites in the Limpopo Province, South Africa: Univen (847 mm rainfall, 29.2 °C maximum and 18.9 °C minimum temperature average for the cropping season over the years 2008–2017) and Syferkuil (491 mm rainfall, with 27.0 °C maximum and 14.8 °C minimum temperature). Analysis revealed three key results: The treatment with intercropped-SP had significantly lower maize yields (2320 kg ha−1) compared with maize in intercropped-DP (2865 kg ha−1) or sole-maize (2623 kg ha−1). As expected, maize yields in the El Niño affected in season 2015/2016 were on average 1688 kg ha−1 lower than in 2016/2017. Maize yields were significantly lower (957 kg ha−1) at Univen, the warmer site with higher rainfall, than at Syferkuil. In 2015/2016, maximum temperature at Univen exceeded 40 °C around anthesis. Furthermore, soil water was close to the estimated permanent wilting point (PWP) for most of the cropping season, which indicates possible water limitations. In Syferkuil, the soil water was maintained well above PWP. Lablab yields were low, around 500 ha−1, but stable as they were not affected by treatment across season and site. Overall, the study demonstrated that intercropped-DP appears to use available soil water more efficiently than sole maize. Intercropped-DP could therefore be considered as an option for sustainable intensification under high climate risk and resource-limited conditions for smallholders in southern Africa.
Introduction: Little is known about the variety of roles volunteers play in the emergency department (ED), and the potential impact they have on patient experience. The objective of this scoping review was to identify published and unpublished reports that described volunteer programs in EDs, and determine how these programs impacted patient experiences or outcomes. Methods: Electronic searches of Medline, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and CINAHL were conducted and reference lists were hand-searched. A grey literature search was also conducted (Web of Science, ProQuest, Canadian Business and Current Affairs Database ProQuest Dissertations and Theses Global). Two reviewers independently screened titles and abstracts, reviewed full text articles, and extracted data. Results: The search strategy yielded 4,589 potentially relevant citations. After eliminating duplicate citations and articles that did not meet eligibility criteria, 87 reports were included in the review. Of the included reports, 18 were peer-reviewed articles, 6 were conference proceedings, 59 were magazine or newspaper articles, and 4 were graduate dissertations or theses. Volunteer activities were categorized as non-clinical tasks (e.g., provision of meals/snacks, comfort items and mobility assistance), navigation, emotional support/communication, and administrative duties. 52 (59.8%) programs had general volunteers in the ED and 35 (40.2%) had volunteers targeting a specific patient population, including pediatrics, geriatrics, patients with mental health and addiction issues and other vulnerable populations. 20 (23.0%) programs included an evaluative component describing how ED volunteers affected patient experiences and outcomes. Patient satisfaction, follow-up and referral rates, ED and hospital costs and length of stay, subsequent ED visits, medical complications, and malnutrition in the hospital were all reported to be positively affected by volunteers in the ED. Conclusion: This scoping review demonstrates the important role volunteers play in enhancing patient and caregiver experience in the ED. Future volunteer engagement programs implemented in the ED should be formally described and evaluated to share their success and experience with others interested in implementing similar programs in the ED.
A common property regime was established at the founding of the Maya site of Actuncan, Belize, in the Terminal Preclassic period (175 BC–AD 300), which governed access to land until the Terminal Classic period (AD 780–1000). This interpretation is based on urban settlement patterns documented through household excavation and remote-sensing programs. Excavations of all visible patio-focused groups in the urban core provided data to reconstruct residential histories, and a 60,621 m2 gradiometer survey resulted in a magnetic gradient map that was used to document buried constructions. Twenty ground-truth testpits correlated types of magnetic signatures to buried patio-focused groups and smaller constructions, including walled plots in agricultural field systems that were later exposed more fully through large-scale excavations. Combined, these methods provided data to reconstruct four correlates of land tenure systems: (1) the spatial proximity of residential units to land and resources, (2) diachronic changes in community settlement patterns, (3) land subdivision and improvements, and (4) public goods. Spatial analyses documented that houselots did not cluster through time, but instead became gradually improved, lending evidence to suggest the transgenerational inheritance of property rights in the Late and Terminal Classic periods.
The majority of paediatric Clostridioides difficile infections (CDI) are community-associated (CA), but few data exist regarding associated risk factors. We conducted a case–control study to evaluate CA-CDI risk factors in young children. Participants were enrolled from eight US sites during October 2014–February 2016. Case-patients were defined as children aged 1–5 years with a positive C. difficile specimen collected as an outpatient or ⩽3 days of hospital admission, who had no healthcare facility admission in the prior 12 weeks and no history of CDI. Each case-patient was matched to one control. Caregivers were interviewed regarding relevant exposures. Multivariable conditional logistic regression was performed. Of 68 pairs, 44.1% were female. More case-patients than controls had a comorbidity (33.3% vs. 12.1%; P = 0.01); recent higher-risk outpatient exposures (34.9% vs. 17.7%; P = 0.03); recent antibiotic use (54.4% vs. 19.4%; P < 0.0001); or recent exposure to a household member with diarrhoea (41.3% vs. 21.5%; P = 0.04). In multivariable analysis, antibiotic exposure in the preceding 12 weeks was significantly associated with CA-CDI (adjusted matched odds ratio, 6.25; 95% CI 2.18–17.96). Improved antibiotic prescribing might reduce CA-CDI in this population. Further evaluation of the potential role of outpatient healthcare and household exposures in C. difficile transmission is needed.
Methods are presented for the determination of uranium, or uranium and neptunium, in plutonium metal and plutonium alloys. Anion exchange or a combination of anion exchange - solvent extraction is used to concentrate the elements for x-ray fluorescence analysis, depending upon the impurities present and the elements to be determined. The precision for determining between 3 and 250 μg of uranium or neptunium ranges “between 30 and 2%.
The St. Louis aerosol was sampled during the period 16-22 August 1973 simultaneously at two locations using cascade impactors for sequential 12-hour samples. The six particle size fractions of each sampling were individually analyzed using PIXE for elements from S to Br and beyond and for heavy elements including Pb which permitted time variations of concentrations and particle size distributions to be followed and related to meteorological changes during the sampling period. In addition, the data were compared with average levels of the elements in coastal north Florida and maritime Bermuda as well as at a third St. Louis site. From this it appeared that some of the concentrations in St. Louis were at natural levels whereas others appeared to be higher and linked to air pollution sources. These relationships and others in this study may lead to criteria for distinguishing between pollutants and natural background in urban aerosols.
Laser-based compact MeV X-ray sources are useful for a variety of applications such as radiography and active interrogation of nuclear materials. MeV X rays are typically generated by impinging the intense laser onto ~mm-thick high-Z foil. Here, we have characterized such a MeV X-ray source from 120 TW (80 J, 650 fs) laser interaction with a 1 mm-thick tantalum foil. Our measurements show X-ray temperature of 2.5 MeV, flux of 3 × 1012 photons/sr/shot, beam divergence of ~0.1 sr, conversion efficiency of ~1%, that is, ~1 J of MeV X rays out of 80 J incident laser, and source size of 80 m. Our measurement also shows that MeV X-ray yield and temperature is largely insensitive to nanosecond laser contrasts up to 10−5. Also, preliminary measurements of similar MeV X-ray source using a double-foil scheme, where the laser-driven hot electrons from a thin foil undergoing relativistic transparency impinging onto a second high-Z converter foil separated by 50–400 m, show MeV X-ray yield more than an order of magnitude lower compared with the single-foil results.
To evaluate whole-genome sequencing (WGS) as a molecular typing tool for MRSA outbreak investigation.
Investigation of MRSA colonization/infection in a neonatal intensive care unit (NICU) over 3 years (2014–2017).
Single-center level IV NICU.
NICU infants and healthcare workers (HCWs).
Infants were screened for MRSA using a swab of the anterior nares, axilla, and groin, initially by targeted (ring) screening, and later by universal weekly screening. Clinical cultures were collected as indicated. HCWs were screened once using swabs of the anterior nares. MRSA isolates were typed using WGS with core-genome multilocus sequence typing (cgMLST) analysis and by pulsed-field gel electrophoresis (PFGE). Colonized and infected infants and HCWs were decolonized. Control strategies included reinforcement of hand hygiene, use of contact precautions, cohorting, enhanced environmental cleaning, and remodeling of the NICU.
We identified 64 MRSA-positive infants: 53 (83%) by screening and 11 (17%) by clinical cultures. Of 85 screened HCWs, 5 (6%) were MRSA positive. WGS of MRSA isolates identified 2 large clusters (WGS groups 1 and 2), 1 small cluster (WGS group 3), and 8 unrelated isolates. PFGE failed to distinguish WGS group 2 and 3 isolates. WGS groups 1 and 2 were codistributed over time. HCW MRSA isolates were primarily in WGS group 1. New infant MRSA cases declined after implementation of the control interventions.
We identified 2 contemporaneous MRSA outbreaks alongside sporadic cases in a NICU. WGS was used to determine strain relatedness at a higher resolution than PFGE and was useful in guiding efforts to control MRSA transmission.
Farmers’ market interventions are a popular strategy for addressing chronic disease disparities in low-income neighbourhoods. With limited resources, strategic targeting of interventions is critical. The present study used spatial analysis to identify where market interventions have the greatest impact on healthy food access within a geographic region.
All farmers’ markets in a mixed urban/rural county were mapped and those that accepted Supplemental Nutrition Assistance Program (SNAP) electronic benefit transfer (EBT) cards identified. Households were grouped into small neighbourhoods and mapped. The area of ‘reasonable access’ around each market (walking distance (0·8 km; 0·5mile) in urban areas, driving distance (15 min) in rural areas) was calculated using spatial analysis. The percentage of county low-income households within a market’s access area, and the percentage of county SNAP-participating households within an EBT-accepting market’s access area, were calculated. The ten neighbourhoods with the most low-income households and with the most SNAP-participating households were then identified, their access areas calculated and mapped, and those lacking access identified. County-level gains resulting from improving market accessibility in these areas were calculated.
Honolulu County, Hawaii, USA.
Only 44 % of SNAP-participating households had EBT-market access. Six of the ten highest SNAP-participant neighbourhoods lacked access. Improving access for these neighbourhoods increased county-level access by 23 %. Market access for low-income households was 74 %. Adding markets to these low-income neighbourhoods without market access increased county-level access by 4 %.
Geographic identification of market access demographics, and strategic targeting of EBT interventions, could improve regional access to healthy foods.
Serial spherical linkages have been used in the design of a number of robots for minimally invasive surgery, in order to mechanically constrain the surgical instrument with respect to the incision. However, the typical serial spherical mechanism suffers from conflicting design objectives, resulting in an unsuitable compromise between avoiding collision with the patient and producing good kinematic and workspace characteristics. In this paper, we propose a multi-robot system composed of two redundant serial spherical linkages to achieve this purpose. A multi-objective optimization for achieving the aforementioned design goals is presented first for a single redundant robot and then for a multi-robot system. The problem of mounting multiple robots on the operating table as well as the way cooperative actions can be performed is addressed. The sensitivity of each optimal solution (single-robot and multi-robot) to uncertainties in the design parameters is investigated.
Hill (Twin Research and Human Genetics, Vol. 21, 2018, 84–88) presented a critique of our recently published paper in Cell Reports entitled ‘Large-Scale Cognitive GWAS Meta-Analysis Reveals Tissue-Specific Neural Expression and Potential Nootropic Drug Targets’ (Lam et al., Cell Reports, Vol. 21, 2017, 2597–2613). Specifically, Hill offered several interrelated comments suggesting potential problems with our use of a new analytic method called Multi-Trait Analysis of GWAS (MTAG) (Turley et al., Nature Genetics, Vol. 50, 2018, 229–237). In this brief article, we respond to each of these concerns. Using empirical data, we conclude that our MTAG results do not suffer from ‘inflation in the FDR [false discovery rate]’, as suggested by Hill (Twin Research and Human Genetics, Vol. 21, 2018, 84–88), and are not ‘more relevant to the genetic contributions to education than they are to the genetic contributions to intelligence’.
Prior research has documented shared heritable contributions to non-suicidal self-injury (NSSI) and suicidal ideation (SI) as well as NSSI and suicide attempt (SA). In addition, trauma exposure has been implicated in risk for NSSI and suicide. Genetically informative studies are needed to determine common sources of liability to all three self-injurious thoughts and behaviors, and to clarify the nature of their associations with traumatic experiences.
Multivariate biometric modeling was conducted using data from 9526 twins [59% female, mean age = 31.7 years (range 24–42)] from two cohorts of the Australian Twin Registry, some of whom also participated in the Childhood Trauma Study and the Nicotine Addiction Genetics Project.
The prevalences of high-risk trauma exposure (HRT), NSSI, SI, and SA were 24.4, 5.6, 27.1, and 4.6%, respectively. All phenotypes were moderately to highly correlated. Genetic influences on self-injurious thoughts and behaviors and HRT were significant and highly correlated among men [rG = 0.59, 95% confidence interval (CI) (0.37–0.81)] and women [rG = 0.56 (0.49–0.63)]. Unique environmental influences were modestly correlated in women [rE = 0.23 (0.01–0.45)], suggesting that high-risk trauma may confer some direct risk for self-injurious thoughts and behaviors among females.
Individuals engaging in NSSI are at increased risk for suicide, and common heritable factors contribute to these associations. Preventing trauma exposure may help to mitigate risk for self-harm and suicide, either directly or indirectly via reductions in liability to psychopathology more broadly. In addition, targeting pre-existing vulnerability factors could significantly reduce risk for life-threatening behaviors among those who have experienced trauma.
Bismuth triiodide (BiI3) is a potential candidate for application in solar cell due to its good optoelectronic properties and because it is free of toxic elements. It can be used as the absorber material in solar cells or converted into the perovskite-like material MA3Bi2I9, suitable also for photovoltaic applications. Bismuth triiodide has been prepared by physical vapour transport (PVT) and by solution process through spin coating. In this work we present optical and structural/topological properties of BiI3 deposited by thermal evaporation under high vacuum. The films are slightly tensile, polycrystalline, homogenously distributed and with good adherence on several substrates, with an indirect bandgap of 1.81 eV, index of refraction of 3.3 (630 nm), photoluminescence centered at 1.74 eV and a Raman peak at 118cm-1 associated with the Ag mode.