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Exposure to toxic fumes from an industrial chemical fire may not only lead to airway burns and inhalational injury but also toxic exposure via the transdermal route.
A 45-year-old gentleman presented with dyspnea two hours after a ten-minute exposure to toxic fumes while fighting an industrial chemical fire without personal protective equipment. He reported voice hoarseness and chest tightness. Nasoendoscopy demonstrated paranasal sinus soot and significant upper airway edema. Awake fiber-optic intubation was performed for prophylactic airway protection in the Burns ICU but bronchoscopy did not reveal any inhalational burns.
However, the patient developed worsening lactic acidosis (serum lactate 2.8mmol/L to 8.1mmol/L with pH 7.28) within 12 hours post-exposure. Carboxyhemoglobin was 0.9%. Toxicology was consulted for suspicions of transdermal HAZMAT contamination, in particular cyanide given the profound lactic acidosis. The patient was given two doses of hydroxocobalamin and brought to the Hospital Decontamination Unit for de-gowning and thorough wash-down. The chemical scan meter showed high levels (352IU) of an unknown chemical on his skin pre-decontamination, which could not be detected post-decontamination. Lactate improved to 5.0mmol/L within two hours post-decontamination while acidosis resolved at eight hours post-decontamination. The patient was extubated and discharged without sequelae.
To our knowledge, no other human cases of transdermal cyanide poisoning have been reported. Cyanide interferes with mitochondrial oxidative phosphorylation pathways to cause toxicity and death if untreated. However, its effects via transdermal exposure are often delayed compared to exposure via more conventional inhalational routes. This makes recognition difficult and compounds the challenge of long turnaround time for blood cyanide tests. Increased transdermal absorption is possible through intact skin if moistened by sweat.
The potential for transdermal HAZMAT absorption from exposure to toxic fumes is underrecognized. It is crucial to maintain vigilance given the challenges in diagnosing transdermal cyanide toxicity and importance of initiating treatment early.
There is limited data on the dietary patterns of 5-year-old children in Asia. The study examined childhood dietary patterns and their maternal and child correlates in a multi-ethnic Asian cohort. Based on caregiver-reported 1-month quantitative FFQ of 777 children from the Growing Up in Singapore Towards healthy Outcomes cohort, cluster analysis identified two mutually exclusive clusters. Children in the ‘Unhealthy’ cluster (43·9 %) consumed more fries, processed meat, biscuits and ice cream, and less fish, fruits and vegetables compared with those in the ‘Healthy’ cluster (56·1 %). Children with mothers of lower educational attainment had twice the odds of being assigned to the ‘Unhealthy’ cluster (adjusted OR (95 % CI) = 2·19 (95 % CI 1·49–3·24)). Children of Malay and Indian ethnicities had higher odds of being assigned to the ‘Unhealthy’ cluster (adjusted OR = 25·46 (95 % CI 15·40, 42·10) and 4·03 (95 % CI 2·68–6·06), respectively), relative to Chinese ethnicity. In conclusion, this study identified two dietary patterns in children, labelled as the ‘Unhealthy’ and ‘Healthy’ clusters. Mothers’ educational attainment and ethnicity were two correlates that were associated with the children’s assignments to the clusters. These findings can assist in informing health promotion programmes targeted at Asian children.
We present a study of optical and electronic properties of solutions and films based on the fungi-derived pigment xylindein, extracted from decaying wood and processed without and with a simple purification step (“ethanol wash”). The “post-wash” xylindein solutions exhibited considerably lower absorption in the ultraviolet spectral range and dramatically reduced photoluminescence below 600 nm, due to removal of contaminants most likely to be fungal secondary metabolites. The “post-wash” xylindein-based films were characterized by two orders of magnitude higher charge carrier mobilities as compared to “pre-wash” samples. This underlines the importance of minimizing contaminants that disrupt the conductive xylindein network in xylindein-based electronic devices.
Crystallographic and X-ray powder diffraction data were derived from a sample of (Na0.5Bi0.5)TiO3 synthesized by standard ceramic techniques. The powder data were indexed on a monoclinic cell having the space group P2 or Pm, which differed from a previously reported rhombohedral cell.
We report the energy band alignment of Ge2Sb2Te5 and a variety of common complementary-metal-oxide-semiconductor (CMOS) compatible materials. These materials include silicon, silicon oxide, hafnium oxide, silicon nitride as well as nickel silicide. High-resolution X-ray photoelectron spectroscopy was employed as the main tool to obtain the core-level spectra, the valence band spectra, and the energy loss spectra. A precise determination of the valence band offsets of Ge2Sb2Te5 and the various materials were obtained. The conduction band offsets were then determined. The energy band line-ups of Ge2Sb2Te5 and these CMOS compatible materials were established.
Few studies have prospectively examined psychosocial and psychiatric
predictors of adolescent substance use disorders simultaneously.
To identify psychosocial and psychiatric predictors of substance use
disorders in adolescence.
School children aged 12 years (s. d. =0. 3) free from any substance use
disorder at grade7(n=428) were assessed in three
consecutive years, using a standardised psychiatric interview. Their
baseline psychosocial information was also collected. The outcome was the
onset age of a substance use disorder. The Cox regression model was used
for data analysis.
The most significant predictive factors for adolescent substance use
disorder included male gender, attention-deficit hyperactivity disorder,
conduct disorder and sibling use of tobacco. Three protective factors
against such morbidity included living in a household with two parents, a
good academic grade at grade 7 and objection to the use of
Early intervention for disruptive behaviour disorders and specific
psychosocial risk factors might prevent substance use disorders in early
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