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Introduction: Intranasal ketamine (INK) has an emerging role for procedural sedation (PSA) in children in the emergency department (ED). While INK is less invasive and requires fewer personnel than IV ketamine, widespread adoption in the paediatric ED would require strong nursing acceptance. To inform INK implementation strategies, we explored nursing perspectives surrounding INK, including perceived barriers to its adoption. Methods: Nurses in the paediatric ED of London Health Sciences Centre, London, Ontario were recruited by email. Two, one-hour, in-person focus groups were conducted on January 26 and February 2, 2018 using a semi-structured interview format. Transcription was performed by a professional medical transcription service and analyzed using an inductive qualitative approach involving code words corresponding to recurring topics. Thematic analysis was used to group similar codes into themes. The analytic process was managed using the NVivo 11 software package. Results: Results: Eight nurses participated. All nurses were female and had a mean of 8.9 (range: 2.5 - 26) years of pediatric emergency nursing experience. Seven nurses had experience monitoring and administering INK to children for PSA. Five themes emerged: 1) attributes of INK, 2) INK effects on patients and families, 3) INK effects on health care providers, 4) INK effects on the ED environment, and 5) uncertainty regarding INK's effectiveness, predictability, and fit into institutional sedation protocols. Subthemes included 1) perceptions that INK produced a relatively shallower, slower-onset, and/or less titratable sedation, 2) the importance of patient cooperation (i.e. INK may be preferred by providers for older patients undergoing relatively painful or long procedures), 3) belief that INK was an effective anxiolytic and sedative with the potential to improve nursing resource utilization, and 4) belief that physician resistance to change and lack of personal familiarity were barriers to adoption. Conclusion: Conclusions: We identified clinical advantages to using INK in children, the importance of selecting appropriate patients, and barriers to widespread INK adoption. Importantly, our findings highlighted uncertainty about INK's effectiveness and incorporation into sedation protocols. Our findings will inform future knowledge translation strategies when implementing INK in the clinical setting.
Borderline personality disorder (BPD) is characterised by recurring crises, hospitalisations, self-harm, suicide attempts, addictions, episodes of depression, anxiety and aggression and lost productivity. The objective of this study is to determine the use of direct health care resources by persons with BPD in Ireland and the corresponding costs.
This prevalence-based micro-costing study was undertaken on a sample of 196 individuals with BPD attending publicly funded mental health services in Ireland. All health care costs were assessed using a resource utilisation questionnaire completed by mental health practitioners. A probabilistic sensitivity analysis, using a Monte Carlo simulation, was performed to examine uncertainty.
Total direct healthcare cost per individual was €10 844 annually (ranging from 5228 to 20 609). Based on a prevalence of 1% and an adult population (18–65 years) of 2.87 million, we derived that there were 28 725 individuals with BPD in Ireland. Total yearly cost of illness was calculated to be up to €311.5 million.
There is a dearth of data on health care resource use and costs of community mental health services in Ireland. The absence of this data is a considerable constraint to research and decision-making in the area of community mental health services. This paper contributes to the limited literature on resource use and costs in community mental health services in Ireland. The absence of productivity loss data (e.g. absenteeism and presenteeism), non-health care costs (e.g. addiction treatment), and indirect costs (e.g. informal care) from study participants is a limitation of this study.
Immature fruit fly stages of the family Tephritidae are commonly intercepted on breadfruit from Pacific countries at the New Zealand border but are unable to be identified to the species level using morphological characters. Subsequent molecular identification showed that they belong to Bactrocera xanthodes, which is part of a species complex that includes Bactrocera paraxanthodes, Bactrocera neoxanthodes and an undescribed species. To establish a more reliable molecular identification system for B. xanthodes, a reference database of DNA barcode sequences for the 5’-fragment of COI gene region was constructed for B. xanthodes from Fiji, Samoa and Tonga. To better understand the species complex, B. neoxanthodes from Vanuatu and B. paraxanthodes from New Caledonia were also barcoded. Using the results of this analysis, real-time TaqMan polymerase chain reaction (PCR) assays for the detection of B. xanthodes complex and for the three individual species of the complex were developed and validated. The assay showed high specificity for the target species, with no cross-reaction observed for closely related organisms. Each of the real-time PCR assays is sensitive, detecting the target sequences at concentrations as low as ten copies µl−1 and can be used as either singleplex or multiplex formats. This real-time PCR assay for B. xanthodes has been successfully applied at the borders in New Zealand, leading to the rapid identification of intercepted Tephritidae eggs and larvae. The developed assays will be useful biosecurity tools for rapid detection of species in the B. xanthodes complex worldwide.
Coinfection with human immunodeficiency virus (HIV) and viral hepatitis is associated with high morbidity and mortality in the absence of clinical management, making identification of these cases crucial. We examined characteristics of HIV and viral hepatitis coinfections by using surveillance data from 15 US states and two cities. Each jurisdiction used an automated deterministic matching method to link surveillance data for persons with reported acute and chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infections, to persons reported with HIV infection. Of the 504 398 persons living with diagnosed HIV infection at the end of 2014, 2.0% were coinfected with HBV and 6.7% were coinfected with HCV. Of the 269 884 persons ever reported with HBV, 5.2% were reported with HIV. Of the 1 093 050 persons ever reported with HCV, 4.3% were reported with HIV. A greater proportion of persons coinfected with HIV and HBV were males and blacks/African Americans, compared with those with HIV monoinfection. Persons who inject drugs represented a greater proportion of those coinfected with HIV and HCV, compared with those with HIV monoinfection. Matching HIV and viral hepatitis surveillance data highlights epidemiological characteristics of persons coinfected and can be used to routinely monitor health status and guide state and national public health interventions.
Simulation is used in many aspects of medical training but less so for echocardiography instruction in paediatric cardiology. We report our experience with the introduction of simulator-based echocardiography training at Weill Cornell Medicine for paediatric cardiology fellows of the New York–Presbyterian Hospital of Columbia University and Weill Cornell Medicine. Knowledge of CHD and echocardiographic performance improved following simulation-based training. Simulator training in echocardiography can be an effective addition to standard training for paediatric cardiology trainees.
The Molonglo Observatory Synthesis Telescope (MOST) is an 18000 m2 radio telescope located 40 km from Canberra, Australia. Its operating band (820–851 MHz) is partly allocated to telecommunications, making radio astronomy challenging. We describe how the deployment of new digital receivers, Field Programmable Gate Array-based filterbanks, and server-class computers equipped with 43 Graphics Processing Units, has transformed the telescope into a versatile new instrument (UTMOST) for studying the radio sky on millisecond timescales. UTMOST has 10 times the bandwidth and double the field of view compared to the MOST, and voltage record and playback capability has facilitated rapid implementaton of many new observing modes, most of which operate commensally. UTMOST can simultaneously excise interference, make maps, coherently dedisperse pulsars, and perform real-time searches of coherent fan-beams for dispersed single pulses. UTMOST operates as a robotic facility, deciding how to efficiently target pulsars and how long to stay on source via real-time pulsar folding, while searching for single pulse events. Regular timing of over 300 pulsars has yielded seven pulsar glitches and three Fast Radio Bursts during commissioning. UTMOST demonstrates that if sufficient signal processing is applied to voltage streams, innovative science remains possible even in hostile radio frequency environments.
The class of radio transients called Fast Radio Bursts (FRBs) encompasses enigmatic single pulses, each unique in its own way, hindering a consensus for their origin. The key to demystifying FRBs lies in discovering many of them in order to identity commonalities – and in real time, in order to find potential counterparts at other wavelengths. The recently upgraded UTMOST in Australia, is undergoing a backend transformation to rise as a fast transient detection machine. The first interferometric detections of FRBs with UTMOST, place their origin beyond the near-field region of the telescope thus ruling out local sources of interference as a possible origin. We have localised these bursts to much better than the ones discovered at the Parkes radio telescope and have plans to upgrade UTMOST to be capable of much better localisation still.
It now appears almost certain that the precursor of SN 1987a was the brighter of the components of Sk-69 202, a blue supergiant, with a precursor mass of perhaps 12-16 solar masses. Prior to the explosion the precursor had a core mass of order six solar masses, and 0.1 to 0.2 solar masses of residual hydrogen envelope. The compact nature of this star can account for many of the odd features of the subsequent light curve and spectral evolution.
An analysis of the light curve and colour evolution shows four distinct epochs, which probably relate to the initial expansion of the fireball and the escape of shock-deposited thermal energy, the hydrogen-rich layers becoming optically thin, the exposure of the helium core, and the increasing transparency of the helium core.
The supernova appeared to be at its maximum on May 10, but is dimmer than a normal Type II because its light is apparently derived from recombinations and the radioactive decay of 56Ni to 56Co to 56Fe rather than by the thermal energy deposited by the passage of the shock.
3D printing is a versatile fabrication method that offers the potential to realize complex 3D devices with metamaterial characteristics in a single process directly from a computer aided design. However, the range of functional devices that might be realized by 3D printing is limited by the current range of materials that are compatible with a given 3D printing process: fused deposition modelling (FDM), which is a widely used 3D printing method, typically employs only common thermoplastics. Here we describe the development of a magnetic feedstock based on polymer-ferrite composite that is compatible with FDM. The feasibility of the technique is demonstrated by the permittivity and permeability measurement of direct printed blocks and the fabrication of a complex 3D diamond-like lattice structure. The development of printable magnetic composites provides increased design freedom for direct realization of devices with graded electromagnetic properties operating at microwave frequencies.
Endophthalmitis is a vision-threatening inflammation of the inner eye fluids and tissues. Infectious endophthalmitis results from either exogenous or endogenous entry of microbes into the eye. In reported clinical series, exogenous endophthalmitis is much more common than endogenous (or metastatic) endophthalmitis. By far, the most common cause of exogenous infection is intraocular procedures. Until recently, cataract surgery was the most frequently performed type of intraocular procedure, accounting for the greatest number of exogenous endophthalmitis cases. Intravitreal injection has now surpassed cataract surgery as the most frequently performed intraocular procedure and consequently is a significant contributor to the total number of exogenous endophthalmitis cases reported. Exogenous endophthalmitis can also occur after other types of intraocular surgery, including secondary lens implantation, glaucoma filtering surgery, vitrectomy surgery, and corneal transplantation. Organisms may also enter the eye during penetrating trauma, intraocular injection of medication, and contiguous spread into the eye from an infected corneal ulcer. Gram-positive bacteria are the most common cause of exogenous endophthalmitis.
Postoperative endophthalmitis cases from the University of Miami (Bascom Palmer Eye Institute) over an 8-year period (2002 to 2009) demonstrated the incidence of nosocomial endophthalmitis after cataract surgery to be 0.025%. Endophthalmitis occurs after open-globe injuries in 3% to 30% of patients depending on the nature of the injury. The rate of development of Candida endogenous endophthalmitis in patients with documented candidemia has been reported to range from 2.8% to 45%.
Complex faceted features of micrometer sizes and with intense luminescence rise 200-300 nm above the surface of a GaN thin film grown by molecular beam epitaxy on (0001) sapphire. Cathodoluminescence measurements at room temperature and at 8K were used to investigate the luminescence properties of these microfeatures in comparison with those of the background GaN material. The morphology of the micro-features was studied by scanning electron microscopy and by atomic force microscopy.
GaN and related compounds have been considered as promising materials for light emitting devices in the short wavelength visible and UV spectral regions because of their direct, wide band gaps and high luminescence efficiency. Remarkable, rapid success has been achieved in developing devices based on III-V nitrides, which allows these material systems to rival other systems under development . Blue-green LEDs fabricated from InGaN/AlGaN double-heterostructure layers on sapphire substrates by Nichia Chemical Industries in Japan are commercially available, despite the presence of high extended defect densities in the 1010 /cm2 range . In December 1995, an important milestone in the development of nitride lasers was reached; Nakamura et al. in Nichia demonstrated the first nitride-based laser diode which operated at 417 nm under pulsed conditions at room temperature .
The morphology and spatial distribution of luminescence in GaN thin films have been investigated by several research groups , , , although most efforts have been directed to developing appropriate growth conditions for improved film quality. From observations by scanning electron microscopy (SEM) and atomic force microscopy (AFM), Trager-Cowan et al. described an MBE-grown GaN film which contained an assembly of oriented hexagonal crystallites rising above a background of polycrystalline or amorphous material . All the crystallites, oriented in a similar fashion, had roughly the same sizes, 1 or 2 μm across a hexagonal face and about 1 μm high. These crystallites were much brighter than the surrounding background material in panchromatic low-temperature cathodoluminescence (CL) images. Trager-Cowan et al. concluded that the crystallites were of better quality than the background material. They also observed a green emission band, attributed to impurities, which became weaker for higher electron beam voltages, generating luminescence from deeper in the film. From this observation, they concluded that higher quality material is located closer to the film's outer surface. Spatial variation of the luminescence efficiency from MOCVD-grown films has also been observed by Ponce et al. in their room-temperature CL microscopy studies. Their results showed significant nonuniformities in both the band-edge and yellow band emissions. Although they reported no faceted island structures, one of their samples had “marked surface features” and consisted of hexagonal crystals 10 to 50 μm in diameter. The crystals gave strong band-to-band (364 nm) luminescence.
In this paper, the morphology of a GaN film grown on (0001) sapphire by MBE is characterized by SEM and AFM, and CL measurements are used to investigate the luminescence properties of the film at room temperature and at 8K. Some regions of this film are similar to the one described by Trager-Cowan et al.  in having micron sized, brightly luminescent islands. The hexagonal facet angles and bright luminescence of islands in our film also resemble the larger scale, more regularly shaped hexagonal crystals of Ponce et al. . These regions lie on the boundary of excess gallium growth conditions. Our results differ from those of Trager-Cowan in terms of the island morphologies and the spectral character of luminescence from the islands and from the background material. Possible causes of the large variations in luminescence efficiency are discussed.
It has been suggested that vitamin D2 is not very prevalent in the human food chain. However, data from a number of recent intervention studies suggest that the majority of subjects had measurable serum 25-hydroxyvitamin D2 (25(OH)D2) concentrations. Serum 25(OH)D2, unlike 25(OH)D3, is not directly influenced by exposure of skin to sun and thus has dietary origins; however, quantifying dietary vitamin D2 is difficult due to the limitations of food composition data. Therefore, the present study aimed to characterise serum 25(OH)D2 concentrations in the participants of the National Adult Nutrition Survey (NANS) in Ireland, and to use these serum concentrations to estimate the intake of vitamin D2 using a mathematical modelling approach. Serum 25(OH)D2 concentration was measured by a liquid chromatography–tandem MS method, and information on diet as well as subject characteristics was obtained from the NANS. Of these participants, 78·7 % (n 884) had serum 25(OH)D2 concentrations above the limit of quantification, and the mean, maximum, 10th, 50th (median) and 90th percentile values of serum 25(OH)D2 concentrations were 3·69, 27·6, 1·71, 2·96 and 6·36 nmol/l, respectively. To approximate the intake of vitamin D2 from these serum 25(OH)D2 concentrations, we used recently published data on the relationship between vitamin D intake and the responses of serum 25(OH)D concentrations. The projected 5th to 95th percentile intakes of vitamin D2 for adults were in the range of 0·9–1·2 and 5–6 μg/d, respectively, and the median intake ranged from 1·7 to 2·3 μg/d. In conclusion, the present data demonstrate that 25(OH)D2 concentrations are present in the sera of adults from this nationally representative sample. Vitamin D2 may have an impact on nutritional adequacy at a population level and thus warrants further investigation.