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Mastoid surgery is an aerosol-generating procedure that involves the use of a high-speed drill, which produces a mixture of water, bone, blood and tissue that may contain the viable coronavirus disease 2019 pathogen. This potentially puts the surgeon and other operating theatre personnel at risk of acquiring the severe acute respiratory syndrome coronavirus-2 from contact with droplets or aerosols. The use of an additional drape designed to limit the spread of droplets and aerosols has been described; such drapes include the ‘Southampton Tent’ and ‘OtoTent’.
To evaluate the use of a novel drape ‘tent’ that has advantages over established ‘tent’ designs in terms of having: (1) a CE marking; (2) no requirement for modification during assembly; and (3) no obstruction to the surgical visual field.
Results and conclusion
During mastoid surgery, the dispersion of macroscopic droplets and other particulate matter was confined within the novel drape ‘tent’. Use of this drape ‘tent’ had no adverse effects upon the surgeon's manual dexterity or efficiency, the view of the surgical field, or the sterility. Hence, our findings support its use during mastoid surgery in the coronavirus disease 2019 era.
Clozapine is the most effective antipsychotic medication, but it has the highest propensity for metabolic side effects. A clozapine clinic was established within an early intervention for psychosis service to facilitate the timely commencement of clozapine and to manage the associated adverse effects. This study describes the changes in the weight, body mass index (BMI), waist circumference and blood pressure after 6 months in young people commenced on clozapine.
This was a prospective cohort study of all young people, aged 15–24 years, commenced on clozapine within an early intervention service in Melbourne, Australia, between 01.04.2016 and 30.06.2018. Continuous data were analyzed with paired t-test and categorical with Wilcoxon signed-rank test.
Twenty-six young people received 6 months of treatment with clozapine, of whom the mean age was 19.8 years (s.d. ±3.1) and 66.7% were male. After 6 months, the mean weight gain was 5.1 kg (s.d. ±10.1 kg) and over half (53.8%) gained clinically significant weight. The proportion of young people classified as either overweight or obese rose from 69.2% to 88.5% (p = 0.006). The proportion of young people with a waist circumference above the recommended parameters increased from 57.9% to 78.9% (p = 0.008). Hypertension was present in 30%, and after 6 months, 45% had hypertension (p = 0.64). Metformin was prescribed to 34.6%, typically to those with the greatest and most rapid weight gain.
Among young people with treatment resistant psychosis, clozapine is associated with significant metabolic side effects in the early stages of commencement. More interventions aimed at attenuating this weight gain are needed.
We report new laboratory experiments of a flow accelerating from an initially turbulent state following the opening of a valve, together with large eddy simulations of the experiments and extended Stokes first problem solutions for the early stages of the flow. The results show that the transient flow closely resembles an accelerating laminar flow superimposed on the original steady turbulent flow. The primary consequence of the acceleration is the temporal growth of a boundary layer from the wall, gradually leading to a strong instability causing transition. This extends the findings of previous direct numerical simulations of transient flow following a near-step increase in flow rate. In this interpretation, the initial turbulence is not the primary characteristic of the resulting transient flow, but can be regarded as noise, the evolution of which is strongly influenced by the development of the boundary layer. We observe the spontaneous appearance of turbulent spots and discontinuities in the velocity signals in time and space, revealing rich detail of the transition process, including a striking contrast between streamwise and wall-normal fluctuating velocities.
To establish if the relatively low rate of involuntary psychiatric admission in a suburban area between 2007 and 2011 was maintained in 2014/2015, and explore key correlates of involuntary status.
We used existing hospital records and data sources to extract rates and selected potential correlates of voluntary and involuntary admission in south west Dublin (catchment area: 273 419 people) over 18 months in 2014/2015 and compared these with published national data from the census and Health Research Board.
The rate of involuntary admission in the suburban area studied between 2007 and 2011 was 33.8 involuntary admissions per 100 000 population annually, which was lower than the national rate (48.6). By 2014/2015, the rate of involuntary admission in this area had risen to 46.8 involuntary admissions per 100 000 population annually, similar to the national rate (44.9). Nevertheless, the overall (voluntary and involuntary) admission rate in the suburban area (346.7 admissions per 100 000 population annually) was still lower the national rate (387.9), owing to a lower rate of voluntary admission in the suburban area (299.9) compared to Ireland as a whole (342.9). Multi-variable testing demonstrated that diagnosis was the strongest driver of involuntary admission in the suburban area: this area had 28.5 involuntary admissions per 100 000 population annually with schizophrenia or related disorders, compared to 18.9 nationally. Schizophrenia and related disorders accounted for 60.9% of involuntary admissions in the suburban area compared to 42.1% nationally.
Schizophrenia is the strongest driver of involuntary admission in the suburban area in this study.
To explore the mental health tribunal experiences of people admitted involuntarily under the Mental Health Act 2001.
Employing a qualitative descriptive study design, data were collected from 23 service users who had experienced mental health tribunals during a recent involuntary admission. Face-to-face semi-structured interviews were conducted ~3 months post-revocation of their involuntary admission order. Data were analysed using an inductive thematic process.
The majority of participants reported mixed experiences comprising positive and negative aspects in relation to information provision, emotional support and an inclusive atmosphere. Some participants reported receiving accessible information about the tribunal process, felt emotionally supported throughout, and encountered respectful and dignifying practices during the tribunal proceedings. However, many participants described experiencing non-inclusive practices, reported feeling ill-informed regarding the tribunal process, emotionally unsupported during and after the tribunal, and distressed by what they perceived as adversarial tribunal proceedings.
Systemic changes could ensure that the positive experiences encountered by the minority of participants in this study are more consistently experienced. Ongoing education and training of stakeholders in the provision of inclusive tribunal practices, and the provision of accessible information and emotional support to service users through the stages of the involuntary admission process appear likely to be beneficial. Service users should automatically be offered the option of having a support person of their choosing present during tribunals.
Although repeatedly associated with white matter microstructural alterations, bipolar disorder (BD) has been relatively unexplored using complex network analysis. This method combines structural and diffusion magnetic resonance imaging (MRI) to model the brain as a network and evaluate its topological properties. A group of highly interconnected high-density structures, termed the ‘rich-club’, represents an important network for integration of brain functioning. This study aimed to assess structural and rich-club connectivity properties in BD through graph theory analyses.
We obtained structural and diffusion MRI scans from 42 euthymic patients with BD type I and 43 age- and gender-matched healthy volunteers. Weighted fractional anisotropy connections mapped between cortical and subcortical structures defined the neuroanatomical networks. Next, we examined between-group differences in features of graph properties and sub-networks.
Patients exhibited significantly reduced clustering coefficient and global efficiency, compared with controls globally and regionally in frontal and occipital regions. Additionally, patients displayed weaker sub-network connectivity in distributed regions. Rich-club analysis revealed subtly reduced density in patients, which did not withstand multiple comparison correction. However, hub identification in most participants indicated differentially affected rich-club membership in the BD group, with two hubs absent when compared with controls, namely the superior frontal gyrus and thalamus.
This graph theory analysis presents a thorough investigation of topological features of connectivity in euthymic BD. Abnormalities of global and local measures and network components provide further neuroanatomically specific evidence for distributed dysconnectivity as a trait feature of BD.
The Edinburgh-Cape Bright QSO Survey is a very small sub-set of the Edinburgh Cape Blue Object Survey, which is a major survey to discover blue stellar objects brighter than B~18 in the southern sky. It will cover an area of sky of 10,000 square degrees with |b|>30 and dec <0. The blue stellar objects are selected by automatic techniques from U and B pairs of UK Schmidt Telescope plates scanned with the COSMOS measuring machine. Follow-up photometry and spectroscopy is being obtained with the SAAO telescopes to classify the types of objects brighter than B=16.5, with some of the more stubborn objects being subjected to AAO service spectroscopy. Some preliminary results for the 6% QSO minority are presented in this paper and comparison is made with the Palomar-Green QSO Survey in the north, which we find to be at least a factor of two incomplete.
To evaluate and compare the opinions of key stakeholders involved in the involuntary admission and treatment of patients under the Mental Health Act (MHA) 2001 regarding their views towards the operation of the legislation.
We employed a descriptive survey design. A questionnaire was distributed to stakeholders involved in the operation of the MHA 2001 (except service users, whose views were explored in a separate qualitative study) via paper or online versions evaluating their opinions regarding the operation of the MHA 2001 in relation to assessment, care, rights, transfer and information available.
Stakeholders agreed that in their opinion that patients generally benefit from the care they receive (79%) and that the MHA 2001 ensures an independent and fair review of the person’s detention (65%). However, only 23% of stakeholders were satisfied with the process of transferring patients to hospital and with the clinical assessment procedures therein (37%), with the greatest levels of dissatisfaction amongst Gardai (Police), general practitioners (GPs) and family members.
While the introduction of the MHA 2001 has assisted delivery of care to patients with improved adherence to international human rights frameworks applicable at the time of its enactment, substantial dissatisfaction with the implementation of the MHA 2001 in practice is experienced by stakeholders particularly at the distressing phase of clinical assessment and transfer to hospital.
A direct numerical simulation investigation of a transient flow in a channel with a smooth top wall and a roughened bottom wall made of close-packed pyramids is presented. An initially stationary turbulent flow is accelerated rapidly to a new flow rate and the transient flow behaviour after the acceleration is studied. The equivalent roughness heights of the initial and final flows are
and 41.5, respectively. Immediately after the acceleration ends, the induced change behaves in a ‘plug-flow’ manner. Above the roughness crests, the additional velocity due to the perturbation flow is uniform; below the crest, it reduces approximately linearly to zero at the bottom of the roughness elements. The interaction of the perturbation flow with the rough wall is characterised by a series of events that resemble those observed in roughness-induced laminar–turbulent transitions. The process has two broad stages. In the first of these, large-scale vortices, comparable in extent to the roughness wavelength, develop around each roughness element and high-speed streaks form along the ridge lines of the elements. After a short time, each vortex splits into two, namely (i) a standing vortex in front of the element and (ii) a counter-rotating hairpin vortex behind it. The former is largely inactive, but the latter advects downstream with increasing strength, and later lifts away from the wall. These hairpin vortices wrap around strong low-speed streaks. The second stage of the overall process is the breakdown of the hairpin vortices into many smaller multi-scale vortices distributed randomly in space, leading eventually to a state of conventional turbulence. Shortly after the beginning of the first stage, the three components of the r.m.s of the velocity fluctuation all increase significantly in the near-wall region as a result of the vortical structures, and their spectra bear strong signatures of the surface topology. During the second stage, the overall turbulence energy in this region varies only slightly, but the spectrum evolves significantly, eventually approaching that of conventional turbulence. The direct effect of roughness on the flow is confined to a region up to approximately three element heights above the roughness crests. Turbulence in the core region does not begin to increase until after the transition near the wall is largely complete. The processes of transition over the smooth and rough walls of the channel are practically independent of each other. The flow over the smooth wall follows a laminar–turbulent transition and, as known from previous work, resembles a free-stream turbulence-induced boundary layer bypass transition.
This editorial discusses the application of a novel brain imaging analysis technique in the assessment of neuroanatomical dysconnectivity in psychotic illnesses. There has long been a clinical interest in psychosis as a disconnection syndrome. In recent years graph theory metrics have been applied to functional and structural imaging datasets to derive measures of brain connectivity, which represent the efficiency of brain networks. These metrics can be derived from structural neuroimaging datasets acquired using diffusion imaging whereby cortical structures are parcellated into nodes and white matter tracts represent edges connecting these nodes. Furthermore neuroanatomical measures of connectivity may be decoupled from measures of physiological connectivity as assessed using functional imaging, underpinning the need for multi-modal imaging approaches to probe brain networks. Studies to date have reported a number of structural brain connectivity abnormalities associated with schizophrenia that carry potential as illness biomarkers. Structural connectivity abnormalities have also been reported in well patients with bipolar disorder and in unaffected relatives of patients with schizophrenia. Such connectivity metrics may represent clinically relevant biomarkers in studies employing a longitudinal design of illness course in psychosis.
In November 1973 Newcastle disease suddenly appeared in Northern Ireland, where the viscerotropic disease had not been seen in 3½ years and the two Irelands had been regarded as largely disease free for 30 years. It was successfully controlled with only 36 confirmed affected layer flocks, plus 10 more slaughtered as ‘dangerous contacts’. Contemporary investigations failed to reveal the source of the Irish epidemic. Using archival virus samples from most of the affected flocks, RT–PCR was conducted with primers selected for all six NDV genes. Phylogenetic analyses of three genes, HN, M and F, confirmed vaccine as the cause of one of the outbreaks. The other six samples were identical and closely related to previous outbreaks in the United States and western Europe initiated by infected imported Latin American parrots. The probable cause of the epidemic followed from the importation from The Netherlands of bulk feed grains contaminated with infected pigeon faeces.
We present the initial results of an abundance analysis of echelle UV spectra of 5 hot subdwarf B (sdB) stars, which form part of a study to test pulsation and diffusion calculations. SdB stars have been identified as core helium-burning objects on the extreme Horizontal Branch. Around 5% of sdB stars show short-period acoustic mode oscillations, which models predict are due to an opacity bump caused by the ionisation of iron group elements. The necessary metal abundance has to be maintained by diffusive equilibrium between gravitational settling and radiative levitation. However, analyses of high resolution optical spectra has revealed that we cannot discriminate between pulsating and non-pulsating sdB stars on the basis of the surface iron abundance. Our initial analysis of HST/STIS observations of 3 pulsators and 2 non-pulsators in the near and far UV suggests this may also be the case for other iron group elements, although further work will be needed to verify this.
Susceptibility to coeliac disease involves HLA and non-HLA-linked genes. The CTLA4/CD28 gene region encodes immune regulatory T-cell surface molecules and is a strong candidate as a susceptibility locus. We evaluated CTLA4/CD28 in coeliac disease by genetic linkage and association and combined our findings with published studies through a meta-analysis. 116 multiplex families were genotyped across CTLA4/CD28 using eight markers. The contribution of CTLA4/CD28 to coeliac disease was assessed by non-parametric linkage and association analyses. Seven studies were identified that had evaluated the relationship between CTLA4/CD28 and coeliac disease and a pooled analysis of data undertaken. In our study there was evidence for a relationship between variation in the CTLA4/CD28 region and coeliac disease by linkage and association analyses. However, the findings did not attain formal statistical significance (p = 0·004 and 0·039, respectively). Pooling findings with published results showed significant evidence for linkage (504 families) and association (940 families): p values, 0·0001 and 0·0014 at D2S2214, respectively, and 0·0008 and 0·0006 at D2S116, respectively. These findings suggest that variation in the CD28/CTLA4 gene region is a determinant of coeliac disease susceptibility. Dissecting the sequence variation underlying this relationship will depend on further analyses utilising denser sets of markers.
Trypanosome infections are often difficult to detect by conventional microscopy and their pleomorphy often confounds differential diagnosis. Molecular techniques are now being used to diagnose infections and to determine phylogenetic relationships between species. Complete small subunit rRNA gene sequences were determined for isolates of Trypanosoma chelodina from the Brisbane River tortoise (Emydura signata), the saw-shelled tortoise (Elseya latisternum), and the eastern snake-necked tortoise (Chelodina longicollis) from southeast Queensland, Australia. Partial sequence data were also obtained for T. binneyi from a platypus (Ornithorhynchus anatinus) from Tasmania. Phylogenetic relationships between T. chelodina, T. binneyi and other species were examined by maximum parsimony and likelihood methods. The Australian tortoise and platypus trypanosomes did not exhibit any close phylogenetic relationships with those of mammals, reptiles or amphibians, but were closely related to each other, and to fish trypanosomes. This contra-indicates their co-evolution with their vertebrate hosts but does not exclude co-evolution with different groups of invertebrate vectors, notably insects and leeches.
Wool growth is derived directly from protein synthesis in the skin of sheep, and is affected by the nutritional status of the animals. The present experiment examined both protein synthesis in the skin and muscle and wool growth in Merino lambs differing in live weight, intake and dietary protein source. The experiment was a 23 factorial design: twenty-four 5-month-old lambs initially weighing 33 kg (heavy) or 25 kg (light) were fed on a hay-based diet with either lupin seed or rapeseed meal as the major protein sources to maintain live weight (M) for 56 d, or were fed at 0.6M for 28 d (period 1) followed by 28 d at 1.6M (period 2). Fractional protein synthesis rates (FSR, % per d) in the skin and the m. longissimus dorsi on days 4 and 24 of period 1 and day 4 of period 2 were measured by means of a flooding dose of l-[ring-d5]phenylalanine, and wool growth on a skin patch over period 1 was also measured. The FSR ranged from 13.2 to 20.2% per d in the skin, higher than reported for other breeds, and 1.53–3.07% per d in the muscle. Sheep on the low intake (0.6M) had significant reductions in FSR, protein content (g), protein synthesis (g/d) in the skin, and wool growth (g/d). The heavy lambs had similar FSR to the light lambs, but had a higher skin protein content and total protein synthesis per unit of skin area (100 cm2) and, therefore, grew more wool. The rapeseed-meal diet increased FSR and wool growth only in the light lambs over the short term. The protein deposited in wool over period 1 was 0.185 of the total protein synthesis in the skin, regardless of live weight, intake or diet, a result similar to other breeds. With the changes in dietary intake, protein synthesis in the skin and muscle responded differentially, with nutrient partitioning at sub-maintenance in favour of wool growth but at supra-maintenance, following a nutrient restriction, in favour of weight gain in young growing sheep.
The Edinburgh-Cape Blue Object Survey (Stobie et al. 1997a) is a southern hemisphere survey to discover hot, blue stellar objects brighter than B=18 at galactic latitudes more than 30° from the galactic plane. The main categories of object detected are hot subdwarfs, white dwarfs, blue horizontal branch stars, apparently normal B stars, cataclysmic variables and (stellar-like) active galactic nuclei. Over 50% of the EC Survey comprises hot subdwarfs.
We present optical photometry of the eclipsing supersoft source, CAL 87. We find the eclipse structure to be stable over ~ 4 y, derive an improved ephemeris of To = HJD 2450111.5144(3)+0.442674(7)E, and see new structure in the light curve morphology.
The Edinburgh-Cape Blue Object Survey is a major survey to discover blue stellar objects brighter than B ∼ 18 in the southern sky. It covers an area of sky of 10,000 square degrees with |b| > 30° and δ < 0°. The blue stellar objects are selected by automatic techniques from U and B pairs of UK Schmidt Telescope plates scanned with the COSMOS measuring machine. Follow-up photometry and spectroscopy are being obtained with the SAAO telescopes to classify objects brighter than B = 16.5. This paper describes the survey, the techniques used to extract the blue stellar objects, the photometric accuracy, and the completeness of the survey.
The variability of CD-24 7599 (V=11.48 mag) was discovered by JCC during observing run XCOV7 of the Whole Earth Telescope (WET, Nather et al. 1990) network in February, 1992. The star was observed as an additional target and 117 hours of high-quality temporal spectroscopic observations were obtained.
Our analysis of these data revealed the presence of 7 independent pulsation modes between 27.0 and 38.1 cycles per day (313 – 441 μHz) with semiamplitudes of 2.1 – 10.2 milli-modulation amplitudes (mma). We showed that peaks at linear combination frequencies detected in the power spectra were not due to eigenmodes excited to visible amplitude by resonant mode coupling.
For asteroseismological reasons the discovery of new pulsating degenerate stars is important. Bradley (1993) lists the number of known pulsating white dwarfs at that time - 23 known DAV (ZZ Ceti) stars, 7 known DBV stars and 5 known DOV (PG1159) stars. Of these degenerate pulsators 80% (including all DBVs) are in the northern hemisphere. This illustrates the great incompleteness in the search for such objects in the southern hemisphere.
The Edinburgh-Cape Blue Object Survey is a potential source of candidate degenerate pulsators in the southern hemisphere (Stobie et al. 1992). The blue stellar objects are identified from COSMOS scans of U and B plates taken with the UK Schmidt Telescope. Follow-up photometry and spectroscopy are being obtained at the South African Astronomical Observatory (SAAO) to classify and determine the nature of each blue stellar object. Currently, over 190 DA white dwarfs have been identified, of which the majority are not in existing catalogues (O’Donoghue et al. 1993). From these white dwarfs, we have selected DA stars with B-V colours near or within the range 0.15 ≤ B-V ≤ 0.25 together with all the non-DA degenerate stars (DO, DB, etc.) to monitor for variability.