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The benefit of mandibular advancement devices in patients with sleep-disordered breathing and as a potential option for obstructive sleep apnoea syndrome is well recognised. Their use in the setting of epilepsy or other seizure disorders is typically contraindicated.
A 48-year-old patient with a history of poorly controlled epilepsy and obstructive sleep apnoea syndrome was referred for ENT review for possible tracheostomy. The patient was wheelchair-bound with 24-hour continuous positive airway pressure, but sleep studies demonstrated persistent, severe episodes of apnoea and notable sleep disturbance. Sleep nasendoscopy demonstrated marked improvement on capnography with the laryngeal mask airway in situ, and this was maintained with mandibular advancement using jaw thrust following removal of the laryngeal mask airway. A mandibular advancement device was subsequently trialled; this had no subjective benefit for the patient, but the seizures resolved and control of apnoea was achieved with the combination of a mandibular advancement device and continuous positive airway pressure.
This paper highlights a novel application of mandibular advancement devices, used in combination with continuous positive airway pressure, which resulted in complete resolution of sleep deprivation and apnoea-induced epileptic events.
Psychiatric in-patients are often transferred to an emergency department for care of minor wounds, incurring significant distress to the patient and cost to the service.
To improve superficial wound management in psychiatric in-patients and reduce transfers to the emergency department.
Thirty-four trainees attended two peer-led suturing and wound management teaching sessions, and a suturing kit box was compiled and stored at the Royal Edinburgh Hospital. Teaching was evaluated using Kirkpatrick's model, and patient transfer numbers were acquired by reviewing in-patient Datix reports and emergency department case notes for 6 months before and after teaching.
The proportion of patients transferred to the emergency department decreased significantly from 90% 6 months before the workshop to 30% 6 months after (P < 0.05). Trainees engaged positively and there was a significant increase in self-confidence rating following the workshop (P < 0.05). The estimated cost saving per transfer was £183.76.
The combination of a peer-led workshop and on-site suturing kit box was effective in reducing transfers to the emergency department and provided a substantial cost saving.
Disordered eating (DE) is a widespread, serious problem. Efficacious prevention programs that can be delivered at-scale are needed.
A pragmatic randomized controlled trial of two online programs was conducted. Participants were young-adult women from Australia and New Zealand seeking to improve their body image. Media Smart-Targeted (MS-T) and Student Bodies (SB) were both 9-module interventions released weekly, whilst control participants received positive body image information. Primary [Eating Disorder Examination–Questionnaire (EDE-Q) Global], secondary (DE risk factors) and tertiary (DE) outcome measures were completed at baseline, post-program, 6- and 12-month follow-up.
Baseline was completed by 608 women (M age = 20.71 years); 33 were excluded leaving 575 randomized to: MS-T (N = 191); SB (N = 190) or control (N = 194). Only 66% of those randomized to MS-T or SB accessed the intervention and were included in analyses with controls; 78% of this sample completed measures subsequent to baseline. Primary intent-to-treat (ITT) analyses revealed no differences between groups, while measure completer analyses found MS-T had significantly lower EDE-Q Global than controls at 12-month follow-up. Secondary ITT analyses found MS-T participants reported significantly higher quality of life–mental relative to both SB and controls (6-month follow-up), while MS-T and controls had lower clinical impairment relative to SB (post-program). Amongst measure completers, MS-T scored significantly lower than controls and SB on 5 variables. Of those with baseline DE, MS-T participants were significantly less likely than controls to have DE at 12-month follow-up.
Given both programs were not therapist-moderated, MS-T has potential to achieve reductions in DE risk at low implementation costs.
We examine time series of the transition region spectral line O v 629 Å, observed with the Coronal Diagnostic Spectrometer (CDS) onboard the SoHO spacecraft. Primarily we were looking for intensity and velocity oscillations in polar plumes, however by chance we detected a giant macro-spicule at the limb and were able to follow its dynamical structure. We have reported the dynamics of the giant macro-spicule in Banerjee et al. (2000a) and have also reported the existence of long period oscillations in the polar plumes as observed in the O v 629 Å line in Banerjee et al. (2000a,b). In this short contribution we revisit one of these dataset, namely s16834r01 to test the reliability of the observed periods. The statistical significance of the oscillations is estimated by using a randomisation method. Our analysis re-confirms the presence of compressional waves with periods of 20-25 minutes.
The algal polysaccharides laminarin (LAM) and fucoidan (FUC) have potent anti-inflammatory activities in the gastrointestinal tract. Our objective was to examine the impact of prior consumption of LAM and/or FUC on pathology and inflammation following a dextran sodium sulfate (DSS) challenge in pigs. Pigs (n 7/group) were assigned to one of five experimental groups for 56 d. From 49–55 d, distilled water or DSS was administered intragastrically. The experimental groups were: (1) basal diet + distilled water (control); (2) basal diet + DSS (DSS); (3) basal diet + FUC + DSS (FUC + DSS); (4) basal diet + LAM + DSS (LAM + DSS); and (5) basal diet + LAM + FUC + DSS (LAMFUC + DSS). The DSS group had decreased body-weight gain (P < 0·05) and serum xylose (P < 0·05), and increased proximal colon pathology score (P < 0·05), diarrhoeal score (P < 0·001) and colonic Enterobacteriaceae (P < 0·05) relative to the control group. The FUC + DSS (P < 0·01), LAM + DSS (P < 0·05) and LAMFUC + DSS (P < 0·05) groups had improved diarrhoeal score, and the LAMFUC + DSS (P < 0·05) group had improved body weight relative to the DSS group. The FUC + DSS group (P < 0·001), LAM + DSS group (P < 0·05) and LAMFUC + DSS group (P < 0·001) had lower IL-6 mRNA abundance relative to the DSS group. The LAM + DSS group had reduced Enterobacteriaceae in proximal colon digesta relative to the DSS group (P < 0·05). In conclusion, FUC or a combination of FUC and LAM improved body-weight loss, diarrhoeal scores and clinical variables associated with a DSS challenge in pigs, in tandem with a reduction in colonic IL-6 mRNA abundance.
The experiment investigated the effect of maternal dietary supplementation of seaweed-derived polysaccharides (SDP) (–SDP v. +SDP, n 20) from day 83 of gestation until weaning (day 28) on selected sow faeces and piglet digesta microbiota populations, piglet small-intestinal morphology, and intestinal nutrient transporter and inflammatory cytokine gene expression at birth, 48 h after birth and weaning. The effect of maternal dietary treatment on the piglet gene expression profile of inflammatory cytokines in the colon following a lipopolysaccharide (LPS) challenge was also investigated. Dietary SDP reduced sow faecal Enterobacteriaceae gene numbers at parturition. Small-intestinal morphology, nutrient transporter and cytokine gene expression in newborn piglets did not differ between maternal dietary treatments (P > 0·10). At 48 h after birth, sodium–glucose-linked transporter 1 gene expression was down-regulated in the ileum of piglets suckling the SDP-supplemented sows compared with those suckling the basal sows (P = 0·050). There was a SDP × LPS challenge interaction on IL-1 and IL-6 gene expression in the colon of piglets (P < 0·05). The gene expression of IL-1 and IL-6 was down-regulated in the LPS-challenged colon of piglets suckling the SDP sows compared with those suckling the basal sows (P < 0·05). However, there was no difference in IL-1 and IL-6 gene expression in the unchallenged colon between treatment groups. At weaning, piglets suckling the SDP-supplemented sows had increased villus height in the jejunum and ileum compared with those suckling the basal-fed sows (P < 0·05). In conclusion, maternal dietary SDP supplementation enhanced the immune response of suckling piglets and improved gut morphology, making them more immune competent to deal with post-weaning adversities.
In the present study, a 2 × 2 factorial arrangement was conducted to investigate the effect of maternal supplementation with seaweed extracts ( − SWE v. +SWE, n 20) from day 83 of gestation until weaning (day 28) on post-weaning (PW) growth performance, faecal score, faecal enterotoxigenic Escherichia coli (ETEC) toxin quantification, intestinal histology and cytokine mRNA of unchallenged and ETEC-challenged pigs. Pigs were ETEC challenged on day 9 PW. There was a maternal treatment × challenge (SWE × ETEC) interaction effect on growth performance and faecal score (P< 0·05). Pigs from SWE-supplemented sows and ETEC-challenged (SE) had higher average daily gain (ADG) during 0–13 d PW and reduced faecal score during 0–72 h post-challenge than those from basal-fed sows and ETEC-challenged (BE) (P< 0·05). However, there was no difference between unchallenged pigs from the SWE-supplemented sows (SC) and basal-fed sows (BC) (P>0·10). Pigs from the SWE-supplemented sows had reduced heat-labile enterotoxin gene copy numbers than those from the basal-fed sows (P< 0·05). Maternal SWE supplementation increased the villus height in the ileum of pigs (P< 0·05). There was a SWE × ETEC interaction effect (P< 0·05) on IL-6 mRNA and a SWE × gastrointestinal (GI) region interaction effect (P< 0·05) on transforming growth factor-β1 (TGF-β1) and TNF-α mRNA. IL-6 mRNA was down-regulated in SC pigs than BC pigs (P< 0·05). However, there was no difference in IL-6 mRNA between SE and BE pigs. The mRNA of TGF-β1 and TNF-α was down-regulated in the colon of pigs from the SWE-supplemented sows compared with those from the basal-fed sows (P< 0·05). However, there was no difference in TGF-β1 and TNF-α mRNA in the ileum between the pigs from the SWE-supplemented sows and basal-fed sows. In conclusion, maternal SWE supplementation improves ADG and the aspects of GI health of weaned pigs following an ETEC challenge.
In the present study, two experiments were conducted to (1) evaluate the effect of laminarin and/or fucoidan on ileal morphology, nutrient transporter gene expression and coefficient of total tract apparent digestibility (CTTAD) of nutrients and (2) determine whether laminarin inclusion could be used as an alternative to ZnO supplementation in weaned pig diets. Expt 1 was designed as a 2 × 2 factorial arrangement, comprising four dietary treatments (n 7 replicates, weaning age 24 d, live weight 6·9 kg). The dietary treatments were as follows: (1) basal diet; (2) basal diet+300 ppm laminarin; (3) basal diet+240 ppm fucoidan; (4) basal diet+300 ppm laminarin and 240 ppm fucoidan. There was an interaction between laminarin and fucoidan on the CTTAD of gross energy (GE) (P< 0·05) and the expression of sodium–glucose-linked transporter 1 (SGLT1/SLC5A1) and GLUT1/SLC2A1 and GLUT2/SLC2A2 (P< 0·05) in the ileum. The laminarin diet increased the CTTAD of GE and increased the expression of SGLT1, GLUT1 and GLUT2 compared with the basal diet. However, there was no effect of laminarin supplementation on these variables when combined with fucoidan. Expt 2 was designed as a complete randomised design (n 8 replicates/treatment, weaning age 24 d, live weight 7·0 kg), and the treatments were (1) basal diet, (2) basal diet and laminarin (300 ppm), and (3) basal diet and ZnO (3100 ppm, 0–14 d, and 2600 ppm, 15–32 d post-weaning). The laminarin diet increased average daily gain and gain:feed ratio compared with the basal diet during days 0–32 post-weaning (P< 0·01) and had an effect similar to the ZnO diet. These results demonstrate that laminarin provides a dietary means to improve gut health and growth performance post-weaning.
A 2 × 2 factorial experiment was conducted to investigate the interactions between laminarin (LAM; 0 and 300 parts per million (ppm)) and fucoidan (FUC; 0 and 240 ppm) levels on intestinal morphology, selected microbiota and inflammatory cytokine gene expression in the weaned pig. There was an interaction between LAM and FUC supplementation on the Enterobacteriaceae population (P< 0·05) and the abundance of attaching and effacing Escherichia coli (AEEC) strains (P< 0·05) in the colon. Pigs offered the FUC diet had a reduced Enterobacteriaceae population compared with pigs offered the basal diet. However, the effect of FUC on the Enterobacteriaceae population was not observed when combined with LAM. Pigs offered the LAM diet had reduced abundance of AEEC strains compared with pigs offered the basal diet. However, there was no effect of LAM on the abundance of AEEC strains when combined with FUC. There was an interaction between LAM and FUC supplementation on villous height (P< 0·01) and the villous height:crypt depth ratio (P< 0·01) in the duodenum. Pigs offered the LAM or FUC diet had an increased villous height and villous height:crypt depth ratio compared with pigs offered the basal diet. However, there was no effect of the LAM and FUC combination diet on intestinal morphology. Pigs offered the LAM-supplemented diets had a lower IL-6 (P< 0·05), IL-17A (P< 0·01) and IL-1β (P< 0·01) mRNA expression in the colon compared with pigs offered the diets without LAM. In conclusion, supplementation with either LAM or FUC alone modified intestinal morphology and selected intestinal microbiota, but these effects were lost when offered in combination.
Ballistic-electron-emission microscopy (BEEM) has been used to study band-offsets in n-and p-type GaInP/GaAs heterostructures. We determine room temperature offsets of 30 meV and 350 meV in the conduction and valence bands, respectively, for thin GaInP layers grown by metal-organic chemical vapor deposition (MOCVD) at 610°C. Low temperature (77 K) measurements also indicate at least 90% of the band discontinuity lies in the valence band for these ordered GaInP samples.
Two experiments, a performance experiment and a mineral balance study, were conducted on grower–finisher pigs (42 to 101 kg live weight) to investigate the effects of Peniophora lycii phytase enzyme and 25-hydroxyvitamin D3 (25-OHD3) on growth performance, carcass characteristics, nutrient retention and excretion, and bone and blood parameters. The two experiments were designed as a 2 × 2 factorial (two levels of phytase and two levels of 25-OHD3). The four diets were T1, low-phosphorous diet; T2, T1 + phytase; T3, T1 + 25-OHD3 and T4, T1 + phytase + 25-OHD3 diet. In all, 25 μg of 25-OHD3 was used to replace 1000 IU of vitamin D3 in diets T3 and T4. Diets were pelleted (70°C) and formulated to contain similar concentrations of energy (13.8 MJ DE/kg), lysine (9.5 g/kg) and digestible phosphorus (P; 1.8 g/kg). Neither the inclusion of phytase nor 25-OHD3 in the diet had any effect on pig performance. There was an interaction between phytase and 25-OHD3 on calcium (Ca) and P retention (P < 0.01) and on the apparent digestibility of ash (P < 0.01), P (P < 0.001) and Ca (P < 0.001). Pigs offered phytase diets only, had a higher retention of Ca and P and digestibility of ash (P < 0.01), P (P < 0.001) and Ca (P < 0.01) compared with pigs offered unsupplemented diets. However, when the combination of phytase and 25-OHD3 were offered, no effects were detected compared with 25-OHD3 diets only. Pigs fed phytase diets had higher bone ash (P < 0.01), bone P (P < 0.01) and bone Ca (P < 0.05) concentrations compared with pigs offered non-phytase diets. In conclusion, pigs offered phytase diets had a significantly increased bone ash, Ca and P than pigs offered unsupplemented phytase diets. However, there was no advantage to offering a combination of phytase and 25-OHD3 on either bone strength or mineral status compared to offering these feed additives separately.
An outbreak of measles occurred in a community school and the surrounding area in Crowborough, East Sussex, UK, from December 1992 to February 1993. There were 96 suspected cases reported: 66 cases among 1673 students at one school and 30 community cases. The majority of suspected cases were in those aged 11–17 (78%), 2 cases occurred in infants < 1 year old and 8 cases in adults aged 18 years or over. Data collected on 60 (91 %) of the 66 suspect school cases showed 56 (93%) had an illness which met a case definition of measles. Eighteen had confirmatory IgM measles antibody. Two cases were hospitalized. The local percentage uptake for measles immunization for the school age years affected varied between 64 % and 84 %. A survey of parents showed that approximately 74% of the students attending the school had a history of measles immunization. The immunization rates reported by parents for children who developed measles was 21 %. (29 % based on GP records) compared with 77 % for those who remained well. Vaccine efficacy was estimated to be 92%. This outbreak, along with others recently reported in older unimmunized children in the UK, reinforces the need for catch-up immunization programmes to reach this susceptible group of adolescents.
It is generally accepted that the very first stars in the universe were significantly more massive and formed much more in isolation than stars observed today. This suggests that there was a transition in star formation modes that was most likely related to the metallicity of the star-forming environment. We study how the addition of heavy elements alters the dynamics of collapsing gas by performing a series of numerical simulations of primordial star formation with various levels of pre-enrichment, using the adaptive mesh refinement, hydrodynamic + N-body code, Enzo. At high redshifts, the process of star formation is heavily influenced by the cosmic microwave background (CMB), which creates a temperature floor for the gas. Our results show that cloud-collapse can follow three distinct paths, depending on the metallicity. For very low metallicities (log10(Z/Z⊙) < −3.5), star formation proceeds in the primordial mode, producing only massive, singular objects. For high metallicities (log10(Z/Z⊙) > −3), efficient cooling from the metals cools the gas to the CMB temperature when the core density is still very low. When the gas temperature reaches the CMB temperature, the core becomes very thermally stable, and further fragmentation is heavily suppressed. In our simulations with log10(Z/Z⊙) > −3, only a single object forms with a mass-scale of a few hundred M⊙. We refer to this as the CMB-regulated star formation mode. For metallicities between these two limits (−3.5 < log10(Z/Z⊙) < −3), the gas cools efficiently, but never reaches the CMB temperature. In this mode, termed the metallicity-regulated star formation mode, the minimum gas temperature is reached at much higher densities, allowing the core to fragment and form multiple objects with mass-scales of only a few M⊙. Our results imply that the stellar initial mass function was top-heavy at very high redshift due to stars forming in the CMB-regulated mode. As the CMB temperature lowers with time, the metallicity-regulated star formation mode (producing multiple low-mass stars) operates at higher metallicities and eventually becomes the sole mode of star formation.
We present results on the realization of a multicolour
microspherical glass light source fabricated from the erbium doped fluoride
glass ZBLALiP. Whispering gallery mode lasing and upconversion processes
give rise to laser and fluorescent emissions at multiple wavelengths from
the ultraviolet to the infrared. Thirteen discrete emissions ranging from
320 to 849 nm have been observed in the upconversion spectrum. A Judd-Ofelt
analysis was performed to calculate the radiative properties of
Er3+:ZBLALiP microspheres, including the radiative transition
probabilities, the electric dipole strengths, the branching ratios and the
radiative lifetimes of the transitions involved. We have also identified the
primary processes responsible for the generation of the observed wavelengths
and have shown that this material has an improved range of emissions over
other erbium doped fluoride glasses.