To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
The coronavirus disease 2019 pandemic requires urgent modification to existing head and neck cancer diagnosis and management practices. A protocol was established that utilises risk stratification, early investigation prior to clinical review and a reduction in aerosol generating procedures to lessen the risk of coronavirus disease 2019 spread.
Two-week wait referrals were stratified into low, intermediate and high risk. Low risk patients were referred back to primary care with advice; intermediate and high risk patients underwent investigation. Clinical encounters and aerosol generating procedures were minimised. A combined diagnostic and therapeutic surgical approach was undertaken where possible.
Forty-one patients were used to assess feasibility. Thirty-one per cent were low risk, 35 per cent were intermediate and 33 per cent were high risk. Thirty-three per cent were discharged with no imaging.
Implementing this protocol reduces the future burden on tertiary services, by empowering primary care physicians to re-refer low risk patients. The protocol is applicable across the UK and avoids diagnostic delay.
Cell-based meat, also called ‘clean’, lab, synthetic or in vitro meat, has attracted much media interest recently. Consumer demand for cellular meat production derives principally from concerns over environment and animal welfare, while secondary considerations include consumer and public health aspects of animal production, and food security. The present limitations to cellular meat production include the identification of immortal cell lines, availability of cost-effective, bovine-serum-free growth medium for cell proliferation and maturation, scaffold materials for cell growth, scaling up to an industrial level, regulatory and labelling issues and at what stage mixing of myo-, adipo- and even fibrocytes can potentially occur. Consumer perceptions that cell-based meat production will result in improvements to animal welfare and the environment have been challenged, with the outcome needing to wait until the processes used in cell-based meat are close to a commercial reality. Challenges for cell-based meat products include the simulation of nutritional attributes, texture, flavour and mouthfeel of animal-derived meat products. There is some question over whether consumers will accept the technology, but likely there will be acceptance of cell-based meat products, in particular market segments. Currently, the cost of growth media, industry scale-up of specific components of the cell culture process, intellectual property sharing issues and regulatory hurdles mean that it will likely require an extended period for cellular meat to be consistently available in high-end restaurants and even longer to be available for the mass market. The progress in plant-based meat analogues is already well achieved, with products such as the ImpossibleTM Burger and other products already available. These developments may make the development of cellular meat products obsolete. But the challenges remain of mimicking not only the nutritional attributes, flavour, shape and structure of real meat, but also the changes in regulation and labelling.
We describe the investigation of two temporally coincident illness clusters involving salmonella and Staphylococcus aureus in two states. Cases were defined as gastrointestinal illness following two meal events. Investigators interviewed ill persons. Stool, food and environmental samples underwent pathogen testing. Alabama: Eighty cases were identified. Median time from meal to illness was 5·8 h. Salmonella Heidelberg was identified from 27 of 28 stool specimens tested, and coagulase-positive S. aureus was isolated from three of 16 ill persons. Environmental investigation indicated that food handling deficiencies occurred. Colorado: Seven cases were identified. Median time from meal to illness was 4·5 h. Five persons were hospitalised, four of whom were admitted to the intensive care unit. Salmonella Heidelberg was identified in six of seven stool specimens and coagulase-positive S. aureus in three of six tested. No single food item was implicated in either outbreak. These two outbreaks were linked to infection with Salmonella Heidelberg, but additional factors, such as dual aetiology that included S. aureus or the dose of salmonella ingested may have contributed to the short incubation periods and high illness severity. The outbreaks underscore the importance of measures to prevent foodborne illness through appropriate washing, handling, preparation and storage of food.
Auditory implantation into the inner ear is increasingly performed for a variety of indications. Infective complications are rare, but when they occur they can have devastating consequences.
This paper reports two cases where vestibular sequestration of the bony labyrinth developed following implantation into the middle ear.
To the authors' knowledge, these are the first reported cases where vestibular sequestration has resulted from auditory implant surgery. This paper outlines the radiological changes characteristic of this pathology. It also describes the surgical and conservative treatment options for this condition, challenging the previously accepted belief that affected patients always require aggressive surgical intervention.
Immunoglobulin A (IgA) is a predominant immunoglobulin present in human breast milk and is known to play an important role in infant gut immunity maturation. Breast milk composition varies between populations, but the environmental and maternal factors responsible for these variations are still unclear. We examined the relationship between different exposures and levels of IgA in colostrum. The objective of this study was to examine whether exposures analysed influence levels of IgA in colostrum. The present study used 294 colostrum samples from the MecMilk International cohort, collected from women residing in London, Moscow and Verona. Samples were analysed in automated Abbott Architect Analyser. We found an inverse correlation between time postpartum and colostrum total IgA level (r=−0.49, P<0.001). Adjusting for maternal parity, smoking, fresh fruit and fish consumption and allergen sensitization, multiple regression model showed that IgA levels were influenced by colostrum collection time (P<0.0001) and country of collection (P<0.01). Mode of delivery influence did not appear to be significant in univariate comparisons, once adjusted for the above maternal characteristics it showed a significant influence on total IgA (P=0.01). We conclude that the concentration of IgA in colostrum drops rapidly after birth and future studies should always consider this factor in analysis. IgA concentration varied significantly between countries, with the highest level detected in Moscow and lowest in Verona. Mode of delivery effect should be confirmed on larger cohorts. Further work is needed to determine ways to correct for IgA decline over time in colostrum, and to find the cause of variations in IgA levels between the countries.
Grass silage is typically fed to dairy cows in temperate regions. However, in vivo information on methane (CH4) emission from grass silage of varying quality is limited. We evaluated the effect of two rates of nitrogen (N) fertilisation of grassland (low fertilisation (LF), 65 kg of N/ha; and high fertilisation (HF), 150 kg of N/ha) and of three stages of maturity of grass at cutting: early maturity (EM; 28 days of regrowth), mid maturity (MM; 41 days of regrowth) and late maturity (LM; 62 days of regrowth) on CH4 production by lactating dairy cows. In a randomised block design, 54 lactating Holstein–Friesian dairy cows (168±11 days in milk; mean±standard error of mean) received grass silage (mainly ryegrass) and compound feed at 80 : 20 on dry matter basis. Cows were adapted to the diet for 12 days and CH4 production was measured in climate respiration chambers for 5 days. Dry matter intake (DMI; 14.9±0.56 kg/day) decreased with increasing N fertilisation and grass maturity. Production of fat- and protein-corrected milk (FPCM; 24.0±1.57 kg/day) decreased with advancing grass maturity but was not affected by N fertilisation. Apparent total-tract feed digestibility decreased with advancing grass maturity but was unaffected by N fertilisation except for an increase and decrease in N and fat digestibility with increasing N fertilisation, respectively. Total CH4 production per cow (347±13.6 g/day) decreased with increasing N fertilisation by 4% and grass maturity by 6%. The smaller CH4 production with advancing grass maturity was offset by a smaller FPCM and lower feed digestibility. As a result, with advancing grass maturity CH4 emission intensity increased per units of FPCM (15.0±1.00 g CH4/kg) by 31% and digestible organic matter intake (33.1±0.78 g CH4/kg) by 15%. In addition, emission intensity increased per units of DMI (23.5±0.43 g CH4/kg) by 7% and gross energy intake (7.0±0.14% CH4) by 9%, implying an increased loss of dietary energy with advancing grass maturity. Rate of N fertilisation had no effect on CH4 emissions per units of FPCM, DMI and gross energy intake. These results suggest that despite a lower absolute daily CH4 production with a higher N fertilisation rate, CH4 emission intensity remains unchanged. A significant reduction of CH4 emission intensity can be achieved by feeding dairy cows silage of grass harvested at an earlier stage of maturity.
Infections cause morbidity and mortality in neonatal intensive care units (NICUs). The association between nursery design and nosocomial infections is unclear.
To determine whether rates of colonization by methicillin-resistant Staphylococcus aureus (MRSA), late-onset sepsis, and mortality are reduced in single-patient rooms.
Retrospective cohort study.
NICU in a tertiary referral center.
Our NICU is organized into single-patient and open-unit rooms. Clinical data sets including bed location and microbiology results were examined over 29 months. Differences in outcomes between bed configurations were determined by χ2 and Cox regression.
All NICU patients.
Among 1,823 patients representing 55,166 patient-days, single-patient and open-unit models had similar incidences of MRSA colonization and MRSA colonization-free survival times. Average daily census was associated with MRSA colonization rates only in single-patient rooms (hazard ratio, 1.31; P=.039), whereas hand hygiene compliance on room entry and exit was associated with lower colonization rates independent of bed configuration (hazard ratios, 0.834 and 0.719 per 1% higher compliance, respectively). Late-onset sepsis rates were similar in single-patient and open-unit models as were sepsis-free survival and the combined outcome of sepsis or death. After controlling for demographic, clinical, and unit-based variables, multivariate Cox regression demonstrated that bed configuration had no effect on MRSA colonization, late-onset sepsis, or mortality.
MRSA colonization rate was impacted by hand hygiene compliance, regardless of room configuration, whereas average daily census affected only infants in single-patient rooms. Single-patient rooms did not reduce the rates of MRSA colonization, late-onset sepsis, or death.
Infect Control Hosp Epidemiol 2015;36(10):1173–1182
In nature, biomolecules guide the formation of hierarchically-ordered, lightweight, inorganic-organic composites such as corals, shells, teeth and bones. M13 bacteriophage has been used to mimic bio-inspired material development due to its rigid, nanoscale rod-like morphology. Liquid-crystalline monolayers of genetically engineered phage have been used to template crystallization of thin layers of inorganic and metallic materials. We have created thin films composed of engineered M13 phage capable of binding inorganic components. We employed both a dip-cast and a drop-cast film fabrication method on both smooth and rough gold, silica and glass casting surfaces to create thin films and 3D structures of various degrees of hierarchical order. We have found the engineered M13 phage and the inorganic mineral significantly affected both film morphology and the mechanical properties of the film. Similarly, film fabrication parameters such as solution chemistry, temperature, and pulling speed affected film properties. Using a calcium phosphate biomineralized 4E phage, film thickness increased linearly with the number of layers/dips in the phage solution. The stiffness of these composites (Young's modulus) were >80 GPa for mineralized, multilayer films. These materials are an order of magnitude stiffer than the biological equivalent collagen. Stiffness, however, does not appear to increase in a multilayer film beyond a saturation point. Ultimately, we have developed a platform for phage-based bio-composites for developing high performance materials.
Satellite altimetric time series allow high-precision monitoring of ice-sheet mass balance. Understanding elevation changes in these regions is important because outlet glaciers along ice-sheet margins are critical in controlling flow of inland ice. Here we discuss a new airborne altimetry dataset collected as part of the ICECAP (International Collaborative Exploration of the Cryosphere by Airborne Profiling) project over East Antarctica. Using the ALAMO (Airborne Laser Altimeter with Mapping Optics) system of a scanning photon-counting lidar combined with a laser altimeter, we extend the 2003–09 surface elevation record of NASA’s ICESat satellite, by determining cross-track slope and thus independently correcting for ICESat’s cross-track pointing errors. In areas of high slope, cross-track errors result in measured elevation change that combines surface slope and the actual Δz/Δt signal. Slope corrections are particularly important in coastal ice streams, which often exhibit both rapidly changing elevations and high surface slopes. As a test case (assuming that surface slopes do not change significantly) we observe a lack of ice dynamic change at Cook Ice Shelf, while significant thinning occurred at Totten and Denman Glaciers during 2003–09.
Designing new materials with well-defined structures and desired functions is a challenge in materials science, especially with nanomaterials. Nature, however, solves design of these materials through a self-assembling, hierarchically ordered process. We have investigated the mechanisms by which the high- aspect ratio and unique surface chemistry of M13 bacteriophage can give rise to increasingly complex, hierarchically ordered, bundled phage structures with a wide range of material applications. A molecular dynamic simulation of the 3-D structure of a 20-nm section of wild type (WT) and mutant phage types were developed based on WT phage crystal structure and ab initio calculations. Simulations of these phage were then used to examine repulsive and attractive forces of the particles in solution. Examination of contact interactions between two WT phage indicated the phage were maximally attracted to each other in a head to tail orientation. A mutant phage (4E) with a higher negative surface charge relative to WT phage also preferentially ordered head to tail in solution. In contrast, a mutant phage (CLP8) with a net positive surface charge had minimal repulsion in a 90° orientation. Understanding the self-assembly process through molecular dynamic simulations and decomposition of fundamental forces driving inter- and intra-strand interactions has provided a qualitative assessment of mechanisms that lead to hierarchical phage bundle structures. Results from simulation agree with experimentally observed patterns from self-assembly. We anticipate using this system to further investigate development of hierarchical structures not only from biological molecules but also from synthetic materials.
Fractional passage rates form a fundamental element within modern feed evaluation systems for ruminants, but knowledge on feed-specific fractional passage is largely lacking. Commonly applied tracer techniques based on externally applied markers, such as chromium-mordanted neutral detergent fibre (Cr-NDF), have been criticised for behaving differently to feed particles. This study describes the use of the carbon stable isotope ratio (13C : 12C) as an internal digesta marker to quantify the fractional passage rate of concentrates through the digestive tract of dairy cows. In a crossover study, five dairy cows were fed low (24.6%) and high (52.6%) levels of concentrates (dry matter (DM) basis) and received a pulse-dosed Cr-NDF and 13C isotopes. The latter was administered orally by exchanging part of the dietary concentrates of low 13C natural abundance with a pulse dose of maize bran-based concentrates of high 13C natural abundance. Fractional passage rates from the rumen (K1) and from the large intestine (K2) were determined from faecal marker concentrations of Cr-NDF and of 13C in the DM (13C-DM), NDF (13C-NDF) and neutral detergent soluble (13C-NDS). No differences in K1 estimates were found for the two concentrate levels fed but significant differences between markers (P<0.001) were observed. Faecal Cr-NDF excretions gave lower K1 estimates (0.037–0.039/h) than 13C-DM (0.054–0.056/h) and 13C-NDF (0.061–0.063/h). The 13C-NDS was calculated by the difference of 13C in the DM and NDF, and K1 values (0.039–0.043/h) were comparable to Cr-NDF. Total mean retention time was considerably higher for Cr-NDF (40.9–42.0 h) as compared to 13C-DM and 13C-NDF (32.0–33.5 h; P<0.001). The accuracy of the curve fits for Cr-NDF and 13C-DM and 13C-NDF was overall good (mean prediction error of 9.9–13.9%). Fractional passage rate of Cr-NDF was comparable to studies where this marker was assumed to represent the fractional passage of roughages. However, K1 estimates based on the 13C : 12C ratio varied considerably from studies based on external markers. Our results suggest that the use of 13C isotopes as digesta passage markers can provide feed component-specific K1 estimates for concentrates and provides new insight into passage kinetics of NDF from technologically treated compound feed.
The current status of the DRIFT (Directional Recoil Identification From Tracks)
experiment at Boulby Mine is presented, including the latest limits on the WIMP
spin-dependent cross-section from 1.5 kg days of running with a mixture of CS2
and CF4. Planned upgrades to DRIFT IId are detailed, along with ongoing work
towards DRIFT III, which aims to be the world’s first 10 m3-scale directional
Dark Matter detector.
Background: Behavioral and psychological symptoms of dementia (BPSD) are common and are core symptoms of the condition. They cause considerable distress to the person with dementia and their carers and predict early institutionalization and death. Historically, these symptoms have been managed with anxiolytic and antipsychotic medication. Although potentially effective, such medication has been used too widely and is associated with serious adverse side-effects and increased mortality. Consequently, there is a need to evaluate non-pharmacological therapies for behavioral and psychological symptoms in this population. One such therapy is physical activity, which has widespread health benefits. The aim of this review is to summarize the current findings of the efficacy of physical activity on BPSD.
Method: Published articles were identified using electronic and manual searches. Rather than systematically aggregating data, this review adopted a rapid critical interpretive approach to synthesize the literature.
Results: Exercise appears to be beneficial in reducing some BPSD, especially depressed mood, agitation, and wandering, and may also improve night-time sleep. Evidence of the efficacy of exercise on improving other symptoms such as anxiety, apathy, and repetitive behaviors is currently weak or lacking.
Conclusion: The beneficial effect of exercise type, its duration, and frequency is unclear although some studies suggest that walking for at least 30 minutes, several times a week, may enhance outcome. The methodological shortcomings of current work in this area are substantial. The research and clinical implications of current findings are discussed.
Here we report rich and new resonant Raman spectral features for several sub-nanometer diameter single wall carbon nanotubes (sub-nm SWNTs) samples grown using chemical vapor deposition technique operating at different temperatures. We find that the high curvature in sub-nm SWNTs leads to (i) an unusual S-like dispersion of the G‑band frequency due to perturbations caused by the strong electron-phonon coupling, and (ii) an activation of diameter-selective intermediate frequency modes that are as intense as the radial breathing modes (RBMs). Furthermore, an analytical approach which includes the effects of curvature into the overlap integral and the energy gap between the van Hove singularities is discussed. Lastly, we show that the phonon spectra for sub-nm SWNTs obtained from the molecular dynamic simulations which employs a curvature-dependent force field concur with our experimental observations.
Direct deposition of graphene from carbon sources on foreign substrates without the use of metal catalysts is shown to be an effective process with several advantages over other growth techniques. Carbon source molecular beam epitaxy (CMBE) in particular provides an additional control parameter in carbon flux and enables growth on substrates other than SiC, including oxidized Si and sapphire. CMBE using thermally evaporated C60 and a heated graphite filament on SiC is reported here. The graphene films were characterized by Raman spectroscopy, X-ray photoelectron spectroscopy, atomic force microscopy and Hall effect. Graphene films on Si-face SiC grown using the C60 source have Bernal-like stacking and n-type conduction while those grown using the graphite filament have turbostratic stacking and p-type conduction. The sheet concentration for both n- and p-type doping is linearly dependent on film thickness.
In this work we present preliminary results from molecular dynamics simulations for carbon nanotubes serpentine dynamics formation. These S-like nanostructures consist of a series of parallel and straight nanotube segments connected by alternating U-turn shaped curves. Nanotube serpentines were experimentally synthesized and reported in recent years, but up to now no atomistic simulations have been carried out to address the dynamics of formation of these structures. We have carried out fully atomistic molecular dynamics simulations in the framework of classical mechanics with a standard molecular force field. Multi-million atoms structures formed by stepped substrates with a carbon nanotube (about 1 micron in length) placed on top of them have been considered in our simulations. A force is applied to the upper part of the tube during a short period of time and then turned off and the system set free to evolve in time. Our results showed that these conditions are sufficient to form robust serpentines and validate the general features of the ‘falling spaghetti mechanism’ previously proposed to explain their formation.
High resolution far infrared absorption measurements were carried out for single walled and double walled carbon nanotubes samples (SWCNT and DWCNT) encased in a polyethylene matrix to investigate the temperature and bundling effects on the low frequency phonons associated with the low frequency circumferential vibrations. At a temperature where kBT is significantly lower than the phonon energy, the broad absorption features as observed at room temperature become well resolved phonon transitions. For a DWCNT sample whose inner tubes have a similar diameter distribution as the SWCNT sample studied, a series of sharp features were observed at room temperature at similar positions as for the SWCNT samples studied. The narrow linewidth is attributed to the fact that the inner tubes are isolated from the polyethylene matrix and the weak inter-tubule interactions. More systematic studies will be required to better understand the effects of inhomogeneous broadening and thermal-excitation on the detailed position and lineshape of the low frequency phonon features in carbon nanotubes.