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Shiga toxin-producing Escherichia coli (STEC) infection can cause serious illness including haemolytic uraemic syndrome. The role of socio-economic status (SES) in differential clinical presentation and exposure to potential risk factors amongst STEC cases has not previously been reported in England. We conducted an observational study using a dataset of all STEC cases identified in England, 2010–2015. Odds ratios for clinical characteristics of cases and foodborne, waterborne and environmental risk factors were estimated using logistic regression, stratified by SES, adjusting for baseline demographic factors. Incidence was higher in the highest SES group compared to the lowest (RR 1.54, 95% CI 1.19–2.00). Odds of Accident and Emergency attendance (OR 1.35, 95% CI 1.10–1.75) and hospitalisation (OR 1.71, 95% CI 1.36–2.15) because of illness were higher in the most disadvantaged compared to the least, suggesting potential lower ascertainment of milder cases or delayed care-seeking behaviour in disadvantaged groups. Advantaged individuals were significantly more likely to report salad/fruit/vegetable/herb consumption (OR 1.59, 95% CI 1.16–2.17), non-UK or UK travel (OR 1.76, 95% CI 1.40–2.27; OR 1.85, 95% CI 1.35–2.56) and environmental exposures (walking in a paddock, OR 1.82, 95% CI 1.22–2.70; soil contact, OR 1.52, 95% CI 2.13–1.09) suggesting other unmeasured risks, such as person-to-person transmission, could be more important in the most disadvantaged group.
The maintenance of biodiversity in tropical forests is thought to be dependent on fine-scale mechanisms of niche partitioning that allow species to coexist. This study examined whether three species of short-tailed fruit bat that co-occur at a lowland tropical forest site in Costa Rica (Carollia castanea, C. perspicillata, C. sowelli) avoid inter- and intraspecific competition through dietary specialization on species in the genus Piper. First, dietary composition was examined using faecal samples (N = 210), which yielded three main findings: (1) bat species and sexes vary in overall reliance on fruits of Piper, with a higher percentage of seeds of Piper detected in the diets of C. castanea (98.2%) and females (91.5%); (2) adults and juveniles partition species of Piper by habitat, with a lower percentage of mid- to late-successional species of Piper detected in adults (20.8%); and (3) overall, there is a strong dietary overlap among and within the three species of Carollia. Second, controlled choice experiments were conducted with individual bats (N = 123) to examine preferences for different species of Piper. These results indicated few differences in Piper preference based on bat species, sex, age class or reproductive status, suggesting preference is not the primary mechanism shaping the observed differences in dietary composition. Overall, the dietary composition and preference similarities suggest there is strong competition both among and within the three species of Carollia for food resources.
The paper outlines a system for processing the data of a life office to make efficient use of men and of machines available at the present time. The conditions to be met by an electronic computer and the persons responsible for its operation (systems analysts, programmers and operators) are first considered. The mechanical and manual aspects of the system are then dealt with in turn. After an outline of the problems involved in the institution of the system, the financial and other benefits to be expected are estimated in the light of the experience so far gained. Finally, a brief look is taken at the way in which developments may proceed in the future.
R. Ll. Gwilt in his paper “Mortality in the Past Hundred Years” (T.F.A. vol. 24, p. 40) reviewed the trend of mortality in six countries over the period 1850 to 1950. In their paper to the XVIth International Congress of Actuaries (Vol. II, p. 379) J. L. Anderson and the writer reviewed the trend in 17 countries over the period 1937 to 1956. Both these papers indicated some of the factors which cause variations in mortality rates, but it is felt that a study of the mortality variations over a short period in one country might yield further information.
Ageing is associated with weight loss and subsequently poor health outcomes. The present study assessed agreement between two field methods, bioelectrical impedance spectroscopy (BIS) and corrected arm muscle area (CAMA) for assessment of body composition against dual-energy X-ray absorptiometry (DXA), the reference technique. Agreement between two predictive equations estimating skeletal muscle mass (SMM) from BIS against SMM from DXA was also determined. Assessments occurred at baseline < 14 d post-surgery (n 79), and at 6 months (6M; n 75) and 12 months (12M; n 63) in community-living older adults after surgical treatment for hip fracture. The 95 % limits of agreement (LOA) between BIS and DXA, CAMA and DXA and the equations and DXA were assessed using Bland–Altman analyses. Mean bias and LOA for fat-free mass (FFM) between BIS and DXA were: baseline, 0·7 ( − 10·9, 12·4) kg; 6M, − 0·5 ( − 20·7, 19·8) kg; 12M, 0·1 ( − 8·7, 8·9) kg and for SMM between CAMA and DXA were: baseline, 0·3 ( − 11·7, 12·3) kg; 6M, 1·3 ( − 4·5, 7·1) kg; 12M, 0·9 ( − 5·4, 7·2) kg. Equivalent data for predictive equations against DXA were: equation 1: baseline, 15·1 ( − 9·5, 20·6) kg; 6M, 17·1 ( − 12·0, 22·2) kg; 12M, 17·5 ( − 13·0, 22·0) kg; equation 2: baseline, 12·6 ( − 7·3, 19·9) kg; 6M, 14·4 ( − 9·7, 19·1) kg; 12M, 14·8 ( − 10·7, 18·9) kg. Proportional bias (BIS: β = − 0·337, P< 0·001; CAMA: β = − 0·294, P< 0·001) was present at baseline but not at 6M or 12M. Clinicians should be cautious in using these field methods to predict FFM and SMM, particularly in the acute care setting. New predictive equations would be beneficial.
Background: Paranoid delusions are a common and difficult-to-manage feature of Alzheimer's disease (AD). We investigated the neuroanatomical correlates of paranoid delusions in a cohort of AD patients, using magnetic resonance imaging (MRI) to measure regional volume and regional cortical thickness.
Methods: 113 participants with probable AD were assessed for severity of disease, cognitive and functional impairment. Presence and type of delusions were assessed using the Neuropsychiatric Inventory (NPI). Structural MRI images were acquired on a 1.5T scanner, and were analyzed using an automated analysis pipeline.
Results: Paranoid delusions were experienced by 23 (20.4%) of the participants. Female participants with paranoid delusions showed reduced cortical thickness in left medial orbitofrontal and left superior temporal regions, independently of cognitive decline. Male participants with delusions did not show any significant differences compared to males without delusions. An exploratory whole brain analysis of non-hypothesized regions showed reduced cortical thickness in the left insula for female participants only.
Conclusion: Frontotemporal atrophy is associated with paranoid delusions in females with AD. Evidence of sex differences in the neuroanatomical correlates of delusions as well as differences in regional involvement in different types of delusions may be informative in guiding management and treatment of delusions in AD.
We present a study of the effects of the active cavity layer thickness variation on the operating characteristics of normally-on low-voltage high performance asymmetric Fabry-Perot modulators. For a modulator consisting of 25.5 periods of a multiple-quantum-well active region (100Å GaAs / 45Å (GaAs/AlAs) short period superlattices) with 5 pairs and 20.5 pairs of top and bottom quarter-wave stacks respectively, assuming only layer thickness variation in the active cavity caused by Ga flux nonuniformity, the shift of the Fabry-Perot mode wavelength is ∼5.8 times that of the QW heavy-hole exciton. This affects the relative distance between the wavelengths of the quantum well exciton and the Fabry-Perot resonance, and hence the performance of the modulators. Also, the tolerable percentage change of the Fabry-perot mode wavelength should be less than 0.13% in order that such modulator arrays have at least 10:1 contrast ratios at a fixed optimum operating wavelength. This defines the epitaxial growth tolerance for obtaining the uniformity of the operating wavelength of an array and the precision with which we can obtain a desired wavelength, its reproducibility, and its uniformity across a wafer.
The epidemiology and clinical features of invasive group A streptococcal (iGAS) disease in Queensland children was investigated in response to anecdotal evidence of an increase in frequency and severity of this condition. A retrospective review of clinical records of all cases of iGAS disease notified to Queensland Health aged 0–18 years during a 5-year period was conducted. The annualized incidence of iGAS was 3·5/100 000 for the total population aged 0–18 and 13·2/100 000 for the Indigenous population of similar age. The annualized incidence was highest in Indigenous infants but no increase in frequency or severity of iGAS infections was observed. Findings included an increased prevalence in Indigenous children particularly in those aged <1 year, a significant male preponderance, lack of seasonal variation and an association with blunt trauma. Further studies are required to confirm and investigate these findings and to define specific risk factors in high-risk groups.
Jugular foramen schwannomas are rare skull base tumours which typically have a variable clinical presentation. Glossopharyngeal syncope syndrome is an unusual clinical presentation; in the following case report, it was the sole presentation of an extracranial jugular foramen tumour.
The presentation of a patient with glossopharyngeal neuralgia syncope syndrome is reviewed and the pathophysiology, clinical features and treatment discussed.
A 45-year-old woman presented with unilateral throat pain, bradycardia and hypotension leading to episodes of impaired consciousness when lying on her left side or turning her head to the left. Imaging detected a left-sided extracranial jugular foramen schwannoma. The tumour was excised, and the patient had no more syncopal attacks.
Glossopharyngeal neuralgia syncope syndrome can be the sole presentation of a jugular foramen schwannoma. Although this syndrome may be treated with anti-dysrhythmic drugs, cardiac pacing or nerve section, in the presented patient excision of the jugular foramen schwannoma was successful in preventing further episodes of syncope.
The soil fumigants methyl bromide, chioropicrin and Basamid or mixtures of Basamid and chloropicrin proved to be of no use in killing T. trichiura ova in soil. However, on untreated plots the eggs died at a rate such that only 20 % of the ova remained viable after 18 months.
To evaluate, in terms of function and mobility, the predictive value of commonly adopted anthropometric ‘definitions’ used in the nutritional assessment of older adults, in a cohort of older Australians.
Prospective cohort study – Australian Longitudinal Study of Ageing (ALSA).
Adelaide, South Australia (1992–1994).
Data were analysed from 1272 non-institutionalised (685 males, 587 females) older adults ≥70 years old in South Australia. Seven ‘definitions’ commonly used in the anthropometric assessment of both under- and overnutrition (including four using body mass index (BMI), waist-to-hip ratio, waist circumference and percentage weight change) were evaluated at baseline, for their ability to predict functional and mobility limitation assessed (by self-report questionnaire) at two years follow-up. All questionnaires were administered and anthropometry performed by trained investigators. The associations between the definitions and decline in mobility and physical function were evaluated over two years using multiple logistic regression.
A BMI >85th percentile or >30 kgm−2 or a waist circumference of >102 cm in males and >88 cm in females increased risk of functional and mobility limitations. Over two years, a loss of 10% body weight significantly increased the risk of functional and mobility limitations.
Maintaining weight within older adults, irrespective of initial body weight, may be important in preventing functional and mobility limitations. Excessive weight is associated with an increased risk of limitation in function and mobility, both key components of health-related quality of life.
We report the cloning and sequencing of a DNA fragment encoding a putative C2H2 zinc finger protein from Aspergillus nidulans. The gene was isolated by complementation cloning of a salt sensitive phenotype of the A. nidulans sltA1 mutant. A 3·8 kb PstI fragment that restored wild type salt tolerance contained one large open reading frame of 2202 bp. The predicted protein (StzA) from this reading frame comprises 698 amino acids and has three Zinc fingers along with a putative transcriptional activation domain rich in acidic amino acids. The corresponding sequence from a sltA1 mutant contains a premature STOP codon resulting in loss of the putative transcriptional activator in the C-terminal region. The Zinc fingers show conserved motifs with a number of transcription factors including CreA from A. nidulans and the human Wilm's tumour susceptibility protein WT-1.
A longitudinal investigation on natural populations of Ascaris in humans and pigs and an investigation of soil contamination with Ascaris eggs were carried out from June 1993 to June 1994 in 2 villages, Manhu area, Xinjian County, Jiangxi Province, China. Results from these studies indicate that although human ascariasis is endemic there is significant fluctuation in both prevalence and the mean number of eggs/g faeces (epg) of the communities. Fluctuation of age-stratified prevalence and mean epg was detected in children but not in most adult groups. Most cases of human ascariasis were judged to involve low intensities of infection and a typical overdispersion distribution pattern was observed through the year. It was estimated that during the year, nearly half of the eggs discharged in the environment came from infections in children aged between 2 and 15 years which accounted for about 30% of the total population. Soil in and around houses and in vegetable gardens was found to be contaminated by Ascaris eggs and this situation remained relatively stable throughout the year. Monthly developmental rate of Ascaris eggs in soil was detected and the results suggest that the fluctuation in prevalence observed during the year should be directly attributed to the effect of seasonality of egg development. Features of Ascaris infection in pigs were found to be similar to those in humans except for a lower mean intensity of infection. The possibility of cross-infection of Ascaris between human and pig hosts is discussed.
A study to compare the effects of different frequencies of targeted chemotherapy with levamisole (Ketrax: JAGAL Pharma, Lagos, Zeneca Pharmaceuticals UK) as an action for the control of Ascaris lumbricoides was carried out in 3 communities in rural Oyo State, Nigeria. The targeted group comprised children, aged 5 to 15 years, attending primary school within their village. Treatment was provided within the school with the assistance of the school teachers. Three frequencies of targeted treatment were offered. In one village targeted treatment was provided on 1 occasion in 1 year, in another village at two 6-monthly intervals and in the third village every 4 months. Prevalence and intensity (e.p.g.) of A. lumbricoides infection were determined immediately before and after the period of intervention using a modified Kato–Katz technique. In the villages which received treatment once and at 6-monthly intervals, a reduction in post-treatment intensity of A. lumbricoides was observed in the total population but this failed to attain statistical significance. In contrast, within the village which received 4-monthly targeted chemotherapy, a significant reduction in post-treatment intensity of A. lumbricoides was observed in the total population and in the targeted children. In general, reductions in the intensity of A. lumbricoides after intervention were not particularly pronounced in untreated children (aged 0–4 years) even in the 4-monthly targeted village, whereas in untreated adults, reductions approached statistical significance in villages which received targeted treatment once and at 4-monthly intervals.
The aerodynamic performance of a multi-element high-lift system has a critical influence on the direct operating cost of a subsonic civil transport aircraft. A thorough understanding of the aerodynamic characteristics of these multi-element aerofoils and wings allows aircraft companies to design and build more competitive aircraft with high-lift systems that are less complex and lighter for given high-lift performance or that have improved lift and drag characteristics for given system complexity and weight. Flight experiments on NASA Langley's B737-100 aircraft have been conducted to further enhance the understanding of the complex flows about multi-element high-lift systems at full-scale flight conditions. In this paper, an overview of the flight program is provided, followed by highlights of experimental results and computational analysis. Measurements included surface pressures on the slats, main element and flap elements using flush pressure ports and pressure belts, surface shear stresses using Preston tubes, off-surface velocity distributions using boundary layer/wake rakes, aeroelastic deformations of the flap elements using an optical positioning system, and boundary layer transition detection using hot-film anemometers and an infrared imaging system. Boundary layer transition measurements on the slat using hot-film sensors are correlated with the flow visualisation results from an infrared imaging technique. Extensive application of several computational techniques and comparisons with flight measurements are shown for a limited number of cases. This program has generated an extensive set of data, much of which are still being analysed.