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We compared antibiotic prescribing to older people in different settings to inform antibiotic stewardship interventions. We used data linkage to stratify individuals aged 65 years and over in Northern Ireland, 1st January 2012–31st December 2013, by residence: community dwelling, care home dwelling or ‘transitioned’ if admitted to a care home. The odds of being prescribed an antibiotic by residence were analysed using logistic regression, adjusting for patient demographics and selected medication use (proxy for co-morbidities). Trends in monthly antibiotic prescribing were examined in the 6 months pre- and post-admission to the care home. The odds of being prescribed at least one antibiotic were twofold higher in care homes compared with community dwellers (adjusted odds ratio 2.05, 95% CI 1.93–2.17). There was a proportionate increase of 51.5% in the percentage prescribed an antibiotic on admission, with a monthly average of 23% receiving an antibiotic in the 6 months post admission. While clinical need likely accounts for some of the observed antibiotic prescribing in care homes we cannot rule out more liberal prescribing, given the twofold difference between care home residents and their community dwelling peers having accounted for co-morbidities. The appropriateness of antibiotic prescribing in the care home setting should be examined.
The US Department of Agriculture’s Summer Food Service Program and Seamless Summer Option (summer nutrition programmes (SNP)) aim to relieve food insecurity for children and teens during summer months. More needs to be known about when and where SNP are available, and how availability varies by community characteristics, particularly in rural areas where food insecurity and reduced food access are more prevalent.
The present study examined the geographic availability of SNP and summer meal uptake rates in 2016, using state-wide administrative claims data.
Public schools and SNP in California, USA.
Schools (n 8842) and SNP (n 4685).
Urban counties were more likely than rural counties to have higher summer uptake rates, calculated as the percentage of summer meals served relative to eligible students utilizing school meal programmes during the academic school year, but uptake overall was low at 18·2 % of target populations. Geographic availability analyses showed that 63·9 % of public urban schools had an SNP available within 1·6 km (1 mile), but availability was significantly higher within the proximity of larger, higher-poverty high schools with diverse or majority non-White students, and those with higher school-year breakfast participation rates. Availability of an SNP within 16 km (10 miles) of rural schools averaged 68·1 % but was significantly higher around larger schools, higher-poverty schools and those with diverse or majority non-White students.
While many communities have SNP available, much more work is needed to increase the availability of these programmes to reduce summer food insecurity for children, particularly in rural communities.
Given the challenges in accurately identifying unexposed controls in case–control studies of diarrhoea, we examined diarrhoea incidence, subclinical enteric infections and growth stunting within a reference population in the Global Enteric Multicenter Study, Kenya site. Within ‘control’ children (0–59 months old without diarrhoea in the 7 days before enrolment, n = 2384), we examined surveys at enrolment and 60-day follow-up, stool at enrolment and a 14-day post-enrolment memory aid for diarrhoea incidence. At enrolment, 19% of controls had ⩾1 enteric pathogen associated with moderate-to-severe diarrhoea (‘MSD pathogens’) in stool; following enrolment, many reported diarrhoea (27% in 7 days, 39% in 14 days). Controls with and without reported diarrhoea had similar carriage of MSD pathogens at enrolment; however, controls reporting diarrhoea were more likely to report visiting a health facility for diarrhoea (27% vs. 7%) or fever (23% vs. 16%) at follow-up than controls without diarrhoea. Odds of stunting differed by both MSD and ‘any’ (including non-MSD pathogens) enteric pathogen carriage, but not diarrhoea, suggesting control classification may warrant modification when assessing long-term outcomes. High diarrhoea incidence following enrolment and prevalent carriage of enteric pathogens have implications for sequelae associated with subclinical enteric infections and for design and interpretation of case–control studies examining diarrhoea.
The effects of shape and thickness of a tin surface layer and of the energy of a 170 ps neodymium:yttrium-aluminum-garnet laser pulse on the conversion efficiency (CE) into extreme ultraviolet emission in the 13.5 nm region is investigated. Whereas a CE of up to 1.16% into the 2% reflection band of multilayer Mo/Si optics was measured for a bulk Sn target at a laser energy of 25 mJ, significant CE enhancement up to 1.49% is demonstrated for a 200-nm-thick Sn layer on a microstructured porous alumina substrate.
We examined the use of functional analysis methodologies to identify the environmental determinants of challenging behaviour for two students with severe disabilities. With one student the functional analysis was conducted in an outpatient clinic which was removed from the school setting. The functional analysis was conducted in the classroom setting with the other student. These assessments produced clear hypotheses regarding the controlling contingencies for challenging behaviour with both students. Individualised support plans were then developed and were successfully implemented by classroom personnel. The results of this study are discussed in terms of using a flexible approach to functional assessment in schools based on the individual characteristics of the student and the classroom context.
The impressive architecture of Angkor Wat conveys a sense of harmonious design, but recent survey using ground-penetrating radar (GPR), coupled with targeted excavation, reveals a more complex picture. Fragmentary traces of a quincunx of earlier towers have been detected, which were partially demolished when the outer enclosure and western gateway were completed. Are these the remains of a shrine used during the construction period? If so, they throw new light on associated ritual activity during the building of Angkor Wat.
Measles vaccination is estimated to have averted 13·8 million deaths between 2000 and 2012. Persisting heterogeneity in coverage is a major contributor to continued measles mortality, and a barrier to measles elimination and introduction of rubella-containing vaccine. Our objective is to identify determinants of inequities in coverage, and how vaccine delivery must change to achieve elimination goals, which is a focus of the WHO Decade of Vaccines. We combined estimates of travel time to the nearest urban centre (⩾50 000 people) with vaccination data from Demographic Health Surveys to assess how remoteness affects coverage in 26 African countries. Building on a statistical mapping of coverage against age and geographical isolation, we quantified how modifying the rate and age range of vaccine delivery affects national coverage. Our scenario analysis considers increasing the rate of delivery of routine vaccination, increasing the target age range of routine vaccination, and enhanced delivery to remote areas. Geographical isolation plays a key role in defining vaccine inequity, with greater inequity in countries with lower measles vaccine coverage. Eliminating geographical inequities alone will not achieve thresholds for herd immunity, indicating that changes in delivery rate or age range of routine vaccination will be required. Measles vaccine coverage remains far below targets for herd immunity in many countries on the African continent and is likely to be inadequate for achieving rubella elimination. The impact of strategies such as increasing the upper age range eligible for routine vaccination should be considered.
Decompression of the endolymphatic sac for Ménière's disease gives unpredictable results. This may be because the sac is difficult to identify and decompress accurately without causing surgical trauma.
In order to test this idea, transmastoid decompression was simulated in 5 cadaver half heads and the anatomy of the endolymphatic sac was reviewed in a further 14 specimens.
The endolymphatic sac was found and confirmed by histology in all five simulated decompressions. A newly described feature, a trapezoid thickening of dura, was a useful guide. The review showed that the sac was constant proximally, but variable distally. The posterior semicircular canal, posterior fossa dura and sigmoid sinus are at risk during dissection.
The endolymphatic sac may be identified on inspection by an overlying patch of dura, thereby reducing exploratory dissection. It is best to decompress the sac as far proximally as possible, whilst protecting the posterior semicircular canal.
The key to avoiding damage to the horizontal facial nerve in middle-ear surgery is to formally identify the nerve in the early stages of the procedure.
In the non-infected ear this can be achieved relatively easily by identifying the oval window niche. However, in the infected ear with cholesteatoma, the safest landmark to use is the processus cochleariformis, which can be identified by three different methods.
In an infected ear that is full of granulation tissue and/or cholesteatoma, the horizontal facial nerve can be reliably identified by locating the processus cochleariformis using the three methods described. This avoids damage to the nerve and important structures around it.
Members of the solid solution system La1.5−xBa1.5+Cu7+ywith x = 0, 0.125, 0.25. 0.375 and 0.5 have been prepared both in air and under one atmosphere of flowing oxygen. In general, except for x =0, the oxygen annealed compounds are superconducting while the air-annealed samples are semiconductors. Tc's measured by Meissner effect and resistivity data range to 70K. The crystal symmetry in all cases is apparently tetragonal as verified for x = 0.375 by variable temperature Guinier x-ray experiments at temperatures down to 8K. Crystal structures have been refined from neutron powder diffraction data. A correlation is noted between Cu-0 distances which connect adjacent Cu planes - the average copper valence and the occurrence of superconductivity.
Positron annihilation spectroscopy (PAS) has been developed to characterize the free-volume properties of polymers. Positron annihilation lifetime measurements give direct information about the dimension, content, and hole-size distributions of free-volume in amorphous materials. The angular correlation of positron annihilation radiation measurements give additional information about the shape of the free-volume holes in oriented polymeric materials. The unique capability of PAS to probe free-volume properties is from the fact that positronium atom is preferentially trapped in the atomic-scale holes which have a size ranging from 1 to 10 Å.
The effects of Lewis acid complexation on the glass transition temperature (Tg) of several polymers with strong intermolecular interactions was investigated. The decrease in the Tg due to GaCl3 complexation of aliphatic and aromatic polyamides was 40–600° C and 148° C, respectively, and was shown to originate from scission of the intermolecular hydrogen bonds. The reduction in the Tg due to GaCl3 complexation of rigid–chain polymers was greater that 325° C and can be explained by the mitigation of the otherwise strong van der Waals forces in the pristine polymers. Thus, the dominant effect of intermolecular interactions on the Tg of several polymers has been probed by Lewis acid complexation.
Glassy polycarbonate was subjected to cyclic stresses and the changes in its structure were studied by DSC, positronium annihilation lifetime spectroscopy (PALS), and small and medium angle X-ray scattering. Upon increased exposure to cyclic loading, the enthalpy overshoot near Tg increased in a manner similar to increasing physical aging. However, the “hole” size as revealed by PALS increased, unlike physical aging. SAXS reveals an increase in the short range order and the amplitude of density fluctuation. These results can be explained in a consistent manner. We conclude that mechanical loading does cause changes in the glassy structure.
Copper (I) chloride (CuCl) is a potential candidate for ultra violet optoelectronics due to the fact that it is closely lattice matched with silicon, which makes it readily integrable with silicon device technology. The structural and optoelectronic properties of CuCl thin films deposited by RF magnetron sputtering are investigated. The crystallinity is studied using X-ray diffraction which confirms the growth of CuCl thin films with cubic zinc blende structure predominantly orientated in <111> direction. Excitonic transitions in the thin films were thoroughly investigated using optical absorbance and luminescence spectroscopies. Room temperature absorption spectroscopic analysis confirms the existence of two exciton peaks namely Z12 and Z3 at 372 and 380 nm respectively. A strong UV emission is observed at room temperature in cathodoluminescence and photoluminescence spectra due to the recombination of Z3 exciton at approximately 384 nm. In the low temperature photoluminescence spectrum, a free exciton (Z3) and a bound exciton (I1) are observed. A variation of 1.3 nm to 10 nm was observed in the Z3 exciton line width from 10 K to 300 K.
Various models for funding special education services have been described in the literature. This paper aims at moving the debate concerning special education funding reform beyond the descriptive level by reviewing studies that investigated the impact of various models for funding special education. Systematic searches were conducted of ERIC and PsycINFO to identify studies that investigated the impact, implications, or outcome of one or more special education funding models. Ten studies were identified covering five major funding models. The results showed that the funding reforms investigated in these studies each had associated benefits, but also potential detriments. However, these studies mainly involved indirect outcome measures, often failed to fully assess impact on academic achievement or cost-effectiveness. Results highlight the need for additional research on the impact of special education funding reform.
We assessed the use of a microswitch cluster (i.e. a combination of two micro-switches) plus contingent stimulation for promoting adaptive responding and reducing aberrant behaviour in a woman with profound developmental disabilities. The woman was initially taught an adaptive hand response that activated a pressure microswitch and produced preferred stimuli. Subsequently, her hand response led to preferred stimuli only if it occurred free from face hiding (i.e. aberrant behaviour detected through a mercury microswitch). The study also included a 3-month post-intervention and generalization check, and a social validation assessment. Data showed that the woman increased her adaptive responding, learned to perform this responding largely free from aberrant behaviour, and maintained and generalized the new performance across settings. Forty-five psychology students provided positive social validation of the woman's new performance and the use of microswitch-cluster technology.
Objectives: To describe the use of the great auricular nerve as a 'road map' for locating the accessory nerve in the anterior and posterior triangle, in comparison with other methods described in the literature.
Design: A review of the literature using Medline and Embase searches was performed. Illustrative photographs were taken from consenting, elective patients.
Results: Various methods have been described, using different anatomical landmarks. We describe a new method, based on the fact that the great auricular nerve runs, with relation to the edges of the sternocleidomastoid muscle, 1 cm superior to the accessory nerve anteriorly and 1 cm inferior posteriorly.
Conclusions: This is a reliable and safe method, used by the senior authors in their extensive work as head and neck and skull base surgeons. It allows the accessory nerve to be located in both the anterior and posterior triangle. This avoids the inherent dangers of following the nerve's tortuous course through the sternocleidomastoid.
Lemierre's syndrome is characterized by acute oropharyngeal infection complicated by internal jugular venous thrombosis secondary to septic thrombophlebitis, and metastatic abscesses. We report a case of Lemierre's syndrome in an 18-year-old Caucasian woman presenting with a peritonsillar abscess and ipsilateral VIth cranial nerve palsy.