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UK guidelines recommend routine HIV testing in high prevalence emergency departments (ED) and targeted testing for HBV and HCV. The ‘Going Viral’ campaign implemented opt-out blood-borne virus (BBV) testing in adults in a high prevalence ED, to assess seroprevalence, uptake, linkage to care (LTC) rates and staff time taken to achieve LTC. Diagnosis status (new/known/unknown), current engagement in care, and severity of disease was established. LTC was defined as patient informed plus ⩾1 clinic visit. A total of 6211/24 981 ED attendees were tested (uptake 25%); 257 (4.1%) were BBV positive (15 co-infected), 84 (33%) required LTC. 100/147 (68%) HCV positives were viraemic; 44 (30%) required LTC (13 new, 16 disengaged). 26/54 (48%) HBV required LTC (seven new, 11 disengaged). 16/71 (23%) HIV required LTC (10 new, five disengaged). 26/84 (31%) patients requiring LTC had advanced disease (CD4 <350, APRI (AST-to-Platelet Ratio Index) >1, Fibroscan F3/F4 or liver cancer), including five with AIDS-defining conditions and three hepatocellular carcinomas. There were five BBV-related deaths. BBV prevalence was high (4.1%); most were HCV (2.4%). HIV patients were more successfully and quickly LTC than HBV or HCV patients. ED testing was valuable as one-third of those requiring LTC (new, disengaged or unknown status patients) had advanced disease.
Antineuronal antibodies are associated with psychosis, although their clinical significance in first episode of psychosis (FEP) is undetermined.
To examine all patients admitted for treatment of FEP for antineuronal antibodies and describe clinical presentations and treatment outcomes in those who were antibody positive.
Individuals admitted for FEP to six mental health units in Queensland, Australia, were prospectively tested for serum antineuronal antibodies. Antibody-positive patients were referred for neurological and immunological assessment and therapy.
Of 113 consenting participants, six had antineuronal antibodies (anti-N-methyl-D-aspartate receptor antibodies [n = 4], voltage-gated potassium channel antibodies [n = 1] and antibodies against uncharacterised antigen [n = 1]). Five received immunotherapy, which prompted resolution of psychosis in four.
A small subgroup of patients admitted to hospital with FEP have antineuronal antibodies detectable in serum and are responsive to immunotherapy. Early diagnosis and treatment is critical to optimise recovery.
Bovine tuberculosis (bTB) is an important disease of cattle caused by infection with Mycobacterium bovis, a pathogen that may be extremely difficult to eradicate in the presence of a true wildlife reservoir. Our objective was to identify and review relevant literature and provide a succinct summary of current knowledge of risk factors for transmission of infection of cattle. Search strings were developed to identify publications from electronic databases to February 2015. Abstracts of 4255 papers identified were reviewed by three reviewers to determine whether the entire article was likely to contain relevant information. Risk factors could be broadly grouped as follows: animal (including nutrition and genetics), herd (including bTB and testing history), environment, wildlife and social factors. Many risk factors are inter-related and study designs often do not enable differentiation between cause and consequence of infection. Despite differences in study design and location, some risk factors are consistently identified, e.g. herd size, bTB history, presence of infected wildlife, whereas the evidence for others is less consistent and coherent, e.g. nutrition, local cattle movements. We have identified knowledge gaps where further research may result in an improved understanding of bTB transmission dynamics. The application of targeted, multifactorial disease control regimens that address a range of risk factors simultaneously is likely to be a key to effective, evidence-informed control strategies.
We describe an instrumental configuration for detecting large gas-giant planets orbiting main sequence stars via the small drop in stellar brightness that occurs when the planet transits the stellar disk. Our proposed scheme involves the long-term monitoring of the light-curves of tens of thousands of stars using a Schmidt telescope coupled to a CCD via a bundle of 10,000 optical fibres. Using an existing theoretical model of planetary system formation we calculate a detection rate of 14 transits per year for our proposed system.
Despite national guidance recommending testing and vaccination of household contacts of hepatitis B-infected pregnant women, provision and uptake of this is sub-optimal. The aim of this study was to evaluate the use of in-home dried blood spot (DBS) testing to increase testing and vaccination of household contacts of hepatitis B-infected pregnant women as an alternative approach to conventional primary-care follow-up. The study was conducted across two London maternity trusts (North Middlesex and Newham). All hepatitis B surface antigen-positive pregnant women identified through these trusts were eligible for inclusion. The intervention of in-home DBS testing for household contacts was introduced at North Middlesex Trust from November 2010 to December 2011. Data on testing and vaccination uptake from GP records across the two trusts were compared between baseline (2009) and intervention (2010–2011) periods. In-home DBS service increased testing uptake for all ages (P < 0·001) with the biggest impact seen in partners, where testing increased from 30·3% during the baseline period to 96·6% during the intervention period in North Middlesex Trust. Although impact on vaccine uptake was less marked, improvements were observed for adults. The provision of nurse-led home-based DBS may be useful in areas of high prevalence.
In June 2014 Public Health England confirmed a case of Legionnaires' disease (LD) in a neonate following birth at home in a hired birthing pool incorporating a heater and a recirculation pump which had been filled in advance of labour. The case triggered a public health investigation and a microbiological survey of an additional ten heated birthing pools hired or recently hired to the general public across England. The birthing pool used by the parent of the confirmed case was identified as the source of the neonate's infection following detection of Legionella pneumophila ST48 in both patient and environmental samples. Legionella species were detected by quantitative polymerase chain reaction but not culture in a further three pools together with other opportunistic pathogens identified by culture and matrix-assisted laser desorption ionization–time of flight (MALDI–ToF) mass spectrometry. A Patient Safety Alert from NHS England and Public Health England was issued stating that heated birthing pools filled in advance of labour should not be used for home births. This recommendation remains in place. This investigation in conjunction with other recent reports has highlighted a lack of awareness regarding the microbiological safety of heated birthing pools and their potential to be a source of LD and other opportunistic infections. Furthermore, the investigation raised important considerations with regards to microbiological sampling and testing in such incidents. Public health authorities and clinicians should consider LD in the differential diagnosis of severe respiratory infection in neonates within 14 days of a water birth.
We present a new, three-dimensional (3D) plotting library with advanced features, and support for standard and enhanced display devices. The library — s2plot — is written in c and can be used by c, c++, and fortran programs on GNU/Linux and Apple/OSX systems. s2plot draws objects in a 3D (x,y,z) Cartesian space and the user interactively controls how this space is rendered at run time. With a pgplot-inspired interface, s2plot provides astronomers with elegant techniques for displaying and exploring 3D data sets directly from their program code, and the potential to use stereoscopic and dome display devices. The s2plot architecture supports dynamic geometry and can be used to plot time-evolving data sets, such as might be produced by simulation codes. In this paper, we introduce s2plot to the astronomical community, describe its potential applications, and present some example uses of the library.
In this paper we shall look at a technique, known as impurity free vacancy diffusion (IFVD) for selectively altering the optoelectronic response of quantum well material after growth with a view to monolithic device integration. We will discuss the mechanism, practical considerations and some possible applications.
The aim of this study was to estimate the amount of childhood hepatitis B virus transmission in children born in the UK, a very low-prevalence country, that is preventable only by universal hepatitis B immunization of infants. Oral fluid specimens were collected from schoolchildren aged 7–11 years in four inner city multi-ethnic areas and tested for the presence of antibody to hepatitis B core antigen (anti-HBc). Those found positive or indeterminate were followed up with testing on serum to confirm their hepatitis B status. The overall prevalence of anti-HBc in children was low [0·26%, 95% confidence interval (CI) 0·14–0·44]. The estimated average annual incidence of hepatitis B was estimated to be 29·26/100 000 children (95% CI 16·00–49·08). The total incidence that is preventable only by a universal infant immunization programme in the UK was estimated to be between 5·00 and 12·49/100 000. The study demonstrates that the extent of horizontal childhood hepatitis B virus transmission is low in children born in the UK and suggests that schools in the UK are an uncommon setting for the transmission of the virus. Targeted hepatitis B testing and immunization of migrants from intermediate- and high-prevalence countries is likely to be a more effective measure to reduce childhood transmission than a universal infant immunization programme.
When a minor amount of HF is added to the SnF2 reacted with lead nitrate in aqueous solutions to prepare PbSnF4, a phase transition from tetragonal α-PbSnF4 to orthorhombíc o-PbSnF4 takes place. The transition is essentially bidimensional and takes place in the (a,b) plane of the unit-cell. The compactness of the structure increases at the transition. No essential structural change occurs: the transition is most likely displacive and it is driven by bidimensional nonuniform strain acting along the aand baxes of the unit-cell. This transition is similar to ferroic transitions (in this case, paraelastic → ferroelastic). No detectable change of chemical composition occurs at the transition, and the reason why the presence of HF in the reaction mixture causes the transition remains unknown.
The effect of bath temperature, megasonic power, and NH4-OH:H2O ratio are studied for particle removal efficiency, surface roughness, and surface Fe concentration in SC-1 cleaning solutions. Experimental results are presented which show removal efficiencies better than 97% on bare silicon wafers for optimized process conditions. These results are related to the etch rate of thermal oxides and a model is developed for reducing surface roughness and minimizing Fe contamination levels while maximizing particle removal efficiency.
We report on the use of the Surface PhotoVoltage (SPV) technique to monitor the Si surface bonding arrangement, and the impurity metallic contamination level prior to critical diffusion processes via the indirect measurement of surface charge and diffusion length, respectively. We show that the effectiveness of the pre-diffusion wet chemical cleaning and rinsing sequences can be accurately monitored via the real-time, nondestructive SPV measurement. In particular the nature of the surface passivation/chemical oxide formed during the cleaning and rinsing operations can be monitored by quantitative surface charge measurements. The importance of the prior wafer history is highlighted, as is the role of the Si starting material and measurement parameters.
We have studied the emission from LEDs based on GaInNAs Quantum Wells (QWs) and InAs Quantum Dots (QDs) as a function of temperature and current. It is found that the carrier loss in GaInNAs QWs is dominated by non-radiative monomolecular and Auger processes resulting in an external quantum efficiency of only 0.08 % at 10 °C and 1000 A cm-2. In contrast, the InAs QDs have a higher external quantum efficiency, peaking at 0.8 % at 10 °C and 5 A cm-2, but this value rapidly decreases as the excited states of the QDs are filled and Auger-like processes become dominant. These results highlight the issues that must be addressed if these materials are to find commercial application: namely, the areal density of QDs must be increased and the material quality of the GaInNAs QWs must be improved.
Stress/Strain fields associated with thin film buckling induced by compressive stresses or blistering due to the presence of gas bubbles underneath single crystal surfaces are difficult to measure owing to the microscale dimensions of these structures. In this work, we show that micro Scanning X-ray diffraction is a well suited technique for mapping the strain/stress tensor of these damaged structures.
An unlinked anonymous survey was conducted to measure the prevalence of selected markers for HIV, hepatitis B and C infection in recruits to the UK Armed Forces to inform future screening and hepatitis B vaccination policies. During 2007, nearly 14 000 left-over samples taken from new recruits for blood typing were collected, unlinked from identifiers and anonymously tested for HIV, hepatitis C and current and past cleared hepatitis B infection. Overall, serological evidence of HIV and hepatitis C was found in 0·06% and 0·06% of recruits, respectively. Evidence of past cleared and current hepatitis B infection was found in 3·63% and 0·37% of recruits, respectively. Overall, prevalence rates were broadly consistent with UK population estimates of infection. However, HIV and hepatitis B prevalence was higher in recruits of African origin than in those from the UK (P<0·0001). Screening for these infections is an option that could be considered for those entering Services from high-prevalence countries.
The new Core-XAS (X-ray absorption spectroscopy) beamline (B18) at Diamond aims to provide a reliable spectrometer for a broad scientific community. With this in mind, B18 has been built as a general-purpose beamline and offers to users a variety of sample environments and detection methods. Here we will present the first commissioning results and some of the capabilities of this versatile instrument.
Two isolations of Arizona from humans were made in Sheffield in 1966. The first was from a 3-year-old girl with a history of gastro-enteritis; the second was from her 5-year-old brother who was a symptomless excretor. Infection was traced to pet terrapins recently purchased from a local pet shop. The relative epidemiological significance of Arizona infection and the potential hazard of pet terrapins has been reviewed.
We wish to thank Dr V. G. S. Damms for his help and co-operation and for allowing us to publish details of his patients, Dr J. G. Wallace for his work on the preliminary identification of the organism, and Dr Joan Taylor and Dr E. H. Gillespie for their helpful advice and criticism.