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Neonates are at high risk of bleeding after open-heart surgery. We sought to determine pre-operative and intra-operative risk factors for increased bleeding after neonatal open-heart surgery with cardiopulmonary bypass.
We conducted a retrospective cohort study of neonates (0–30 days old) who underwent open-heart surgery with cardiopulmonary bypass from January, 2009, to March, 2013. Cardiac diagnosis; demographic and surgical data; and blood products, haemostatic agents, and anti-thrombotic agents administered before, during, and within 24 hours after surgery were abstracted from the electronic health record and anaesthesia records. The outcome of interest was chest tube output (in ml/kg body weight) within 24 hours. Relationships between chest tube output and putative associated factors were evaluated by unadjusted and adjusted linear regression.
The cohort consisted of 107 neonates, of whom 79% had a Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) Mortality Category of 4 or 5. Median chest tube output was 37 ml/kg (range 9–655 ml/kg). Age, African-American race, and longer durations of surgery and cardiopulmonary bypass each had statistically significant associations with increased chest tube output in unadjusted analyses. In multivariable analysis, African-American race retained an independent, statistically significant association with increased chest tube output; the geometric mean of chest tube output among African-American neonates was 71% higher than that of Caucasians (95% confidence interval, 29–125%; p = 0.001).
Among neonates with CHD undergoing open-heart surgery with cardiopulmonary bypass, African-American race is independently associated with greater chest tube output over the first 24 hours post-operatively.
We previously studied the phenomena of the mesenchymal cell-dependent mode of cartilage growth in quail and catfish. Thus, we selected the two cartilage models in which mesenchymal cells participate in their growth. In such models, cartilage degradation occurred to facilitate cellular invasion. The studies do not explain the nature of the cartilage degrading cells. The current study aims to explore the nature of the cartilage-degrading cells using transmission electron microscopy (TEM) and immunohistochemistry. Samples of cartilage have been isolated from the air-breathing organ of catfish and the cartilage of the prospective occipital bone of quail embryos. Samples have been processed for TEM and immunohistochemistry. We found that two different cell types are involved in cartilage degradation; the macrophage in the cartilage of catfish and mesenchymal cells in the cartilage of the quail. Areas of cellular invasion in both catfish cartilage and quail embryo cartilage had an immunological affinity for MMP-9. In catfish, cartilage-degrading cells had identical morphological features of macrophages, whereas in quail embryos, cartilage-degrading cells were mesenchymal-like cells which had cell processes rich in vesicles and expressed CD117. Further study should consider the role of macrophage and mesenchymal cells during cartilage degradation. This could be valuable to be applied to remove the defective cartilage matrix formed in osteoarthritic patients to improve cartilage repair strategies.
Soiling can lead to severe performance losses of photovoltaic (PV) plants. Within this study, three different anti-soiling coatings (ASC) were applied to three different commercial, solar-grade rolled glasses with different surface structures. Laboratory soiling experiments were performed including wind simulation and a novel rotational force test to assess the influence of different surface structures of the glass substrate on the anti-soiling performance of the coatings. A detailed microscopic evaluation indicates a consistent ranking of the ASC with regard to particle resuspension behavior for both test methods and all substrates. Furthermore, the rotational force test yields a quantitative measure of the median force needed for particle removal from the respective coating, which is independent of the glass substrate surface morphology.
This paper presents a vision-based path planning strategy that aims to reduce the computational time required by a robot to find a feasible path from a starting point to the goal point. The proposed algorithm presents a novel strategy that can be implemented on any well-known path planning algorithm such as A*, D* and probabilistic roadmap (PRM), to improve the swiftness of these algorithms. This path planning algorithm is suitable for real-time scenarios since it reduces the computational time compared to the basis and traditional algorithms. To test the proposed path planning strategy, a tracking control strategy is implemented on a mobile platform. This control strategy consists of three major stages. The first stage deals with gathering information about the surrounding environment using vision techniques. In the second stage, a free-obstacle path is generated using the proposed reduced scheme. In the final stage, a Lyapunov kinematic tracking controller and two Artificial Neural Network (ANN) based-controllers are implemented to track the proposed path by adjusting the rotational and linear velocity of the robot. The proposed path planning strategy is tested on a Pioneer P3-DX differential wheeled mobile robot and an Xtion PRO depth camera. Experimental results prove the efficiency of the proposed path planning scheme, which was able to reduce the computational time by a large percentage which reached up to 88% of the time needed by the basis and traditional scheme, without significant adverse effect on the workability of the basis algorithm. Moreover, the proposed path planning algorithm has improved the path efficiency, in terms of the path length and trackability, challenging the traditional trade-off between swiftness and path efficiency.
To investigate a Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak event involving multiple healthcare facilities in Riyadh, Saudi Arabia; to characterize transmission; and to explore infection control implications.
Cases presented in 4 healthcare facilities in Riyadh, Saudi Arabia: a tertiary-care hospital, a specialty pulmonary hospital, an outpatient clinic, and an outpatient dialysis unit.
Contact tracing and testing were performed following reports of cases at 2 hospitals. Laboratory results were confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) and/or genome sequencing. We assessed exposures and determined seropositivity among available healthcare personnel (HCP) cases and HCP contacts of cases.
In total, 48 cases were identified, involving patients, HCP, and family members across 2 hospitals, an outpatient clinic, and a dialysis clinic. At each hospital, transmission was linked to a unique index case. Moreover, 4 cases were associated with superspreading events (any interaction where a case patient transmitted to ≥5 subsequent case patients). All 4 of these patients were severely ill, were initially not recognized as MERS-CoV cases, and subsequently died. Genomic sequences clustered separately, suggesting 2 distinct outbreaks. Overall, 4 (24%) of 17 HCP cases and 3 (3%) of 114 HCP contacts of cases were seropositive.
We describe 2 distinct healthcare-associated outbreaks, each initiated by a unique index case and characterized by multiple superspreading events. Delays in recognition and in subsequent implementation of control measures contributed to secondary transmission. Prompt contact tracing, repeated testing, HCP furloughing, and implementation of recommended transmission-based precautions for suspected cases ultimately halted transmission.
New excavations at the Jebel Moya cemetery in Sudan reveal extensive evidence for Meroitic-era occupation, providing valuable data on contemporaneous diet, migration, exchange and population composition in sub-Saharan Africa.
Coincidence site lattice (CSL) grain boundaries (GBs) are believed to be low-energy, resistant to intergranular fracture, as well as to hydrogen embrittlement. Nevertheless, the behavior of CSL-GBs are generally confused with their angular deviations. In the current study, the effect of angular deviation from the perfect
$\Sigma 3(111)[1\bar 10]$
GBs in α-iron on the hydrogen diffusion and the susceptibility of the GB to hydrogen embrittlement is investigated through molecular static and dynamics simulations. By utilizing Rice–Wang model, it is shown that the ideal GB shows the highest resistance to decohesion below the hydrogen saturation limit. Finally, the hydrogen diffusivity along the ideal GB is observed to be the highest.
BACKGROUND: IGTS is a rare phenomenon of paradoxical germ cell tumor (GCT) growth during or following treatment despite normalization of tumor markers. We sought to evaluate the frequency, clinical characteristics and outcome of IGTS in patients in 21 North-American and Australian institutions. METHODS: Patients with IGTS diagnosed from 2000-2017 were retrospectively evaluated. RESULTS: Out of 739 GCT diagnoses, IGTS was identified in 33 patients (4.5%). IGTS occurred in 9/191 (4.7%) mixed-malignant GCTs, 4/22 (18.2%) immature teratomas (ITs), 3/472 (0.6%) germinomas/germinomas with mature teratoma, and in 17 secreting non-biopsied tumours. Median age at GCT diagnosis was 10.9 years (range 1.8-19.4). Male gender (84%) and pineal location (88%) predominated. Of 27 patients with elevated markers, median serum AFP and Beta-HCG were 70 ng/mL (range 9.2-932) and 44 IU/L (range 4.2-493), respectively. IGTS occurred at a median time of 2 months (range 0.5-32) from diagnosis, during chemotherapy in 85%, radiation in 3%, and after treatment completion in 12%. Surgical resection was attempted in all, leading to gross total resection in 76%. Most patients (79%) resumed GCT chemotherapy/radiation after surgery. At a median follow-up of 5.3 years (range 0.3-12), all but 2 patients are alive (1 succumbed to progressive disease, 1 to malignant transformation of GCT). CONCLUSION: IGTS occurred in less than 5% of patients with GCT and most commonly after initiation of chemotherapy. IGTS was more common in patients with IT-only on biopsy than with mixed-malignant GCT. Surgical resection is a principal treatment modality. Survival outcomes for patients who developed IGTS are favourable.
This work focuses on the syntheses of Zn-enriched PtZn nanoparticle electrocatalysts by solution combustion for ethanol oxidation reaction (EOR). Analytical techniques of x-ray diffraction, transmission electron microscopy (TEM), scanning electron microscopy, TEM/scanning TEM-energy dispersive x-ray spectroscopy, and x-ray photoelectron spectroscopy are used for the characterization of electrocatalysts. Cyclic voltammetry and chronoamperometry are applied for the electrocatalysis of C2H5OH and stability test in an alkaline medium, respectively. Electrochemical data show that PtZn/C has improved electrocatalytic activity by ~2.3 times compared with commercial Pt/C, in addition to having earlier onset potential and better stability for EOR. The variation of fuel amount in the synthesis has affected crystallite sizes, electronic, and electrochemical properties in electrocatalysts.
This work aims to develop simple and cost-effective methods in reduction of Cr(VI) from water to less toxic and easy separated Cr(III) using Titanium dioxide (TiO2).
TiO2 nanoparticles are prepared by a sol-gel method using titanium tetra-chloride and characterized using X-Ray Diffraction (XRD), Scanning electron microscope (SEM), Energy dispersive X-ray Fluorescence spectrometer (EDX) and UV-visible spectroscopy. XRD shows Anatase structure of TiO2 after annealing at 600°C for four hours. The particles size is estimated to be 70 nm using SEM.UV-Visible spectroscopy indicated that TiO2 nanoparticles played important role in decreasing the concentration of Cr (VI) in water samples for different pH range of 1 to 4. The decrease in Cr(VI) concentration after the treatment is ascribed to the reduction caused by the photocatalyst effect that resulted from the presence of TiO2 nanoparticle in water samples under direct exposure to direct sunlight.
Apis mellifera jemenitica, the only indigenous honey bee race of Saudi Arabia, is well adapted to the harsh local environmental conditions. A large-scale field survey was conducted to screen major Saudi Arabian beekeeping locations for infection by Paenibacillus larvae. Paenibacillus larvae is one of the major bacterial pathogens of honey bee broods and is the causative agent of American foulbrood disease. Larvae from samples suspected of infection were collected from different apiaries and homogenized in phosphate-buffered saline. Bacteria were isolated on MYPGP agar medium. Two bacterial isolates, ksuPL3 and ksuPL5 (16S rRNA GenBank accession numbers, KR780760 and KR780761, respectively), were subjected to molecular identification using P. larvae-specific primers. A BLAST sequence analysis revealed that the two isolates were P. larvae with more than 98% sequence identity. This detection of P. larvae in the indigenous honey bee is the first recorded incidence of this pathogen in Saudi Arabia. This study emphasizes the need for the relevant authorities to take immediate steps towards treating and limiting the spread of this disease throughout the country.
To assess the feasibility and outcomes of flexible carbon dioxide laser surgery in a clinic-based setting.
A prospective study was conducted in a tertiary centre. Clinical indications, clinical outcomes and patient satisfaction were assessed in patients treated with flexible carbon dioxide laser surgery via transnasal endoscopy and followed up over a period of up to nine months. Patients who were not fit for general anaesthesia or those with lesions that cannot be accessed by micro-laryngoscopy were included.
A total of 13 patients (14 procedures) were included. Clinical indications for surgery were small-to-medium sized benign pathologies in the upper aero-digestive tract. Patient satisfaction was assessed using a validated questionnaire.
Early data suggest that flexible carbon dioxide laser is a versatile and feasible instrument with potential applications for a range of benign pathologies in the upper aero-digestive tract.
This is a dosimetric study to compare the feasibility of carotid artery sparing as a primary objective, as well as planning target volume coverage and dose to spinal cord as a secondary objective, by using 3D conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT) for patients with early glottis cancer.
Patients and methods
Six patients who had been treated for early stage glottic carcinoma (stage T1-2 N0M0) were included in this study. All patients were immobilised in the supine position with a thermoplastic mask and treatment planning computed tomography scans were obtained from the top of the skull to the top of aortic arch with a 3-mm slice thickness. Two plans were created for every patient, one using 3DCRT and the second using IMRT. Comparison between the two plans was undertaken and analysis was made regarding the dose to the carotids arteries, target coverage and doses to the organs at risk.
For target coverage, the V95% for both plans was the same with no significant difference, hot spots were the highest in 3DCRT with p=0·002, the homogeneity index for IMRT plan was better than 3DCRT (p=0·0001). Regarding the dose to the carotids, it was significantly lower in the IMRT plan compared with the 3DCRT plan (p=0·01). The spinal cord dose was significantly higher in the IMRT plan.
IMRT significantly reduces the radiation dose to the carotid arteries compared with 3DCRT while maintaining clinical target volume coverage. Such a results assists in decreasing the incidence of radiation-induced carotid stenosis, thus improving the quality of life for patients.
No recent original studies on the pattern of diet are available for Saudi Arabia at the national level. The present study was performed to describe the consumption of foods and beverages by Saudi adults.
The Saudi Health Interview Survey (SHIS) was conducted in 2013. Data were collected through interviews and anthropometric measurements were done. A diet history questionnaire was used to determine the amount of consumption for eighteen food or beverage items in a typical week.
The study was a household survey in all thirteen administrative regions of Saudi Arabia.
Participants were 10 735 individuals aged 15 years or older.
Mean daily consumption was 70·9 (se 1·3) g for fruits, 111·1 (se 2·0) g for vegetables, 11·6 (se 0·3) g for dark fish, 13·8 (se 0·3) g for other fish, 44·2 (se 0·7) g for red meat, 4·8 (se 0·2) g for processed meat, 10·9 (se 0·3) g for nuts, 219·4 (se 5·1) ml for milk and 115·5 (se 2·6) ml for sugar-sweetened beverages. Dietary guideline recommendations were met by only 5·2 % of individuals for fruits, 7·5 % for vegetables, 31·4 % for nuts and 44·7 % for fish. The consumption of processed foods and sugar-sweetened beverages was high in young adults.
Only a small percentage of the Saudi population met the dietary recommendations. Programmes to improve dietary behaviours are urgently needed to reduce the current and future burden of disease. The promotion of healthy diets should target both the general population and specific high-risk groups. Regular assessments of dietary status are needed to monitor trends and inform interventions.
Endoscope-associated infections are reported despite following proper reprocessing methods. Microbiological testing can confirm the adequacy of endoscope reprocessing. Multiple controversies related to the method and interpretation of microbiological testing cultures have arisen that make their routine performance a complex target.
We conducted a pilot study using disposable bronchoscopes (DBs) to simulate different reprocessing times and soaking times and to compare high-level disinfection versus ethylene oxide sterilization. We also reviewed the time to reprocessing and duration of the procedures.
Bronchoscopes were chosen because an alternative disposable scope is commercially available and because bronchoscopes are more prone to delays in processing. Disposable bronchoscopes were contaminated using a liquid bacterial suspension and were then incubated for 1–4 hours. Standard processing and high-level disinfection were performed on 36 endoscopes. Ethylene oxide sterilization was performed on 21 endoscopes. Endoscope cultures were performed using the standard “brush, flush, brush” technique.
After brushing was performed, a final water-flush culture procedure was the most effective method of detecting bacterial persistence on the disposable scopes. Klebsiella pneumoniae was the most commonly recovered organism after reprocessing. Ethylene oxide sterilization did not result in total elimination of viable bacteria.
Routine endoscopy cultures may be required to assess the adequacy of endoscopic processing.
Fifteen lactating Damascus goats (44 ± 0·8 kg body weight) were used in a completely randomized design to evaluate the supplementation of Chlorella vulgaris microalgae at 0 (Control), 5 (Alg05) and 10 g/goat/day (Alg10) for 12 weeks. Chlorella vulgaris treatments increased feed intake and apparent diet digestibility compared with a control diet. No differences were noted in the ruminal pH and ammonia-N concentrations, but increased concentration of total volatile fatty acids and propionic acid were observed in goats fed with Alg05 and Alg10. Diets of Alg05 and Alg10 increased serum glucose concentration but decreased glutamate-oxaloacetate transaminase, glutamate-pyruvate transaminase and cholesterol concentrations. Additionally, C. vulgaris supplementation moderately increased milk yield, energy corrected milk, total solids, solids not fat and lactose. Feeding Alg05 and Alg10 diets increased milk unsaturated fatty acids with concomitant increases in total conjugated linoleic acid concentrations. It is concluded that the daily inclusion of 5 or 10 g of C. vulgaris in the diets of Damascus goats increased milk yield and positively modified milk fatty acid profile.