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 objective of this study was to develop a novel methodology that enables pig diets to be formulated explicitly for environmental impact objectives using a Life Cycle Assessment (LCA) approach. To achieve this, the following methodological issues had to be addressed: (1) account for environmental impacts caused by both ingredient choice and nutrient excretion, (2) formulate diets for multiple environmental impact objectives and (3) allow flexibility to identify the optimal nutritional composition for each environmental impact objective. An LCA model based on Canadian pig farms was integrated into a diet formulation tool to compare the use of different ingredients in Eastern and Western Canada. By allowing the feed energy content to vary, it was possible to identify the optimum energy density for different environmental impact objectives, while accounting for the expected effect of energy density on feed intake. A least-cost diet was compared with diets formulated to minimise the following objectives: non-renewable resource use, acidification potential, eutrophication potential, global warming potential and a combined environmental impact score (using these four categories). The resulting environmental impacts were compared using parallel Monte Carlo simulations to account for shared uncertainty. When optimising diets to minimise a single environmental impact category, reductions in the said category were observed in all cases. However, this was at the expense of increasing the impact in other categories and higher dietary costs. The methodology can identify nutritional strategies to minimise environmental impacts, such as increasing the nutritional density of the diets, compared with the least-cost formulation.
Population modelling is an invaluable tool for identifying effective management strategies for threatened species whose populations are too small for experimental manipulation. Recently developed Bayesian approaches allow us to combine deterministic models with probability distributions to create stochastic models that account for uncertainty. We illustrate this approach in the case of the takahe Porphyrio hochstetteri, an Endangered flightless rail, which is supported by one of New Zealand's costliest recovery programmes. Using mark–recapture and logistic regression models implemented in a Bayesian framework we calculated demographic parameters for a fully stochastic population model based on 25 years of data collected from the last wild population of takahe in the Murchison Mountains, Fiordland. Our model results show that stoat trapping, captive rearing and cross-fostering of eggs/chicks in wild pairs all have a positive effect on takahe demography. If it were not for these management actions the Fiordland population would probably be declining (λ = 0.985; confidence interval, CI = 0.39–1.08), with a non-negligible risk of quasi-extinction (P = 16%) within 20 years. The captive rearing of eggs and chicks has been the main factor responsible for the positive growth observed during the last decade but in the future expanding stoat trapping to cover the entire Murchison Mountains would be the single most beneficial management action for the takahe population (λ = 1.038; CI = 0.86–1.10), followed by captive rearing (λ = 1.027; CI = 0.85–1.09).
To determine the frequency of multiple pathology [Alzheimer Disease (AD) plus Vascular Dementia and/or Dementia with Lewy Bodies] in patients enrolled in clinical trials of AD therapy, and to compare the cognitive and functional assessments between patients with pure AD and AD with multiple pathology.
We conducted a retrospective analysis of patients with a clinical diagnosis of AD who were enrolled in AD therapy clinical trials and subsequently received an autopsy for confirmation of their diagnosis from 2000 to 2009. Performance on cognitive screening tests, namely Modified Mini Mental state (3MS) exam, Mini Mental state Exam (MMSE) and Functional Rating Scale (FRS) were compared between patients with pure AD and multiple pathology.
Autopsy reports were available for 16/47 (34%) of deceased patients. Of these 16 patients, 5 (31%) had pure AD pathology, 10 (63%) had AD with other pathology, and 1 (6%) had non-AD pathology. Compared to patients with pure AD, patients with AD mixed with other pathology had poorer baseline FRS in problem-solving (p<0.01) and community affairs (p<0.02).
While the strict enrollment criteria for clinical trials identified the presence of AD pathology in the majority of cases (15/16), multiple pathology was more common than pure AD in our series of autopsied patients. Premortem biomarkers that can distinguish between pure AD and AD with multiple pathology will be beneficial in future clinical trials and dementia patient management.
There are a wide range of approaches available for investigating the dynamics of the demographics and occurrence of ecological populations. So many that it would take an entire book, or more, to cover the important issues and options in sufficient detail. In this single chapter it is clearly impossible for me to go into detail on specific approaches, so I instead focus more on outlining some of the options available for addressing different types of questions and on general considerations, particularly with respect to program design. Inherently, because of those whom I have been fortunate enough to work with and learn from to this point in my career, most of the methods I discuss assume that detection of the items of interest (whether it be individual animals or plants, or of a species as a whole) will be imperfect, i.e. it will not be observed with certainty whenever you venture into the field to find it. However, many of the issues I will discuss are still relevant even with perfect detection. Recommended readings for further details on the topics I cover are Williams et al. (2002), Amstrup et al. (2005) and MacKenzie et al. (2006).
Before launching into the main thrust of this chapter, I am going to make a few comments (some might even say a rant) about the importance of thinking hard about Why, What, and How during the conception stage of any monitoring program. Although these are fairly basic questions that have been discussed early in this volume, their fundamental importance cannot be emphasized enough.
To estimate the proportion of patients who acquire methicillin-resistant Staphylococcus aureus (MRSA) while in hospital and to identify risk factors associated with acquisition of MRSA.
Retrospective cohort study.
Adult patients discharged from 36 general specialty wards of 2 Scottish hospitals that had implemented universal screening for MRSA on admission.
Patients were screened for MRSA on discharge from hospital by using multisite body swabs that were tested by culture. Discharge screening results were linked to admission screening results. Genotyping was undertaken to identify newly acquired MRSA in MRSA-positive patients on admission.
Of the 5,155 patients screened for MRSA on discharge, 2.9% (95% confidence interval [CI], 2.43–3.34) were found to be positive. In the subcohort screened on both admission and discharge (n = 2,724), 1.3% of all patients acquired MRSA while in hospital (incidence rate, 2.1/1,000 hospital bed-days in this cohort [95% CI, 1.5–2.9]), while 1.3% remained MRSA positive throughout hospital stay. Three risk factors for acquisition of MRSA were identified: age above 64 years, self-reported renal failure, and self-reported presence of open wounds. On a population level, the prevalence of MRSA colonization did not differ between admission and discharge.
Cross-transmission of MRSA takes place in Scottish hospitals that have implemented universal screening for MRSA. This study reinforces the importance of infection prevention and control measures to prevent MRSA cross-transmission in hospitals; universal screening for MRSA on admission will in itself not be sufficient to reduce the number of MRSA colonizations and subsequent MRSA infections.
To achieve 65 nm technology node requirements, CMP processes must provide improved control of selectivity, topography, wire cross section, and process robustness. Slurries and processes must also be compatible with fragile low k materials by providing low erosion and shear forces. We present data on a unique step 1 bulk Cu removal slurry with high selectivity, removal rates over 8000 Å/min, and extremely low liner removal/erosion in high (90%) density structures. This is achieved through a combination of surface modified abrasives and alternative inhibitors which provide superior performance and reduced electrochemical activity compared to benzotriazole, a commonly used inhibitor. The step 1 slurry was used with a step 2 liner removal slurry that can be chemically tuned to adjust relative selectivities of Cu:Ta:oxide from the nominal ratio of 1:0.9:1.6, allowing its use with a variety of integration schemes. Results of CMP planarization experiments on 200 mm blanket and patterned single damascene test wafers are described, including electrical data which demonstrates low overpolish sensitivity.
Hydrogen is found to readily diffuse into InGaN, InAIN and InGaAIN epitaxial layers during plasma exposures at 170 – 250 °C for 40 sec - 30 min. The diffusivity of hydrogen is > 10−11 cm2-s−1 at 170 °C, and the native donor species are passivated by association with the hydrogen. Reactivation of these species occurs at 450–500°C, but the hydrogen remains in the material until ≥ 800 °C.
Transparent lithium niobate (LiNbO3) with thickness from 0.1 - 1.2 μm were made on silicon, fused silica, and sapphire substrates by the sol-gel processing. Alkoxide solutions were used as starting materials. X-ray diffraction has been used to confirm the crystallization of the films. Refractive index, dielectric and ferroelectric properties of LiNbO3 films were studied. Absorption spectra of films of LiNbO3 and LiNbO3 with doping of different amount of Fe (0.1 - 2.5mol%) were measured. Short-circuit photocurrent measurements revealed both transient and steady state components attributed to a pyroelectric effect and a bulk photovoltaic effect respectively. Epitaxial growth of LiNbO3 thin film on sapphire(012) substrate by sol-gel method was also obtained.
Well compacted, silica fume-modified ordinary Portland cement pastes are well known for their low permeability. This quality can be maintained to temperatures slightly in excess of 200°C. Above this temperature, however, a continuous pore structure develops, making the material permeable and therefore unsuitable for high temperature applications (250–400°C) where vacuum integrity is necessary. To overcome this obstacle the permeability can be exploited for impregnating the concrete with an organic polymer. Organic polymers traditionally employed for impregnated concretes are not thermally stable enough to be used at high temperatures. Therefore, a high temperature-resistant organic resin has been studied for this application. The optimum conditions for impregnating this viscous resin into a high strength mortar have been investigated.
Ferroelectric thin films including undoped and doped PZT (lead zirconate titanate), BaTiO3 (barium titanate), SBN (strontium barium niobate), KNbO3 (potassium niobate), PBN (lead barium niobate), KNSBN (potassium sodium strontium barium niobate), and LiNbO3 (lithium niobate) were made on silicon and fused silica substrates by a sol-gel process. Microstructure and physical (pyroelectric, ferroelectric and optical) properties of these thin films were studied. Transparent and preferentially orientated SBN thin films on fused silica substrates can be obtained by applying a d.c. electric field during heat treatment. A heterojunction effect was observed in ferroelectric thin films on both n-silicon and p-silicon through measurement of I-V characteristics, and by the demonstration of a photocurrent effect.
Wet chemical etching of A1N and InxAl1-xN was investigated in KOH-based solutions as a function of etch temperature, and material quality. The etch rates for both materials increased with increasing etch temperatures, which was varied from 20 °C to 80 °C. The crystal quality of A1N prepared by reactive sputtering was improved by rapid thermal annealing at temperatures to 1100 °C with a decreased wet etch rate of the material measured with increasing anneal temperature. The etch rate decreased approximately an order of magnitude at 80 °C etch temperature after a 1100 °C anneal. The etch rate for In0.19Al0.81N grown by Metal Organic Molecular Beam Epitaxy was approximately three times higher for material on Si than on GaAs. This corresponds to the superior crystalline quality of the material grown on GaAs. Etching of InxAl1-xN was also examined as a function of In composition. The etch rate initially increased as the In composition changed from 0 to 36%, and then decreased to 0 Å/min for InN. The activation energy for these etches is very low, 2.0 ± 0.5 kcal•mol-1 for the sputtered A1N. The activation energies for InAIN were dependent on In composition and were in the range 2–6 kcal mol-1. GaN and InN layers did not show any etching in KOH at temperatures up to 80 °C.
ICl/Ar ECR discharges provide the fastest dry etch rates reported for GaN, 1.3 µm/min. These rates are much higher than with Cl2/Ar, CH4/H2/Ar or other plasma chemistries. InN etch rates up to 1.15 µm/min and 0.7 µm/min for In0.5Ga0.5N are obtained, with selectivities up to 5 with no preferential loss of N at low rf powers and no significant residues remaining. The rates are much lower with IBr/Ar, ranging from 0.15 µm/min for GaN to 0.3 µm/min for InN. There is little dependence on microwave power for either chemistry because of the weakly bound nature of IC1 and IBr. In all cases the etch rates are limited by the initial bond breaking that must precede etch product formation and there is a good correlation between materials bond energy and etch rate. The fact that low microwave power can be employed is beneficial from the viewpoint that photoresist masks are stable under these conditions, and there is no need for use of silicon nitride or silicon dioxide. Selectivities for GaN over A1N with IC1 and IBr are still lower than with Cl2- only.
In order to maximize the performance of III-Nitride devices, it is necessary to develop thermally stable low resistance Ohmic contacts to III-N based electronic structures. This paper reports on the utility of InN as an aid to contact formation on widegap materials such as InAIN. For n-type materials, several questions relating to the growth conditions have been explored. Specifically, the impact of substrate type (GaAs vs. Sapphire), cap layer growth temperature and V/III ratio on contact resistance has been investigated. It was found that the use of sapphire substrates combined with high growth temperatures (575°C) and high V/III ratios produced acceptable contact resistances (∼10−6Ohm-cm2) to InAIN.
Airway endoscopy carries a risk of detrimental effects. We aimed to develop a minimum endolaryngeal surgery dataset, for use in laryngology practice as an audit tool.
Materials and methods:
A minimum dataset was designed, incorporating pre- and post-operative clinical, surgical and patient-reported data. We prospectively recruited 272 consecutive patients between May 2007 and May 2009. The Voice Symptom Scale was used to assess patient-reported vocal morbidity.
Complete clinical and surgical details were obtained for 272 patients (100 per cent). Thus, information on diagnosis, procedure type and procedure aim was obtained for all patients. The Voice Symptom Scale was completed pre-operatively by 250 patients, and three months post-operatively by 169 patients (68 per cent). A statistically significant improvement in Voice Symptom Scale score was observed in patients undergoing surgery to improve their voice, compared with pre-operative measurements (p = 0.01).
We developed a minimum dataset to characterise endolaryngeal surgical activity and outcomes. This dataset could be used to determine best practice, and to audit endolaryngeal surgery outcomes for surgeon recertification and revalidation.
There is growing interest in the long term outcomes of critical care. The degree of vocal morbidity suffered by patients surviving intensive care admission has not previously been reported.
To determine the degree of subjective, patient-reported vocal morbidity following discharge from intensive care.
Materials and methods:
A prospective study was undertaken of patients admitted to intensive care. A total of 273 consecutive admissions were assessed; 181 patients were suitable for inclusion.
Main outcome measure:
The Voice Symptom Scale questionnaire.
Eighty-three patients responded. Twenty-seven patients (33 per cent) reported a degree of vocal morbidity greater than that suffered by patients treated for early laryngeal cancer. Thirteen patients (16 per cent) reported a degree of morbidity greater than that suffered by patients attending voice clinics.
Up to one-third of patients who survived admission to an intensive care unit reported suffering significant vocal morbidity. The Voice Symptom Scale could be used in an intensive care follow-up setting to identify and ensure the referral of such patients.
Researchers evaluating voice disorder interventions currently have a plethora of voice outcome measurement tools from which to choose. Faced with such a wide choice, it would be beneficial to establish a clear rationale to guide selection. This article reviews the published literature on the three main areas of voice outcome assessment: (1) perceptual rating of voice quality, (2) acoustic measurement of the speech signal and (3) patient self-reporting of voice problems. We analysed the published reliability, validity, sensitivity to change and utility of the common outcome measurement tools in each area. From the data, we suggest that routine voice outcome measurement should include (1) an expert rating of voice quality (using the Grade-Roughness-Breathiness-Asthenia-Strain rating scale) and (2) a short self-reporting tool (either the Vocal Performance Questionnaire or the Vocal Handicap Index 10). These measures have high validity, the best reported reliability to date, good sensitivity to change data and excellent utility ratings. However, their application and administration require attention to detail. Acoustic measurement has arguable validity and poor reliability data at the present time. Other areas of voice outcome measurement (e.g. stroboscopy and aerodynamic phonatory measurements) require similarly detailed research and analysis.
The effects of cigarette smoking on the incidence of epidemic influenza and on the serological response to influenza vaccination with killed subunit and live attenuated vaccines have been investigated during comparative vaccine trials in Western Australia. It was found that cigarette smokers with no pre-epidemic haemagglutination-inhibiting (HI) antibody (titres of ≤ 12) were significantly more susceptible to epidemic influenza than non-smokers. Smokers were no more susceptible however, if they had possessed detectable pre-epidemic HI antibody. A significantly higher proportion of smokers sero-converted after receiving the live virus vaccine than their non-smoking counterparts, but this could not be correlated with pre-vaccination HI antibody titres. The longevity of the immune response to the subunit vaccine was severely depressed 50 weeks post-vaccination in smokers who had possessed little or no immunity before vaccination (titres of ≤ 12). This antibody deficit was not observed in live virus vaccinees or subunit vaccinees with pre-vaccination HI antibody (titres of ≥ 24). Post-vaccinal symptoms were similar regardless of vaccine group or smoking history.
Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) with the type IV staphylococcal chromosomal cassette mec (SCCmec) is rarely reported as being acquired in hospital. We report a hospital outbreak, in Grampian, Scotland, of eight cases of skin and soft-tissue infections due to such a strain. All patients had been in the labour, delivery and maternity units of a small community hospital during a 7-month period. Typing by pulsed-field gel electrophoresis showed the isolates to be a single strain closely related to the USA800 lineage (paediatric clone) and additional typing confirmed it as ST5-MRSA-IV. Genes for exfoliative toxin A (ETA) and enterotoxin D were detected by PCR in all the isolates although none carried the Panton–Valentine leukocidin gene. Region-wide surveillance of over 6000 MRSA isolates collected from 1998 to 2004 showed that 95 (1·6%) were closely related to the outbreak strain although only 60 carried the ETA gene. The strain has not been seen elsewhere in Scotland.
Deafness is the hidden disability of childhood, and leads to poor educational and employment prospects. There is little published information on deafness in Pakistan. Profound hearing impairment is more prevalent in countries where consanguineous marriages are common, such as Pakistan. This study aimed to assess causes of childhood deafness and association with parental consanguinity, within deaf and hearing children in the Peshawar district of Pukhtoonkhwa Province, Pakistan.
One hundred and forty deaf children were identified from two schools for deaf children within the Peshawar district. These children were assessed via audiology, otoscopic examination, case note review and parental history, in order to attempt to ascertain the cause of their deafness. Two hundred and twenty-one attendees at a local immunisation clinic (taken as representative of the local childhood population) were also screened for hearing impairment. Parents of both groups of children were assessed by interview and questionnaire in order to ascertain the mother and father's family relationship (i.e. whether cousins or unrelated).
Of the 140 deaf school pupils, 92.1 per cent were profoundly hearing impaired and 7.9 per cent were severely hearing impaired. All these children had bilateral sensorineural hearing loss. A possible cause of deafness was identified in only six of these children. Parental consanguinity (i.e. first or second cousins) was established for 86.4 per cent of deaf school pupils and 59.7 per cent of immunisation clinic attendees. None of the control children were identified as having a hearing problem.
The prevalence of parental consanguinity was significantly higher in deaf children compared with non-hearing impaired children. However, the study also confirmed a high rate of consanguinity within the general Peshawar community. In this setting, prevention of consanguineous unions is the only means of reducing levels of congenital hearing impairment. The current levels of hearing disability represent both a prominent public health problem and an important, potentially preventable childhood disability.
Extraskeletal Ewing's sarcoma is a rare tumour of mesenchymal origin, which is histologically similar to primary osseous Ewing's sarcoma. The majority of cases have been reported in the lower limb and paravertebral region, with a few cases reported in the neck.
We report a patient with extraskeletal Ewing's sarcoma presenting with a right-sided neck mass, vocal fold palsy and T1 nerve root involvement. The detection of characteristic features on computed tomography and magnetic resonance imaging scans, in conjunction with histological analysis, was required to make the diagnosis.
Radiological imaging demonstrated that the tumour was infiltrating through the neural exit foramina of the lower cervical nerve roots, with encasement of the vertebral artery. The patient was managed with combination chemotherapy for systemic control and irradiation for local control.
Extraskeletal Ewing's sarcoma has a propensity to occur in a paravertebral location, being found rarely in the cervical region, and has a predilection to infiltrate through neural exit formina. Computed tomography and magnetic resonance imaging are helpful in the diagnosis of this rare tumour.