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Currently no national guidelines exist for the management of scabies outbreaks in residential or nursing care homes for the elderly in the United Kingdom. In this setting, diagnosis and treatment of scabies outbreaks is often delayed and optimal drug treatment, environmental control measures and even outcome measures are unclear. We undertook a systematic review to establish the efficacy of outbreak management interventions and determine evidence-based recommendations. Four electronic databases were searched for relevant studies, which were assessed using a quality assessment tool drawing on STROBE guidelines to describe the quality of observational data. Nineteen outbreak reports were identified, describing both drug treatment and environmental management measures. The quality of data was poor; none reported all outcome measures and only four described symptom relief measures. We were unable to make definitive evidence-based recommendations. We draw on the results to propose a framework for data collection in future observational studies of scabies outbreaks. While high-quality randomised controlled trials are needed to determine optimal drug treatment, evidence on environmental measures will need augmentation through other literature studies. The quality assessment tool designed is a useful resource for reporting of outcome measures including patient-reported measures in future outbreaks.
This study seeks to elucidate the linear transient growth mechanisms in a uniform duct with square cross-section applicable to flows of electrically conducting fluids under the influence of an external magnetic field. A particular focus is given to the question of whether at high magnetic fields purely two-dimensional mechanisms exist, and whether these can be described by a computationally inexpensive quasi-two-dimensional model. Two Reynolds numbers of
$5000$
and
$15\,000$
and an extensive range of Hartmann numbers
$0\leqslant \mathit{Ha}\leqslant 800$
were investigated. Three broad regimes are identified in which optimal mode topology and non-modal growth mechanisms are distinct. These regimes, corresponding to low, moderate and high magnetic field strengths, are found to be governed by the independent parameters; Hartmann number, Reynolds number based on the Hartmann layer thickness
$R_{H}$
and Reynolds number built upon the Shercliff layer thickness
$R_{S}$
, respectively. Transition between regimes respectively occurs at
$\mathit{Ha}\approx 2$
and no lower than
$R_{H}\approx 33.\dot{3}$
. Notably for the high Hartmann number regime, quasi-two-dimensional magnetohydrodynamic models are shown to be excellent predictors of not only transient growth magnitudes, but also the fundamental growth mechanisms of linear disturbances. This paves the way for a precise analysis of transition to quasi-two-dimensional turbulence at much higher Hartmann numbers than is currently achievable.
Coups d’état, once a common end for democracies in the Americas, have declined sharply in recent years. This article investigates whether overall public support for coups is also in decline. Examining 21 countries in Latin America and the Caribbean from 2004 to 2014 helps to evaluate two alternative theses on democratization: Mainwaring and Pérez-Liñán’s 2013 normative regime preferences theory, which inquires (but does not test) whether public opinion can signal to elites a reluctance or willingness to support a coup; and classic modernization theory (Inglehart 1988; Inglehart and Welzel 2005). We find a substantively meaningful effect of democratic attitudes on coup support and a weak effect for national wealth, from which we infer that evolving elite values and preferences are paralleled at the mass level and that together, those two trends play a stronger role in the consolidation of democratic regimes than does modernization.
Commonly thought of as a disease of poverty and overcrowding in resource-poor settings globally, scabies is also an important public health issue in residential care facilities for the elderly (RCFE) in high-income countries such as the UK. We compared and contrasted current local Health Protection Team (HPT) guidelines for the management of scabies outbreaks in RCFE throughout England. We performed content analysis on 20 guidelines, and used this to create a quantitative report of their variation in key dimensions. Although the guidelines were generally consistent on issues such as the treatment protocols for individual patients, there was substantial variation in their recommendations regarding the prophylactic treatment of contacts, infection control measures and the roles and responsibilities of individual stakeholders. Most guidelines did not adequately address the logistical challenges associated with mass treatment in this setting. We conclude that the heterogeneous nature of the guidelines reviewed is an argument in favour of national guidelines being produced.
Scabies is an important public health problem in residential care homes. Delayed diagnosis contributes to outbreaks, which may be prolonged and difficult to control. We investigated factors influencing outbreak recognition, diagnosis and treatment, and staff experiences of outbreak control, identifying areas for intervention. We carried out a semi-structured survey of managers, affected residents and staff of seven care homes reporting suspected scabies outbreaks in southern England over a 6-month period. Attack rates ranged from 2% to 50%, and most cases had dementia (37/39, 95%). Cases were diagnosed clinically by GPs (59%) or home staff (41%), none by dermatologists. Most outbreaks were attributable to avoidably late diagnosis of the index case. Participants reported considerable challenges in managing scabies outbreaks, including late diagnosis and recognition of outbreaks; logistically difficult mass treatment; distressing treatment processes and high costs. This study demonstrates the need for improved support for care homes in detecting and managing these outbreaks.
The key hurdle in nanoscience and nanotechnology is the large-scale integration of nanoscale materials with micron scale electronics and structures to form functional devices and sensors. We have developed an innovative bottom-up wafer scale fabrication method that combines nanopatterning and nanomaterials synthesis with traditional silicon micromachining technologies. We have achieved nano-micro integration through catalyst nanopatterning and registration at wafer scale and through effective nanocatalyst protection and release before and after microfabrication. Our wafer scale fabrication process has produced 244 carbon nanotube (CNT) probes per 4-inch silicon wafer with control over the CNT location, diameter, length, orientation, and crystalline morphology. CNT probes with diameters of 40-80 nm and lengths of 2-6 μm are found to be functional nano probes for atomic force microscopy (AFM) imaging. In this paper, we will address our nano probe design and fabrication considerations in detail. CNT tip locations and diameters are defined by e-beam lithography. CNT length, orientation, and crystalline quality are controlled by the plasma enhanced chemical vapor deposition (PECVD) method. With effective catalyst protection schemes, this fabrication process is very similar to the conventional approach for fabricating wafer-scale silicon AFM probe tips. Process control is feasible and the overall yield is greatly improved. Our method and technology can be easily adapted to many other nanomaterials (nanotubes and nanowires) synthesis and processes for their rational design, fabrication, and integration in their applications.
Carbon nanotube (CNT) related nanostructures possess remarkable electrical, mechanical, and thermal properties. To produce these nanostructures for real world applications, a large-scale controlled growth of carbon nanotubes is crucial for the integration and fabrication of nanodevices and nanosensors. We have taken the approach of integrating nanopatterning and nanomaterials synthesis with traditional silicon microfabrication techniques. This integration requires a catalyst or nanomaterial protection scheme. In this paper, we report our recent work on fabricating wafer-scale carbon nanotube AFM cantilever probe tips. We will address the design and fabrication considerations in detail, and present the preliminary scanning probe test results. This work may serve as an example of rational design, fabrication, and integration of nanomaterials for advanced nanodevice and nanosensor applications.
Poly (methyl methacrylate)/single walled carbon nanotube (PMMA/SWNT) composites were polymerized in the presence of carbon nanotubes via three methods: heat, uv radiation and ionizing radiation (gamma). Samples were solvent processed and cast into films. Thin films with varying degrees of transparency resulted from these composites. Differential Scanning Calorimetry (DSC) characterized glass transition temperatures. Ultraviolet-visible spectroscopy (UV-VIS) quantified the transparency of composites. The dielectric constant (ε') was obtained from Dielectric Analysis (DEA) and correlated to the refractive index values using Maxwell's Relationship. Scanning Electron Microscopy (SEM) provided images of the polymer- nanotube composite.
Single-wall carbon nanotube (SWNT)/poly(methyl methacrylate) (PMMA) composites were fabricated and exposed to ionizing radiation for a total dose of 5.9 Mrads. Neat nanotube paper and pure PMMA were also exposed for comparison, and nonirradiated samples served as controls. A concentration of 0.26 wt% SWNT increased the glass transition temperature (Tg), the Vickers hardness number, and modulus of the matrix. Irradiation of the composite did not significantly change the Tg, the Vickers hardness number, or the modulus; however, the real and imaginary parts of the complex permittivity increased after irradiation. The dielectric properties were found to be more labile to radiation effects than mechanical properties.
As we rapidly approach the point at which solid-state electronic devices cease to be made any smaller, molecular scale electronics offers, perhaps, the best chance for a continued miniaturization of computational devices. We must, however, completely re-think our approach to lithography. Presented in this paper are our solution-phase and solid-support based syntheses of molecular wires of precise length and dimensions, and our methods of addressing these wires via molecular “alligator clips” to gold and platinum electrodes of macroscale dimensions.
In this chapter I describe ongoing research that seeks to provide a common framework for the generation and interpretation of spontaneous gesture in the context of speech. I present a testbed for this framework in the form of a program that generates speech, gesture, and facial expression from underlying rules specifying (a) what speech and gesture are generated on the basis of a given communicative intent, (b) how communicative intent is distributed across communicative modalities, and (c) where one can expect to find gestures with respect to the other communicative acts. Finally, I describe a system that has the capacity to interpret communicative facial, gestural, intonational, and verbal behaviors.
Introduction
I am addressing in this chapter one very particular use of the term “gesture” – that is, hand gestures that co-occur with spoken language. Why such a narrow focus, given that so much of the work on gesture in the human-computer interface community has focused on gestures as their own language – gestures that might replace the keyboard or mouse or speech as a direct command language? Because I don't believe that everyday human users have any more experience with, or natural affinity for, a “gestural language” than they have with DOS commands. We have plenty of experience with actions and the manipulation of objects. But the type of gestures defined as (Väänänen & Böhm, 1993) “body movements which are used to convey some information from one person to another” are in fact primarily found in association with spoken language (90% of gestures are found in the context of speech, according to McNeill, 1992).
The effect of wall cooling on hypersonic boundary-layer separation near a compression ramp is considered. Two cases are identified corresponding to the value of the average Mach number $\overline{M}$ across the upstream boundary layer approaching the compression ramp. The flow is referred to as supercritical for $\overline > 1$ and subcritical for $\overline{M} < 1$. The interaction is described by triple-deck theory, and numerical results are given for both cases for various ramp angles and levels of wall cooling. The effect of wall cooling on the absolute instability described recently by Cassel, Ruban & Walker (1995) for an uncooled wall is of particular interest; a stabilizing effect is observed for supercritical boundary layers, but a strong destabilizing influence occurs in the subcritical case. Wall cooling also influences the location and size of the separated region. For supercritical flow, progressive wall cooling reduces the size of the recirculating-flow region, the separation point moves downstream, and upstream influence is diminished. In contrast for the subcritical case downstream influence is reduced with increased cooling. In either situation, a sufficient level of wall cooling eliminates separation altogether for the ramp angles considered. The present numerical results closely confirm the strong wall cooling theory of Kerimbekov, Ruban & Walker (1994).
The process of unsteady two-dimensional boundary-layer separation at high Reynolds number is considered. Solutions of the unsteady non-interactive boundary-layer equations are known to develop a generic separation singularity in regions where the pressure gradient is prescribed and adverse. As the boundary layer starts to separate from the surface, however, the external pressure distribution is altered through viscous—inviscid interaction just prior to the formation of the separation singularity; hitherto this has been referred to as the first interactive stage. A numerical solution of this stage is obtained here in Lagrangian coordinates. The solution is shown to exhibit a high-frequency inviscid instability resulting in an immediate finite-time breakdown of this stage. The presence of the instability is confirmed through a linear stability analysis. The implications for the theoretical description of unsteady boundary-layer separation are discussed, and it is suggested that the onset of interaction may occur much sooner than previously thought.
The arithmetic (= number theory) of curves of genus 0 is well understood. For genus 1, there is a rich body of theory and conjecture, and in recent years notable success has been achieved in transforming the latter into the former. For curves of higher genus there is a rich body of theory with some spectacular successes (e.g. Faltings' proof of ‘Mordell's Conjecture’), but our command is still rudimentary. For genus 1, a concrete question about an individual curve can usually be answered by one means or another: for higher genus, this is far from the case.
For curves of genus 0 and 1 the road between general theory and particular cases is no one-way street. Numerous individual cases were investigated by amateurs as well as as by distinguished mathematicians such as Diophantos, Fermat, Euler, Sylvester, Mordell, Selmer, Birch and Swinnerton-Dyer. Regularities which emerged, sometimes quite unexpectedly, suggested theorems, which could sometimes be proved. The new theorems suggested new questions. For higher genus, existing theory is notoriously unadapted to the study of individual curves, and few have been elucidated. What is needed is a corpus of explicit concrete cases and a middlebrow arithmetic theory which would provide both a practicable means to obtain them and a framework to understand any unexpected regularities.
Such a theory will, of course, draw freely from the existing body of knowledge, but the emphasis on feasibility gives new perspectives.
The number theoretic properties of curves of genus 2 are attracting increasing attention. This book provides new insights into this subject; much of the material here is entirely new, and none has appeared in book form before. Included is an explicit treatment of the Jacobian, which throws new light onto the geometry of the Kummer surface. The Mordell–Weil group can then be determined for many curves, and in many non-trivial cases all rational points can be found. The results exemplify the power of computer algebra in diophantine contexts, but computer expertise is not assumed in the main text. Number theorists, algebraic geometers and workers in related areas will find that this book offers unique insights into the arithmetic of curves of genus 2.