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 email@example.com
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.
CVD and associated metabolic diseases are linked to chronic inflammation, which can be modified by diet. The objective of the present study was to determine whether there is a difference in inflammatory markers, blood metabolic and lipid panels and lymphocyte gene expression in response to a high-fat dairy food challenge with or without milk fat globule membrane (MFGM). Participants consumed a dairy product-based meal containing whipping cream (WC) high in saturated fat with or without the addition of MFGM, following a 12 h fasting blood draw. Inflammatory markers including IL-6 and C-reactive protein, lipid and metabolic panels and lymphocyte gene expression fold changes were measured using multiplex assays, clinical laboratory services and TaqMan real-time RT-PCR, respectively. Fold changes in gene expression were determined using the Pfaffl method. Response variables were converted into incremental AUC, tested for differences, and corrected for multiple comparisons. The postprandial insulin response was significantly lower following the meal containing MFGM (P < 0·01). The gene encoding soluble epoxide hydrolase (EPHX2) was shown to be more up-regulated in the absence of MFGM (P = 0·009). Secondary analyses showed that participants with higher baseline cholesterol:HDL-cholesterol ratio (Chol:HDL) had a greater reduction in gene expression of cluster of differentiation 14 (CD14) and lymphotoxin β receptor (LTBR) with the WC+MFGM meal. The protein and lipid composition of MFGM is thought to be anti-inflammatory. These exploratory analyses suggest that addition of MFGM to a high-saturated fat meal modifies postprandial insulin response and offers a protective role for those individuals with higher baseline Chol:HDL.
The sports domain presents a number of significant computational challenges for artificial intelligence (AI) and machine learning (ML). In this paper, we explore the techniques that have been applied to the challenges within team sports thus far. We focus on a number of different areas, namely match outcome prediction, tactical decision making, player investments, fantasy sports, and injury prediction. By assessing the work in these areas, we explore how AI is used to predict match outcomes and to help sports teams improve their strategic and tactical decision making. In particular, we describe the main directions in which research efforts have been focused to date. This highlights not only a number of strengths but also weaknesses of the models and techniques that have been employed. Finally, we discuss the research questions that exist in order to further the use of AI and ML in team sports.
Introduction: To describe dosing, duration, and pre- and post-infusion analgesic administration of continuous intravenous sub-dissociative dose ketamine (SDK) infusion for managing a variety of painful conditions in the emergency department (ED). Methods: Retrospective chart review of patients aged 18 and older presenting to the ED with acute and chronic painful conditions who received continuous SDK infusion in the ED for a period over 6 years (2010-2016). Primary data analyses included dosing and duration of infusion, rates of pre- and post-infusion analgesic administration, and final diagnoses. Secondary data included pre- and post-infusion pain scores and rates of side effects. Results: 104 patients were enrolled in the study. Average dosing of ketamine infusion was 11.26 mg/hr, the mean duration of infusion was 135.87 minutes with 38% increase in patients not requiring post-infusion analgesia. The average decrease in pain score was 5.04. There were 12 reported adverse effects with nausea being the most prevalent. Conclusion: Continuous intravenous SDK infusion has a role in controlling pain of various etiologies in the ED with a potential to reduce need for co-analgesics or rescue analgesic administration. There is a need for more robust, prospective, randomized trials that will further evaluate the analgesic efficacy and safety of this modality across wide range of pain syndromes and different age groups in the ED.
Introduction: Collaborative Emergency Centres (CECs) provide access to care in rural communities. After hours, registered nurses (RNs) and paramedics work together in the ED with telephone support by an emergency medical services (EMS) physician. The safety of such a model is unknown. Relapse visits are often used as a proxy measure for safety in emergency medicine. The primary outcome of this study is to measure unscheduled relapses to emergency care. Methods: The electronic patient care record (ePCR) database was queried for all patients who visited two CECs from April 1, 2012 to April 1, 2013. Abstracted data included demographics, time, acuity score, clinical impression, chief complaint, and disposition. Records were searched for each discharged CEC patient to identify unscheduled relapses to emergency care, defined as presenting back to EMS, CEC, or any other ED within the Health Authority within 48 hours of CEC discharge. Results: There were 894 CEC visits, of which 66 were excluded due to missing data. The dispositions from CEC were: 131/828 (15.8%) transferred to regional ED; 264/828 (31.9%) discharged home; 488/828 (58.9%) discharged with follow up visit booked; and 11/82 (1.2%) left the CEC without being seen. There was 37/828 (4.5%) visits which relapsed back to emergency care, all of whom were discharged from CEC or left without being seen: 3/828 (0.4%) relapsed back to EMS (two taken to regional ED and one to CEC); 16/828 (1.9%) relapsed to regional ED (by walking-in); and 18/828 (2.2%) had a relapse to the CEC (walk-in). 516/828 (62.3%) CEC visits were resolved in a single visit. Conclusion: This study was based on only two of the 7 operating CECs due to accessing paper-based charts for multiple health regions. We also acknowledge the limitations of using relapse as a proxy for safety, and that low volumes and acuity will make detection of adverse events challenging. Albeit a proxy measure, the rate of patients who relapse to emergency care was under 5% in this case series of two CECs. Most patients had their concern resolved in a single visit to a CEC. Further research is underway to determine the effectiveness, optimal utilization and safety of this collaborative model of rural emergency care.
Whole apples have not been previously implicated in outbreaks of foodborne bacterial illness. We investigated a nationwide listeriosis outbreak associated with caramel apples. We defined an outbreak-associated case as an infection with one or both of two outbreak strains of Listeria monocytogenes highly related by whole-genome multilocus sequence typing (wgMLST) from 1 October 2014 to 1 February 2015. Single-interviewer open-ended interviews identified the source. Outbreak-associated cases were compared with non-outbreak-associated cases and traceback and environmental investigations were performed. We identified 35 outbreak-associated cases in 12 states; 34 (97%) were hospitalized and seven (20%) died. Outbreak-associated ill persons were more likely to have eaten commercially produced, prepackaged caramel apples (odds ratio 326·7, 95% confidence interval 32·2–3314). Environmental samples from the grower's packing facility and distribution-chain whole apples yielded isolates highly related to outbreak isolates by wgMLST. This outbreak highlights the importance of minimizing produce contamination with L. monocytogenes. Investigators should perform single-interviewer open-ended interviews when a food is not readily identified.
Positive psychological constructs have been associated with reduced suicidal ideation, and interventions to cultivate positive feelings have the potential to reduce suicide risk. This study compares the efficacy of a 6-week, telephone-based positive psychology (PP) intervention against a cognition-focused (CF) control intervention among patients recently hospitalized for depression and suicidal ideation or behavior.
A total of 65 adults with a current major depressive episode reporting suicidal ideation or a recent suicide attempt were enrolled from participating in-patient psychiatric units. Prior to discharge, participants were randomized to the PP (n = 32) or CF (n = 33) intervention. In both interventions, participants received a treatment manual, performed weekly PP (e.g. gratitude letter) or CF (e.g. recalling daily events) exercises, and completed weekly one-on-one telephone sessions over 6 weeks. Between-group differences in hopelessness (primary outcome), depression, suicidality and positive psychological constructs at 6 and 12 weeks were tested using mixed-effects models accounting for intensity of post-hospitalization psychiatric treatment.
Compared with PP, the CF intervention was associated with significantly greater improvements in hopelessness at 6 weeks (β = −3.15, 95% confidence interval −6.18 to −0.12, effect size = −0.84, p = 0.04), but not 12 weeks. Similarly, the CF intervention led to greater improvements in depression, suicidal ideation, optimism and gratitude at 6 and 12 weeks.
Contrary to our hypothesis, the CF intervention was superior to PP in improving hopelessness, other suicide risk factors and positive psychological constructs during a key post-discharge period among suicidal patients with depression. Further study of this CF intervention is warranted in populations at high suicide risk.
We present a simple, accurate method for computing singular or nearly singular integrals on a smooth, closed surface, such as layer potentials for harmonic functions evaluated at points on or near the surface. The integral is computed with a regularized kernel and corrections are added for regularization and discretization, which are found from analysis near the singular point. The surface integrals are computed from a new quadrature rule using surface points which project onto grid points in coordinate planes. The method does not require coordinate charts on the surface or special treatment of the singularity other than the corrections. The accuracy is about O(h3), where h is the spacing in the background grid, uniformly with respect to the point of evaluation, on or near the surface. Improved accuracy is obtained for points on the surface. The treecode of Duan and Krasny for Ewald summation is used to perform sums. Numerical examples are presented with a variety of surfaces.
The 2013 multistate outbreaks contributed to the largest annual number of reported US cases of cyclosporiasis since 1997. In this paper we focus on investigations in Texas. We defined an outbreak-associated case as laboratory-confirmed cyclosporiasis in a person with illness onset between 1 June and 31 August 2013, with no history of international travel in the previous 14 days. Epidemiological, environmental, and traceback investigations were conducted. Of the 631 cases reported in the multistate outbreaks, Texas reported the greatest number of cases, 270 (43%). More than 70 clusters were identified in Texas, four of which were further investigated. One restaurant-associated cluster of 25 case-patients was selected for a case-control study. Consumption of cilantro was most strongly associated with illness on meal date-matched analysis (matched odds ratio 19·8, 95% confidence interval 4·0–∞). All case-patients in the other three clusters investigated also ate cilantro. Traceback investigations converged on three suppliers in Puebla, Mexico. Cilantro was the vehicle of infection in the four clusters investigated; the temporal association of these clusters with the large overall increase in cyclosporiasis cases in Texas suggests cilantro was the vehicle of infection for many other cases. However, the paucity of epidemiological and traceback information does not allow for a conclusive determination; moreover, molecular epidemiological tools for cyclosporiasis that could provide more definitive linkage between case clusters are needed.
A sphenoethmoidal cell is a posterior ethmoid cell that pneumatises superiorly and/or laterally to the sphenoid sinus. Disease within such a cell may cause visual symptoms because of the close relationship of the optic nerve.
This paper reports four cases of chronic rhinosinusitis involving a sphenoethmoidal cell, two with visual loss. The management of such cases is discussed and the current literature is reviewed.
Pathology within a sphenoethmoidal cell must be considered in cases of optic neuropathy. The presence of these cells may be relevant even in cases of seemingly uncomplicated rhinosinusitis as they are associated with a higher rate of optic nerve protrusion and dehiscence.
A straightforward method is presented for computing three-dimensional Stokes flow, due to forces on a surface, with high accuracy at points near the surface. The flow quantities are written as boundary integrals using the free-space Green’s function. To evaluate the integrals near the boundary, the singular kernels are regularized and a simple quadrature is applied in coordinate charts. High order accuracy is obtained by adding special corrections for the regularization and discretization errors, derived here using local asymptotic analysis. Numerical tests demonstrate the uniform convergence rates of the method.
Boundary integral methods are naturally suited for the computation of harmonic functions on a region having inclusions or cells with different material properties. However, accuracy deteriorates when the cell boundaries are close to each other. We present a boundary integral method in two dimensions which is specially designed to maintain second order accuracy even if boundaries are arbitrarily close. The method uses a regularization of the integral kernel which admits analytically determined corrections to maintain accuracy. For boundaries with many components we use the fast multipole method for efficient summation. We compute electric potentials on a domain with cells whose conductivity differs from that of the surrounding medium. We first solve an integral equation for a source term on the cell interfaces and then find values of the potential near the interfaces via integrals. Finally we use a Poisson solver to extend the potential to a regular grid covering the entire region. A number of examples are presented. We demonstrate that increased refinement is not needed to maintain accuracy as interfaces become very close.
Nasal polyposis is characterised by opacification of the nasal cavities, paranasal sinuses and ostiomeatal complexes on computed tomography scanning. Sinonasal bony changes have been reported as disease sequelae.
To assess the prevalence of sinonasal bone expansion, erosion and thickening in patients with nasal polyposis, and to correlate disease severity with the prevalence of bony changes.
A retrospective radiological study was conducted comprising pre-operative computed tomography scans of 104 patients with nasal polyposis and scans of 44 age- and gender-matched individuals (control group) without sinonasal disease. Lund–Mackay scores and bony changes were quantified.
Ninety-three per cent of the study group scans showed sinonasal bony change, with no changes in the control group. Radiological severity of nasal polyposis correlated positively with the prevalence of bony changes (rs = 0.31; p < 0.01).
Sinonasal bony changes were common in the study group. This highlights the importance of pre- and intra-operative imaging, which can help to prevent intra-operative complications. As bony changes may mimic invasive disease, the importance of histological assessment of polyps is emphasised.
Medical patients are often screened for distress in the clinic using a questionnaire such as the Hospital Anxiety and Depression Scale (HADS) while awaiting their consultation. However, might the context of the clinic artificially inflate the distress score? To address this question we aimed to determine whether those who scored high on the HADS in the clinic remained high scorers when reassessed later at home.
We analysed data collected by a distress and depression screening service for cancer out-patients. All patients had completed the HADS in the clinic (on computer or on paper) prior to their consultation. For a period, patients with a high score (total of ⩾15) also completed the HADS again at home (over the telephone) 1 week later. We used these data to determine what proportion remained high scorers and the mean change in their scores. We estimated the effect of ‘regression to the mean’ on the observed change.
Of the 218 high scorers in the clinic, most [158 (72.5%), 95% confidence interval (CI) 66.6–78.4] scored high at reassessment. The mean fall in the HADS total score was 1.74 (95% CI 1.09–2.39), much of which could be attributed to the estimated change over time (regression to the mean) rather than the context.
Pre-consultation distress screening in clinic is widely used. Reassuringly, it only modestly overestimates distress measured later at home and consequently would result in a small proportion of unnecessary further assessments. We conclude it is a reasonable and convenient strategy.
Hydrodynamic effects of the relationship between the roll and pitch oscillations in low-aspect-ratio fins, with a laminar section and a rounded leading edge, flapping at transitional to moderately high Reynolds numbers, are considered. The fin is hinged at one end and its roll amplitude is large. Also examined is how this relationship is affected by spanwise twist, which alters the pitch oscillation amplitude and its phase relative to the roll motion. Force, efficiency and surface hot-film-anemometry measurements, and flow visualization are carried out in a tow tank. A fin of an abstracted penguin-wing planform and a NACA 0012 cross-section is used, and the chord Reynolds number varies from 3558 to 150 000 based on total speed. The fin is forced near the natural shedding frequency. Strouhal number and pitch amplitude are directly related when thrust is produced, and efficiency is maximized in narrow combinations of Strouhal number and pitch amplitude when oscillation of the leading-edge stagnation point is minimal. Twist makes the angle of attack uniform along the span and enhances thrust by up to 24 %, while maintaining high efficiency. Only 5 % of the power required to roll is spent to pitch, and yet roll and pitch are directly related. During hovering, dye visualization shows that a diffused leading-edge vortex is produced in rigid fins, which enlarges along the span; however, twist makes the vortex more uniform and the fin in turn requires less power to roll. Low-order phase maps of the measurements of force oscillation versus its derivative are modelled as due to van der Pol oscillators; the higher-order maps show trends in the sub-regimes of the transitional Reynolds number. Fin oscillation imparts a chordwise fluid motion, yielding a Stokes wave in the near-wall vorticity layer. When the roll and pitch oscillations are directly related, the wave is optimized: causing vorticity lift-up as the fin is decelerated at the roll extremity; the potential energy at the stagnation point is converted into kinetic energy; a vortex is produced as the lifted vorticity is wrapped around the leading edge; and free-stream reattachment keeps the vortex trapped. When the twist oscillation is phased along the span, this vortex becomes self-preserving at all amplitudes of twist, indicating the most stable (low-bandwidth) tuned nature.
1. After inoculation of eggs with a large dose (108·6 ID50) of influenza virus, chorio-allantoic membranes harvested from the 3rd to at least the 21st hr. (but not at the 1st or 2nd hr.) gave rise to large amounts of soluble antigen in 6 hr. in the chorio-allantoic membranes of sub-inoculated eggs (6 hr. soluble antigen production test). These amounts were larger than resulted from inoculation of equivalent numbers of ID50 of standard allantoic fluid virus. By the conventional 72 hr. test, the infectivity of the chorio-allantoic membranes increased 1 hr. later, at the 4th hr. after inoculation.
2. Allantoic fluids and chorio-allantoic membranes harvested from passages of very large and of small amounts of influenza virus were tested by 6 hr. soluble antigen production. The relative amounts of soluble antigen formed by different seeds appeared to be determined by their ID50: HA ratios, irrespective of whether they were allantoic fluid or chorio-allantoic membrane preparations. Larger amounts of soluble antigen were formed in 6 hr. per ID50 inoculated by preparations having lower ID50: HA ratios, i.e. containing larger amounts of ‘incomplete’ virus, and vice versa.
3. It is suggested that high infectivity in the 6 hr. soluble antigen test per ID50 inoculated is due to a content of ‘incomplete’ virus, or of virus precursors: possibly these are in fact the same.
4. More particles of an incomplete virus preparation than of standard allantoic fluid virus must be inoculated to produce a given amount of soluble antigen in 6 hr. It is suggested that a process resembling multiplicity reactivation must occur in cells infected with more than one particle of ‘incomplete’ virus.
1. The 6 hr. soluble antigen production test for comparing the infectivity of influenza virus preparations is described in detail. Dilutions of the preparations are inoculated intra-allantoically into groups of fertile eggs, and after 6 hr. of incubation the amounts of soluble antigen formed in their chorio-allantoic membranes are determined. Reproducible results can be obtained.
2. The similar test, in which haemagglutinins in the chorio-allantoic membranes are measured 6 hr. after inoculation of seed virus, is less accurate and less sensitive.
3. Eggs of different ages of incubation form different amounts of soluble antigen in their chorio-allantoic membranes in 6 hr. when inoculated with the same amounts of virus.
Quadruple vaccine containing 75 D antigen units of killed type 1 poliovirus was given to children at ages 2, 3 and 4 months followed by a booster dose at 15 months.
The serological response to the primary course was difficult to assess owing to maternal antibody. Antibody titres to the type 1 component after the booster dose were very satisfactory and about 10 times higher than those observed in a similar group of children given attenuated vaccine. Response to the poliovirus types 2 and 3 in the quadruple vaccine was less satisfactory.
Graded doses of attenuated poliovirus type 1 were fed to the children 2 months after the primary course and 1 month after the booster dose. Children who had received no poliovaccine and children immunized with attenuated vaccine were included for comparison.
Immunization with killed vaccine did not greatly affect the size of the minimal infecting dose of live virus but reduced both the duration of the subsequent infection and the titre of virus in the faeces.
The epidemiological significance of these findings is discussed.